Tag: nevin manimala

Orthop Surg. 2025 Aug 23. doi: 10.1111/os.70155. Online ahead of print.

ABSTRACT

OBJECTIVE: Given the limitations of conventional anterior and lateral approaches, such as variable success rates and risks of neurovascular injury, there is a critical need to evaluate alternative techniques that enhance procedural safety and efficiency. This study aimed to investigate the safety and precision of the anterolateral approach for hip joint puncture and compare its clinical efficacy with those of the anterior and lateral approaches.

METHODS: A single-center, prospective, randomized Williams crossover trial was conducted from March 2023 to June 2023 involving 30 patients with hip pain. Each patient underwent three hip joint punctures within 3 weeks, all conducted using anatomical landmark-guided blind puncture. The punctures were administered in different sequences of anterior, anterolateral, and lateral approaches, with one-week intervals between punctures. Thirty patients were randomly assigned to six groups (n = 5), following different sequences of the three approaches. The primary outcomes were the success rate and accuracy, and the secondary outcomes were post-puncture pain assessed using the Visual Analogue Scale (VAS), procedure time, puncture depth, and complications.

RESULTS: The anterolateral approach achieved a higher success rate (96.7%) compared to the anterior (86.7%) and lateral (83.3%) approaches; although statistical significance was not reached (p = 0.328). Besides, it significantly shortened procedure duration (72.87 s, SD 9.66) compared to anterior (87.20 s, SD 20.57) and lateral (92.80 s, SD 39.02) approaches (p = 0.006). The puncture path length was shorter with the anterolateral approach (57.77 mm, SD 1.295) than with the lateral approach (63.33 mm, SD 1.295) (p = 0.004). The anterolateral approach achieved lower VAS pain scores (1.77, SD 0.94) compared to the lateral approach (2.90, SD 2.17). During the anterior approach injection, one patient experienced numbness in the lateral thigh of the surgical side.

CONCLUSION: This preliminary randomized crossover trial demonstrates that the anterolateral approach offers significant advantages in procedural efficiency (reduced time, shorter path length) and suggests a trend toward higher success rates compared to standard anterior and lateral approaches for hip joint puncture. These findings, particularly the improvements in efficiency and patient comfort (lower VAS), support the anterolateral approach as an effective technique.

LEVEL OF EVIDENCE: I, Randomized controlled trial.

TRIAL REGISTRATION: chictr.org.cn: ChiCTR2300074174.

PMID:40849673 | DOI:10.1111/os.70155

Cardiovasc Diabetol. 2025 Aug 23;24(1):347. doi: 10.1186/s12933-025-02866-7.

ABSTRACT

BACKGROUND: The objective of this study was to examine the degree to which conventional cardiovascular (CV) risk factor changes induced by once-weekly exenatide (EQW) might explain the placebo-controlled differences in CV outcomes observed in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

METHODS: We entered participant-level risk factor values over time into a validated type 2 diabetes-specific clinical outcomes model to estimate event rates, and compared simulated with observed relative risk changes in EXSCEL. We performed simulations for each participant to minimize uncertainty and to optimize confidence interval precision around risk point estimates. Six outcomes were examined: major adverse CV event (MACE), all-cause mortality (ACM), CV death, fatal or nonfatal myocardial infarction (MI), fatal or nonfatal stroke, and hospitalization for heart failure (hHF). We also performed a mediation analysis using Cox regression models to evaluate potential key mediators for ACM.

RESULTS: Model simulations explained only modest proportions of the observed relative risk reductions for MACE (29%), ACM (15%), CV death (18%), and stroke (29%), but greater proportions for hHF (67%) and MI (200%). Mediation analysis suggested that baseline-to-6 or 12-month changes in HbA_1c, blood pressure, heart rate, low-density lipoprotein cholesterol, triglycerides, and weight did not mediate the EQW effect on ACM.

CONCLUSIONS: These model simulations explain only a modest proportion of the impact of observed EQW-induced changes in conventional CV risk factors on EXSCEL outcomes, apart from hHF and MI. Up to 1-year changes in conventional risk factors did not mediate the observed ACM risk reduction.

