Tag: nevin manimala

Orthop Surg. 2025 Oct 12. doi: 10.1111/os.70185. Online ahead of print.

ABSTRACT

OBJECTIVES: Knee osteoarthritis (OA) is a common cause of pain and disability, and conventional conservative treatments often provide only limited and temporary relief. Platelet-rich plasma (PRP) injections have emerged as a promising biological therapy; however, patient response is highly variable, and biomechanical factors such as lower extremity malalignment may influence treatment outcomes. This study aimed to evaluate the effect of the lower extremity mechanical axis angle (MAA) on the clinical efficacy of PRP injection therapy in improving knee function and pain in patients with OA.

METHODS: A total of 210 patients with knee OA who consented to PRP treatment between January 1, 2018, and January 1, 2023, were enrolled. Patients were stratified into three groups according to baseline varus angle: Group 1, 0°-5° (n = 70); Group 2, 6°-10° (n = 70); and Group 3, 11°-15° (n = 70). Clinical evaluations were performed at baseline and at 1, 3, 6, 12, and 24 months post-treatment using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), MAA measurement, and a Visual Analogue Scale (VAS) for pain.

RESULTS: All groups demonstrated significant improvements in pain and functional scores over the 24-month follow-up compared to baseline (p < 0.001), with the most notable gains observed at 3 and 6 months. At 3, 6, and 12 months, Group 1 achieved significantly better VAS and KOOS Pain subscale scores than Group 3 (p < 0.05). Both Groups 1 and 2 had higher KOOS Total scores than Group 3 at these time points (p < 0.05). Spearman correlation analysis revealed moderate negative associations between baseline MAA and changes from baseline to 6 months in VAS (ρ = -0.58), KOOS Total (ρ = -0.54), and Kujala scores (ρ = -0.53) (all p < 0.001). Statistical analyses were conducted using ANOVA or Kruskal-Wallis tests as appropriate, and effect sizes (Cohen’s d) with 95% confidence intervals were calculated.

CONCLUSION: PRP injection therapy yields significant improvements in pain and functional outcomes in patients with knee OA. However, increased MAA is associated with reduced clinical benefit, indicating that baseline lower extremity alignment should be considered in treatment planning.

PMID:41077561 | DOI:10.1111/os.70185

J Child Psychol Psychiatry. 2025 Oct 12. doi: 10.1111/jcpp.70058. Online ahead of print.

ABSTRACT

BACKGROUND: There is limited evidence from systematic nationwide studies evaluating the impact of cannabis legalization on cannabis-related exposures among the pediatric population. Using the National Poison Data System (NPDS), we calculated the effects of medical and recreational cannabis dispensaries on reported pediatric cannabis exposures.

METHODS: We analyzed data from 36,161 reported cannabis-related exposures for individuals aged 2-20 between 2016 and 2021, comparing states with and without open medical cannabis dispensaries and states with open recreational cannabis dispensaries to states with open medical cannabis dispensaries. Using a difference-in-difference design, we estimated the effects of cannabis dispensary openings on semi-annual cannabis exposures by age group: young children (2-6 years old), children (7-11), adolescents (12-17), and young adults (18-20).

RESULTS: Patients aged 2-6 (96.3%) and 7-11 (82.4%) frequently incurred unintentional exposures, while patients aged 12-17 (79.9%) and 18-20 (77.5%) more often incurred intentional exposures. Medical cannabis dispensary openings were associated with a 52.3% increase (CI 37.5-67.0; p < .001) in cannabis-related exposure rates in individuals aged 2-6. However, we found a 42.4% decrease (95% CI: -62.2 to -22.6; p < .001) in the number of exposures occurring per 100,000 population when recreational dispensaries opened, relative to states with only medical cannabis dispensaries open. While we did not find statistically significant increases among children aged 7-11 following medical cannabis dispensary openings, we did see a 26.6% (95% CI: -45.1 to -8.1) decrease following recreational cannabis dispensary openings. We did not find statistically significant effects for other age groups.

CONCLUSIONS: Our findings indicate policymakers may need to invest in providing cannabis safety education when medical cannabis dispensaries open to avoid unintended exposures, though some of that effect appears to be mitigated by the time recreational dispensaries (eventually) open. Professionals that provide medical cannabis or provide care in medical cannabis states should consider providing education about how to safely use and store cannabis in the household to prevent cannabis-involved exposures.

