Tag: nevin manimala

J Robot Surg. 2025 Jun 14;19(1):292. doi: 10.1007/s11701-025-02439-6.

ABSTRACT

Robotic ventral hernia repair (rVHR) is an advanced form of minimally invasive surgery that offers enhanced precision, reduced complications, and faster recovery time. However, direct comparisons between enhanced-view totally extraperitoneal (eTEP) and transabdominal preperitoneal (TAPP) approaches remain limited. This study aimed to compare the safety and clinical outcomes of eTEP and TAPP in rVHR. In this retrospective cohort study, 117 patients underwent rVHR (82 eTEP, 35 TAPP) between 2023 and 2024. Propensity score matching (PSM) (1:1) balanced baseline characteristics, resulting in 33 patients per group. Patient demographics, operative data, and postoperative outcomes were collected from electronic medical records. Statistical analyses were conducted using SPSS, with statistical significance defined as p < 0.05. Following matching, eTEP demonstrated significantly longer operative times (median 115 vs. 83 min, p = 0.004) and larger mesh sizes (420 cm² vs. 195 cm², p = 0.001). Surgical drains were more frequently used in eTEP (48.4% vs. 3%, p = 0.001). Postoperative outcomes, length of hospital stay, and pain scores did not differ significantly between the groups. Surgical site occurrences (SSOs) showed no significant difference between groups (18.1% eTEP vs. 9% TAPP, p = 0.475). Both eTEP and TAPP are safe and effective robotic approaches for ventral hernia repair with comparable clinical outcomes. The longer operative time and larger mesh size in eTEP suggests its preferential use in more complex hernia cases requiring detailed anatomical reconstruction.

PMID:40517208 | DOI:10.1007/s11701-025-02439-6

J Robot Surg. 2025 Jun 14;19(1):293. doi: 10.1007/s11701-025-02459-2.

ABSTRACT

An isthmocele, also called a cesarean scar defect or niche, is a defect in the lower uterine segment myometrium that occurs as a result of a cesarean delivery. This study aims to review our institution’s comprehensive data following robotic-assisted laparoscopic isthmocele repair (RA-IR) including birth outcomes and changes in the dimensions of the isthmocele. This was a retrospective case series at a single high-volume tertiary medical center in the United States with over 2500 gynecologic surgeries performed yearly. All women with an identified isthmocele who underwent RA-IR between 9/2015 and 12/2022 were included. Detailed chart review, imaging review with a pelvic radiologic specialist, and post-operative questionnaire were utilized in our analysis. Our primary outcome was post-operative live births. Secondary outcomes included post-operative fertility rate, radiologic changes, and symptom improvement. Twenty-eight patients underwent RA-IR during the study period. Of the 17 patients who attempted pregnancy, 94.1% were able to conceive status post-repair including 7 patients with a pre-operative diagnosis of primary or secondary infertility. Of these, 12 who continued their pregnancies achieved their goal of a live birth (n = 12 of 15, 80.0%). There were a total of 20 pregnancies post-repair, resulting in 12 live births, 6 miscarriages, 1 cesarean scar pregnancy, and 1 termination, which corresponds to a live birth rate per pregnancy of 60.0% (n = 12 of 20). There was a statistically significant improvement in myometrial depth, width, and residual myometrial thickness postoperatively (p < 0.1). The greatest difference was seen in the depth of the isthmocele. The residual myometrial thickness improved from mean of 0.63 mm before to 5.13 mm after surgery. Twelve patients completed a questionnaire regarding symptoms and obstetric outcomes. Symptom improvement was reported by 100% of patients, with 66.7% experiencing complete resolution. RA-IR results in improved defect width, depth, and residual myometrial thickness with preservation of fertility and good obstetric outcomes with a live birth yield of 80.0%.

PMID:40517207 | DOI:10.1007/s11701-025-02459-2

Calcif Tissue Int. 2025 Jun 14;116(1):85. doi: 10.1007/s00223-025-01389-3.

