Tag: nevin manimala

Cardiovasc Intervent Radiol. 2025 Sep 21. doi: 10.1007/s00270-025-04198-1. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to systematically evaluate the efficacy and safety of different bleomycin administration routes for treating GHHs, with a subgroup analysis comparing Transarterial chemoembolization (TACE) and percutaneous sclerotherapy (PS).

METHODS: A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science from inception through May 6, 2025. Studies included reporting clinical and radiological outcomes after PS and TACE for GHHs (≥ 4 cm). Primary outcomes included technical success (complete and accurate application as predetermined in the study protocol), safety outcomes, clinical (symptom relief without additional intervention), and radiological success (≥ 50% size reduction and/or lack of enhancement on follow-up imaging). The outcomes were analyzed using a random-effects meta-analysis 106 1586.

RESULTS: A total of 17 studies, including 1692 patients (1586 treated with TACE and 106 with PS) and 1825 GHHs, were included. Among these, 13 studies assessed TACE, and four studies evaluated PS. The overall technical success rate was 100%, with pooled clinical and radiological success rates of 96.93% and 81.75%, respectively. In subgroup analyses, both TACE and PS achieved 100% technical success. TACE showed slightly higher clinical success, at 99.9%, compared to PS at 89.73%, although the difference was not statistically significant (p = 0.15). Radiological success was comparable (TACE: 81.9%, PS: 81.29%). Major complications were rare (0.27%, 95% CI: 0-0.55%). No significant differences were observed in major complication rates (TACE: 0.26%, PS: 0.85%, p = 0.67), total complications (p = 0.48), or procedure-related morbidity.

CONCLUSION: Both TACE and PS are effective treatments for GHHs, with PS showing a lower systemic complication rate.

PMID:40976792 | DOI:10.1007/s00270-025-04198-1

Br J Oral Maxillofac Surg. 2025 Aug 8:S0266-4356(25)00200-1. doi: 10.1016/j.bjoms.2025.07.012. Online ahead of print.

ABSTRACT

Assessing the health-related quality of life (HRQOL) in maxillofacial trauma patients is essential for understanding the holistic impact of injury. Whilst validated tools exist for oral cancer, trauma-specific HRQOL questionnaires are lacking. The University of Washington Quality of Life (UOW-QOL) questionnaire for oral cancer was adapted to evaluate maxillofacial patients as a pilot study. The aim was to capture functional and psychosocial challenges unique to trauma, thereby improving patient care. Thirty-five patients who sustained facial injuries then underwent surgery at the Royal London Hospital were recruited. They were routinely followed up in clinic one to six months postoperatively and completed the adapted QOL questionnaire, tailored for maxillofacial trauma. Version 28 IBM SPSS statistics software was used for data analysis. There was a statistically significant association between the dentoalveolar region and QOL (p < 0.001), indicating a lower QOL, potentially reflecting current NHS dental care deficiencies. The total severity of complications was significantly correlated with QOL (p < 0.047), meaning an increase in the number and severity of complications led to QOL deterioration. Among the complications, appearance and scarring were significant (p < 0.03 and p < 0.029, respectively), with a negative self-perception of appearance and more severe scarring contributing to a lower QOL. A validated QOL questionnaire is needed to assess maxillofacial patients postoperatively for more standardised comparisons of outcomes. The researchers found this tool effective in evaluating the QOL of these patients, and believe that if future studies adopt it, more consistent and comparable data can be generated.

PMID:40976755 | DOI:10.1016/j.bjoms.2025.07.012

Br J Oral Maxillofac Surg. 2025 Aug 22:S0266-4356(25)00211-6. doi: 10.1016/j.bjoms.2025.08.005. Online ahead of print.