PMID:41077545 | DOI:10.1111/jcpp.70058

Nutr Metab Cardiovasc Dis. 2025 Sep 12:104359. doi: 10.1016/j.numecd.2025.104359. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Whether uric acid-lowering therapy improves arterial stiffness (AS) still remain controversial. This study aimed to evaluate the effect of low-dose febuxostat on AS in elderly patients with asymptomatic hyperuricemia (HUA) and chronic kidney disease (CKD).

METHODS AND RESULTS: A total of 102 elderly patients (mean age 89.20 ± 3.20 years) were enrolled in this prospective cohort study and assigned to either a low-dose (20 mg/day), a normal-dose (40 mg/day), or a control group (lifestyle intervention). All patients underwent evaluations at baseline and the 3rd, 6th and 9th months. The primary endpoints were changes in SUA and brachial-ankle pulse wave velocity (baPWV). Multivariate analysis of variance was used for statistical analysis. Compared with those in control group, the SUA levels in both treatment groups fell to the lowest point at the 3rd month and remained low until the end of the study (intergroup, time, intergroup∗time; P < 0.001). Similarly, the baPWV in both treatment groups decreased by the 3rd month, followed by a gradual increase, and finally returned to the baseline levels (intergroup P = 0.003, time P = 0.487, intergroup∗time P = 0.872). Post-hoc multiple comparisons revealed significant differences in baPWV between each treatment group and the control group (low-dose vs. control: P = 0.001; normal-dose vs. control: P = 0.015), whereas no significant difference was observed between the two treatment groups (P = 0.374). No serious adverse events (AEs) were reported, but three gout attacks occurred in the normal-dose group.

CONCLUSIONS: Low-dose febuxostat demonstrated comparable urate-lowering efficacy to the normal-dose regimen and was also associated with a short-term improvement in arterial stiffness in elderly patients with asymptomatic HUA and CKD.

PMID:41077539 | DOI:10.1016/j.numecd.2025.104359

Eur J Intern Med. 2025 Oct 11:106543. doi: 10.1016/j.ejim.2025.106543. Online ahead of print.

ABSTRACT

BACKGROUND: The determinants and prognosis of left ventricular (LV) geometric remodeling remain uncharacterized in immunoglobulin A nephropathy (IgAN). We investigated the (1) clinicopathological correlates of LV hypertrophy (LVH), (2) longitudinal evolution of LV geometry, and (3) associations of LVH phenotypes with cardiorenal outcomes.

METHODS: In this retrospective study, 683 adults with biopsy-proven primary IgAN (2013-2021) underwent comprehensive echocardiographic phenotyping. Multivariable Cox regression modeled associations of baseline LV geometry with a composite renal endpoint (50 % estimated glomerular filtration rate [eGFR] decline or kidney failure) and a cardiovascular endpoint (major adverse cardiovascular events [MACE]).

RESULTS: Among 683 patients, 60 (8.8 %) had LVH at baseline. Age, hypertension, proteinuria, eGFR, and arteriolar hyalinosis were significant risk factors for LVH. Hemoglobin (hazard ratio = 1.03, P = 0.043) and endocapillary hypercellularity (hazard ratio = 2.87, P = 0.017) were significant risk factors for LVH deterioration. The most critical finding was that compared with normal LV geometry, concentric hypertrophy conferred a 4.14-fold renal risk (95 % confidence interval [CI]: 1.02-16.75, P = 0.047), while eccentric hypertrophy predicted a 3.42-fold MACE risk (95 % CI: 1.08-10.8, P = 0.036) independent of clinicopathological confounders.

CONCLUSIONS: In IgAN, age, hypertension, proteinuria, eGFR, and arteriolar hyalinosis are risk factors for LVH, while hemoglobin and endocapillary hypercellularity accelerate LVH progression. The key finding was that concentric LV remodeling signals renal risk, whereas eccentric hypertrophy independently portends MACE.

PMID:41077532 | DOI:10.1016/j.ejim.2025.106543

J Pediatr Urol. 2025 Sep 22:S1477-5131(25)00544-3. doi: 10.1016/j.jpurol.2025.09.024. Online ahead of print.

ABSTRACT

INTRODUCTION: Sacrococcygeal teratomas (SCT), which are the most common germ cell tumours in the neonatal period, have frequent long-term complications including gastrointestinal and urological problems due to the anatomical region of origin. This study evaluates the lower urinary tract and bowel functions in patients who underwent surgery for SCT.

