Tag: nevin manimala

J Craniofac Surg. 2025 Sep 23. doi: 10.1097/SCS.0000000000011741. Online ahead of print.

ABSTRACT

BACKGROUND: Metopic craniosynostosis (MCS) presents unique diagnostic challenges. Objective measures to correctly diagnose MCS have been developed, but mostly rely on thresholds obtained through subjective clinical diagnosis. This study quantifies the spectrum of normal infant anterior cranial shapes using an entirely automated method to aid in diagnosis of MCS using population statistics.

METHODS: A retrospective review of computed tomography (CT) scans from patients aged 0 to 24 months was completed. Patients with known craniosynostosis or associated syndromes, hydrocephalus, or other brain or cranial abnormalities were excluded. Optimal interfrontal angle (oIFA), transverse forehead width (TFW), skull circumference (SC), intracranial volume (ICV), and malformation range (MR) were calculated using an automated analysis pipeline.

RESULTS: A total of 582 subjects were included. Median age at CT scan was 11.6 months. Males demonstrated significantly higher median ICV, TFW, and SC than females (P<0.001 for all). OIFA was inversely correlated with age, decreasing by approximately 8 degrees between neonates and 24-month-old children. Transverse forehead width, SC, and ICV all increased significantly over the same age range (P<0.001 for all).

CONCLUSION: This study provides the largest and most comprehensive evaluation of normal frontal cranial shape in infants to date. The data presented show that forehead convexity follows a normal distribution after correcting for age. These oIFA measurements were collected using an automated method, allowing analysis of forehead shape without any basis in subjective interpretation. This data provides a basis for abandoning subjective, clinical diagnosis of MCS.

PMID:40986846 | DOI:10.1097/SCS.0000000000011741

J Craniofac Surg. 2025 Sep 23. doi: 10.1097/SCS.0000000000011976. Online ahead of print.

ABSTRACT

The impact of psychiatric disorders on oral/maxillofacial diseases through sleep apnea syndrome (SAS) remains incompletely understood. Using bidirectional and multivariable Mendelian randomization (MR), this study aimed to investigate potential causal links between psychiatric disorders, SAS, and oral/maxillofacial diseases, while assessing the mediating role of SAS. The authors analyzed genome-wide association study (GWAS) summary statistics using univariable MR to evaluate whether genetically predicted psychiatric disorders influence oral/maxillofacial manifestations; bidirectional MR and mediation MR were used to determine causal directionality and mediation effects. Univariable MR revealed that major depressive disorder increased risks of dentofacial anomalies (OR=1.25, 95% CI: 1.06-1.48, P=0.007), temporomandibular disorders (TMD) (OR=1.54, P=8×10-5), and temporomandibular muscle pain (OR=1.52, P=0.0008); post-traumatic stress disorder elevated risks of dentofacial anomalies (OR=1.07, P=0.02) and TMD (OR=1.09, P=0.04); autism spectrum disorder was associated with temporomandibular muscle pain (OR=8.10, P=0.008). Bidirectional MR confirmed mutual causation between SAS and dentofacial anomalies. Mediation analysis estimated SAS mediated 21.5% (95% CI: 13.1%-31.2%) of the effect of major depressive disorder on dentofacial anomalies. Psychiatric disorders exert causal effects on oral/maxillofacial diseases, partially mediated by SAS; these results highlight SAS as a mediator between psychiatric disorders and oral/maxillofacial diseases and underscore its bidirectional causality with dentofacial anomalies, suggesting novel targets for preventive interventions.

PMID:40986834 | DOI:10.1097/SCS.0000000000011976

Proc Natl Acad Sci U S A. 2025 Sep 30;122(39):e2509444122. doi: 10.1073/pnas.2509444122. Epub 2025 Sep 23.

