Nevin Manimala

JMIR Ment Health. 2025 Nov 4;12:e73188. doi: 10.2196/73188.

ABSTRACT

BACKGROUND: Although web-based mental health resources have the potential to assist millions, particularly those who face barriers to treatment, most mental health website visitors disengage before accessing resources that can help improve their mental health.

OBJECTIVE: We used a sequential multiple assignment randomized trial to test whether personalized tailoring improved engagement on a self-guided mental health website.

METHODS: Data were collected via voluntary response sampling on the Mental Health America website. Inclusion criteria included residing in the United States and viewing a postscreening survey after completing the Patient Health Questionnaire-9 (PHQ-9). Participants were randomized to 1 of 2 postscreening survey conditions: the demographics survey or the Next Steps survey, which included additional tailoring questions assessing perceived need and participants’ intended next steps. Participants who viewed the following screening results page were subsequently randomized to 1 of 5 conditions that displayed nontailored or tailored messages and featured resources, as well as persistent general resources that did not vary by condition. Data were analyzed using logistic regressions predicting disengagement and clicks on featured resources (versus persistent general resources) by condition.

RESULTS: Adding questions to inform tailoring significantly increased the odds of disengaging by 14% (demographics survey: 25%; Next Steps survey: 27.5%; odds ratio [OR] 1.14, 95% CI 1.11-1.16; P<.001). Among participants who viewed a postscreening survey (n=169,647), 87,712 participants were randomized to the demographics survey condition, and 81,935 participants were randomized to the Next Steps survey condition. Among participants who submitted the demographics survey (n=38,490), tailoring resources to demographics reduced the odds of disengaging by 10% (OR 0.90, 95% CI 0.87-0.94; P<.001) and, among those who engaged, increased the odds of clicking a featured resource versus a persistent general resource by 90% (OR 1.90, 95% CI 1.79-2.01; P<.001). Among participants who submitted the Next Steps survey (n=34,204), tailoring messages to perceived need (P=.33), tailoring resources to intended next steps (P=.51), and a combination of both (P=.52) did not significantly reduce the odds of disengaging compared with the nontailored condition. However, tailoring resources to intended next steps and combining a tailored message to perceived need with tailored resources to intended next steps increased the odds of clicking a featured resource by 25% (OR 1.25, 95% CI 1.14-1.37; P<.001) and 34% (OR 1.34, 95% CI 1.23-1.47; P<.001), respectively. Tailoring resources to demographics was significantly more effective in improving engagement than tailoring to perceived need or intended next steps (P≤.004).

CONCLUSIONS: There was a small but statistically significant cost to engagement from adding tailoring questions assessing perceived need and intended next steps. Among the strategies tested in this study, tailoring resources to demographics was the most effective strategy for increasing engagement among visitors who viewed their screening results. This study demonstrates how personalization may increase engagement with mental health websites and provides design implications for future research.

PMID:41187311 | DOI:10.2196/73188

J Clin Oncol. 2025 Nov 4:JCO2500872. doi: 10.1200/JCO-25-00872. Online ahead of print.

ABSTRACT

PURPOSE: This phase III (ClinicalTrials.gov identifier: NCT03665441) study evaluated eryaspase in combination with chemotherapy as second-line treatment in advanced pancreatic ductal adenocarcinoma (PDAC).

PATIENTS AND METHODS: TRYBECA-1 enrolled patients 18 years and older whose disease progressed on or after 1L chemotherapy. Patients were randomly assigned to eryaspase plus chemotherapy (gemcitabine/nab-paclitaxel or fluorouracil [5-FU], leucovorin [LV], and irinotecan/nanoliposomal irinotecan) or chemotherapy. Treatment was administered in a 4-week cycle for each of the following drugs until disease progression or unacceptable toxicity: eryaspase 100 U/kg intravenously on days 1 and 15; gemcitabine 1,000 mg/m² and nab-paclitaxel 125 mg/m² intravenously on days 1, 8 and 15; irinotecan 180 mg/m² (or nanoliposomal irinotecan 70 mg/m²) intravenously on days 1 and 15; 5-FU 2,400 mg/m² as one 46-hour infusion (with a bolus of 400 mg/m²); and LV 400 mg/m² intravenously on days 1 and 15. The primary end point was overall survival (OS); secondary end points included progression-free survival (PFS), objective response rate (ORR), and safety.

