Tag: nevin manimala

Pediatr Radiol. 2025 Oct 11. doi: 10.1007/s00247-025-06416-x. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric rotator cuff (RTC) injuries are uncommon, yet supraspinatus tendon (SST) signal alterations on T2-weighted imaging are frequently observed.

OBJECTIVE: To compare rates of SST signal alterations on shoulder MRIs of adolescents who are considered low- and high-risk for RTC injury.

MATERIALS AND METHODS: We retrospectively reviewed non-arthrogram shoulder MRI reports in 12-17-year-old patients at a large tertiary children’s hospital (01/2010-09/2024). We identified a low-risk patient cohort who lacked (a) clinical concern for RTC pathology, (b) athletic history associated with RTC injuries, (c) recent trauma, or (d) prior shoulder intervention. We also identified an age- and sex-matched high-risk patient cohort who had clinical concern for RTC pathology. Two experienced pediatric radiologists independently and blindly reviewed the shoulder MRIs in a random order from these cohorts. SST was evaluated using coronal oblique fat-suppressed T2-weighted sequences. Logistic regression models were developed to investigate differences between cohorts.

RESULTS: Both low- and high-risk cohorts included 26 patients (14 males). Their median (inter-quartile range) ages were 14.0 (2.0) years and 14.5 (3.0) years, respectively. In the low-risk cohort, SST signal alterations were identified in 23 (88.5%) and 22 (84.6%) patients by readers 1 and 2, respectively. In the high-risk group, SST signal alterations were identified in 24 (92.3%) and 23 (88.5%) patients by readers 1 and 2, respectively. Overall inter-reader agreement was substantial (Cohen’s kappa=0.63). There was no statistical difference in the SST signal alteration grades between the low- and high-risk cohorts (P≥0.07).

CONCLUSION: SST signal alterations are common in adolescent shoulder MRIs regardless of the clinical concern for RTC injury.

PMID:41073751 | DOI:10.1007/s00247-025-06416-x

J Expo Sci Environ Epidemiol. 2025 Oct 10. doi: 10.1038/s41370-025-00804-z. Online ahead of print.

ABSTRACT

BACKGROUND: U.S. military personnel deployed to Afghanistan and Iraq were stationed on bases impacted by airborne hazards including emissions from combustion sources. Due to limited environmental monitoring during military operations, exposure levels remain poorly characterized.

OBJECTIVE: We used satellite observations to identify the locations and persistence of combustion sources on and near military bases in Afghanistan and Iraq from 2002 to 2012, the peak period of open-air combustion.

METHODS: Daily fire detections from the Moderate Resolution Imaging Spectroradiometer (MODIS) were clustered using density-based methods to identify persistent burning within 5 km of bases. Validation was conducted using military imagery and Google Earth. A sensitivity analysis compared MODIS fire detections to those from the newer Visible Infrared Imaging Spectroradiometer (VIIRS) at a civilian burn pit in Djibouti.

RESULTS: MODIS detected 285,810 fires in Iraq and 3702 in Afghanistan. Clustering identified 398 bases in Iraq and 122 in Afghanistan with burning nearby. In Iraq, persistent clusters were linked to oil and gas flares, while smaller clusters on bases in both countries were consistent with burn pits. MODIS and VIIRS both detected the Djibouti burn pit, but VIIRS recorded three times more fire detections, highlighting its sensitivity in detecting biomass and waste burning.

IMPACT: This study is the first to use satellite fire detections to objectively map and quantify combustion sources at U.S. military bases in Iraq and Afghanistan during 2002-2012. By applying density-based clustering to MODIS data and validating with high-resolution imagery, we identified persistent burning patterns near and on bases. This approach overcomes the limitations of self-reported exposure data and provides a reproducible framework for assessing deployment-related combustion exposures. The findings highlight both the utility and limitations of MODIS and demonstrate the potential of satellite observations for Veteran health research.

PMID:41073689 | DOI:10.1038/s41370-025-00804-z

CNS Drugs. 2025 Oct 10. doi: 10.1007/s40263-025-01235-y. Online ahead of print.

