Tag: nevin manimala

J Neurol. 2025 Sep 29;272(10):659. doi: 10.1007/s00415-025-13383-8.

ABSTRACT

OBJECTIVE: About 30% of patients with isolated adult-onset dystonia report an improvement of their motor symptoms after the consumption of alcohol. In this cross-sectional study, we sought to investigate whether the observed improvement is attributable to the anxiolytic, euphoric, and analgesic properties of alcohol, rather than or in addition to its effect on dystonic movements, as psychiatric symptoms and pain frequently occur in dystonia patients and as emotional stress is a well-established trigger for symptom exacerbation.

METHODS: We analyzed data from 339 prospectively enrolled participants with recently diagnosed isolated dystonia (mean age: 55.2 ± 12.5 years, 228 female) of the Natural History Project of the Dystonia Coalition, a large international multicenter study. Alcohol responsiveness was determined by patients´ self-report. Symptoms of depression, as well as generalized and social anxiety, were assessed using the Hospital Anxiety and Depression Scale and the Liebowitz Social Anxiety Scale. Severity of pain was measured using question 21 of the RAND 36-Item Health Survey.

RESULTS: Participants with more severe pain reported greater response to alcohol than those with less severe pain (p = .004), whereas symptoms of depression (p = .986), generalized anxiety (p = .395) and social anxiety (p = .953) were not associated.

CONCLUSION: Alcohol responsiveness in isolated dystonia is associated with higher levels of pain, whereas self-reported alcohol-related improvements in dystonic movements or tremor do not depend on the euphoric or anxiolytic effects of alcohol. This finding underscores the potential role of pain management in alleviating motor symptoms in dystonia.

PMID:41016940 | DOI:10.1007/s00415-025-13383-8

Oral Maxillofac Surg. 2025 Sep 29;29(1):162. doi: 10.1007/s10006-025-01449-w.

ABSTRACT

PURPOSE: This study aimed to compare the postoperative clinical outcomes between the conservative bone trocar and open conventional techniques for iliac crest bone harvesting for alveolar bone grafting.

METHODS: The study included 20 unilateral cleft patients aged between 8 and 11 years, just before canine eruption, who suffered from oro-nasal communication, and were divided into two groups. Group A: ten patients using the open technique with a 4 cm incision at the anterior superior iliac crest for harvesting bone chips. Group B: ten patients using a conservative technique with a 1 cm incision at the anterior superior iliac crest using a special bone trocar extractor and curette. Postoperative evaluation included the Visual Analogue Scale (VAS) for pain assessment to compare the level of pain postoperatively. Also Vancouver scale was used for scar wound evaluation through clinical examination of wound size and concerning tissue vascularity, pigmentation, pliability, and height.

RESULTS: There were no postoperative complications observed, including infection, dehiscence, and graft resorption in both groups. Two weeks postoperative: Group A reported significantly higher pain (7.8 ± 0.79) compared to Group B (3.6 ± 0.97) & p < 0.001, indicating statistically significant lower pain levels in Group B. Regarding the Vancouver Scar Scale, two weeks postoperative: Group A had significantly higher scar severity (9.1 ± 0.88) compared to Group B (3.0 ± 0.82) and p < 0.001, suggesting better scar satisfaction in Group B. One month postoperatively, Group B over time confirmed better scar appearance.

CONCLUSION: Autogenous iliac crest using a conservative technique with a bone trocar is significantly more beneficial, less painful, and provides better wound scar healing satisfaction than the standard open approach in terms of VAS pain scale and Vancouver scar scale.

PMID:41016933 | DOI:10.1007/s10006-025-01449-w

J Pediatr Urol. 2025 Sep 16:S1477-5131(25)00486-3. doi: 10.1016/j.jpurol.2025.09.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) in the management of overactive bladder (OAB) in children by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS: A systematic search of PubMed, Embase and the Cochrane Library was conducted to identify RCTs comparing TENS with standard therapies (urotherapy, sham TENS, or oxybutynin) in children with OAB. Inclusion criteria encompassed RCTs published between 2004 and 2024, reporting TENS as a primary intervention. Data were pooled using a meta-analysis framework, and heterogeneity was assessed using I² statistics. Risk of bias was evaluated using the ROBVIS tool.

