Tag: nevin manimala

Med Ultrason. 2025 Apr 29. doi: 10.11152/mu-4507. Online ahead of print.

ABSTRACT

AIM: Caudal epidural injection is used for lumbosacral radicular pain but there is a risk of vascular injection. An ultrasound-guided catheter-over-needle technique was proposed to reduce this risk. This study compared the incidence of vascular injections between the catheter-over-needle and Tuohy needle methods for caudal epidural injections.

MATERIAL AND METHODS: This prospective, randomized clinical trial included patients aged ≥19 years with degenerative lumbar disease accompanied by radicular pain who were unresponsive to non-invasive treatments and scheduled for caudal epidural injection. The participants were randomized into two groups: catheter-over-needle and Tuohy needle groups. Under ultrasound guidance, the contrast medium was injected and observed in real time using fluoroscopy. An independent physician assessed the vascular injection rates.

RESULTS: The incidence of vascular injection was significantly lower in the catheter-over-needle group (15.7%) than in the Tuohy needle group (37.5%; p=0.014). Chronic pain lasting >12 months was a significant risk factor for vascular injection (p=0.035). However, no statistically significant association was found between sacral opening depth and vascular injection, although the sacral opening depth was shorter in patients who received intravascular injections.

CONCLUSIONS: The catheter-over-needle technique significantly reduces the risk of vascular injection. The depth of the sacral opening may also influence vascular injection.

PMID:40349375 | DOI:10.11152/mu-4507

Trends Psychiatry Psychother. 2025 May 11. doi: 10.47626/2237-6089-2024-1006. Online ahead of print.

ABSTRACT

BACKGROUND: Depression is a prevalent mental health condition with a significant global burden, yet treatment coverage remains limited. Digital interventions offer a promising avenue for expanding access to evidence-based interventions.

METHODS: In a three-arm randomized clinical trial, we evaluated the efficacy and safety of an app-based intervention and an online group cognitive behavioral therapy (GCBT) to reduce depressive symptoms compared to a waiting list control (WLC). Participants (N=109) with PHQ-9 scores ≥9 were randomized into three groups. Informed consent was obtained. The primary outcome, depressive symptoms, was assessed at baseline and every 4 weeks over 12 weeks. Secondary outcomes included anxiety symptoms, loneliness perception, and treatment-related adverse effects. We used one-tailed Student’s t-tests and Mann-Whitney U tests, adjusting p-values for false discovery rate. Statistical significance was set at 5%. ClinicalTrials.gov identifier: NCT05450614.

RESULTS: After excluding dropouts, 58 participants remained (28 app; 19 GCBT; 11 WLC). Most were women (app: 86%; GCBT: 89%; WLC: 100%) and identified as white (app: 61%; GCBT: 63%; WLC: 82%), aged 36 to 39, with high income and education. Only GCBT showed a significant reduction in anxiety (t(23.92) = 2.20, p = 0.019; padj = 0.038; Cohen’s d = 0.81, 95% CI [0.17, ∞). The remaining comparisons were not statistically significant.

CONCLUSION: While only GCBT showed significant improvement in anxiety symptoms, both treatments showed trends toward depressive symptom reduction. High dropout rates and a small sample may have impacted results. Further research should assess the long-term impact and scalability of digital interventions in mental health.

PMID:40349367 | DOI:10.47626/2237-6089-2024-1006

J Community Psychol. 2025 May;53(4):e70017. doi: 10.1002/jcop.70017.

ABSTRACT

AIMS: Knowledge about unaccompanied women experiencing homelessness in the US remains scant. This study used a feminization of homelessness framework to compare time that unaccompanied women and men spent in the coordinated entry system (US process for housing service prioritization and allocation) based on reasons for entering homelessness.

METHODS: Bivariate tests and negative binomial models were run using data for persons within one southern U.S. community in 2022 (N = 3,258).

RESULTS: Women spent 232 mean days less in the system than men, and more entered homelessness due to unaffordable housing, eviction, and domestic violence; men entered due to institutional discharge, substance abuse, or job loss. For women, domestic violence predicted less time; substance abuse or being Black predicted more. For men, job loss, mental illness, being Black, or having a disability predicted longer time.

CONCLUSION: Results underscore the benefits of women-centered trauma-responsive housing, and prioritizing job training and mental healthcare for men. Universally, structural inequalities and racial discrimination are the backdrop of unaccompanied homelessness.

PMID:40349361 | DOI:10.1002/jcop.70017

J Nephrol. 2025 May 11. doi: 10.1007/s40620-025-02303-8. Online ahead of print.