PMID:40849664 | DOI:10.1186/s12933-025-02866-7

Eur J Med Res. 2025 Aug 23;30(1):794. doi: 10.1186/s40001-025-03080-7.

ABSTRACT

BACKGROUND: Hypoxia can impair cell and organ function, and cause apoptosis and various diseases. At present, there are many studies on pulmonary hypoxia but few studies on bronchial injury. The study aimed to research the impact of hypoxia on the barrier function of human bronchial epithelial cells and the expression level of tight junction proteins.

METHODS: Primary human bronchial epithelial cells were allocated into four groups: (1) control group, (2) intermittent hypoxia group, (3) sustained hypoxia group, and (4) cigarette smoke exposure group. Apoptosis in each group was assessed by flow cytometric analysis. The expression levels of ZO-1, occludin, and claudin-1 were evaluated via Western blotting. Furthermore, trans-epithelial electrical resistance (TEER) was measured using an epithelial voltohmmeter to assess barrier function.

RESULTS: (1) Compared with the control group, the intermittent hypoxia group exhibited no significant differences in apoptosis rate, TEER, or the expression of tight junction proteins ZO-1, occludin, and claudin-1 (P > 0.05). In contrast, both the sustained hypoxia and cigarette smoke groups demonstrated significantly elevated apoptosis rates (P < 0.05). Claudin-1 expression was significantly reduced in the sustained hypoxia group (P < 0.05), while the increase in ZO-1 expression was not statistically significant (P > 0.05). In the cigarette smoke group, expression levels of ZO-1, occludin, and claudin-1 were all markedly decreased (P < 0.05). (2) Compared with the control group, TEER values were significantly reduced in both the sustained hypoxia and cigarette smoke groups (P < 0.05). (3) A significant difference in ZO-1 expression was observed between the sustained hypoxia and cigarette smoke groups (P < 0.05).

CONCLUSIONS: Hypoxia modulates the expression of tight junction proteins in human bronchial epithelial cells, disrupts intercellular junctional integrity, increases epithelial permeability, and ultimately impairs barrier function.

PMID:40849658 | DOI:10.1186/s40001-025-03080-7

BMC Health Serv Res. 2025 Aug 23;25(1):1122. doi: 10.1186/s12913-025-13162-1.

ABSTRACT

BACKGROUND: Globally, maternal and child health outcomes were negatively affected during the COVID-19 pandemic. There is limited qualitative evidence focused on access to maternal health services during the COVID-19 pandemic in rural sub-Saharan African populations. This study aims to fill this gap by exploring key community perspectives on access to maternal health services during the COVID-19 pandemic in rural western Kenya.

METHODS: We conducted five focus group discussions and sixty one in-depth interviews. Participants were mothers who delivered in 2020 during the acute phase of the COVID-19 pandemic and rural community health workers (CHWs) in Siaya and Kisii counties. The three-delay model framework helped to guide discussions around access to maternal health services during the COVID-19 pandemic in rural western Kenya. We transcribed the data and conducted a thematic content analysis.

RESULTS: According to CHWs and expectant mothers, fear and misconceptions about COVID-19 were associated with delays in making the decision to seek maternal health care. Lockdowns, movement restrictions, and curfews made it challenging to physically reach health facilities. The shortage of drugs and supplies and an insufficient number of healthcare workers in health facilities were barriers to care seeking. The quality of maternal health services was perceived to have declined during the COVID-19 pandemic. Mothers reported the Linda Mama health insurance program helped them pay for maternal health services during the COVID-19 pandemic; however, out-of-pocket expenses were common. As reported by mothers, CHWs when engaged and active, helped alleviate access challenges by serving as a link to the health system. There were significant socio-economic difficulties experienced by community members because of closed businesses and schools.

CONCLUSIONS: Community perspectives revealed significant challenges with accessing maternal health services during the COVID-19 pandemic in rural western Kenya. The pandemic amplified each of three delays in accessing care leading to poorer access to maternal health services. The overriding perception among mothers was that CHWs helped mitigate challenges around access to health services. CHWs should be included in future pandemic preparedness and response efforts.

