Tag: nevin manimala

N Am Spine Soc J. 2025 Feb 13;21:100594. doi: 10.1016/j.xnsj.2025.100594. eCollection 2025 Mar.

ABSTRACT

BACKGROUND: Adjacent segment disease (ASD) is one of the most common complications after spinal fusion. There are several risk factors for ASD, but recently the quality of the paraspinal musculature has been implicated as a potential risk factor. The purpose of this study is to examine the association between paraspinal muscle degeneration and risk of surgery for ASD.

METHODS: We conducted a retrospective review of spinal fusion patients at our institution from 2009 to 2022 who underwent subsequent surgery for ASD. Inclusion criteria included patients aged 18 and older at time of index operation. Control cohort included patients who did not undergo subsequent surgery for adjacent segment disease with a minimum one year follow up. Patients were matched based on age, gender, and BMI. We measured paraspinal fat percentage and circumferential surface area (CSA) at L3 and at the proximal end of their future construct. Paraspinal fat percentage and CSA were measured using ImageJ (National Institutes of Health, Bethesda, Maryland, USA). Student T-test was used to evaluate for statistically significant differences with p-value ≤ .05.

RESULTS: A total of 154 patients were reviewed with 77 patients in each cohort. The average age and BMI in the control group was 61.3 and 30.0 versus 61.2 and 29.6 in patients who underwent subsequent surgery. Overall, patients who underwent surgery for adjacent segment disease had 24% higher paraspinal fat percentage at L3 (13.8 ± 7.7% vs. 11.1 ± 6.5%, p-value = .02) and 22% higher paraspinal fat percentage at the top end of their construct (16.0 ± 9.0% vs. 13.1 ± 7.1%, p-value = .03).

CONCLUSIONS: Our study found that patients who undergo surgery for adjacent segment disease have 24% higher fat percentage in their paraspinal musculature at L3 and 22% higher fat percentage at the proximal end of their fusion construct.

PMID:40145066 | PMC:PMC11938154 | DOI:10.1016/j.xnsj.2025.100594

JHLT Open. 2024 Aug 12;6:100147. doi: 10.1016/j.jhlto.2024.100147. eCollection 2024 Nov.

ABSTRACT

BACKGROUND: Combined heart-liver transplantation (CHLT) is a complex procedure with rising demand and is subject to ongoing assessment. Here, we provide an update on indications, patient outcomes, and risk factors.

METHODS: This retrospective study utilized CHLT data from the United Network for Organ Sharing registry between 1990 and 2023. Recipient and donor characteristics, and risk factors for mortality were analyzed using Cox regression hazard models. Recipient and graft survival at 30 days, 1 year, and 5 years were analyzed using the Kaplan-Meier method.

RESULTS: This cohort included 532 patients with median survival of 16.9 years (SD: 1.09). The most common indications for CHLT were congenital heart disease (36%) and dilated cardiomyopathy (31%). Patient survival at 30 days, 1 year, and 5 years were 94%, 85%, and 77%, respectively. Combined heart-liver graft survival was 93%, 85%, and 77%, respectively. Diabetes (hazard ratio [HR]: 1.74; p = 0.04) was associated with multigraft failure and mortality in multivariate analysis. Compared to congenital heart disease, dilated (HR: 0.55; p = 0.03) and restrictive myopathies (HR: 0.5; p = 0.03) were associated with improved graft and overall survival. Higher donor left ventricular ejection fraction (EF) was also associated with improved graft and overall survival (HR: 0.96; p = 0.008).

CONCLUSIONS: CHLTs are being performed at increasingly higher rates with comparable survival to single-organ transplants. Diabetes was associated with increased mortality. Recipient dilated or restrictive myopathies and higher donor EF were correlated with improved survival compared to congenital heart disease. Further studies are needed to better understand these observations.

PMID:40145062 | PMC:PMC11935517 | DOI:10.1016/j.jhlto.2024.100147

JHLT Open. 2024 Sep 5;6:100154. doi: 10.1016/j.jhlto.2024.100154. eCollection 2024 Nov.