ABSTRACT

BACKGROUND: Recombinant human erythropoietin (rHuEPO) and darbepoetin alfa (DA) are key treatments for anemia in individuals with chronic kidney disease (CKD), including children, but evidence comparing their efficacy in the pediatric population remains inconclusive.

METHODS: This systematic review, adhering to PRISMA guidelines, analyzed randomized controlled trials and observational studies comparing rHuEPO and DA in pediatric patients with CKD (≤ 18 years; ≥ 10 children per study), searched across medical databases and clinical trial registries until 31/12/2024. The Cochrane Risk of Bias was used for assessment. Meta-analysis evaluated hemoglobin (Hb) increase and cost-effectiveness using the incremental cost-effectiveness ratio.

RESULTS: From 1298 screened articles, 7 studies were included: 3 prospective studies, 2 randomized open-label non-inferiority trials, and 2 retrospective cohort studies, comprising 208 children for direct comparisons and 357 for transitioning studies. Meta-analysis found no significant Hb improvement differences between rHuEPO and DA after 21-28 weeks of treatment (DA + 0.15 g/dL, 95% CI – 0.22 to + 0.52). rHuEPO was more cost-effective than DA. Transitioning to DA increased Hb by + 0.93 g/dL (95% CI 0.53-1.33) in children with suboptimal levels, after 21-28 weeks of rHuEPO. The incremental cost-effectiveness ratio of switching to DA was ~ €340 per g/dL of Hb over 24 weeks.

CONCLUSIONS: rHuEPO is the most cost-effective initial anemia treatment in pediatric CKD. However, transitioning to DA may be considered for patients who do not achieve adequate Hb response. The small number of randomized controlled trials (RCTs), variability in dose conversion, and study heterogeneity may limit generalizability.

PROSPERO ID: CRD42023460872.

PMID:40349276 | DOI:10.1007/s40620-025-02303-8

J Neurol. 2025 May 11;272(6):390. doi: 10.1007/s00415-025-13130-z.

ABSTRACT

BACKGROUND AND OBJECTIVES: Motor neuron disease (MND) is a progressive neurodegenerative disorder associated with high morbidity and mortality. With global aging, the burden of MND is expected to increase, particularly in regions with rapidly aging populations. This study utilizes Global Burden of Disease (GBD) 2021 data to assess the global and regional MND burden from 1990 to 2021, examining trends by age, sex, and socio-demographic index (SDI), and projecting future trends to 2040.

METHODS: Data from the GBD 2021 database for the years 1990-2021 were analyzed to evaluate age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and disability-adjusted life years (DALYs) for MND across SDI regions, age groups, and sexes. Temporal trends were explored using joinpoint regression analysis, while future projections were generated using the Bayesian age-period-cohort (BAPC) model for 2021-2040.

RESULTS: From 1990 to 2021, global MND prevalence increased by 68.43%, reaching 272,732 cases, while the age-standardized prevalence rate (ASPR) slightly declined, reflecting the influence of population aging. Although global incidence increased by 74.54%, the age-standardized incidence rate (ASIR) showed a modest decline, suggesting improvements in diagnostic practices. Mortality and DALY rates continued to rise globally, with high-SDI regions bearing the highest burden. Projections indicate that by 2040, global MND prevalence will decline slightly, while incidence, mortality, and DALYs will continue to rise in low- and middle-SDI regions due to aging populations.

DISCUSSION: The global MND burden is heavily influenced by aging, particularly in high-SDI regions. Although incidence rates have slightly decreased, mortality and disability burdens are increasing, highlighting ongoing challenges in disease management and treatment. The findings stress the importance of age-targeted interventions, improving healthcare access, and addressing socio-economic disparities to mitigate the future impact of MND, particularly in low- and middle-SDI regions.

PMID:40349275 | DOI:10.1007/s00415-025-13130-z

Discov Oncol. 2025 May 11;16(1):724. doi: 10.1007/s12672-025-02072-7.

ABSTRACT

OBJECTIVE: To establish a clinical prediction model for specific and overall survival in advanced salivary gland malignant tumors, providing a potential reference tool for personalized clinical care and adjunct treatment decision-making.