ABSTRACT

BACKGROUND: Migraine is often associated with impaired sleep quality, including insomnia, fragmented sleep, and circadian rhythm disturbances. These factors can exacerbate migraine severity and chronification. Calcitonin gene-related peptide (CGRP), a key player in migraine pathophysiology, also influences sleep regulation. While CGRP monoclonal antibodies have shown mixed effects on sleep, no study to date has evaluated the impact of gepants on sleep quality. This study assessed whether atogepant, recently approved for migraine prevention, affects sleep quality and sleep-related adverse events in real-world settings.

METHODS: We conducted a prospective, observational, open-label, single-center study. All received atogepant 60 mg/day up to 12 weeks. Adults (≥ 18 years) with migraine (with/without aura or chronic migraine) experiencing ≥ 4 monthly migraine days were enrolled. Inclusion required ≥ 1 month of headache diaries and stable preventive or sleep treatments for ≥ 3 months. Patients were accepted regardless of prior preventive failures. Exclusion criteria were unstable treatments, recent sleep-impacting disease, and pregnancy. Sleep quality was assessed using five validated questionnaires (Pittsburgh Sleep Quality Index [PSQI], Athens Insomnia Scale [AIS], Bergen, Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]) at baseline and at follow-up. Migraine frequency, disability (Migraine Disability Assessment [MIDAS], Headache Impact Test [HIT-6]), allodynia (Allodynia Symptom Checklist [ASC-12]), acute medication use, and adverse events (AEs) were also recorded. Pre-post differences were assessed with Wilcoxon and McNemar’s tests, while linear mixed-effects models were applied to evaluate the impact of clinical factors (response status, psychiatric comorbidities, prior anti-CGRP failures) on PSQI outcomes, with model fit estimated via REML and pseudo-R².

RESULTS: The study population included 43 participants (93.0% female, mean age of 51.6 [IQR 48.4-54.8] years, mean age at disease onset of 18.9 [16.0-21.7] years); 30 (69.8%) participants had chronic migraine, and among them, 23 (76.7%) had a concomitant diagnosis of medication overuse headache. Atogepant significantly improved sleep quality with PSQI scores decreased from 9.6 to 8.2 (p = 0.002) and improvements in AIS (p = 0.014) and Bergen scores (p = 0.046). Sleep duration was the only PSQI subdomain with a statistically significant change. No differences were found in ESS or ISI scores. Notably, no patients reported sleep-related AEs such as somnolence, nightmares, or vivid dreams. Psychiatric comorbidities were associated with poorer baseline sleep but did not influence the magnitude of improvement. Prior anti-CGRP failure predicted a lesser sleep benefit. Finally, migraine burden improved across all evaluated migraine-related variables. Only two patients discontinued treatment.

CONCLUSIONS: Atogepant improved subjective sleep quality without causing sleep-related adverse events, supporting its role in comprehensive migraine management, particularly in patients with disrupted sleep.

PMID:41073685 | DOI:10.1007/s40263-025-01235-y

Biol Trace Elem Res. 2025 Oct 10. doi: 10.1007/s12011-025-04837-1. Online ahead of print.