ABSTRACT

The relationship between muscle mass and visceral fat with mortality risk in diabetes has been extensively studied. This study investigates the association between the appendicular skeletal muscle mass-to-visceral fat area ratio (SVR) and cardiovascular and cancer-related mortality in diabetic patients in the United States. A nationwide cohort study was conducted using NHANES data (2011-2018), including 1439 diabetic patients with dual-energy X-ray absorptiometry (DXA) measurements. Weighted Cox proportional hazards models and restricted cubic splines (RCS) were employed to evaluate the association between SVR and cause-specific mortality rates. Weighted receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of SVR and other conventional indicators in predicting mortality. After adjusting for multiple confounding factors, SVR showed a linear negative association with cardiovascular and cancer-related mortality in diabetes. Each 0.01-unit increase in SVR was associated with a 3% reduction in the risk of cardiovascular death and a 2% reduction in cancer-related death. However, SVR demonstrated weak diagnostic performance for both cardiovascular and cancer mortality, with weighted AUCs of 0.520 and 0.527, respectively, compared to other metrics including BMI, WC, ASM, and VFA. Although SVR was significantly associated with cardiovascular and cancer mortality, its predictive performance was not superior to that of simpler or more established indicators, suggesting that it has limited clinical utility for predicting mortality in diabetic patients.

PMID:40517189 | DOI:10.1007/s00223-025-01389-3

Pediatr Cardiol. 2025 Jun 14. doi: 10.1007/s00246-025-03923-4. Online ahead of print.

ABSTRACT

Congenital heart disease (CHD) remains a leading cause of neonatal morbidity and mortality. The University of California Fetal Consortium implemented a Standardized Clinical Assessment and Management Plan (SCAMP) to optimize birth timing and mode of birth in pregnancies complicated by fetal CHD. This study evaluates the impact of SCAMP implementation on neonatal outcomes, specifically survival to hospital discharge, birth weight, and hospital length of stay. A retrospective cohort study was conducted comparing neonates with prenatally diagnosed CHD before (historical cohort) and after (intervention cohort) SCAMP implementation. Neonatal data, including mode of birth, birth weight, survival to discharge, and CHD classification was collected from five UC medical centers. Comparative analyses were performed using t-tests for continuous variables and chi-square tests for categorical variables. A total of 414 neonates met inclusion criteria (167 in the historical cohort, 247 in the intervention cohort). The overall neonatal survival rate to discharge was significantly higher in the intervention cohort (91.1% vs. 83.1%, p = 0.04). Survival following cesarean birth was also improved in the intervention cohort (89.1% vs. 78.1%, p = 0.04), while no significant differences were found for induction of labor or spontaneous vaginal births. Birth weight was significantly higher post-SCAMP (2977 g vs. 2838 g, p = 0.01), and hospital length of stay was significantly shorter (11.5 vs. 26 days, p < 0.01). Survival differences by CHD risk classification were not statistically significant. SCAMP implementation was associated with improved neonatal survival, increased birth weight, and reduced hospitalization duration in CHD-affected pregnancies. These findings underscore the importance of standardized perinatal management in optimizing outcomes for neonates with CHD.

PMID:40517188 | DOI:10.1007/s00246-025-03923-4

NPJ Genom Med. 2025 Jun 14;10(1):48. doi: 10.1038/s41525-025-00507-2.

ABSTRACT

Genome-wide association studies (GWAS) have established key role of immune dysfunction in Age-related Macular Degeneration (AMD), though the precise role of immune cells remains unclear. Here, we develop an explainable machine-learning pipeline (ML) using transcriptome data of 453 donor retinas, identifying 81 genes distinguishing AMD from controls (AUC-ROC of 0.80, CI 0.70-0.92). Most of these genes were enriched in their expression within retinal glial cells, particularly microglia and astrocytes. Their role in AMD was further strengthened by cellular deconvolution, which identified distinct differences in microglia and astrocytes between normal and AMD. We corroborated these findings using independent single-cell data, where several ML genes exhibited differential expression. Finally, the integration of AMD-GWAS data identified a regulatory variant, rs4133124 at PLCG2, as a novel AMD association. Collectively, our study provides molecular insights into the recurring theme of immune dysfunction in AMD and highlights the significance of glial cell differences in AMD progression.

PMID:40517179 | DOI:10.1038/s41525-025-00507-2

Eur J Hum Genet. 2025 Jun 14. doi: 10.1038/s41431-025-01891-0. Online ahead of print.