ABSTRACT

The phenotypic effect of a mutation may depend on the genetic background in which it occurs, a phenomenon referred to as epistasis. One source of epistasis in proteins is direct interactions between residues in close physical proximity to one another. However, epistasis may also occur in the absence of specific interactions between amino acids if the genotype-to-phenotype map is nonlinear. Disentangling the contributions of these two phenomena-specific and global epistasis-from noisy, high-throughput mutagenesis experiments is highly nontrivial: The form of the nonlinearity is generally not known and model misspecification may lead to over- or underestimation of specific epistasis. In contrast to previous approaches, we do not attempt to model the fitness measurements directly. Rather, we begin with the observation that global epistasis, under the assumption of monotonicity, imposes strong constraints on the rank statistics of a combinatorial mutagenesis experiment. Namely, the rank-order of mutant phenotypes should be preserved across genetic backgrounds. We exploit this constraint to devise a simple semiparametric method to detect specific epistasis in the presence of global epistasis and measurement noise. We apply this method to three high-throughput mutagenesis experiments, uncovering known protein contacts with similar accuracy to existing, more complicated procedures. Our method immediately generalizes beyond proteins, providing a simple, yet powerful framework for interpreting the epistasis observed in combinatorial datasets.

PMID:40986352 | DOI:10.1073/pnas.2509444122

J Vet Dent. 2025 Sep 23:8987564251379636. doi: 10.1177/08987564251379636. Online ahead of print.

ABSTRACT

Hyaluronic acid (HA) has been extensively studied and utilized in human and veterinary medicine due to its versatile biological functions, including tissue hydration, anti-inflammatory effects, wound healing, regenerative effects, biocompatibility, biodegradability and antimicrobial properties. Historically, HA was first isolated in 1934 and has since been reviewed and applied across species in numerous clinical and nonclinical settings. In animal studies, canine models have demonstrated the efficacy of HA as an adjunct to periodontal interventions, particularly in improving bone and soft tissue regeneration in controlled experimental settings. Similarly, human studies have shown statistically significant improvements in periodontal outcomes such as probing depth, clinical attachment levels, and decreased periodontal inflammation when HA is used as an adjunct to scaling and root planing or surgical procedures. This review summarizes the current evidence on HA’s structure, biological function, and applications in periodontal disease, with a focus on its potential to address unmet needs in veterinary dentistry. Given its demonstrated benign safety profile and proven efficacy in humans, HA holds promise as a valuable therapeutic option for managing periodontal disease in companion animals.

PMID:40986332 | DOI:10.1177/08987564251379636

Eur J Ophthalmol. 2025 Sep 23:11206721251379938. doi: 10.1177/11206721251379938. Online ahead of print.

ABSTRACT

PurposeThis study aimed to evaluate anatomical changes in the posterior corneal surface in a cohort of patients who underwent Descemet membrane endothelial keratoplasty (DMEK) with manual descemetorhexis in one eye and femtosecond-assisted descemetorhexis in the fellow eye.MethodsIn this prospective case series study, morphological changes in the posterior corneal surface of nine patients who underwent DMEK with manual descemetorhexis in one eye and femtosecond-assisted descemetorhexis in the other eye were investigated. Main outcome measures were obtained with Pentacam (Oculus, Weltzar, Germany) and included the best-fit sphere at 4 mm in the posterior surface, asphericity coefficient Q, posterior corneal elevation, posterior simulated keratometry, pachymetry and higher order aberrations.ResultsThe differences in the posterior corneal surface were not statistically significant for any variable nor were their differences in best-corrected visual acuity, refraction or endothelial cell density. A rebubbling procedure was performed for each group.ConclusionsThe femtosecond descemetorhexis circular cut and asymmetry in the stromal depth of cut did not result in a less favorable outcome than the manual dissection profile in terms of posterior corneal surface irregularity or corneal aberration, and thus on the visual outcome.

PMID:40986323 | DOI:10.1177/11206721251379938

Interv Neuroradiol. 2025 Sep 23:15910199251380394. doi: 10.1177/15910199251380394. Online ahead of print.