ABSTRACT

BACKGROUND: Heart transplantation is the gold standard treatment for end-stage heart failure patients. However, the shortage of donor hearts limits its applicability. This study aims to evaluate the risk factors associated with survival within 1-year after heart transplantation.

METHODS: A single-center retrospective cohort study evaluated 299 adult patients who underwent transplantation at the Heart Institute (Incor) between January 2013 and December 2019. Univariate and multivariate Cox regression analyses were conducted to identify independent predictors of 1-year survival among well-established prognostic clinical characteristics described in the literature. Patients were followed until death or the last observation on October 12, 2022. A Simple Risk Index was created based on the hazard ratio of each factor.

RESULTS: Chagas disease was the most common cause of cardiomyopathy (36%). Most patients were male (65%) with a median age of 50 (39-58) years. Four variables observed during the last clinical assessment in the intensive care unit before surgery were found to be statistically significant: maximum Sequential Organ Failure Assessment (SOFA) score, creatinine clearance in 3 quartile categories, C-reactive protein in 3 categories, and white blood cell count in 3 categories. The model demonstrated good discrimination (C-index = 0.74) and calibration. The group at high risk (>20 points) exhibited significantly higher mortality rates at 1 year (p < 0.001).

CONCLUSIONS: The study introduces a risk prediction score for 1-year post-transplant mortality in a reference center in Brazil. The score is based on four variables: maximum SOFA score, creatinine clearance, C-reactive protein, and white blood cell count.

PMID:40145057 | PMC:PMC11935338 | DOI:10.1016/j.jhlto.2024.100154

JHLT Open. 2024 Aug 28;6:100155. doi: 10.1016/j.jhlto.2024.100155. eCollection 2024 Nov.

ABSTRACT

BACKGROUND: Donor-derived cell-free DNA (dd-cfDNA) is a nonspecific plasma biomarker for tissue injury that has been validated for monitoring acute rejection (AR) after lung transplantation (LT). However, no studies to date have focused specifically on single lung transplantation (SLT). Herein, we report the performance of dd-cfDNA in detecting AR in SLT from 6 academic centers that implemented this biomarker surveillance in their standard of practice (SOP).

METHODS: dd-cfDNA test results were corrected for SLT by an algorithm in the Clinical Laboratory Improvement Amendments (CLIA) laboratory to permit comparison against the same 1.0% threshold used in double-lung transplant. Investigators reviewed patient SOP electronic medical record clinical data to assign test results into cohorts based on clinical allograft health status. To avoid ambiguity in interpretation, samples drawn after a prior AR or infection event or without histopathologic confirmation of AR were excluded from further analysis. Diagnostic cohorts included AR (N=25 samples), healthy (STABLE, N=137), allograft infection (INFXN, N=41), chronic lung allograft dysfunction (CLAD, N=7), and “OTHER” types of graft injury (N=12).

RESULTS: The study included a total of 257 dd-cfDNA results from 103 SLT patients with one patient excluded due to active cancer. Samples were drawn a median of 233 days (interquartile range: 96-489) after SLT. Laterality for SLT (R vs L) and median dd-cfDNA fraction in AR and STABLE cohort were not statistically different. The median dd-cfDNA fraction was elevated with AR (1.8%) and INFXN (1.1%) vs STABLE (0.46%; p < 0.0001). dd-cfDNA with CLAD was also significantly higher than STABLE cohort (p = 0.0155). The area under receiver operator characteristics curve was 0.850 (95% confidence interval: 0.72-0.95, p < 0.0001) for AR vs STABLE cohort. Applying the dd-cfDNA threshold ≥1.0% for detection of AR yielded a sensitivity = 77.8%, specificity = 84.6%, positive predictive value = 38.31%, and negative predictive value = 96.83%.

CONCLUSIONS: These multicenter data, incorporating real-world experiences, support the clinical validity and utility of dd-cfDNA monitoring of SLT recipients. Additional studies of the impact of biomarker surveillance on clinically meaningful outcomes should be forthcoming from robust, prospective, and clinical trials already in progress.