RESULTS: A total of 512 patients were randomly assigned (n = 255 for eryaspase and n = 257 for chemotherapy alone). Baseline characteristics were balanced between the two groups. There were 420 deaths, with a median OS of 7.5 months for eryaspase and chemotherapy versus 6.7 months for chemotherapy (hazard ratio [HR], 0.92 [95% CI, 0.76 to 1.11]; P = .374); the median PFS was 3.7 months versus 3.4 months (HR, 0.88 [95% CI, 0.73 to 1.07]; P = .196), and the ORR was 16.1% versus 12.5% (odds ratio, 1.35; [95% CI, 0.81 to 2.24]), respectively. Grade ≥3 adverse events (AEs) included neutropenia (25.4% v 20.3%), asthenia (16.9% v 13.8%), and anemia (17.3% v 12.2%) in the experimental versus control arms, respectively.

CONCLUSION: The addition of eryaspase to chemotherapy did not improve OS, PFS, or ORR. AEs were generally consistent with previous reports of chemotherapy. These results do not support additional development of eryaspase in PDAC.

PMID:41187298 | DOI:10.1200/JCO-25-00872

J Am Acad Orthop Surg Glob Res Rev. 2025 Nov 3;9(11). doi: 10.5435/JAAOSGlobal-D-25-00314. eCollection 2025 Nov 1.

ABSTRACT

INTRODUCTION: The J. Robert Gladden Orthopaedic Society (JRGOS) aims to increase diversity in orthopaedic surgery and promote high-quality musculoskeletal care for all. Through targeted research funding, JRGOS supports projects aligned with its mission. Despite awarding over $300,000 in research grants since 2011, the return on investment (ROI) of this program has not been analyzed. This study evaluates the ROI of JRGOS research grants from 2011 to 2023.

METHODS: We conducted a retrospective review of all JRGOS research grants awarded between 2011 and 2023. Data included recipient demographics, grant titles, award year, institution, and amount. PubMed and Google Scholar were used to identify resulting publications as of March 8, 2025. We also recorded recipients’ practice setting and years in practice at the time of award.

RESULTS: From 2011 to 2023, JRGOS awarded 52 grants totaling $308,765. Recipients were 40% female (n = 21) and 60% male (n = 31). Among 26 practicing orthopaedic surgeon recipients, 88% (n = 23) were in academic practice and 12% (n = 3) in private practice, with a median of 3 years (range 0-25) in independent practice. Most grants (73.1%) supported clinical research. The overall ROI, defined as the proportion of grants resulting in at least one publication, was 67.3% (35/52), with practicing orthopaedic surgeons achieving an ROI of 92.3%. In total, 72 publications appeared in 40 journals (mean impact factor 3.6), most commonly in the Journal of Bone and Joint Surgery.

CONCLUSION: JRGOS grants demonstrate high efficiency, with a 67.3% ROI and frequent publication in high-impact journals. Practicing orthopaedic surgeons achieved the highest ROI (92.3%).

PMID:41187297 | DOI:10.5435/JAAOSGlobal-D-25-00314

J Am Acad Orthop Surg Glob Res Rev. 2025 Nov 3;9(11). doi: 10.5435/JAAOSGlobal-D-25-00199. eCollection 2025 Nov 1.

ABSTRACT

INTRODUCTION: Unfortunately, some lumbar fusion patients will experience psychological distress and a deterioration of mental health postoperatively. At the extreme, these changes can lead to self-harm and suicide. This study evaluated the incidence of self-harm within 1 year of elective lumbar fusion procedures to identify risk factors for self-harm events.

METHODS: The PearlDiver Mariner 170 data set from 2010 to 2023 was retrospectively analyzed. Patients undergoing 1-level to 3-level posterior lumbar fusion with minimum 1-year follow-up were included. Patients with a history of self-harm before surgery were excluded. Univariate and multivariate analyses were done to assess risk factors for self-harm. Statistical significance was assessed at P < 0.05.