METHODS: Retrospective data from the Surveillance, Epidemiology, and End Results (SEER) 8.4.3 version were utilized. Clinical variables collected included patient age, gender, race, diagnosis year, SERR historic stage A, histological types(The histological classification of advanced salivary gland malignant tumors in this study mainly include acinic cell carcinoma, adenoid cystic, mucoepidermoid carcinoma, salivary duct carcinoma, carcinoma ex pleomorphic adenoma, squamous cell carcinoma NOS, salivary gland carcinoma NOS and other histological types), T stage, N stage, M stage, treatment modalities (including surgery, radiotherapy, and chemotherapy), marital status, cancer-specific survival (CSS), overall survival (OS), and survival status. Patients diagnosed with TNM III/TNM IV stage salivary gland malignant tumors between 2010 and 2015 were allocated to the training set, while those diagnosed between 2004 and 2009 served as the test set. Chi-square test compared clinical variables between the training and test sets. Univariate and multivariate COX regression models identified prognostic factors, Kaplan-Meier analysis depicted survival curves, and predictive models for patient OS and CSS were constructed using R-studio environment, with calibration curves and C-index calculated. All statistical analyses were conducted using SPSS 25.0 and R-studio, with P < 0.05 considered significant.

RESULTS: A total of 1477 late-stage salivary gland malignant tumor patients were included. Independent prognostic factors for OS included age, tumor histology, histologic types, T stage, M stage, surgery, and radiotherapy. CSS shared similar prognostic factors with OS. Predictive nomograms based on clinical variables showed high accuracy for 1, 2, 3, 5, and 10-year OS and CSS, with C-indexes of 0.748 and 0.783, respectively. External validation confirmed the models’ accuracy, with well-fitted calibration curves between predicted and observed survival rates.

CONCLUSION: Nomograms constructed from clinical data can effectively predict OS and CSS for advanced salivary gland malignant tumor patients, providing a potential reference tool for personalized clinical care and adjunct treatment strategies.

PMID:40349272 | DOI:10.1007/s12672-025-02072-7

Cancer Control. 2025 Jan-Dec;32:10732748251342068. doi: 10.1177/10732748251342068. Epub 2025 May 11.

ABSTRACT

IntroductionContrast-enhanced computed tomography (CT) is the primary imaging modality for accurate risk stratification in gastrointestinal stromal tumors (GISTs). However, contrast-enhanced CT may not always be accessible or suitable for all patients undergoing risk assessment of GISTs. Therefore, this study explored the use of non-enhanced CT imaging for assessing body composition in patients with GISTs to preoperatively predict risk stratification.MethodsWe retrospectively analyzed 233 patients with GISTs who met the inclusion criteria. Pretreatment complete abdominal CT images from these patients were processed and analyzed using the Siemens Syngo imaging system. The data were subsequently organized and analyzed using the SPSS software (version 26.0).ResultsThrough two independent samples t-tests, Mann-Whitney U tests, and chi-square tests (including corrected chi-square tests and Fisher’s exact tests), the intermediate-high risk group exhibited a lower visceral fat index (VFI) and higher tumor volumes and proportions of necrosis (P < .05), compared to the low-risk group (P < .05). No statistically significant differences were observed in the other indicators. Our research demonstrates that tumor volume is positively correlated with the National Institutes of Health (NIH) classification and exhibits the highest specificity among the four models (specificity = 0.735). However, its sensitivity is lower than that of the combined model (sensitivity = 0.803) and the VFI model (sensitivity = 0.972).ConclusionBased on the vascular abundance index, tumor volume, and necrosis status observed in the CT plain scan images of patients with GIST, a comprehensive predictive model was developed. This model can accurately predict the NIH grade of stromal tumors, thereby providing a robust basis for formulating effective treatment strategies and improving the prognosis of patients with GISTs who cannot undergo contrast-enhanced CT.

PMID:40349268 | DOI:10.1177/10732748251342068

Clin Child Fam Psychol Rev. 2025 May 11. doi: 10.1007/s10567-025-00521-x. Online ahead of print.

ABSTRACT

Emotional and behavioural problems (EBP) are prevalent amongst children, and guided, parent-led digital interventions offer one method of improving access to effective treatments. This systematic review (PROSPERO: CRD42023484098) aimed to examine the evidence base for, and characteristics of, these types of interventions through a narrative synthesis. Systematic searches were conducted using Medline, EMBASE, PsycINFO, Scopus and Web of Science in January 2024 and February 2025, supplemented with hand searching in March/April 2024 and February 2025. Studies were eligible if they reported outcomes related to preadolescent EBP from a guided, fully parent-led, fully digital intervention. Thirteen studies were eligible, including 2643 children and covering eight interventions (addressing anxiety problems, comorbid anxiety and depression, attention deficit hyperactivity disorder, conduct disorder and disruptive behaviour). Studies included randomised controlled trials and pre-post studies. The QualSyst checklist was used to assess study quality; all studies were rated as good quality. All studies showed statistically significant improvements in the child’s symptoms or interference levels, with small to very large effect sizes immediately post-treatment, and at least medium effect sizes by follow-up, suggesting a promising evidence base. A wide range of intervention characteristics were identified, forming a basis for future intervention development for childhood EBP. However, there was a lack of consistency in how information was reported across studies (such as completion rates) and studies lacked information on parent demographics and key intervention details. Further high quality randomised controlled trials for a wider range of EBP are needed to continue building the evidence base.