ABSTRACT

Endometriosis is a non-malignant, estrogen-dependent chronic inflammatory disorder that affects 10-15% of women during their reproductive years. Emerging evidence highlights the undeniable role of oxidative stress in the etiopathogenesis of endometriosis. Selenium, a potent antioxidant, is vital for intracellular redox reactions. Recent research has highlighted the potential of antioxidants as therapeutic agents to mitigate oxidative stress and alleviate endometriosis symptoms. Selenium plays a key role in regulating the enzyme glutathione peroxidase (GPx). This study aimed to evaluate the therapeutic efficacy of a yeast-based organic selenium in disease progression and alleviating painful symptoms. This triple-blind randomized controlled clinical trial was executed within 66 women diagnosed with endometriosis in Tabriz, Iran. Participants were required to possess diagnostically verified endometriosis with endometrioma and a dysmenorrhea score of ≥ 16 on the Menstrual Distress Questionnaire (Moos). Using block randomization with block sizes of 4 or 6, participants were assigned (1:1 ratio) to receive either one 200-mcg capsule of organic selenium or an identical placebo along with routine treatment (2 mg of verojest (dienogest) daily for 3 months). Data were collected using socio-demographic and menstrual-obstetric questionnaires, the Moos, and the visual analogue scale (VAS) for pain. After 3 months, participants completed follow-up questionnaires and underwent ultrasonography. Statistical analyses included descriptive and inferential tests (chi-square, independent t-test, ANCOVA, and repeated-measures ANOVA). A p-value of < 0.05 was considered statistically significant. Three months after the intervention, a statistically significant reduction in endometrioma size was observed in the selenium group (from 4.82 to 3.78 cm) compared to placebo (from 4.07 to 5.31 cm) (adjusted mean difference [aMD]: -1.95 cm; 95% CI -2.6 to -1.3; Cohen’s d = -0.86, large effect). Additionally, the selenium group experienced significantly greater reductions in dysmenorrhea scores (aMD -10.94; 95% CI -15.16 to -6.71; Cohen’s d = -1.14, large effect), dyspareunia (aMD -3.21; 95% CI -4.34 to -2.07), dysuria (aMD -1.41; 95% CI -2.12 to -0.69), dyschezia (aMD -2.11; 95% CI -3.22 to -0.99), and non-cyclic pain (aMD -2.73; 95% CI -3.77 to -1.68) over time (at 1, 2, and 3 months post-intervention), compared to placebo. No serious or health-threatening adverse events were reported in either group. Our findings support the hypothesis that organic selenium supplementation may present a promising adjuvant therapy to reduce the size of endometriomas and alleviate various painful symptoms associated with endometriosis, including dysmenorrhea, dyspareunia, dysuria, non-cyclic pain, and dyschezia. ClinicalTrial.gov Identifier: IRCT20110606006709N26.

PMID:41073678 | DOI:10.1007/s12011-025-04837-1

Res Vet Sci. 2025 Sep 23;196:105913. doi: 10.1016/j.rvsc.2025.105913. Online ahead of print.

ABSTRACT

This study evaluated the effect of a stepwise alveolar recruitment manoeuvre (ARM) at the end of anaesthesia on arterial oxygenation and shunt fraction (F-shunt) during the early postoperative period in sheep. Twenty-four healthy, non-pregnant female Merino sheep underwent either laparoscopic or orthopaedic surgery under isoflurane anaesthesia. At the conclusion of surgery, and under isoflurane anaesthesia, oxygenation parameters and F-shunt values were analysed (Baseline). Animals were then randomly allocated to either the ARM group (ARMstepwise: laparoscopic n = 6, orthopaedic n = 6) or Control group (laparoscopic n = 6; orthopaedic n = 6). In the ARMstepwise group, animals received a stepwise, pressure-controlled ARM in sternal recumbency, with parameters re-evaluated 10 min post-application (PostARM). The control animals remained in sternal recumbency for 10 min following the completion of surgery without undergoing a stepwise ARM. Subsequently, isoflurane was discontinued in both groups. Oxygenation parameters and F-shunt values were recorded 10, 30, and 60 min after extubation. A linear mixed model was used for the statistical analysis. The implementation of a stepwise ARM at the end of isoflurane anaesthesia in healthy sheep enhanced oxygenation across both types of surgical procedures and significantly reduced F-shunt during orthopaedic surgery (Baseline: 26.31 ± 7.93 % vs PostARM: 6.47 ± 4.01 %; p = 0.001). These benefits were not sustained throughout the first postoperative hour, most likely because no PEEP was applied and oxygen was delivered with a high FiO₂ via facemask after extubation. Further research should clarify whether repeated intraoperative ARMs with PEEP and ∼ 60 % FiO₂ reduce atelectasis during anaesthetic recovery in sheep.

PMID:41072080 | DOI:10.1016/j.rvsc.2025.105913

J Neurosurg Spine. 2025 Oct 10:1-12. doi: 10.3171/2025.6.SPINE25395. Online ahead of print.

ABSTRACT

OBJECTIVE: Sacroiliac joint dysfunction is an underrecognized cause of lower back pain, particularly in patients with prior spinal fusion. The relationship between spinopelvic fixation and sacroiliac joint dysfunction requires further investigation. The authors compared outcomes among patients who underwent iliac and S2-alar-iliac (S2AI) pelvic fixation techniques.

