Tag: nevin manimala

Breast Cancer Res. 2025 Mar 15;27(1):39. doi: 10.1186/s13058-025-01989-9.

ABSTRACT

BACKGROUND: Currently, the primary methods for detecting HER2 expression levels are immunohistochemistry (IHC) and in situ hybridization (ISH), with the traditional standard being a HER2-positive score of 3 + accompanied by ERBB2 gene amplification detected through ISH. However, a new entity has recently emerged: HER2-low, defined as HER2 IHC 1 + or 2 + with negative ISH. HER2-low breast cancer, representing 45-60% of all HER2-negative tumors, has distinct biological characteristics and uncertain responses to conventional HER2-targeted therapies. Recent studies suggest varied clinical outcomes, highlighting the need for further investigation into the impact of HER2-low status on treatment efficacy and prognosis.

OBJECTIVE: This meta-analysis evaluates the difference in complete pathological response (pCR), disease-free survival (DFS), and overall survival (OS) between HER2-low and HER2-zero phenotypes.

METHODS: We systematically searched the main databases PubMed, Scopus, and Web of Science for articles evaluating women in neoadjuvant therapy expressing HER2-low and HER2-zero. We computed odds ratios (ORs) or hazard ratios (HRs) using DerSimonian and Laird random-effect models for all endpoints, with 95% confidence intervals (CIs). We assessed the heterogeneity using I² statistics. R, version 4.2.3, was used for statistical analyses.

RESULTS: 38 studies totaling 70,104 patients were included. The HER2-low group accounted for 61.3% of patients while HR + status represented 52.4% in the whole research. In 67,839 women, the pCR was analyzed, which in the overall cohort analysis favored the HER2-zero group (OR 0.84; 95% CI 0.78-0.90; p = 0.000005; I² = 15%). Subgroup analyses for triple-negative breast cancer (TNBC) and HR + patients also favored HER2-zero expression, with an OR of 0.91 (95% CI 0.83-1.0; p < 0.041; I² = 12%) and 0.75 (95% CI 0.70-0.81; p < 0.000001; I² = 0%), respectively. In the multivariate analysis across all patients, both DFS and OS outcomes were significantly favorable for the HER2-low expression group, with HR 0.8317 (95% CI 0.7036-0.9832; p = 0.031) for DFS and HR 0.806 (95% CI 0.663-0.979; p = 0.03) for OS.

CONCLUSION: Based on our findings, HER2-zero status is associated with a significantly higher pathological complete response (pCR) rate compared to HER2-low in early-stage breast cancer, and other survival outcomes. These results suggest that HER2-zero should be considered a prognostic factor in early-stage breast cancer and taken into account in neoadjuvant treatment planning and future clinical research.

PMID:40089780 | DOI:10.1186/s13058-025-01989-9

Health Qual Life Outcomes. 2025 Mar 15;23(1):24. doi: 10.1186/s12955-025-02345-3.

ABSTRACT

BACKGROUND: Health-related quality of life is an important measure of patient-reported outcomes. There is limited evidence on how parental health-related quality of life develops after neonatal hospitalization.

OBJECTIVE: To evaluate parents’ health-related quality of life (HRQL) during the year following their infant’s treatment in the neonatal intensive care unit (NICU).

METHODS: This prospective cohort study, conducted at a German university hospital between 2020 – 2023, examined HRQL among parents of infants hospitalized in the NICU for ≥ 14 days and parents of infants discharged from the maternity ward according to PedsQL™ Family Impact Module. Multiple linear regression analysis was performed to identify associations between cohort affiliation and differences in parental HRQL. Key secondary outcome was parenting sense of competence (PSOC).

RESULTS: Participants included 131 parents of NICU infants and 122 unexposed parents. HRQL increased over time for NICU mothers (58.7 at 14 days, 70.8 at 6 months, 77.0 at 12 months after birth) and NICU fathers (69.8 at 14 days, 73.9 at 6 months, 75.7 at 12 months). NICU treatment was significantly associated with lower HRQL at 14 days (mothers: -20.26 points; P < .001; fathers: -9.40 points; P = .04), but not at 6 or 12 months after birth. At 12 months postpartum, NICU mothers showed higher PSOC compared to unexposed mothers (mean difference -4.85; P = 0.005).

CONCLUSIONS: Parents and especially mothers of NICU infants reported lower HRQL at 14 days postpartum. At 6 and 12 months, their HRQL improved, aligning with that of unexposed parents.

PMID:40089778 | DOI:10.1186/s12955-025-02345-3

Head Neck. 2025 Mar 14. doi: 10.1002/hed.28133. Online ahead of print.

ABSTRACT

BACKGROUND: Literature about ocular toxicity after head and neck cancer (HNC) treatment is scarce. This study aimed to describe visual function and ocular symptoms among HNC patients.