ABSTRACT

Structural variants (SVs) of the nebulin gene (NEB), including intragenic duplications, deletions, and copy number variation of the triplicate region, are an established cause of recessively inherited nemaline myopathies and related neuromuscular disorders. Large deletions have been shown to cause dominantly inherited distal myopathies. Here we provide an overview of 35 families with muscle disorders caused by such SVs in NEB. Using custom Comparative Genomic Hybridization arrays, exome sequencing, short-read genome sequencing, custom Droplet Digital PCR, or Sanger sequencing, we identified pathogenic SVs in 35 families with NEB-related myopathies. In 23 families, recessive intragenic deletions and duplications or pathogenic gains of the triplicate region segregating with the disease in compound heterozygous form, together with a small variant in trans, were identified. In two families the SV was, however, homozygous. Eight of these families have not been described previously. In 12 families with a distal myopathy phenotype (of which 10 are previously unpublished), eight unique, large deletions encompassing 52-97 exons in either heterozygous (n = 10) or mosaic (n = 2) state were identified. In the families where inheritance was recessive, no correlation could be made between the types of variants and the severity of the disease. In contrast, all patients with large dominant deletions in NEB had milder, predominantly distal muscle weakness. For the first time, we establish a clear and statistically significant association between large NEB deletions and a form of distal myopathy. In addition, we provide the hitherto largest overview of the spectrum of SVs in NEB.

PMID:40517164 | DOI:10.1038/s41431-025-01891-0

Eur Arch Otorhinolaryngol. 2025 Jun 14. doi: 10.1007/s00405-025-09512-8. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the diagnostic potential of nystagmus direction observed during bow and lean tests (BLTs) in patients with posterior canal canalolithiasis BPPV (P-BPPV), lateral canal canalolithiasis BPPV (Lca-BPPV), and lateral canal cupulolithiasis BPPV (Lcu-BPPV).

METHODS: A total of 62 patients (40 women, 22 men; aged 24-70 years) with clinically suspected BPPV were enrolled. Diagnoses included 39 cases of P-BPPV, 15 of Lca-BPPV, and 8 of Lcu-BPPV. Each participant underwent the Dix-Hallpike Test (DH), Head Roll Test (HRT), and bow and lean tests for diagnostic assessment. The primary outcome was the presence and direction of nystagmus during BLTs, in relation to BPPV subtype.

RESULTS: Nystagmus was detected in 77.4% of subjects during the bow test and in 46.8% during the lean test. A statistically significant difference was found in nystagmus direction across BPPV subtypes (p < 0.05). Right-beating horizontal nystagmus during the bow test was significantly more frequent in right-sided Lca-BPPV. Right down-beating torsional nystagmus during the bow test occurred exclusively in left P-BPPV, while left down-beating torsional nystagmus was seen only in right P-BPPV. Right up-beating torsional nystagmus was significantly associated with right P-BPPV, and left up-beating torsional nystagmus with left P-BPPV (p < 0.05).

CONCLUSIONS: In P-BPPV, DH-induced nystagmus direction was opposite in the bow position but matched in the lean position. These findings underscore the diagnostic value of BLTs, particularly the bow test, in identifying the affected canal in posterior and lateral canal BPPV.

PMID:40517160 | DOI:10.1007/s00405-025-09512-8

Int J Oral Maxillofac Surg. 2025 Jun 13:S0901-5027(25)01327-X. doi: 10.1016/j.ijom.2025.06.007. Online ahead of print.

ABSTRACT

Surgical removal of mandibular third molars is a routine procedure in oral and maxillofacial surgery, often followed by pain, swelling, trismus, and alveolar osteitis (AO), affecting patient comfort and daily function. Platelet-rich fibrin (PRF) is an autologous biomaterial that promotes healing through the gradual release of cytokines and growth factors. This prospective, randomized, controlled, and patient-blinded study investigated whether PRF applied to the extraction socket reduces postoperative symptoms and complications. Ninety patients scheduled for mandibular third molar removal were randomized to receive PRF or no adjunct treatment prior to wound closure. Seventy-five patients completed follow-up and were included in the analysis. Postoperative outcomes including AO, infection, pain, trismus, analgesic use, and sick leave were recorded over 10 days. The incidence of AO was lower in the PRF group (3.0%) compared to the control group (11.9%), although the difference was not statistically significant. PRF treatment significantly reduced postoperative pain during the first six days. These findings suggest that while PRF may not significantly reduce AO incidence, it can contribute to improved patient comfort and recovery by decreasing early postoperative pain.

PMID:40517125 | DOI:10.1016/j.ijom.2025.06.007

Curr Probl Diagn Radiol. 2025 Jun 3:S0363-0188(25)00114-8. doi: 10.1067/j.cpradiol.2025.06.001. Online ahead of print.

ABSTRACT

BACKGROUND: Breast lesions are a common but often missed incidental finding. We evaluated whether artificial intelligence (AI) algorithms can efficiently detect radiologically significant incidental breast lesions (RSIBLs) missed by original interpreting radiologists (OIRs) on chest CT examinations.