RESULTS: Nine RCTs involving 382 children were included. Five studies compared active TENS with sham TENS, of which three reported superior efficacy for TENS, while two found no difference. Two studies compared TENS with oxybutynin; one demonstrated TENS superiority, while the other found comparable efficacy. One study showed TENS to be as effective as urotherapy, and another found that TENS combined with oxybutynin was superior to either treatment alone. The meta-analysis revealed that TENS significantly increased the likelihood of a full response compared to other treatments (OR 3.96, 95 % CI 2.46-6.38, p < 0.001). TENS was effective both as a standalone therapy (OR 4.34) and as an adjunct (OR 3.27). Parasacral TENS demonstrated a higher response rate than posterior tibial TENS.

CONCLUSION: TENS is an effective, non-invasive therapy for pediatric OAB, either as monotherapy or in combination with urotherapy or medication. However, variability in study protocols and limited long-term follow-up data highlight the need for standardized treatment protocols and larger RCTs to assess long-term outcomes, including relapse rates.

PROSPERO REGISTRATION NUMBER: CRD420251114932.

PMID:41016899 | DOI:10.1016/j.jpurol.2025.09.012

Urol Oncol. 2025 Sep 27:S1078-1439(25)00351-5. doi: 10.1016/j.urolonc.2025.08.029. Online ahead of print.

ABSTRACT

OBJECTIVES: To provide an updated analysis of trends and outcomes for these approaches using data from the SEER database (2000-2021).

METHODS: Patients diagnosed with localized T1a renal cell carcinoma (RCC) were identified from the SEER database. Management strategies were categorized as PN, RN, AT, or non-surgical management (NSM), including AS. Descriptive statistics assessed patient demographics and tumor characteristics. Logistic regression models identified predictors of NSM, adjusting for age, race, tumor grade, histology, and socioeconomic factors. Kaplan-Meier survival analysis and Cox proportional hazards regression evaluated associations between management type and 5-year overall survival.

RESULTS: RN usage declined sharply from ∼75% in 2000 to ∼14% in 2021, while PN steadily increased, surpassing RN around 2017 and reaching ∼50% by 2021. Notably, younger patients (<60 years) demonstrated a more rapid shift toward partial nephrectomy over time, whereas the oldest patients (>75 years) showed a slower uptake of partial nephrectomy and a higher ongoing utilization of non-surgical management. AT and NSM showed gradual adoption, peaking at ∼10% and ∼15% to 20%, respectively, by 2021. PN was associated with the best overall survival, followed by RN and AT, while NSM had the poorest outcomes. Predictors of NSM included advanced age (>75 years, OR = 3.54) and black race (OR = 1.63).

CONCLUSION: PN has become the most widely used management for SRMs, aligned with AUA and EAU guidelines. AS remains a viable and guideline-recommended option for select patients with SRMs <2 cm. The variable use of AT and NSM, coupled with the poorer prognosis of NSM, underscores the importance of individualized patient selection and close follow-up to ensure optimal outcomes.

PMID:41016894 | DOI:10.1016/j.urolonc.2025.08.029

Pain Manag Nurs. 2025 Sep 27:S1524-9042(25)00271-1. doi: 10.1016/j.pmn.2025.09.002. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to compare the effect of auditory distraction and virtual reality (VR) on pain severity and physiological indicators during burn dressing changes among adult patients.

DESIGN: A single-center, randomized controlled trial.

METHODS: A total of 60 patients were randomly assigned to the auditory distraction (n = 20), VR (n = 20), and control (n = 20) groups. All patients in the three groups received intravenous morphine at a dose of 0.05 mg/kg body weight, 15 minutes prior to the dressing change. The auditory distraction group listened to music during the dressing, while the VR group used a headset to view nature images throughout the dressing procedure. Data collection tools were the numeric pain scale, a checklist form of the physiological Indicators, and a pulse oximetry device.

RESULT: Statistically significant differences in pain severity were observed among the VR, auditory distraction, and control groups during dressing changes (p < .05). Despite all patients receiving intravenous morphine (0.05 mg/kg), both interventions led to greater pain reduction. Oxygen saturation and respiratory rates also differed significantly across groups (p < .05), with posthoc analysis confirming that both interventions were equally effective and superior to standard care.

CONCLUSIONS: This study’s findings demonstrated that auditory distraction was as effective as VR techniques in reducing fluctuations in physiological indicators and pain severity during dressing changes in adult patients.