RESULTS: In total, 138,223 patients were included. The incidence of self-harm within 1 year was 0.40% (549 patients). In the multivariable model, younger age, male sex, and higher Charlson Comorbidity Index scores were risk factors for self-harm. Specific comorbidities associated with increased risk for self-harm included alcohol use disorder, anxiety disorders, depression, tobacco use, and preoperative opioid use (all P < 0.001). The strongest associations between comorbidity and self-harm were seen for depression (odds ratio [OR] = 2.68), anxiety (OR = 2.03), and alcohol use disorder (OR = 1.89).

CONCLUSION: Self-harm is a rare, yet understudied potential complication of lumbar fusion procedures. In this national database study, the incidence of self-harm was 0.4% in the year after elective lumbar fusion. Although some risk factors for self-harm are nonmodifiable, other behavioral and mental health comorbidities may serve to flag patients as targets for early preventive intervention.

PMID:41187295 | DOI:10.5435/JAAOSGlobal-D-25-00199

J Am Acad Orthop Surg Glob Res Rev. 2025 Nov 3;9(11). doi: 10.5435/JAAOSGlobal-D-25-00094. eCollection 2025 Nov 1.

ABSTRACT

BACKGROUND: Vitamin D deficiency has been linked to poor outcomes after spinal deformity correction, but it is unclear whether osteoporosis is the underlying factor. This study analyzed a national administrative database to clarify this association.

METHODS: The 2010 to Q1 2022 PearlDiver M161 database was queried for adult spinal deformity surgeries. Patients were stratified by not having versus having vitamin D deficiency diagnosis and matched 4:1 based on age, sex, and Charlson Comorbidity Index (CCI), and multivariate analysis (controlling for age, sex, and CCI) for 90-day postoperative adverse events was used to calculate odds ratios (ORs, Bonferroni correction, α < 0.00417). These methods were then repeated adding osteoporosis to the matching and multivariate controlling variables. Kaplan-Meier analysis comparing 5-year cumulative revision surgery rates was also performed for both sets of comparisons.

RESULTS: In the primary analyses matching for age, sex, and CCI, the vitamin D deficiency cohort showed a higher likelihood of osteoporosis. Multivariate analysis demonstrated that vitamin D deficiency was associated with increased odds of aggregated any (OR 1.34) and minor adverse events (1.39), as well as wound dehiscence (OR 1.91). The vitamin D deficiency group had a higher 5-year revision surgery rate (39.3% vs. 31.7%, P = 0.006).When osteoporosis was included as a matched/controlled variable, vitamin D deficiency was only associated with higher odds of aggregate any (OR 1.35) adverse events and urinary tract infection (OR 1.56). No difference in 5-year revision surgery rates was observed.

CONCLUSION: Following adult deformity surgery, many of the perioperative adverse outcomes were similar regardless of controlling for osteoporosis, but 5-year revisions seemed to be driven by the osteoporosis rather than vitamin D deficiency.

PMID:41187292 | DOI:10.5435/JAAOSGlobal-D-25-00094

J Am Acad Orthop Surg Glob Res Rev. 2025 Nov 3;9(11). doi: 10.5435/JAAOSGlobal-D-25-00091. eCollection 2025 Nov 1.

ABSTRACT

BACKGROUND: Complete and partial flexor tendon lacerations are challenging injuries to diagnose and manage. Imaging modalities can determine grade of laceration, and location of tendon ends preoperatively while detecting presence of adhesions, repair failure, and gap formation postoperatively. Despite these clear advantages, imaging modalities are underutilized because of issues with availability and concerns about accuracy.

METHODS: A systematic search of MEDLINE and Embase was conducted to identify papers examining the accuracy of ultrasonography (US) and MRI in preoperative and postoperative management of flexor tendon lacerations. COVIDENCE was used in blinded selection of papers for abstract and full-text review. R Studio was used for meta-analysis of pooled sensitivities and specificities, diagnostic odds ratios, and summary receiver operating curves of both US and MRI.