ABSTRACT

Injuries to the face, mouth and jaws are common presentations to UK hospitals. Understanding the current volume of work and the recent changes can yield important lessons for the teams that deal with facial injuries. We examined the Hospital Episode Statistics (HES) covering England for the financial reporting years ending in 2015-2024 for relevant diagnoses and procedures undertaken during hospital admissions. A significant reduction in activity in many areas due to COIVD-19 was found. We report on the change between average volumes of activity in the years ending 2015-17, compared with the years ending 2022-24. For soft tissue trauma there was an 11.3% reduction in recorded repairs between these time periods. There were also reductions in orbital (-20.7%), nasoethmoidal (-22.2%), zygomatic complex (-32.4%), nasal (-52.9%), and mandibular (-18.5%) fracture repairs. In many areas this was found in contrast to increased diagnosis of these fracture types. In conclusion, for many types of facial trauma, there has been a reduction in clinically significant events over the last decade. Improved diagnosis and changes in coding behaviour may account for increased recognition of injuries with less clinical relevance.

PMID:40976754 | DOI:10.1016/j.bjoms.2025.08.005

Urol Oncol. 2025 Sep 20:S1078-1439(25)00343-6. doi: 10.1016/j.urolonc.2025.08.024. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Magnetic resonance imaging (MRI)-targeted biopsies for prostate cancer diagnosis can be performed as a transperineal biopsy (TP-Bx), yet its comparative performance with transrectal biopsy (TR-Bx) remains uncertain. We evaluated the detection of clinically significant prostate cancer (csPCa) by TP-Bx and TR-Bx according to lesion size and location using Prostate Imaging Reporting & Data System (PI-RADS) criteria.

METHODS: We retrospectively reviewed biopsy-naïve patients who underwent MRI-guided prostate biopsies at our institution. TR-Bx was performed using MRI-ultrasound fusion in the urology clinic, while TP-Bx utilized an MRI in-bore technique in the radiology department. Lesions were stratified by PI-RADS-defined score, location, and size.

RESULTS: Among 200 patients (100 TP-Bx, 100 TR-Bx), 276 PI-RADS score 3 to 5 lesions were biopsied (141 TP-Bx, 135 TR-Bx). Overall csPCa detection did not differ significantly between TP-Bx and TR-Bx (28% vs. 38%; OR = 1.5, CI = 0.9-2.6, P = 0.12). However, TR-Bx detected significantly more csPCa in non-apical peripheral zone (PZ) lesions compared to TP-Bx [45% (36/80) vs. 29% (21/73), adjusted OR = 4.6, 95% CI = 1.29-16.4, P = 0.019], particularly for small (diameter ≤1 cm) lesions (35% [16/46] vs. 12% [5/42], adjusted OR = 8.06, 95% CI = 1.45-44.7, P = 0.017). No significant difference was observed for larger lesions (diameter >1 cm).

CONCLUSIONS: Overall csPCa detection rates were comparable between TP-Bx and TR-Bx, with no statistically significant difference. However, TR-Bx demonstrated superior detection in small non-apical PZ lesions, suggesting an anatomic and size-dependent advantage. These exploratory findings support further prospective studies to refine MRI-targeted biopsy protocols using PI-RADS-defined lesion characteristics to inform personalized biopsy strategies.

PMID:40976748 | DOI:10.1016/j.urolonc.2025.08.024

J Prosthet Dent. 2025 Sep 20:S0022-3913(25)00695-X. doi: 10.1016/j.prosdent.2025.08.036. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Implant-supported crowns can be fabricated using additive (AM) or subtractive manufacturing (SM) with resin-based materials. However, their fracture strength on different implant abutments remains unclear.

PURPOSE: The purpose of this in vitro study was to evaluate the fracture strength (FS) and failure modes of AM interim crowns cemented on polyetheretherketone (PEEK) or titanium (Ti) abutments and compare them with SM crowns.