PMID:40145054 | PMC:PMC11935494 | DOI:10.1016/j.jhlto.2024.100155

JHLT Open. 2024 Sep 26;6:100159. doi: 10.1016/j.jhlto.2024.100159. eCollection 2024 Nov.

ABSTRACT

BACKGROUND: This study investigated oxygen handling of human hearts donated after circulatory death (DCD) on normothermic ex-situ heart perfusion (ESHP) and evaluated oxygen handling markers as adjuncts to cardiac viability assessment.

METHODS: This single-center retrospective study included human DCD heart transplantation procedures using ESHP. Lactate concentrations, blood gas, myocardial oxygen consumption (MVO₂), delivery (MDO₂), and extraction (MEO₂), coronary blood flow (CBF), coronary vascular resistance (CVR), and adenosine infusion were reported over time. Correlation between parameters was assessed, and statistical testing compared patients who did and did not require extracorporeal membrane oxygenation (ECMO) support after transplantation.

RESULTS: Lactate concentrations decreased during ESHP in all transplanted hearts (n = 25) and increased in 1 rejected heart. Arterial partial pressure of oxygen (PO₂) was 75.2 ± 2.9 kPa, with an arteriovenous ΔPO₂ of 44.8 ± 10.4 kPa. Oxygen saturation was 100% in most arterial and venous samples. Average MVO₂ was 2.7 ± 0.6 ml/min/100 g myocardium, MDO₂ 98.5 ± 20.4 ml/min, and MEO₂ 8.6 ± 1.8%. Average CVR was 0.025 ± 0.006 mm Hg min/ml/100 g and increased over time. ΔPO₂ correlated strongly with MVO₂ (R = 0.797, p < 0.001) and lactate trend (R = 0.799, p < 0.001) in transplanted hearts, without differences compared to the rejected heart with increasing lactate. Adenosine infusion on ESHP was significantly higher in patients requiring ECMO post-transplantation vs non-ECMO cases (11.7 (4.5-21.0) vs 2.2 (1.5-6.7) ml/h, p = 0.039).

CONCLUSIONS: Hearts on normothermic ESHP receive excessive MDO₂, due to high PO₂ and CBF, while the MVO₂ is relatively low. Thus, CBF and PO₂ can potentially be lowered. Furthermore, ΔPO₂ could serve as additional marker of metabolic function under these hyperoxic circumstances. The adenosine infusion rate might predict post-transplantation ECMO requirement.

PMID:40145048 | PMC:PMC11935508 | DOI:10.1016/j.jhlto.2024.100159

Med Sci (Basel). 2025 Mar 12;13(1):29. doi: 10.3390/medsci13010029.

ABSTRACT

BACKGROUND: Synthetic 2D mammography was developed to decrease radiation exposure, but to our knowledge there have been no studies evaluating the impact of implementation of full field synthetic mammography/digital breast tomosynthesis (FFSM/DBT) on indications for stereotactic biopsy.

OBJECTIVE: To compare indications and biopsy outcomes for stereotactic biopsy for full field digital mammography (FFDM/DBT) to those of FFSM/DBT.

METHODS: Retrospective chart review of stereotactic biopsies performed from July 2014 to September 2018. Reports were reviewed and indication for biopsy, lesion size, and final pathology were recorded. Comparison between the two groups following transition to FFSM/DBT in 2016 was performed.

RESULTS: 66 of 361 stereotactic biopsies performed in the FFDM/DBT group were malignant (PPV 18.3%), compared to 60 of the 391 biopsies performed in the FFSM/DBT group (PPV 15.4%) with no significant difference in PPV (p = 0.281). There were statistically significant changes in indications for biopsies after transitioning to FFSM/DBT: with a decrease in calcifications referred for biopsy (68.03% vs. 89.75%; p < 0.001), and a statistically significant increase in referral of masses (10.74% vs. 4.43%; p < 0.001), asymmetries (15.60% vs. 5.26%; p < 0.001), and architectural distortion (5.63% vs. 0.55%; p < 0.001). PPV across all indications (21.8% in FFSM/DBT vs. 20.3% in FFDM; p = 0.213), and invasive cancer yield (5.63% vs. 3.32%; p = 0.129) remained comparable following transition to FFSM/DBT without statistically significant differences.