METHODS: The study used a cross-sectional design. Two surveys, The National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) and an Ocular Symptom Scale, were sent to participants via e-mail. Descriptive statistics were used to describe the sample in the vision change and non-vision change groups. Chi-square and t-tests were used to compare groups.

RESULTS: Of the 485 HNC patients emailed, 126 responded to the survey (26%). Of those, 114 completed the surveys. The scores of NEI-VFQ were significantly lower in the vision change group than in the non-vision change group (p < 0.001). Similarly, all ocular symptoms were significantly different between the two groups (p < 0.05).

CONCLUSIONS: These findings and a scarcity of literature suggest that vision screening after HNC treatment is warranted.

PMID:40087146 | DOI:10.1002/hed.28133

Muscle Nerve. 2025 Mar 14. doi: 10.1002/mus.28396. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Ataxia-telangiectasia (A-T) is a genetic multisystem neurodegenerative disorder characterized by cerebellar ataxia, oculocutaneous telangiectasia, extrapyramidal involvement, peripheral sensorimotor neuropathy, immunodeficiency, pulmonary disease, and an increased risk of malignancy that ultimately determines the shortened lifespan in many patients. A-T nerve ultrasonographic characteristics remain underexplored. This pilot study aimed to characterize the ultrasonographic morphology of peripheral nerves in patients with A-T.

METHODS: Ultrasound cross-sectional areas (CSAs) of the median, ulnar, sural, and tibial nerves were obtained from three A-T patients and were compared to reference values. Nerve conduction studies and electromyography were also performed. Given the small sample size and the exploratory nature of this study, formal statistical analyses were not performed, and descriptive statistics were presented for the data.

RESULTS: Nerve CSAs in A-T patients were smaller than in healthy controls at all measurement sites.

DISCUSSION: Nerve ultrasound revealed atrophy in the peripheral nerves of A-T patients. This reduction in nerve size may distinguish A-T and highlights the utility of nerve ultrasound as a non-invasive diagnostic tool for peripheral sensorimotor neuropathy. These findings may have important implications for early detection in clinical practice.

PMID:40087145 | DOI:10.1002/mus.28396

Cardiovasc Revasc Med. 2025 Mar 6:S1553-8389(25)00067-3. doi: 10.1016/j.carrev.2025.02.017. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic Limb Threat Ischemia (CLTI) is a severe form of peripheral arterial disease characterized by various symptoms including nonhealing wounds, ulcers and gangrene ultimately leading to a possible amputation. Therefore, revascularization either through endovascular intervention (EVI) or surgical bypass (SB) is an important step in management. Literature review of various studies including Randomized clinical trials (RCTs), Meta-analysis and observational studies show varied results with some studies suggesting better outcomes with EVI while majority of the others favors superiority of SB. Our Systematic review and meta-analysis aims to ascertain underlying differences between the approaches.

METHODS: We performed a Meta-analysis of observational studies and RCTs following the PRISMA guidelines. We searched Pubmed, and Cochrane databases. After removing duplicates and studies that did not meet the inclusion criteria, 9 studies were included which comprised of 4 RCTs and 5 observational studies. Outcomes measured include limb salvage, amputation free survival and Mortality. Random effects were applied to calculate Odds ratio (OR) and 95 % confidence Intervals (CI).

RESULTS: A total of 6375 patients from 9 studies were included. The pooled analysis from the meta-analysis comparing Endovascular intervention vs Surgical Bypass showed no statistically significant difference between the outcomes. The Pooled OR was 0.990(95%CI 0.913-1.073). Additionally the heterogeneity among the studies was moderate (i² = 34.7 %) suggesting some variability in the study results but not enough to conclude a significant difference. Additionally subgroup analysis was performed for above-knee and infra popliteal interventions which yielded statistically similar results.

CONCLUSIONS: Based on the results above, neither endovascular intervention nor bypass surgery showed superiority over the other for outcomes such as limb salvage, mortality and amputation free survival. Therefore, effectiveness of both interventions for revascularization is comparable.

PMID:40087129 | DOI:10.1016/j.carrev.2025.02.017

Int J Gynecol Cancer. 2025 Feb 1:101676. doi: 10.1016/j.ijgc.2025.101676. Online ahead of print.

ABSTRACT

OBJECTIVE: The oncologic safety of less-radical surgery for early-stage cervical cancer is currently being actively investigated. Given the paucity of data, this study assessed the temporal trends and oncologic outcomes associated with modified radical hysterectomy for stage IB1 (≤2 cm) cervical cancer in the United States.

METHODS: This retrospective cohort study used data from the Commission-on-Cancer’s National Commission on Cancer Database. The study population was 2902 patients with clinical stage IB1 (≤2 cm) cervical cancer from 2010 to 2020. Temporal trends based on hysterectomy modality (radical hysterectomy, modified radical hysterectomy, and simple hysterectomy) were assessed using linear segmented regression with log-transformation, and the overall survival was assessed using a multivariable Cox proportional hazard regression model.