ABSTRACT

Background and PurposeThe first pass effect (FPE), achieving near-complete revascularization in a single pass, predicts good outcomes in mechanical thrombectomy (MT). FPE30, achieving FPE within 30 min of groin puncture, is a novel procedural metric proposed as an indicator of maximal procedural and systems-level efficiency. This study aimed to determine the incidence of FPE30 and explore potential predictors in a real-world clinical setting, thereby assessing its utility as a performance benchmark.MethodsWe retrospectively analyzed 274 consecutive MT patients at a comprehensive stroke center. The primary outcome was FPE30, defined as achieving mTICI 2c-3 in a single pass within 30 min of groin puncture. Patient characteristics were compared between FPE30 and FPE > 30 groups.ResultsOf 274 patients, 52 (19.0%) achieved FPE; 43 (82.7%) met the FPE30 benchmark. No statistically significant predictors of FPE30 were found. Trends indicated FPE30 was less common in internal carotid artery (ICA) terminus occlusions (7.0% vs. 33.3%; P = .09) and more frequent with radial access (48.8% vs. 33.3%; P = .40). There was no significant difference in good 90-day functional outcomes (mRS 0-2) between FPE30 (34.9%) and FPE > 30 (33.3%) groups (P > .99).ConclusionsAchieving FPE within 30 min was common in this cohort, but not significantly predicted by measured factors. The lack of an association between FPE30 and improved 90-day functional outcomes suggests that the primary benefit is derived from achieving FPE itself, regardless of whether it is accomplished within or just beyond this ultra-early timeframe. Trends suggest occlusion location and access site may affect reperfusion speed. Lack of functional benefit difference highlights that FPE achievement itself remains the key outcome determinant. These findings are hypothesis-generating and warrant larger studies to clarify the value and predictors of FPE30 as both a clinical prognosticator and a quality improvement metric.

PMID:40986320 | DOI:10.1177/15910199251380394

Interv Neuroradiol. 2025 Sep 23:15910199251380363. doi: 10.1177/15910199251380363. Online ahead of print.

ABSTRACT

PurposeThis study aims to evaluate the morphological features and branching patterns of the inferior alveolar artery (IAA) in living individuals using three-dimensional rotational angiography (3D-RA) and to propose a novel radiological classification based on its shape and branching pattern.MethodsA total of 101 hemifaces (53 right, 34 males/34 females) underwent 3D-RA imaging (slice thickness:0.10-0.20 mm). Morphological assessments of the maxillary artery (MA) and the IAA were performed on maximum intensity projection images. Statistical analysis used IBM SPSS Statistics 22.0 (p < 0.05).ResultsMean diameters of the internal carotid artery (ICA), external carotid artery (ECA), and MA were 4.62 ± 0.58 mm, 3.60 ± 0.87 mm, and 2.35 ± 0.41 mm, respectively. Females exhibited significantly smaller ICA, ECA, and MA diameters (p = 0.036, 0.001, 0.001), while IAA diameter (0.95 ± 0.19 mm) showed no sex difference. The IAA originated predominantly from the MA (96%), rarely from the ECA (4%), or was not observed (1%). Duplicated IAAs were detected in two cases. Branching patterns included a single vessel (71%) or a shared trunk with the posterior deep temporal artery (29%), showing significant correlation with MA course (superficial/deep) (p < 0.05). IAA shapes were categorized as straight, curved, or looped, addressing a literature gap.ConclusionsThis is the first in vivo study to radiologically classify variations of the IAA using 3D-RA. The technique enables high-resolution visualization of submillimeter vessels, offering valuable anatomical insights for maxillofacial surgeries. Further studies are warranted to validate these findings and explore clinical correlations.

PMID:40986317 | DOI:10.1177/15910199251380363

JAMA Netw Open. 2025 Sep 2;8(9):e2533193. doi: 10.1001/jamanetworkopen.2025.33193.

ABSTRACT

IMPORTANCE: Postprandial glycemic responses contribute to comorbidities and mortality risk, but the association between food and postprandial glucose responses in general population settings remains uncertain.