RESULTS: A total of 1197 papers were returned, with 40 being selected after full-text review and 24 being sufficient for statistical analysis. Significant heterogeneity existed for preoperative sensitivity of US and MRI, as well as preoperative specificity of US. MRI was more specific than US in the postoperative period (P < 0.01). Diagnostic odds ratios were >1 for all imaging modalities. The area under the curve for summary receiver operating curves in US preoperative, US postoperative, MRI preoperative, and MRI postoperative were 0.92, 0.81, 0.83, and 0.91, respectively.

CONCLUSION: MRI is likely more specific than US in postoperative detection of tendon adhesions, tendon rupture, and gap formation following tendon repair. Notable heterogeneities exist in the literature, highlighting the future need for standardized comparisons of imaging modalities in preoperative management.

PMID:41187290 | DOI:10.5435/JAAOSGlobal-D-25-00091

J Am Acad Orthop Surg Glob Res Rev. 2025 Nov 3;9(11). doi: 10.5435/JAAOSGlobal-D-25-00007. eCollection 2025 Nov 1.

ABSTRACT

INTRODUCTION: The prevalence of ossification of the posterior longitudinal ligament (OPLL) has been primarily studied in East Asian countries; its prevalence in Western populations remains to be elucidated. We aimed to determine the prevalence of OPLL in a Chilean population aged 60 years and older using fluorine-18 fluorodeoxyglucose positron emission tomography and CT (PET-CT) as screening tool.

METHODS: We evaluated patients between 60 and 73 years consecutively studied with PET-CT in a University Hospital. We assessed whole-body CT scans in both sagittal and axial views to detect the presence of OPLL. We used the Mann-Whitney test to analyze continuous variables, the Fisher test for categorical variables, and a logistic regression analysis to determine the independent effect of age and sex on the presence of OPLL.

RESULTS: We studied 1,009 patients (median age = 66 years); 597 were males (59.17%). Nineteen patients had OPLL, with a prevalence of 1.88% (1.04 to 2.72). OPLL was more prevalent in men (2.68%) than in women (0.73%; P = 0.02). All cases presented cervical involvement; only one had cervical and thoracic OPLL. The median age of patients with OPLL (64 years) and without OPLL (66 years) was not statistically different (P = 0.09). Male sex independently influenced the presence of OPLL (odds ratio = 3.85 [1.11 to 13.33]), age did not (odds ratio = 0.89 [0.78 to 1.02]).

DISCUSSION: This is the first study evaluating the prevalence of OPLL in Latin America. It shows a prevalence alike that in non-Asian populations in the United States and lower than the prevalence described in Asian populations.

PMID:41187288 | DOI:10.5435/JAAOSGlobal-D-25-00007

Interact J Med Res. 2025 Nov 4;14:e57731. doi: 10.2196/57731.

ABSTRACT

BACKGROUND: A growing body of evidence has identified that people’s physical health could influence self-rated health and quality of life (QoL). However, only focusing on physical health is not adequate for the well-being of older adults. Studies focusing on the impact of psychological well-being on self-rated health and QoL are still rare.

OBJECTIVE: This study aimed to identify the mediating effect of depression on the association between psychological well-being and self-rated health and QoL to comprehensively understand the relationship between them.

METHODS: We used a cross-sectional study design and secondary data analysis from the Chinese Longitudinal Healthy Longevity Survey of 2017 to 2018. Path analysis was applied to examine the research questions.

RESULTS: A large sample of 8839 older adults was included. Among them, more positive affect was found among those who were younger and had more years of schooling, higher household income, greater social security and social insurance, lower depression levels, and higher self-rated health levels. Depression had a partial mediation effect of psychological well-being on self-rated health and QoL, which explained 36% of the total variance (R2=0.36). In addition, psychological well-being had a statistically significant direct effect on self-rated health and QoL (β=0.290; P<.001).

CONCLUSIONS: Our results indicate that psychological well-being had both direct and indirect effects on self-rated health and QoL. Depression was an important mediator that regulated the effect pathway in older adults.

PMID:41187287 | DOI:10.2196/57731

J Magn Reson Imaging. 2025 Nov 4. doi: 10.1002/jmri.70158. Online ahead of print.