CONCLUSIONS: Following transition to FFSM/DBT, statistically significant shifts in indications for biopsies were observed with a decrease in referral of calcifications and an increase for masses, asymmetries and architectural distortions. PPV for stereotactic biopsy was not significantly different and cancer yield across all indications remained similar, with an increase in invasive cancer diagnosis.

PMID:40137449 | DOI:10.3390/medsci13010029

Med Sci (Basel). 2025 Mar 1;13(1):25. doi: 10.3390/medsci13010025.

ABSTRACT

Background/Objectives: Stress urinary incontinence (SUI) is a common and often under-reported condition that significantly impacts quality of life. SUI is more than just a physical issue; it can also affect social interactions, mental health, and emotional well-being due to the embarrassment and limitations it can cause. SUI is often acquired during pregnancy and childbirth as a result of pelvic floor muscle weakness. The aim of this study was to evaluate the effectiveness of an innovative dual-wavelength laser system (CO₂ + 1540 nm) in SUI management. Methods: A total of 56 women affected by SUI were enrolled in this study. Half of the patients were treated with CO₂ alone, while the other half were treated with the combination of CO₂ + 1540 nm wavelengths. The patients were split into four groups based on the type of treatment they received and their menopausal status. Data were acquired at baseline and at various follow-ups (T1, T2, and T3, respectively, after the first, second, and third treatment). The Visual Analog Scale (VAS) (score 0-10) was used. Cystoscopic images were acquired before and at the end of the laser treatment cycle. Results: At the end of the treatment, the patients in each group were very satisfied, on average. In each group, the treatment led to a statistically significant improvement in the SUI VAS score between baseline and follow-up after the first treatment; in both groups 3 and 4, the treatment led to a significant change in the dryness score, both from baseline to T1 (p < 0.05) and also for T2 and T3 compared to baseline. Finally, cystoscopic photos showed an evident increase in mucosa epithelial thickness after the laser treatment cycle. Conclusions: The use of a dual-wavelength laser system (CO₂ + 1540 nm) was proven to be well tolerated and safe, with promising outcomes in reducing SUI symptoms, especially in non-menopausal patients.

PMID:40137445 | DOI:10.3390/medsci13010025

Med Sci (Basel). 2025 Mar 1;13(1):22. doi: 10.3390/medsci13010022.

ABSTRACT

BACKGROUND: Urinary incontinence and low back pain are often present during pregnancy and after childbirth. The aim of this study was to examine the relationship between the number of children with the occurrence of urinary incontinence and low back pain after pregnancy in the Greek population.

MATERIALS AND METHODS: Seventy-one Greek women (M = 35.0 age, SD = ±4.3) with specific inclusion criteria completed just once the International Consultation on Incontinence Questionnaire and the Oswestry Disability Questionnaire after five years from childbirth.

RESULTS: A total of 28.2% of the participating women experienced urinary incontinence, and 38% experienced low back pain after pregnancy. No relationship has been found between urinary incontinence and the number of births (r = 0.062, p = 0.609) and low back pain with the number of births (r = -0.076, p = 0.529). Statistically significant correlations were found between urinary incontinence and low back pain (r = 0.33, p < 0.01) and the urinary incontinence and the maternal age at first delivery (r = -0.264, p = 0.026) in women who underwent a vaginal delivery in second birth had fewer urinary incontinence symptoms and increased low back pain.

CONCLUSIONS: Few correlations emerged in the present study. Future research is necessary to be conducted to examine the relationship between postpartum women’s demographic data, urinary incontinence, and low back pain.