OBJECTIVE: To investigate the association of dietary glycemic load (GL), meal timing, age, sex, body mass index (BMI), and glycated hemoglobin (HbA1c) concentration with postprandial glycemic response to mixed meals.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from August 21, 2012, to March 26, 2015, at a primary health care center in A Estrada, northwestern Spain. A population-based sample of adults aged 18 to 85 years without diabetes who were randomly selected from National Health System records agreed to participate. Data analysis was performed between April 20, 2023, and March 26, 2024.

EXPOSURE: The main exposure was dietary GL. Additional exposures included age, sex, BMI, meal timing, and HbA1c concentration.

MAIN OUTCOME AND MEASURES: Postprandial glucose response over 3 hours after breakfast, lunch, and dinner was assessed using continuous glucose monitoring (CGM) for 7 days, with dietary assessments. Multilevel regression models evaluated the association between GL and glucose dynamics, accounting for age, sex, BMI, meal timing, and HbA1c concentration.

RESULTS: Of the 622 participants fitted with the CGM device, 514 (median age, 46 years [IQR, 36-58 years]; 64% females) met eligibility criteria and provided analyzable data. More than 1.3 million glucose measurements were analyzed across 2451 days. Dietary GL was associated with higher postprandial blood glucose levels, with maximum rises of up to 1.3 (95% CI, 0.8-1.8) mg/dL per 10 units of GL. Glucose responses were greater and more prolonged after lunches and dinners than after breakfasts, with peak values observed at 70 minutes after lunches and dinners and 50 minutes after breakfasts. Each 10-year increase in age was associated with an increase in postprandial glucose levels of 1.9 (95% CI, 0.6-3.3) mg/dL to 3.5 (95% CI, 2.2-4.8) mg/dL, while BMI was associated with glucose response after breakfast, with increases of up to 0.7 (95% CI, 0.4-1.1) mg/dL per BMI unit increase. Men had lower glucose levels than women during the late postprandial period after lunch and dinner, with differences of up to 4.6 (95% CI, 1.6-7.6) mg/dL. HbA1c concentrations and meal timing were also associated with postprandial glucose levels (eg, glucose levels increased up to 12.0 [95% CI, 6.5-17.5] mg/dL per 1% increase in HbA1c).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of adults without diabetes, higher-GL meals were associated with sustained postprandial glucose elevations, especially after lunch and dinner. Age, sex, BMI, meal timing, and HbA1c concentration were also associated with glucose responses. These findings support the validity of dietary GL as an explanatory factor for glycemic response to mixed meals under typical everyday conditions when meal timing, age, and BMI are considered.

PMID:40986304 | DOI:10.1001/jamanetworkopen.2025.33193

JAMA Netw Open. 2025 Sep 2;8(9):e2533204. doi: 10.1001/jamanetworkopen.2025.33204.

ABSTRACT

IMPORTANCE: Trauma care, with its inherent complexity and unpredictability, substantially contributes to health care costs in the US. Understanding temporal trends and associated factors may inform targeted cost-mitigation strategies.

OBJECTIVE: To examine trends in trauma-related inpatient costs from 2012 to 2021 and identify patient and hospital factors associated with contemporary costs.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the 2012-2021 National Inpatient Sample, which captures 97% of US hospitalizations. Hospitalization for traumatic injuries were identified using International Classification of Diseases, Ninth Revision and International Statistical Classification of Disease, Tenth Revision codes for external causes of injury. The data analysis was performed between September 2 and October 28, 2024.

EXPOSURE: External causes of traumatic injury.

MAIN OUTCOMES AND MEASURES: The primary outcome was temporal trends in annual and per-patient hospitalization costs. Additionally, risk-adjusted associations of patient and hospital characteristics with inpatient costs in 2021 were assessed.