PATIENTS AND METHODS: Fifteen patients who underwent sacrococcygeal teratoma surgery between 2007 and 2021 were retrospectively evaluated for lower urinary tract and bowel functions. Bladder function was assessed using patient interviews, urinalysis, voiding diaries, uroflowmetry, ultrasonography, and pressure-flow studies. In the bowel function evaluation, constipation and continence were assessed. Descriptive statistics were used to present the results as mean, standard deviation, median, frequency, and percentage.

RESULTS: Consequently, 15 patients were included, with a mean follow-up period of 8.5 years. The majority of patients were female, with a female-to-male ratio of 2.75:1. Based on the Altman classification, 73.3 % of the patients had type I SCT, 20 % had type II, and 6.6 % had type IV. The mean follow-up period of the patients was 8.5 years (2 years-15 years). Of the 15 patients whose lower urinary tract functions were assessed, 13 achieved full urinary continence and exhibited normal voiding volumes and frequency for their age. Ultrasonography findings were normal in all evaluated patients, with no residual urine or bladder abnormalities detected. Urodynamic tests showed normal detrusor activity and bladder capacities in most cases, though one patient exhibited a higher-than-expected bladder capacity during the filling phase. Voiding phase assessments revealed normal patterns in most patients, except for an 8-year-old case with Altman type IV SCT showing staccato voiding pattern and pelvic floor electromyography (EMG) activity. Anorectal examinations revealed normal anal anatomy, though fecalomas were detected in two cases. (Altman type II and IV SCT). Constipation, based on Rome IV criteria, was identified in 3 patients (1 Altman type I, 1 type II, and 1 type IV SCT). Based on the Holschneider scale, 11 patients achieved normal scores, while 3 (2 Altman type I, 1 Altman type II SCT). demonstrated good scores, reflecting overall satisfactory bowel control.

CONCLUSION: Bladder function was uneffected in Altman type I and II cases, except for dysfunction in one type IV case. Constipation was noted in one case each of types I, II, and IV, with no other bowel abnormalities detected. Non-invasive investigations should be prioritized for type I and II cases, while invasive methods may be necessary for those with intrapelvic extension.

PMID:41077518 | DOI:10.1016/j.jpurol.2025.09.024

J Prosthet Dent. 2025 Oct 11:S0022-3913(25)00768-1. doi: 10.1016/j.prosdent.2025.09.036. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Computer-aided design and computer-aided manufacturing (CAD-CAM) technologies, including additive manufacturing (3-dimensional printing), have been increasingly applied in dentistry. Assessments of the wear resistance and optimized parameters of 3-dimensionally (3D) printed denture teeth are lacking.

PURPOSE: The purpose of this in vitro study was to compare the wear resistance of denture teeth fabricated using stereolithography (SLA) and digital light processing (DLP) at 0-, 45-, and 90-degree build orientations with prefabricated acrylic resin denture teeth.

MATERIAL AND METHODS: Rectangular cuboid specimens (n=10 per subgroup) were fabricated using SLA and DLP in 3 build orientations (0-, 45-, and 90-degree). A separate control group of prefabricated acrylic resin teeth, which had no orientation levels, served as an independent comparator. After thermocycling, all specimens underwent 2-body wear testing against zirconia antagonists for 120 000 cycles. Wear depth and volume loss were quantified with a contact profilometer, and scanning electron microscopy (SEM) was used for surface morphology analysis. Statistical analysis of technology and orientations was performed using 2-way ANOVA. For overall comparison including the control, a separate 1-way ANOVA with Tukey post hoc tests (α=.05) was conducted.

RESULTS: No significant interaction between printing technology and orientation was found for wear volume loss (P=.179) or wear depth (P=.494). Printing technology significantly influenced wear depth and volume loss (P<.001); orientation had an effect on volume loss (P=.049) but not on wear depth (P=.611). Post hoc analysis showed DLP groups had lower wear than SLA and control. The control group exhibited intermediate wear resistance. The SEM images showed that DLP surfaces had narrow scratches with occasional cracking, SLA surfaces had smoother wear with shallow plowing, and the control group showed rougher textures with more pronounced cracks.

CONCLUSIONS: Printing technology significantly affected wear resistance, with DLP outperforming SLA. Orientation had minimal effect. Filler-containing 3D printed resins may enhance wear resistance.

PMID:41077498 | DOI:10.1016/j.prosdent.2025.09.036

Hepatobiliary Pancreat Dis Int. 2025 Sep 22:S1499-3872(25)00161-4. doi: 10.1016/j.hbpd.2025.09.004. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatocellular carcinoma (HCC) remains a significant global health challenge. While first-line treatments with immune checkpoint inhibitors (ICIs) have improved patient outcomes, the selection of effective second-line therapies remains unclear. This study evaluated the efficacy and safety of regorafenib as a second-line option in advanced HCC patients post-progression on ICI-based therapies.