METHODS: The authors performed a retrospective analysis of patients who underwent index spinopelvic fixation with iliac or S2AI techniques between 2016 and 2022. Patients with < 2-year follow-up data, prior spinopelvic fixation, prior or concomitant sacroiliac joint dysfunction or sacroiliac joint fusion, > 1 pelvic screw per side, and inadequate postoperative standing radiographs were excluded. Summary statistics and univariate and multivariable analyses were performed.

RESULTS: Eighty-nine patients were included in the final analysis. The mean ± SD age was 63.49 ± 8.64 years and 58.4% of patients were female. Forty-two (47.3%) patients were former or current smokers, and 20 (22.5%) had preexisting diabetes. Patients underwent pelvic fixation for long construct fusion (> 3 levels), L5-S1 high-grade spondylolisthesis, and L5-S1 pseudarthrosis in 67 (75.3%), 2 (2.2%), and 20 (22.5%) cases, respectively. The mean number of fusion levels was 6.79 ± 3.86. Sixty-nine (77.5%) and 9 (10.1%) patients underwent posterior column osteotomy and 3-column osteotomy, respectively. Eighty-one (91.0%) patients underwent bilateral pelvic fixation, and 54 (60.7%) and 35 (39.3%) patients underwent iliac and S2AI techniques, respectively. Seventeen (19.1%) patients developed distal failure, defined as implant complication between L5-pelvis and/or L5-S1 pseudarthrosis, with 15 (16.9%) having reoperation. Fourteen (15.7%) patients had postoperative sacroiliac joint dysfunction diagnosed by sacroiliac joint injections, including 10 (11.2%) patients who underwent subsequent sacroiliac joint fusion. Head-to-head univariate comparison showed no difference in postoperative sacroiliac joint dysfunction between iliac and S2AI techniques. Multivariable analysis showed diabetes (p = 0.030) and higher postoperative pelvic tilt (p = 0.024) were significant predictors of sacroiliac joint dysfunction. Performing posterior column osteotomy predicted lower frequency of sacroiliac joint dysfunction (p = 0.006). After exclusion of patients with preexisting bony fusion at L5-S1, multivariable analysis showed that a greater number of fusion levels (p = 0.002) was an independent and significant predictor of distal failure. Pelvic fixation technique (iliac vs S2AI) did not predict distal failure.

CONCLUSIONS: There were no significant differences in sacroiliac joint dysfunction or the rates of distal failure following index pelvic fixation with either the iliac or S2AI technique. Higher postoperative pelvic tilt predicted sacroiliac joint dysfunction, and a higher number of fusion levels predicted distal failure.

PMID:41072054 | DOI:10.3171/2025.6.SPINE25395

J Neurosurg. 2025 Oct 10:1-8. doi: 10.3171/2025.6.JNS25342. Online ahead of print.

ABSTRACT

OBJECTIVE: The Brain Injury Guidelines (BIG) were modified in 2020 to improve efficiency and safety in triage decision-making. The aim of this study was to present characteristics and in-hospital outcomes of patients classified under category 1 of the modified BIG (mBIG 1).

METHODS: A retrospective review of patients presenting with acute traumatic brain injury (TBI) to a level 1 trauma center between 2019 and 2023 was performed. Patients meeting clinical and radiographic criteria for mBIG 1 were identified. An additional cohort of patients was identified who were taking 81 mg of aspirin once daily (ASA81) before the hospital, but who otherwise met mBIG 1 criteria. Summary statistics and univariate analyses were performed.