PMID:40849655 | DOI:10.1186/s12913-025-13162-1

BMC Womens Health. 2025 Aug 23;25(1):404. doi: 10.1186/s12905-025-03952-4.

ABSTRACT

BACKGROUND: Serum levels of anti-Mullerian hormone (AMH), a key indicator of ovarian aging, decrease with age. This decline may be accelerated by genetic and environmental factors. Accordingly, the present study investigates the relationship between serum AMH concentrations and exposure to heavy metals.

METHODS: This cohort study was conducted on 220 women with a median age of 42 years (Range: 37-45). Participants were reproductive-age women from the Tehran Lipid and Glucose Study (TLGS) that met our inclusion criteria. Serum concentration of heavy metals – including lead (Pb), cadmium (Cd), copper (Cu), aluminum (Al) and chromium (Cr) – as well as AMH levels, were measured using stored samples from the second and fifth follow-up visits with a time interval of approximately 10 years. A multivariate linear regression model was used to assess the relationship between AMH and heavy metals, adjusting for age, body mass index (BMI), smoking, physical activity, age at menarche, education, marital status and parity.

RESULTS: The results indicated that serum AMH concentration in women classified within the fourth and third quartiles of Cu was reduced by -0.43 (95%CI: -0.73, -0.13) ng/ml and – 0.34 (95%CI: -0.65, -0.03) ng/ml, respectively. No statistically significant associations were observed between AMH levels and other heavy metals, including Pb, Al, and Cr (P > 0.05).

CONCLUSION: These findings suggest a possible link between elevated Cu levels and diminished AMH concentrations in reproductive-age women. However, further research is needed to confirm these findings and to elucidate the underlying factors, particularly in younger age groups.

PMID:40849647 | DOI:10.1186/s12905-025-03952-4

BMC Musculoskelet Disord. 2025 Aug 23;26(1):815. doi: 10.1186/s12891-025-09086-w.

ABSTRACT

OBJECTIVE: To investigate the relationships among the acromial tilt (AT), the glenoid inclination angle (GIA), the critical shoulder angle (CSA), the acromioglenoid angle (AGA), and degenerative rotator cuff injury via digital reconstruction radiographs (DRRs).

METHODS: A retrospective cohort of 63 patients who met the inclusion criteria were enrolled from the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between April 2023 and April 2024, 33 patients with rotator cuff injury and 30 controls were included. Clinical data and scapular computed tomography (CT) scans were collected, and three-dimensional reconstructions were generated via Amira software (Thermo Fisher Scientific, USA). Digital reconstruction radiograph (DRR) images were simulated at the Grashey and Y positions of the scapula, and the parameters were measured via Digimizer software (MedCalc Software, Belgium). The diagnostic and predictive validity of each parameter for DRR for rotator cuff injury was assessed through statistical analysis of the measured data, including inter-observer consistency, correlation analysis among parameters, and receiver operating characteristic (ROC) curve analysis.

RESULTS: (1) Inter-observer reliability was excellent for all the parameters (intra-class correlation coefficient (ICC) > 0.8). (2) CSA and AGA were significantly greater in the rotator cuff injury group (P_CSA= 0.003;P_AGA < 0.001), whereas GIA was significantly lower (P < 0.001); no difference was detected in AT (P > 0.05). (3) Binary logistic regression analysis revealed that GIA, CSA, and AGA were risk factors for rotator cuff injury (P_CSA=0.008; P_AGA = 0.001; P_GIA = 0.001). (4) ROC analysis yielded area under the curve (AUC) values of 0.755 (GIA), 0.700 (CSA), and 0.796 (AGA), with cutoff thresholds of 83.98°, 30.67°, and 42.04°, respectively. (5) Strong correlations were observed between the CSA and AGA (r = 0.939), whereas the GIA was inversely correlated with both the CSA (r = -0.423) and the AGA (r = -0.471).

CONCLUSION: Measurements of GIA, CSA, and AGA derived from DRRs demonstrate high diagnostic value for degenerative rotator cuff injury. DRR represents a reliable alternative to conventional radiography in clinical practice. In the future, DRR holds promise as a tool for assessing the impact of degenerative rotator cuff injury. However, due to radiation exposure concerns, the current application of DRR is recommended primarily for retrospective studies utilizing existing computed tomography (CT) data.