CLINICAL IMPLICATIONS: Nonpharmacological interventions can serve as effective adjuncts alongside pharmacological treatments in pain management nursing.

PMID:41016886 | DOI:10.1016/j.pmn.2025.09.002

Dig Liver Dis. 2025 Sep 27:S1590-8658(25)01085-0. doi: 10.1016/j.dld.2025.09.007. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Tofacitinib, commonly used for ulcerative colitis, has shown promising results in the management of chronic pouchitis (CP). We performed a pooled analysis of the efficacy and safety of tofacitinib for CP.

METHODS: We searched multiple databases for articles reporting the outcomes of tofacitinib for the treatment of CP and conducted a meta-analysis.

RESULTS: 8 studies including 99 subjects (mean age: 37.5 years and 55.6 % males) were analyzed. The pooled clinical and endoscopic response rate was 47.7 % [Cl 33.3-62.6 %; I2= 40 %] and 51.7 % [Cl 37.4-65.7 %; I2=34 %], respectively. The remission rate was 41.2 % [Cl 26.6-57.6 %; I2= 0 %]. Clinical PDAI score improved markedly post-tofacitinib (Pre: 3.35 [Cl 2.9-3.7; I2 = 68 %] vs Post: 2.0 [Cl 1.59-2.4; Cl = 0 %], p-value <0.001). There was a significant reduction in endoscopic PDAI score (Pre: 4.5 [Cl 3.7-5.2; I2 = 84 %] vs Post: 2.5 [Cl 1.7-3.3; Cl = 64 %], p-value < 0.001) and total PDAI score (Pre: 7.4 [Cl 5.3-9.6; I2 = 96 %] vs Post: 4.3 [Cl 2.8-5.9; Cl = 84 %], p-value < 0.001). The pooled adverse events and discontinuation rates were 30.9 % [Cl 17.5-48.5; I2=24 %] and 43 % [Cl 25-63.1; I2=40 %] respectively.

CONCLUSION: Based on this meta-analysis, tofacitinib caused statistically significant changes in PDAI scores with favourable response and remission rates. Although adverse event and discontinuation rates are high, this is similar to or less frequent than those of other biologics. Future studies are required to evaluate the long-term safety profile of tofacitinib before considering it as an effective alternative for the treatment of CP.

PMID:41016876 | DOI:10.1016/j.dld.2025.09.007

Med Phys. 2025 Oct;52(10):e70011. doi: 10.1002/mp.70011.

ABSTRACT

BACKGROUND: One of the main challenges of utilizing spot-scanning proton arc therapy (SPArc) is treatment delivery efficiency. Previous studies focus on reducing the number of energy layers by ascending switching to shorten the beam delivery time. However, this is not true of all proton therapy systems. The new energy layer switching system was recently upgraded in the University Medical Center Groningen (UMCG), which enables a fast energy layer ascending switching (ELAS).

PURPOSE: We introduce a novel adaptive energy switching SPArc optimization algorithm (SPArc-_AES) based on the machine-specific delivery characteristics of proton therapy systems.

METHODS: The SPArc-_AES optimization algorithm is based on the polynomial increasing feature of energy layer ascending switching. K-Medoids clustering analysis and simulated annealing algorithm were used to optimize the energy delivery sequence. Ten cases were selected to evaluate the plan quality, plan robustness, and the delivery efficiency compared with the previously SPArc energy sequence optimization algorithm, SPArc_seq.

RESULTS: Without extra constraints in the energy ascending constraints, the SPArc-_AES offers a better plan quality and robustness, while the treatment delivery efficiency was significantly improved compared to the SPArc_seq. More specifically, SPArc-_AES effectively shortened the energy layer switching time and the beam delivery time by 34.03% and 31.10%, respectively, while offering better target dose conformality and generally lower dose to organs-at-risk.

CONCLUSIONS: Based on the machine-specific delivery characteristics, we introduced a novel adaptive energy switching algorithm for efficient SPArc optimization, which could significantly improve delivery efficiency while enhancing the plan quality by eliminating no longer necessary constraints on the total number of energy layer ascending switching.

PMID:41016831 | DOI:10.1002/mp.70011

Nihon Ronen Igakkai Zasshi. 2025;62(3):316-323. doi: 10.3143/geriatrics.62.316.