RESULTS: Three hundred three patients were identified and classified as mBIG 1. The mean patient age was 54.45 (SD 1.17) years and 41.3% were female. There were 144 patients (47.5%) who transferred from an outside hospital. The median admission Glasgow Coma Scale score was 15 (interquartile range [IQR] 15-15). Patients underwent an average of 2.28 (SD 0.03) CT scans. There were 123 (40.6%), 18 (5.9%), and 126 (41.6%) patients with subdural hematoma, intraparenchymal hemorrhage, and subarachnoid hemorrhage, respectively, with 36 patients (11.9%) presenting with multiple hemorrhages. Eleven patients (3.6%) experienced hemorrhage progression. No patient underwent neurosurgical intervention. The mean Injury Severity Score was 13.12 (SD 7.04). The median hospital length of stay (LOS) was 1.01 (IQR 0.37-4.56) days, 75.2% of patients were discharged home, 24.1% were discharged to rehabilitation, and 0.7% died in the hospital. An additional 25 patients were identified who were taking ASA81 prehospital, but otherwise met mBIG 1 criteria. None of these patients underwent neurosurgical intervention and there were no in-hospital deaths. One patient (4.0%) taking ASA81 experienced progression of their hemorrhage but still met mBIG 1 criteria. When compared to the mBIG 1 cohort, the aspirin cohort was significantly older (p < 0.001), but otherwise showed no differences in demographic, clinical, or radiographic variables. The combined mBIG 1 + aspirin cohort was stratified by hemorrhage progression (n = 12). Hospital LOS was significantly greater in the progression cohort (p = 0.017) and fewer patients were discharged home (p = 0.001). There was no difference in age, hypertension, admission mean arterial pressure, platelet count, international normalized ratio, partial thromboplastin time, hemorrhage pattern, and aspirin use between the groups.

CONCLUSIONS: Hemorrhage progression was rare, including cases in which patients were receiving prehospital low-dose aspirin therapy. More data are needed that evaluate the role of low-dose aspirin in the triage of patients with mild TBI.

PMID:41072050 | DOI:10.3171/2025.6.JNS25342

J Neurosurg Spine. 2025 Oct 10:1-7. doi: 10.3171/2025.6.SPINE241465. Online ahead of print.

ABSTRACT

OBJECTIVE: Naloxegol, a peripherally acting mu-opioid receptor antagonist, is used to treat opioid-induced constipation. However, its effectiveness following adult spinal deformity surgery remains poorly understood. The objective of this study was to examine naloxegol’s impact on postoperative bowel function in patients undergoing adult spinal deformity surgery.

METHODS: A retrospective analysis was conducted of consecutive spinal deformity surgeries from a single surgeon’s practice, comparing outcomes before and after the introduction of universal postoperative naloxegol administration (12.5 mg daily for 7 days). Multivariable logistic regression and propensity score-matched analyses were used to evaluate the relationship between naloxegol use and markers of postoperative ileus (POI).

RESULTS: Two hundred thirty-four patients (72.2% female, mean age 60.7 [SD 15.8] years, mean BMI 28.8 [SD 5.1]) were analyzed. One hundred fifty-four (65.8%) of these patients were opioid-naïve and 80 (34.1%) received naloxegol. The naloxegol group had significantly lower odds of lateral lumbar interbody fusion (OR 0.13, p = 0.0001) and shorter operative times (5.65 vs 6.75 hours, p = 0.0008). There was no statistical association between naloxegol and postoperative abdominal imaging, nasogastric tube placement, or gastroenterology consultation in either the matched or multivariate analyses (p > 0.05). A gastroenterology consultation (n = 15 patients, 6.5%) was positively associated with anterior lumbar interbody fusion (OR 5.54, p = 0.010) and diabetes (OR 12.37, p = 0.001) and negatively associated with preoperative opioid use (OR 0.18, p = 0.036). Postoperative abdominal imaging correlated positively with the number of vertebrae fused (OR 1.09, p = 0.031) and negatively with preoperative opioid use (OR 0.44, p = 0.026). Weighted time-to-event analysis found a difference in time to first flatus (p = 0.0282), but not in time to bowel movement (p = 0.5600) with naloxegol.

CONCLUSIONS: Postoperative naloxegol had no significant impact on bowel function recovery or markers of POI after spinal deformity surgery. Patients with a history of opioid exposure required fewer consultations and imaging. Further research is required to understand whether pre-induction administration impacts POI and return to bowel function.

PMID:41072046 | DOI:10.3171/2025.6.SPINE241465

J Neurosurg. 2025 Oct 10:1-7. doi: 10.3171/2025.6.JNS241972. Online ahead of print.

ABSTRACT

OBJECTIVE: Vestibular schwannomas (VSs) are cerebellopontine angle tumors that can result in cranial nerve dysfunction, most commonly sensorineural hearing loss. Conventional structural MRI is unable to provide correlative information on cranial nerve function. In this study, the authors used multitensor tractography to study the white matter microstructural properties of the auditory neural pathway as a correlate of cranial nerve function in a cohort of VS patients. They evaluated the relationship between the auditory neural pathway microstructural properties using pure-tone audiometry (PTA) and the speech discrimination score (SDS).