RESULTS: A total of 18 353 296 hospitalizations were identified during the study period (median [IQR] patient age ranging from 69 [47-83] years in 2012 to 70 [52-82] years in 2021; proportion of women ranging from 53.2% in 2012 to 50.7% in 2021). When stratifying by mechanism of injury, motor vehicle collisions incurred the highest median inpatient costs ($15 412; IQR, $8718-$29 376), followed by falls ($11 769; IQR, $6930-$19 052), other blunt trauma ($9818; IQR, $5567-$17 488), and penetrating injury ($9669; IQR, $4948-$19 545). In 2021, falls accounted for the largest share of costs (70.0%), while patients aged 75 years or older represented the most costly group (34.8%) and Medicare incurred the highest costs among all payers (52.6%). Annual inpatient trauma care costs increased from $27 billion in 2012 to $42 billion in 2021. Median per-patient costs rose from $10 662 (IQR, $6141-$17930) to $14 124 (IQR, $8249-$23 491). Following risk adjustment (2021), motor vehicle collisions (β = $4735.80; 95% CI, $4337.19-$5134.41 [reference, falls]), Black race (β = $1134.86; 95% CI, $628.07-$1641.67 [reference, White race]), and care in the Pacific region (β = $7763.20; 95% CI, $6176.90-$9350.31 [reference, New England]) were associated with greater hospitalization costs.

CONCLUSIONS AND RELEVANCE: This cohort study found that inpatient trauma costs nearly doubled between 2012 and 2021, with geriatric falls a major contributor. Geographic and demographic disparities underscore the need for targeted interventions. Addressing systemic inefficiencies and standardizing care practices are critical to curbing rising costs while ensuring equitable trauma care.

PMID:40986303 | DOI:10.1001/jamanetworkopen.2025.33204

JAMA Netw Open. 2025 Sep 2;8(9):e2533266. doi: 10.1001/jamanetworkopen.2025.33266.

ABSTRACT

IMPORTANCE: Management of blunt splenic injury is evolving toward wider use of nonoperative approaches for splenic salvage, and splenic angioembolization (SAE) is being considered even in patients with hypotension on admission. Research is needed to understand the outcomes of these evolving management strategies.

OBJECTIVE: To compare outcomes of the 3 major treatments approaches for splenic injury.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was performed using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database from January 1, 2017, to December 31, 2022. The database collects injury data from more than 815 trauma centers in the US. Adults with isolated, severe (Abbreviated Injury Scale score ≥3) blunt splenic injury were identified. Isolated splenic injury was defined by the absence of other intra-abdominal injury and any other major associated injuries with an Abbreviated Injury Scale score of 3 or higher. Data analysis was performed from September to December 2024.

EXPOSURE: Open splenectomy (OS) vs SAE vs observation.

MAIN OUTCOMES AND MEASURES: The primary outcomes were mortality and any complication. Outcomes were compared using multivariable Cox proportional hazards regression analyses.

RESULTS: A total of 7567 patients (median [IQR] age, 36 [25-55] years; 4901 men [64.8%]) were studied, including 1499 (19.8%) in the OS group, 1547 (20.4%) in the SAE group, and 4521 (59.7%) in the observation group. In multivariable analysis, there was no difference in mortality in the overall cohort or in subgroups. Morbidity was significantly lower in the SAE (odds ratio [OR], 0.61; 95% CI, 0.45-0.81; P < .001) and observation (OR, 0.71; 95% CI, 0.55-0.92; P = .01) groups compared with the OS group. Among patients with hypotension, there was no mortality difference, but shorter hospital length of stay was found in the SAE (β = -1.44; 95% CI, -1.79 to -1.09; P < .001) and observation (β = -1.41; 95% CI, -1.73 to -1.09; P < .001) groups. Compared with initial OS, morbidity was higher for patients in whom SAE (OR, 5.39; 95% CI, 3.39-8.57; P < .001) and observation (OR, 1.95; 95% CI, 1.44-2.64; P < .001) failed, and hospital length of stay was longer for these groups as well (β = 2.50; 95% CI, 1.27-3.73; P < .001 and β = 0.71; 95% CI, 0.07-1.35; P = .03, respectively).

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study, nonoperative management (SAE or observation) was associated with favorable outcomes when compared with OS in isolated severe blunt splenic injury, even in patients with hypotension on admission. Failure of nonoperative management, however, risked higher morbidity without associated increase in mortality. With careful patient selection, splenic salvage may be possible and preferred even in severely injured patients.

PMID:40986302 | DOI:10.1001/jamanetworkopen.2025.33266