PMID:40849641 | DOI:10.1186/s12891-025-09086-w

Adv Simul (Lond). 2025 Aug 23;10(1):43. doi: 10.1186/s41077-025-00374-y.

ABSTRACT

BACKGROUND: Simulation is widely used across many aspects of health professions education and, in recent years, has begun to be explored as an assessme nt tool, particularly in relation to examining technical clinical skills. Although previous research has suggested that simulation may be an effective tool for assessing clinical skills, there is a lack of evidence exploring which form of technology may be a more reliable assessment tool. This crossover study aimed to compare two forms of simulation technology-a high-fidelity manikin and virtual reality, as potential tools for assessing acute clinical care assessment skills.

METHODS: The participating students completed two different simulation scenarios: one scenario using a high-fidelity manikin and one using a virtual reality system. The two scenarios were then marked using a checklist created for the research and a global assessment score. The results for each simulation technology were compared with one another and compared with the participants’ medical final summative assessment scores.

RESULTS: Sixteen students participated in the research. The assessment checklist scores from the two technologies were comparable, with no statistically significant difference (p = 0.918) and a strong positive correlation between the two (correlation coefficient = 0.665, p = 0.005). However, neither simulation technology had a statistically significant correlation with the summative final written examination paper (high-fidelity manikin: correlation coefficient = – 0.25, p = 0.927; virtual reality: correlation coefficient = 0.363, p = 0.167) or final clinical examination scores (high-fidelity manikin: correlation coefficient = – 0.204, p = 0.449; virtual reality: correlation coefficient = – 0.201, p = 0.455).

CONCLUSIONS: The findings from this research suggest that virtual reality simulation is comparable to high-fidelity simulation when comparing student scores across the two forms of simulation. However, neither method demonstrated a strong correlation with final summative examination outcomes, suggesting that a single scenario assessment using either technology may not provide an appropriate alternative to existing final summative examinations. To better understand the role of simulation in assessment, further research is needed to compare these two simulation technologies in more depth and provide additional evidence to support educators in understanding how they can be best used within health professions education.

PMID:40849636 | DOI:10.1186/s41077-025-00374-y

J Orthop Surg Res. 2025 Aug 23;20(1):795. doi: 10.1186/s13018-025-06195-z.

ABSTRACT

BACKGROUND: Functional ankle instability (FAI) is a common chronic disease after ankle sprains, and exercise intervention can improve symptoms of instability. This research aims to assess the effect of two new ankle balance device training programs on the ankle function and postural control ability in individuals with functional ankle instability.

METHODS: A total of sixty-eight participants with FAI were randomly assigned to three groups: the spherical ankle balance device (SABD) group, the ensiform ankle balance device (EABD) group and the control group. Participants in all three groups engaged in an 8-week exercise intervention, conducting 4 times per week, each lasting 30 min. Variables were assessed before and after the intervention immediately, including the CAIT score, peroneal muscle reaction time, joint position sense, ankle inversion and eversion torques, and postural control ability. A paired t-test was utilized to compare results within each group, while one-way ANOVA was applied for comparisons between groups. Stepwise regression analysis was performed using the changes in CAIT score post-training as the dependent variable, with changes in peroneal muscle reaction time, position sense, postural control ability, and ankle torque as independent variables to establish a regression equation. A p-value of less than 0.05 was considered to indicate statistically significant differences.

RESULTS: After eight weeks of intervention, the SABD and EABD groups exhibited significant reductions in peroneal muscle reaction time (P < 0.05) and increases in ankle eversion torque (P < 0.05) compared to the control group. The EABD group demonstrated superior outcomes in ankle inversion and eversion torque and postural control compared to SABD groups (P < 0.05).

CONCLUSION: Training with new ankle balance devices significantly enhanced postural control and ankle function in patients with FAI, especially for ensiform ankle balance device.

TRIAL REGISTRATION: Current Controlled Trials ChiCTR2500107096, 20,250,804 (Retrospectively registered).