METHODS: Retrospective chart review of 258 patients with VS treated at the Toronto Western Hospital Gamma Knife Radiosurgery Unit was conducted. Of these, 3T MR images were analyzed for 57 surgically naive patients with unilateral VS who had preoperative diffusion tensor imaging (DTI) and PTA and SDS results. Patients were excluded if they had bilateral tumors, previous surgical treatment (Gamma Knife radiosurgery or resection), or did not undergo DTI. DTI-derived metrics (fractional anisotropy [FA], radial diffusivity [RD], axial diffusivity [AD], and mean diffusivity [MD]) of five regions of interest positioned along the auditory neural pathway (ipsilateral superior olivary nucleus [SON] and trapezoid body [TB] and contralateral inferior colliculus, lateral lemniscus [LL], and medial geniculate body [MGB]) were measured bilaterally in all subjects. The diffusion metrics were correlated with quantitative average high-frequency (4000 and 8000 Hz) PTA and SDS results.

RESULTS: Salient areas of neuroanatomical correlation included the LL and SON (affected side), where a statistically significant diffusion metric change was seen. This was characterized by higher FA and lower RD values (LL and SON) and a higher AD value (SON). SDS positively correlated with the TB AD. PTA showed a significant negative relationship with MD at the LL and a positive relationship with AD at the inferior colliculus (affected side). PTA also showed a significant negative relationship with RD and MD at the SON and TB, and a positive relationship with FA and AD at the MGB on the contralateral side (all p < 0.05).

CONCLUSIONS: This work outlines that quantitative DTI is a useful tool to evaluate the white matter microstructural alterations in the auditory neural pathway. Importantly, as a noninvasive tool, diffusion metrics can help in understanding the pathophysiology of hearing impairment in this group of patients.

PMID:41072040 | DOI:10.3171/2025.6.JNS241972

South Med J. 2025 Oct;118(10):679-681. doi: 10.14423/SMJ.0000000000001881.

ABSTRACT

OBJECTIVE: Black women in Louisiana have an increased breast cancer incidence. In addition, mortality and incidence of breast cancer in younger patients are on the rise, regardless of race or germline mutations. Most available germline mutation data in breast cancer are based primarily on White patient populations. We sought to evaluate the relationship between race, pathogenic germline mutations, and breast cancer subtypes among young women (younger than 40 years old) diagnosed as having breast cancer in Louisiana.

METHODS: We collected and reviewed a 10-year retrospective database from 2012 to 2022 of 773 women younger than age 40 years diagnosed as having breast cancer in a Louisiana-based regional health system. Associations between subtypes and germline mutations were assessed using the χ² test.

RESULTS: In total, 632 patients had available genetics data: 38% of patients with pathogenic germline mutations were Black or African American and 62% were White, 53% of Black or African American patients had a variant of uncertain significance (VUS) vs 47% of White patients. The association between pathogenic germline mutations and triple-negative breast cancer (estrogen receptor [ER]^–/human epidermal growth factor receptor 2 [HER2]^–) was noted with P = 0.0122. The presence of VUS was not statistically significant when compared with no mutation in the triple-negative cohort (odds ratio [OR] 1.13; 95% confidence interval [CI] 0.70-1.83; P = 0.6224). No statistically significant difference was noted in the prevalence of germline mutations among ER⁺/HER2^– and ER^–/HER2⁺ cancers. Evaluation of the germline mutations demonstrated an association between germline mutation and race (P = 0.0045). VUS was twofold in Black or African American patients compared with no mutation (OR 2.12; 95% CI 1.35-3.34; P = 0.0012). The presence of a pathogenic germline mutation was 1.19 times as common in Black or African American patients compared with no mutation (OR 1.19; 95% CI 0.79-1.79; P = 0.4018].

CONCLUSIONS: These data demonstrate that triple-negative breast cancer continues to have a significant association with germline mutations in a young patient population. Pathogenic germline mutations and VUS may be more common in younger Black or African American patients as demonstrated by our research, however.

PMID:41072033 | DOI:10.14423/SMJ.0000000000001881