PMID:40349266 | DOI:10.1007/s10567-025-00521-x

Dermatol Ther (Heidelb). 2025 May 11. doi: 10.1007/s13555-025-01441-y. Online ahead of print.

ABSTRACT

INTRODUCTION: This randomized, prospective study (MATCH) was designed to assess the clinical utility of a machine learning-based tool (Mind.Px) that predicts patient response to the biologic drug classes used in the management of psoriasis.

METHODS: Patients with psoriasis who were biologic naïve or approaching a medication change owing to nonresponse were enrolled into the study (N = 210). At baseline, a dermal biomarker patch was applied to lesional skin, and Mind.Px test results were provided to physicians for patients in the informed arm of the study prior to biologic selection. The choice of biologic was recorded, and, in the case of physician nonconcordance with Mind.Px test results, a questionnaire was completed to determine the reason for nonconcordance. Patients were evaluated at weeks 4 and 12 after baseline using Psoriasis Area and Severity Index (PASI). Statistical analysis between groups was performed using Fisher’s exact test.

RESULTS: Physician prescribing behavior was measured with and without the inclusion of Mind.Px test results in the decision-making process (N = 205). Additional comparisons were made to a previously collected data set identical to the Mind.Px-uninformed arm (N = 429). Statistical analysis of concordance between the Mind.Px-informed and Mind.Px-uninformed groups (92.3% versus 62.9%, respectively) showed that when given access to Mind.Px results, physician behavior was significantly altered (p = 8.08 × 10^-7). Furthermore, analysis of patients whose physicians followed Mind.Px results showed that not only did more patients reach the clinical endpoint (PASI75) at 12 weeks (p = 5.4 × 10^-4), but also more patients reached this endpoint by week 4 than those in the treatment-as-usual arm (p = 0.01).

CONCLUSIONS: These results provide evidence of the clinical utility of Mind.Px by showing that physicians utilize test results in psoriasis biologic decision-making, leading to improved patient outcomes. These improved patient outcomes can also potentially translate into cost savings for healthcare systems. Mind.Px can minimize the trial-and-error approach to psoriasis treatment, and provide physicians, patients, and payers with an effective tool for re-envisioning the management of patients with psoriasis.

GOV LISTING: NCT05036889.

PMID:40349264 | DOI:10.1007/s13555-025-01441-y

Spine Deform. 2025 May 11. doi: 10.1007/s43390-025-01091-2. Online ahead of print.

ABSTRACT

PURPOSE: This article aimed to determine modifiable risk factors to prevent massive blood transfusion of blood products (MTBP) during spinal fusion in patients with cerebral palsy.

METHODS: Patient data were queried from a prospectively collected multicenter database. Perioperative MTBP was defined as the administration of allogenic blood products equaling at least half (50%) of the patients’ preoperative blood volume during the surgical procedure. Univariate and multivariate logistic regression was used for statistical analysis.

RESULTS: Three hundred thirty-three patients were included. Ninety-four percent of patients were Gross Motor Classification System IV and V. The incidence of MTBP was 29.7% (99/333). The lack of antifibrinolytic use was significant at univariate analysis. Preoperative low weight, blood volume loss, hybrid system, and unit rod use remained significant after the adjustment in multivariate analysis. Loss of more than 68% of patient blood volume was the threshold for MTBP. Patients receiving MTBP had increased hospital (P = 0.006) and intensive care unit (P < 0.001) stays. However, surgical site complications, deep wound infections, and reoperation rate were not different (P = 0.12, P = 0.46, P = 0.22, respectively). There was a significant decrease in MTBP incidence from 2008 (53%) to 2016 (11%) (P < 0.001) with routine administration of antifibrinolytics.

CONCLUSION: The incidence of MTBP in patients with cerebral palsy undergoing PSF during the study period was 29.7% and this rate has decreased over time, making the surgery safer. Optimization of preoperative nutrition status, use of pedicle screw constructs when possible, and use of antifibrinolytics when not contraindicated is recommended to reduce the risk of perioperative MTBP.

LEVEL OF EVIDENCE: Level III-Retrospective cohort study.

PMID:40349263 | DOI:10.1007/s43390-025-01091-2