RESULTS: There was a statistically significant increase in modified radical hysterectomy from 2013 to 2020 (annual percentage rate increase 4.4, 95% CI 0.7 to 16.0, p=.040) and a decrease in simple hysterectomy from 2012 to 2020 (-2.3, 95% CI -3.7 to -1.3, p<.001). The lymphovascular space invasion rates (26.8%, 26.8%, and 23.1% for the radical, modified radical, and simple hysterectomy groups, respectively, p=.10) and pathological nodal metastasis rates (5.0%, 4.4%, and 4.0%, respectively, p=.54) were similar among the 3 groups. The use of adjuvant radiotherapy was higher in the simple hysterectomy group (13.0%, 13.0%, and 18.2% in the radical, modified radical, and simple hysterectomy groups, respectively, p<.001). The 5-year overall survival rates for radical hysterectomy, modified radical hysterectomy, and simple hysterectomy were 96.6 %, 96.3 %, and 95.8 %, respectively (p=.0.66). In multivariable analysis, modified radical hysterectomy (adjusted HR 1.23, 95% CI 0.73 to 2.06) and simple hysterectomy (adjusted HR 1.02, 95% CI 0.70 to 1.48) were not associated with decreased overall survival compared with radical hysterectomy.

CONCLUSIONS: The results of this cohort study in the United States suggest that modified radical hysterectomy for stage IB1 (≤2 cm) may not be associated with overall survival. This observed survival association warrants further investigation stage IB1 (≤2 cm) cervical cancer that does not meet the low-risk criteria.

PMID:40087120 | DOI:10.1016/j.ijgc.2025.101676

Nurse Educ Pract. 2025 Mar 6:104326. doi: 10.1016/j.nepr.2025.104326. Online ahead of print.

ABSTRACT

AIM/OBJECTIVE: To design and test the usability of case-based HIV microlearning lessons using WhatsApp groups. This paper reports on effectiveness and uptake.

BACKGROUND: South Africa has the largest antiretroviral treatment program globally. National guidelines are regularly updated. Ongoing training of healthcare workers is vital but complicated by infrastructural, financial and human resource shortages. Innovative solutions are needed.

DESIGN: A pragmatic, mixed methods, parallel group, cluster randomised trial.

METHODS: Nurses and community health workers (CHWs) at 50 clinics in the Eastern Cape were invited to participate. Online questionnaires tested knowledge and retention of knowledge; retrospective folder reviews measured changes in patient care. Patient folders were sampled purposively pre-/post-intervention for clinical points learned. Descriptive and inferential analyses were performed.

RESULTS: Uptake and participation were good: 232 (79 %) nurses and 207 (76 %) CHWs participated. 96 % of nurses and 88 % of CHWs read the lessons within two weeks. There was a significant intervention effect on knowledge, based on the online questionnaires: nurses (0.5 units; 95 % CI 0.11-1.0; p = 0.0499) and CHWs (0.7 units; 95 % CI 0.2-1.3; p = 0.004). 1083 patient folders were reviewed to compare changes in patient care between the study arms. Adjusting for pre-care differences between the arms, the intervention increased correct patient care by 21 % ( 95 % CI 10 %-32 %; p < 0.001) in the year after the training.

CONCLUSIONS: WhatsApp-based microlearning improves knowledge and patient care. This, with the companion paper’s data showing that it is well received and accepted, makes it a valuable option for simple, accessible, scalable continuing medical education for HCWs.

PMID:40087110 | DOI:10.1016/j.nepr.2025.104326

J Hand Ther. 2025 Mar 13:S0894-1130(25)00008-0. doi: 10.1016/j.jht.2025.01.007. Online ahead of print.

ABSTRACT

BACKGROUND: Musculoskeletal problems, or aromatase inhibitor-associated musculoskeletal syndrome, in the hands and wrists is a known side effect of aromatase inhibitor medication, often prescribed for 5years or more for breast cancer survivors. No studies were found on the effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

PURPOSE: The primary objective of this study is to determine the effectiveness of hand therapy on reducing hand and wrist pain, improving grip strength, improving upper extremity function, and improving health related quality of life in breast cancer survivors diagnosed with aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

STUDY DESIGN: Longitudinal case series.

METHODS: A pre-post design was used to compare the results of standardized testing from initial evaluation to discharge. Participants were evaluated using standard hand therapy methods. Outcome measurements studied were pain levels, grip strength, upper extremity function, and breast cancer health related quality of life, measured with a patient-reported outcome measure specific to this population. A multimodal client centered treatment plan was utilized with each participant. Frequency and duration of the treatment was determined through collaboration with the participant.