METHODS: Advanced HCC patients from eight hospitals in China who received regorafenib after progression on first-line ICI therapies, alone or combined with ICIs were enrolled. Clinical data were collected, and propensity score matching (PSM) was used to ensure comparability between treatment groups. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events. The study was registered at www.chictr.org.cn (ChiCTR2400091318).

RESULTS: A total of 149 patients were included: 113 in the combination therapy group (Rego-ICI group) and 36 in the regorafenib monotherapy group (Rego group). After PSM, the Rego-ICI group showed significantly improved and OS [19.0 vs. 11.0 months, hazard ratio (HR) = 0.426, 95% confidence interval (CI): 0.235-0.772, P = 0.005] and PFS (4.0 vs. 3.0 months, HR = 0.539, 95% CI: 0.337-0.863, P = 0.010) compared to the Rego group. Differences in ORR and DCR were not statistically significant (ORR: 19.4% vs. 9.7%, P = 0.226; DCR: 64.2% vs. 48.4%, P = 0.139), but the Rego-ICI group showed better disease control. Regorafenib plus ICI improved both OS and PFS with no new safety signals.

CONCLUSIONS: The combination of ICIs and regorafenib significantly enhances OS in advanced HCC patients post-progression on first-line ICI treatments. These findings support the potential of regorafenib plus ICIs as an effective second-line therapy.

PMID:41077497 | DOI:10.1016/j.hbpd.2025.09.004

Rev Infirm. 2025 Oct;74(314):33-35. doi: 10.1016/j.revinf.2025.07.031. Epub 2025 Sep 26.

ABSTRACT

Physical inactivity and overactivity are two extremes that can have harmful consequences on health. Adapted physical activities (APAs) are emerging as an alternative to promote a beneficial balance for patients’ physical, psychological, and social health. This article explores the role of healthcare professionals in raising awareness of APAs, particularly in hot weather, to ensure that the benefits are not offset by undue health risks. The aim is to emphasize that the importance of physical activity is conditional on the implementation of essential precautions for the safety of all participants, whether or not they have specific needs.

PMID:41077451 | DOI:10.1016/j.revinf.2025.07.031

Rev Infirm. 2025 Oct;74(314):20-22. doi: 10.1016/j.revinf.2025.07.026. Epub 2025 Sep 23.

ABSTRACT

In 2024, state-certified transplant coordination nurses (Idec) at the Henri-Bismuth Hepatobiliary Center received 754 proposals for liver and pancreatic transplants. Based on a statistical analysis of the activity, this article highlights the specificities of the Idec’s on-call duty in the context of transplantation.

PMID:41077446 | DOI:10.1016/j.revinf.2025.07.026

Low Urin Tract Symptoms. 2025 Nov;17(6):e70033. doi: 10.1111/luts.70033.

ABSTRACT

OBJECTIVES: Urinary incontinence (UI) is prevalent and often underreported due to various barriers affecting healthcare-seeking behavior. This study aimed to identify barriers preventing patients from seeking help for UI, assess the influence of sociodemographic and clinical factors on these barriers, and determine the associations between UI types and barriers in Saudi Arabia.

METHODS: A nationwide, cross-sectional study was conducted from June 2024 to April 2025 among individuals aged ≥ 18 years who experienced UI and had not sought medical consultation. Participants completed a questionnaire that comprised sociodemographic data, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and a modified Barriers to Incontinence Care Seeking Questionnaire (BICS-Q). Data were analyzed using descriptive statistics, independent t-tests, ANOVA, and binary logistic regression.

RESULTS: Of 505 eligible participants, 80.6% were female, predominantly aged 31-45 (40.0%), and the most common UI type was mixed UI (37.2%). The most significant barriers were embarrassment (33.3%), logistical inconvenience (appointments scheduled too far in advance, 36.8%), and provider-related issues (lack of available providers, 12.3%). Gender, obesity, residency region, and type of UI significantly influenced barrier perception. Fear-related barriers were notably higher in nocturnal UI, whereas embarrassment and cultural concerns were highest among those with mixed UI.

CONCLUSION: This study highlights significant embarrassment, inconvenience, and provider-related barriers deterring healthcare-seeking among UI patients in Saudi Arabia. Findings emphasize the need for culturally tailored interventions, improved healthcare accessibility, and targeted public awareness campaigns.

PMID:41077429 | DOI:10.1111/luts.70033