PMID:40137442 | DOI:10.3390/medsci13010022

Expert Rev Vaccines. 2025 Mar 26. doi: 10.1080/14760584.2025.2485252. Online ahead of print.

ABSTRACT

BACKGROUND: As the COVID-19 pandemic transitions into its fourth year, understanding the dynamics of immunity is critical for implementing effective public health measures. This study examines vaccine-induced, natural, and hybrid immunity to SARS-CoV-2 in Hong Kong, focusing on their protective effectiveness and waning characteristics against infection during the Omicron BA.1/2 dominant period.

RESEARCH DESIGN AND METHODS: We conducted a territory-wide retrospective cohort study using vaccination and infection records from the Hong Kong Department of Health. The analysis included over 6.5 million adults, applying the Andersen-Gill model to estimate protective effectiveness while addressing selection bias through inverse probability weighting.

RESULTS: Vaccine-induced immunity peaked one month after the first dose but waned rapidly, while boosters significantly prolonged protection. Infection-induced immunity showed higher initial effectiveness but declined faster than vaccine-induced immunity. Hybrid immunity provided the most durable protection. mRNA vaccines (Comirnaty) demonstrated greater effectiveness and slower waning compared to inactivated vaccines (CoronaVac).

CONCLUSIONS: Hybrid immunity represents the most effective strategy for sustained protection against SARS-CoV-2. Public health policies should emphasize booster campaigns and hybrid immunity pathways to enhance population-level immunity and guide future COVID-19 management in Hong Kong.

PMID:40137440 | DOI:10.1080/14760584.2025.2485252

JMIR Form Res. 2025 Mar 26;9:e65767. doi: 10.2196/65767.

ABSTRACT

BACKGROUND: Children with autism spectrum disorders (ASDs) often struggle with processing information, which can impact their coordination, balance, and other motor skills. Studies have demonstrated that intervention programs based on sensory integration can enhance motor performance in these children.

OBJECTIVE: The objective of this study is to evaluate the applicability of a standardized battery of gross motor skill tests for Moroccan children aged 6 to 12 years with ASD. The objective is to assess the potential efficacy of an innovative pedagogical approach focused on sensorimotor integration and hyperstimulation. This approach will be compared to traditional physical education (PE) sessions to determine its feasibility and potential to bridge the developmental gaps in motor skills between children with ASD and those with a neurotypical profile.

METHODS: A convenience sample of 14 Moroccan children with ASD aged 6 to 12 years participated in this exploratory study. Children with ASD were divided into an experimental group (n=7) and a control group (n=7) based on age, sex, motor performance, and socioeconomic status. The control group followed the standard PE program, while the experimental group underwent a specialized program combining sensorimotor integration and hyperstimulation for a period of 15 weeks. All participants were classified as level 2 (moderate) on the Autism Severity Rating Scale based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria. Gross motor skills were measured at baseline and after 15 weeks of intervention using the UQAC-UQAM (University of Québec in Chicoutimi-University of Québec in Montréal) test battery protocol, which includes 10 items.

RESULTS: At baseline (T1), no significant difference was observed between the control and experimental groups of children with ASD. Following the 15-week intervention, the group participating in traditional PE showed an overall improvement in motor skills of approximately 14.5%. Conversely, the results of the ASD experimental group suggest a more substantial improvement of 44.5%. Additionally, the experimental group exhibited significant better performance across all motor skill variables compared to the control group (minimum P values of <.02) with large effect sizes (>0.80). In this regard, a 2-way repeated measures ANOVA confirms the efficiency of the program implemented within the experimental group, demonstrating significant effects associated with both group and time factors as well as a clinically highly significant group×time interaction across all measured variables (η²p>0.14).

CONCLUSIONS: The results of this study suggest that the approach that emphasizes sensorimotor integration and management of hyperstimulation was more effective in improving motor skills in this population. However, other more exhaustive studies will need to be carried out in order to be able to more precisely measure the full potential of this approach.

PMID:40137439 | DOI:10.2196/65767