METHODS: This retrospective multi-institutional study analyzed chest CT examinations performed in June 2017 by a national teleradiology practice. Visual classifier (VC) and natural language processing (NLP) algorithms flagged potential RSIBLs, which were reviewed independently by two primary readers; disagreements were adjudicated by a third reader. Sizes and margins of confirmed RSIBLs were evaluated similarly. Differences in size and margin obscuration between RSIBLs missed versus identified by OIRs were statistically assessed (alpha, 0.05). A workflow efficiency analysis was performed.

RESULTS: 3279 of 3541 examinations (92.6 %) were marked negative by both algorithms (i.e., VC-/NLP-) and not reviewed. The two primary readers assessed 262 examinations for RSIBLs, with substantial agreement (kappa, 0.77). After adjudication, 76 RSIBLs were confirmed (73 females, 3 males). Compared with the OIRs, the VC algorithm identified more RSIBLs (90.8 % [69/76] vs 39.5 % [30/76]) though with more false positives (67.9 % [178/262] vs. 3.4 % [9/262]). Among the OIRs, missed RSIBLs had smaller diameters than identified RSIBLs (1.4 cm vs. 3.0 cm; P < 0.001). Our reader workflow reduced the number of images viewed by 97.3 % relative to a hypothetical full double-read approach.

CONCLUSION: An AI-based approach enhanced RSIBL detection rates. Although the AI-based approach also increased the number of false positives, our targeted review process allowed for efficient detection of missed RSIBLs.

PMID:40517117 | DOI:10.1067/j.cpradiol.2025.06.001

Epilepsia. 2025 Jun 14. doi: 10.1111/epi.18492. Online ahead of print.

ABSTRACT

OBJECTIVE: Vitamin D has demonstrated potential anticonvulsant effects in experimental and pilot clinical studies; the results of these remain inconclusive. This study aims to investigate the efficacy and safety of adjunctive Vitamin D supplementation in reducing seizure frequency, modulating vitamin D receptor (VDR) activity, and altering the putative biomarkers of epileptogenesis in persons with drug-resistant epilepsy (DRE).

METHODS: This double-blind, placebo-controlled, parallel-group, adjunctive trial recruited patients from a tertiary care hospital in India. Adult persons with DRE and serum Vitamin D levels <30 ng/mL, experiencing ≥2 seizures/month, were randomized (1:1 ratio) to receive either Vitamin D (60,000 IU/week for 3 months, followed by 60 000 IU/month for the next 3 months) or a matching placebo, in addition to their ongoing antiseizure medications. The primary outcome was the percentage change in monthly seizure frequency from baseline to 6 months. Secondary outcomes included 50% responder, serum Vitamin D (25-hydroxycholecalciferol) levels, VDR protein/mRNA expression, putative biomarkers of epileptogenesis (including high-mobility group box protein 1 [HMGB1] and neurotrophin-3 [NT-3]), quality of life, and safety assessment.

RESULTS: Of 200 participants, 99 were in the Vitamin D group and 101 were in the placebo group. No statistically significant difference was observed between the Vitamin D and placebo groups in the primary outcome of percentage change in monthly seizure frequency from baseline after 6 months of intervention (median 33.3, interquartile range [IQR] 0-57.4 vs 16.7, 0-66.7; median estimate 5.5, 95% confidence interval [CI]: -6.7 to 19.2); p = 0.36]. The 50% responder rate was similar between groups (37% vs 35%; odds ratio 1.1, 95% CI: 0.6-1.9; p = 0.68). However, Vitamin D supplementation significantly increased VDR mRNA and protein expression (p < 0.001) and decreased HMGB1 (p = 0.001) and NT-3 (p = 0.002) levels compared to placebo. The recommended serum Vitamin D level (≥30 ng/mL) was achieved in only 36% of subjects in the Vitamin D group. Safety outcomes were comparable between groups.

SIGNIFICANCE: Six months of Vitamin D supplementation at the selected dose did not significantly reduce seizures compared to placebo, potentially due to few persons with DRE achieving recommended serum Vitamin D level (≥30 ng/mL). Significant upregulation of VDR expression and reduction in putative biomarkers of epileptogenesis following Vitamin D supplementation were seen in Vitamin D group despite no corresponding decrease in seizure frequency. This suggests that Vitamin D may have underlying therapeutic effects that warrant further investigation and clinical correlation.

PMID:40516032 | DOI:10.1111/epi.18492