ABSTRACT

BACKGROUND: Gadolinium-based contrast agents (GBCAs) are used in MRI, yet concerns about gadolinium ion release, tissue retention, rare adverse events, and environmental persistence have encouraged the search for alternatives. Prior work on plant-based extracts has been largely confined to gastrointestinal luminal imaging, with limited exploration in extraluminal organs as contrast agents.

PURPOSE: To preclinically investigate the potentials of Betanin and beetroot-derived Betanin-based contrast agents (BBCA) in vitro and in vivo via oral, intravenous, and intraperitoneal administration, and to compare them with gadobutrol (a GBCA).

STUDY TYPE: Prospective preclinical experimental study.

SUBJECTS: In vitro studies on human and mouse fibroblast cell lines, and in vivo tests involving male Wistar albino rats (n = 15) and male New Zealand albino rabbits (n = 2).

FIELD STRENGTH/SEQUENCE: 3 T, spin echo, and gradient echo sequences.

ASSESSMENT: Betanin and BBCA compositions were characterized by mass spectrometry. Safety was assessed by in silico modeling, cytotoxicity, flow cytometry, histology, and blood biochemistry tests. Images of phantom solutions were used to characterize the paramagnetic features via MR relaxation times and relaxivities. In vivo contrast behavior in organs was evaluated following oral, intraperitoneal, and intravenous administrations.

STATISTICAL TESTS: The quantitative data were analyzed with Microsoft Excel and GraphPad Prism 9.0; p value < 0.05 was significant.

RESULTS: Betanin had greater molecular binding efficiency and therapeutic capacity. BBCA was less cytotoxic than gadobutrol. Some elements in BBCA were present in larger amounts than Betanin. T₁ and T₂ decreased with an increase in BBCA concentration, and r₁ and r₂ were estimated as 0.0014 and 0.0224 mmol^-1 s^-1, respectively. Both agents demonstrated contrast enhancements not only in the gastrointestinal lumen but also in the parenchymal organ, as well as in the vascular structure, with lower toxicity and antioxidative benefits. In particular, the enhancement in the liver was noteworthy.

DATA CONCLUSION: Betanin and BBCA may be considered as viable options for contrast-enhanced abdominal MRI.

PMID:41186973 | DOI:10.1002/jmri.70158

Int J Cancer. 2025 Nov 4. doi: 10.1002/ijc.70219. Online ahead of print.

ABSTRACT

In stages II and III hormone receptor positive (HR+) breast cancer, selecting patients for primary surgery (PS) or neoadjuvant therapy remains challenging. This study assessed the occurrence of minimally invasive surgery in the case of PS, neoadjuvant endocrine therapy (NET), and neoadjuvant chemotherapy (NACT). This cohort study included women diagnosed with stages II and III, HR+ breast cancer in 2020-2022 in the Netherlands. Women with positive human epidermal growth factor receptor 2 (HER2+) cancer were excluded. Outcomes focused on surgical techniques and additional treatment. Of the 7809 patients, 4046 (51.8%) underwent PS, 956 (12.2%) received NET and 2807 (35.9%) NACT. NET patients were older (median: 71 years [33-94]), while NACT patients had larger tumors and more lymph node involvement (p < .001). Breast-conserving surgery (BCS) was the first procedure in 2153 (53.2%) PS women, in 694 (72.6%) NET women and 1564 (55.7%) NACT cases. There was no difference regarding free surgical margins in NET versus NACT patients (p = .421). After adjusting for T-stage, BCS occurred significantly more frequently after NET (p < .001). Minimal invasive surgery on the axilla was common after NET (83.9%) and NACT (81.5%). In the PS group, 85% received adjuvant systemic therapy. Optimizing patient selection for neoadjuvant strategies could reduce surgical morbidity. NET was frequently associated with BCS, showed comparable surgical margin outcomes to NACT, and contributed to reduced axillary surgery. These findings suggest that NET is an effective strategy, compared to PS, to facilitate less invasive surgery on the breast and axilla, in HR+/HER2-, stages II and III breast cancer.

PMID:41186970 | DOI:10.1002/ijc.70219