PMID:40849635 | DOI:10.1186/s13018-025-06195-z

J Orthop Surg Res. 2025 Aug 23;20(1):794. doi: 10.1186/s13018-025-05805-0.

ABSTRACT

BACKGROUND: Knee osteoarthritis (OA) is a prevalent condition influenced by various biochemical, anatomical, and lifestyle factors. Vitamin D deficiency has been implicated in OA, but its role in disease severity and associated symptoms remains unclear. We aimed to investigate the prevalence of vitamin D deficiency in knee OA patients and its relationship with inflammatory markers and clinical symptoms.

METHODS: This retrospective study analyzed 986 patients with knee OA over a 3.5-year period. Vitamin D levels, ESR, and platelet counts were assessed, along with demographic and clinical data. Statistical analyses were conducted to explore associations.

RESULT: This study involved 986 patients with knee OA, majority of them (85% ) were female with mean age 52.95 ± 12.44 years. More than half of patients 59.7% had unilateral knee OA and 40.3% had bilateral knee OA. The mean value of Vitamin D3 was 25.35 ± 14.125. Vitamin D deficiency was observed in 70.9% of patients, with moderate deficiency being most prevalent (36.94%). No significant association was found between vitamin D levels and inflammatory markers. However, a strong association was observed between vitamin D deficiency and symptoms like polyarthralgia (p < .05)., Bilateral OA was associated with higher vitamin D deficiency levels compared to unilateral OA (P < .001).

CONCLUSION: OA more prevalence among female .As well as, vitamin D deficiency is highly prevalent in knee OA patients and its severity associated with Bilateral OA and polyarthralgia but not with inflammatory markers. Future research should focus on the long-term impact of vitamin D supplementation and the molecular mechanisms underlying these disparities.

PMID:40849628 | DOI:10.1186/s13018-025-05805-0

BMC Womens Health. 2025 Aug 23;25(1):406. doi: 10.1186/s12905-025-03940-8.

ABSTRACT

BACKGROUND: Menstrual symptoms are a prevalent and frequently encountered woman’s health condition. This study aimed to examine the effect of exercise on menstrual symptoms, sleep quality, fatigue, and physical activity levels.

METHODS: The study was designed as a randomized controlled trial between September 2023 and December 2023. The study included 54 women aged 18 to 45 years. The participants were allocated to the exercise or the control group using simple randomization with a sealed envelope method. All participants were evaluated with the Menstrual Symptom Questionnaire (MSQ), the Menstrual Distress Questionnaire (MDQ), the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire-Short Form (IPAQ) before and after treatment. The control group did not receive an exercise program. The exercise group received strengthening, flexibility, and balance exercises. A moderate-intensity aerobic exercise and walking program was implemented at least three days per week. The study spanned three menstrual cycles for each woman and lasted an average of 12 weeks.

RESULTS: Within-group analysis showed a significant decrease in MSQ (p=0.001), MDQ (menstrual) (p=0.002), FSS (p=0.003), and PSQI (p=0.001) scores after exercise. In contrast, the IPAQ score increased significantly in the exercise group p=0.001). In the control group, a significant decrease was observed only in the MDQ (intermenstrual) score (p=0.915). A comparison of the pre-treatment and post-treatment changes in the exercise and control groups revealed a significant decrease in MSQ (p=0.001), MDQ (menstrual) (p=0.023), and PSQI scores (p=0.001) and an increase in IPAQ scores (p=0.001) in the exercise group compared to the control group. However, the decrease in MDQ (pre-menstrual and intermenstrual) (p=0.626^, p=0.348) and FSS scores (p=0.102) were not statistically different between the groups.

CONCLUSIONS: In conclusion, exercise can decrease the menstrual symptoms in women with menstrual symptoms as a primary outcome. Second, exercise can also increase their sleep quality. Therefore, it can be employed as a non-pharmacological adjuvant method to help women manage their symptoms.

TRIAL REGISTRATION: The protocol is registered with http://clinicaltrials.gov/ (17/August/2023, Clinical Trial, NCT06006507).

PMID:40849627 | DOI:10.1186/s12905-025-03940-8