ABSTRACT

AIM: The dementia support team (DST) is an initiative established based on the knowledge that, when individuals with dementia or older people at risk for delirium are hospitalized because of physical illnesses, there are often cases in which their cognitive symptoms rapidly deteriorate. However, the activities of each hospital are unknown. Therefore, a nation-wide survey of DSTs was conducted.

METHODS: A questionnaire survey was conducted among 1,032 hospitals throughout Japan.

RESULTS: A total of 422 responses were obtained, of which 292 were valid. The main results were as follows: number of beds (200 to <500 beds, n=171), number of types of medical staff (≥4 types, n=248), number of patients for intervention/month (30 patients to <100 patients, n=164), number of team meetings/week (1/week, n=240), cognitive function assessment (Hasegawa Dementia Scale Revised [HDS-R], n=141), advice regarding medication (n=279), rehabilitation (n=243), reduction of physical restraint (n=274), nutrition (n=200) and discharge adjustment (n=233). Patients were divided into 2 groups for analyses: those requested by the other divisions (n=121; 41.4%) and those managed by DST (n=171; 58.6%). There was a higher rate of requested by the other divisions than the managed by the DST related advice for medications and rehabilitation. However, the differences were not statistically significant.

CONCLUSIONS: The present study revealed that requests from other divisions involved a higher rate of advice on medication and rehabilitation than the managed by the DST. Further studies are required to confirm this hypothesis.

PMID:41016786 | DOI:10.3143/geriatrics.62.316

Cochrane Database Syst Rev. 2025 Sep 29;9:CD016131. doi: 10.1002/14651858.CD016131.

ABSTRACT

RATIONALE: Respiratory syncytial virus (RSV) is a highly transmissible pathogen that causes varying degrees of respiratory illness across all age groups. The safety and efficacy profiles of available RSV vaccines, a critical consideration for their integration into public health strategies and clinical practice, remain uncertain.

OBJECTIVES: To assess the benefits and harms of RSV vaccines compared to placebo, no intervention, vaccines for other respiratory infections, other RSV vaccines, or monoclonal antibodies (mAbs) across all human populations.

SEARCH METHODS: We conducted a comprehensive literature search of CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the WHO ICTRP following standard systematic review methodology from 2000 to April 2024.

ELIGIBILITY CRITERIA: We included both randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving all human populations comparing RSV vaccines with placebo, no intervention, vaccines for other respiratory infections, other RSV vaccines, or mAbs. We excluded studies focused on dose-finding schedules and immunogenicity assessment.

OUTCOMES: Benefits included frequency of RSV illness (both lower and upper respiratory illness) confirmed by laboratory tests (RSV-associated lower respiratory tract illness and RSV-associated acute respiratory illness); hospitalisation due to RSV disease (both lower and upper respiratory illness) confirmed by laboratory tests; mortality from illness caused by RSV (confirmed by laboratory test); all-cause mortality; and admission to an intensive care unit. Harms included serious adverse events (SAEs) related to vaccination, including neurological disorders such as Guillain-Barré syndrome.

RISK OF BIAS: We assessed risk of bias in RCTs using Cochrane’s RoB 2 tool.

SYNTHESIS METHODS: We used standard Cochrane methods.

INCLUDED STUDIES: We identified 14 RCTs: five trials (101,825 participants) on older adults; three trials (12,010 participants) on maternal vaccination and effects on infants; one trial (300 participants) on women of childbearing age; and five trials (192 participants) on infants and children. We identified no NRSIs.