RESULTS: Thirty-two participants enrolled and 29 completed the study. Comparison of pre and post data for all four outcome measures revealed statistically significant improvements (p<0.05). Cohen’s d analysis demonstrated large effect for pain, moderate effects for upper extremity function and health related quality of life, and low effect for grip strength. Trigger finger was noted to be present in 62.1% of participants.

CONCLUSIONS: This study demonstrates that hand therapy resulted in statistically and clinically significant improvement in pain, grip strength, upper extremity function, and health related quality of life. The results support the effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

PMID:40087098 | DOI:10.1016/j.jht.2025.01.007

J Pediatr Urol. 2025 Mar 6:S1477-5131(25)00132-9. doi: 10.1016/j.jpurol.2025.02.041. Online ahead of print.

ABSTRACT

INTRODUCTION: Among techniques for short spermatic vessels in nonpalpable undescended testis (UDT), the Fowler-Stephens (F-S) procedure is the most favored. However, traction methods have regained popularity with gradual testicular tension for elongation to avoid ligating the spermatic vessels.

OBJECTIVE: To compare two techniques for low intra-abdominal UDT with a short spermatic cord: staged laparoscopic F-S and a modified staged open traction technique, and to determine if long-practicing surgeons should change their preferred method.

STUDY DESIGN: Seventy boys under six with nonpalpable low intra-abdominal UDT and short cords underwent either staged laparoscopic F-S or staged open traction orchiopexy. Based on surgical exploration and the surgeons’ opinions, the included patients had vessels too short for one-stage orchiopexy. Two expert pediatric surgeons performed the surgeries, each using their preferred technique. Surgeon 1 used staged open traction, anchoring the testis to the pubic tubercle with low tension, followed by canal mobilization and fixation in the scrotum, while Surgeon 2 performed staged laparoscopic F-S. Post-operative ultrasonography at six months assessed success based on the absence of testicular atrophy and correct testis location.

RESULTS: Of the 70 boys, 36 (51.4 %) underwent staged open traction, and 34 (48.6 %) underwent staged laparoscopic F-S. The median age was 1.7 years. No intra- or post-operative complications occurred, and all testes were correctly placed in the scrotum. Testicular atrophy occurred in 6 patients (8.6 %): 2 (5.6 %) in the traction group and 4 (11.8 %) in the F-S group (p-value: 0.422). Atrophy was more common in bilateral cases, but all instances were unilateral (p-value: 0.022).

DISCUSSION: Both techniques had comparable results with no post-operative complications, and all testes were correctly positioned in the scrotum during follow-up. Although 5.6 % of patients in the traction group and 11.8 % in the F-S group experienced testicular atrophy, the difference was not statistically significant. Surgeon 1 performed all open traction surgeries, and Surgeon 2 performed all F-S operations due to their preferences and over 10 years of experience. Acceptable and comparable outcomes in both techniques show that both are safe when performed by an expert surgeon. We suggest that surgeons continue using their preferred technique if they are experts in it for the treatment of UDT. Although we assume our modified open traction method has an acceptable learning curve for less experienced surgeons, this needs further study.

CONCLUSIONS: Both staged traction and F-S techniques, performed by expert surgeons, yielded comparable outcomes, supporting the continued use of preferred methods.

PMID:40087088 | DOI:10.1016/j.jpurol.2025.02.041

J Craniomaxillofac Surg. 2025 Mar 13:S1010-5182(25)00048-4. doi: 10.1016/j.jcms.2025.02.003. Online ahead of print.

ABSTRACT

A modified thoracodorsal artery lateral branch (TDAL) chimeric flap was developed using dual-energy computed tomography (CT) angiography data of perforators to explore the anatomical characteristics and postoperative outcomes of TDAL flaps in complex maxillofacial defect repair. TDAL flaps were harvested from patients with locally advanced oral cancer. Preoperative perforator detection was performed with dual-energy CT angiography. Anatomical data were collected, and patients’ perioperative recovery details and complications were recorded. Upper extremity function and quality of life (QoL) data were compared to control data from a paired anterolateral thigh (ALT) flap group. Seventy-six patients survived without major complications. The length of the vascular pedicle was 8.97 ± 1.34 cm, and the diameter of the supplying artery was 1.60 ± 0.48 mm. In the first 3 months postoperatively, the TDAL group showed improved QoL. However, upper extremity function and QoL did not differ significantly between the TDAL and ALT groups at 6, 9, and 12 months postoperatively. A two-dimensional map of the perforation distribution was drawn based on the statistical distribution of perforations. TDAL can be designed as a long spindle-shaped or multi-leaf chimeric flap based on the perforator distribution map. This flap can be used as an alternative to repair large oral and maxillofacial defects.

PMID:40087081 | DOI:10.1016/j.jcms.2025.02.003