SYNTHESIS OF RESULTS: RSV prefusion vaccine versus placebo in older adults These vaccines reduced RSV-associated lower respiratory tract illness with vaccine efficacy (VE) of 77% (95% confidence interval (CI) 0.70 to 0.83; risk ratio (RR) 0.23, 95% CI 0.17 to 0.30; 4 RCTs, 99,931 participants; high-certainty evidence) and RSV-associated acute respiratory illness with VE of 67% (95% CI 0.60 to 0.73; RR 0.33, 95% CI 0.27 to 0.40; 3 RCTs, 94,339 participants; high-certainty evidence). There may be little to no difference in mortality from illness caused by RSV, all-cause mortality, and SAEs related to vaccination (low-certainty evidence). RSV postfusion F protein-based vaccine versus placebo in older adults There is probably little to no difference in RSV-associated lower respiratory tract illness with VE of -0.37% (95% CI -1.96 to 0.37; RR 1.37, 95% CI 0.63 to 2.96; 1 RCT, 1894 participants; moderate-certainty evidence) and RSV-associated acute respiratory illness with VE of -0.07% (95% CI -1.15 to 0.47; RR 1.07, 95% CI 0.53 to 2.15; 1 RCT, 1894 participants; moderate-certainty evidence). There may be little to no difference in mortality from illness caused by RSV, all-cause mortality, and SAEs related to vaccination (low-certainty evidence). Maternal RSV F protein-based vaccine versus placebo in infants These vaccines reduced medically attended RSV-associated lower respiratory tract illness with VE of 54% (95% CI 0.28 to 0.71; RR 0.46, 95% CI 0.29 to 0.72; 3 RCTs, 12,010 participants; high-certainty evidence), medically attended RSV-associated severe lower respiratory tract illness with VE of 74% (95% CI 0.44 to 0.88; RR 0.26, 95% CI 0.12 to 0.56; 3 RCTs, 12,010 participants; high-certainty evidence), and hospitalisation due to RSV disease with VE of 54% (95% CI 0.27 to 0.71; RR 0.46, 95% CI 0.29 to 0.73; 2 RCTs, 11,502 participants; high-certainty evidence) in infants. There may be little to no difference in mortality from illness caused by RSV, all-cause mortality, and SAEs related to vaccination in mothers and infants (low-certainty evidence). Live-attenuated RSV vaccines versus placebo in infants and children The evidence is very uncertain regarding all-cause medically attended acute respiratory illness (MAARI) with VE of 26% (95% CI -0.01 to 0.46; RR 0.74, 95% CI 0.54 to 1.01; 5 RCTs, 171 participants; very low-certainty evidence) and RSV-associated MAARI with VE of 38% (95% CI -0.24 to 0.69; RR 0.62, 95% CI 0.31 to 1.24; 5 RCTs, 192 participants; very low-certainty evidence). There may be little to no difference in SAEs related to vaccination (low-certainty evidence). RSV recombinant F nanoparticle vaccine versus placebo in women of childbearing age The evidence is very uncertain regarding new RSV infections with VE of 50% (95% CI 0.08 to 0.73; RR 0.50, 95% CI 0.27 to 0.92; 1 RCT, 300 participants; very low-certainty evidence). There may be little to no difference in mortality from illness caused by RSV, all-cause mortality, and SAEs related to vaccination (low-certainty evidence). Phase III trials consistently demonstrated low risk of bias. Whilst phase I and II trials occasionally raised concerns about selection bias in the randomisation process, the overall evidence was deemed robust.

AUTHORS’ CONCLUSIONS: RSV prefusion vaccines reduced RSV-associated lower respiratory tract illness and acute respiratory illness in older adults. There may be little to no difference in SAEs related to vaccination in older adults. Maternal vaccination with RSV F protein-based vaccines reduced medically attended RSV-associated lower respiratory tract illness and severe cases in infants. There may be little to no difference in SAEs related to vaccination in mothers and infants. The evidence is very uncertain regarding the effects of RSV vaccine on women of childbearing age, and the effects of live-attenuated RSV vaccines on infants and children; there may be little to no difference in SAEs related to vaccination.

FUNDING: This review was funded by the EU4Health Programme under a service contract with the European Health and Digital Executive Agency (HaDEA).

REGISTRATION: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023439128).

PMID:41016728 | DOI:10.1002/14651858.CD016131

Intellect Dev Disabil. 2025 Oct 1;63(5):414-427. doi: 10.1352/1934-9556-63.5.414.

ABSTRACT

Respite is a priority for caregivers of people with neurodevelopmental disabilities across the lifespan. The present study aimed to characterize respite availability and frequency of use among 126 caregivers of young people with neurodevelopmental disabilities (from ages 16-22) using an ongoing longitudinal sample. Results indicated that the availability of respite support was greater and more consistent over time for caregivers of those with lower verbal abilities compared to those with higher verbal abilities. On average, the frequency of respite use from household members declined over time, with overall higher frequency of use reported by caregivers of those with a lower verbal intelligence quotient (VIQ). Our findings indicate that respite remains an important resource for caregivers of young people with neurodevelopmental disabilities well into adulthood, particularly for those caring for higher needs individuals.

PMID:41016722 | DOI:10.1352/1934-9556-63.5.414