MATERIAL AND METHODS: Sixty-four implant-supported crowns were fabricated from 3 AM resins (Crowntec [AM_CT], FREEPRINT temp [AM_FP], Varseosmile Crown Plus [AM_VS]) and one SM resin (M-PM Disc [SM_MPM]) (N=16). The crowns were cemented on 1-piece PEEK or Ti abutments (n=8) using dual-polymerizing self-adhesive resin cement after standardized surface treatments. All specimens were subjected to thermomechanical aging (5000 thermal cycles, 250 000 cycles at 49 N, 1.7 Hz) followed by FS testing. Failures were classified as repairable crown crack or fracture, catastrophic crown fracture without abutment damage, abutment distortion without crown damage, or crown and abutment damage. One-way analysis of variance with Tukey test and chi-squared test were used for statistical analysis (α=.05).

RESULTS: All specimens survived cyclic loading. While Ti-supported crowns fractured consistently through catastrophic crown failure without abutment damage, most PEEK-supported crowns exhibited inconsistent failure patterns involving abutment distortion or combined crown-abutment damage. Only 6 crowns on PEEK abutments (4 AM_CT and 2 AM_FP) failed without abutment damage, making statistical comparison unreliable. Therefore, PEEK-supported crowns were excluded from statistical analysis. Among Ti groups, SM_MPM crowns demonstrated the highest FS, followed by AM_CT, while AM_FP and AM_VS showed significantly lower FS values (P≤.003). The distribution of failure modes differed significantly among crown materials, abutment types, and their combinations (P≤.014).

CONCLUSIONS: Crowns on Ti abutments fractured without abutment damage, with SM_MPM resulting in the highest FS, followed by AM_CT. In contrast, most PEEK-supported crowns exhibited abutment distortion without crown damage or simultaneous crown and abutment damage.

PMID:40976743 | DOI:10.1016/j.prosdent.2025.08.036

J Pediatr Urol. 2025 Sep 20:S1477-5131(25)00467-X. doi: 10.1016/j.jpurol.2025.09.002. Online ahead of print.

ABSTRACT

INTRODUCTION: Penile curvature often accompanies hypospadias, and numerous techniques have been described for its correction; however, in some cases, an abnormal erection angle may also be present, further exacerbating the perception of curvature.

OBJECTIVE: This study investigates the significance of the erection angle in hypospadias cases and its correlation with the severity of the anomaly.

STUDY DESIGN: A retrospective analysis of intraoperative photographs of hypospadias cases operated between 2019 and 2023 was performed. Erection angle was measured with a digital goniometer during a full artificial erection. Erection angles in proximal and distal hypospadias cases were analyzed and compared to data from Kinsey’s subgroups representing healthy male erection angles.

RESULTS: This study involved images of 68 patients, with 31 having proximal and 37 distal hypospadias. The median age of the whole group was 11 months (6-156, IQR 9). Median erection angle was 91 (63-119, IQR 11) for distal cases, whereas it was 96 (75-138, IQR 21) for proximal cases. The difference was statistically significant (p = 0.009). The erection angle distribution in our cohort, including both proximal and distal hypospadias cases, skewed toward wider angles, highlighting a distinct pattern compared to data constituted by Kinsey and Sparling.

DISCUSSION: Our findings indicate that the erection angle in hypospadias is significantly wider in proximal cases, suggesting a correlation between erection angle and severity of the hypospadias. While we acknowledge the limitation of comparing our prepubertal cohort with Kinsey’s adult data, the absence of evidence suggesting significant post-pubertal changes in erection angle justifies this approach. Additionally, the use of digital images for angle assessment is not a standardized technique in hypospadias evaluation; these images were initially captured for curvature assessment. Despite these limitations, our study provides novel insights into seldom mentioned association with hypospadias – a wide erection angle, emphasizing the need for further research on its implications for surgical planning and long-term outcomes.

CONCLUSION: This study introduces a wider erection angle as an additional characteristic of hypospadias particularly pronounced in proximal cases. To our knowledge, this is the first focused investigation on addressing this aspect of the condition. It emphasizes the need for further research on adults with wide post-repair erection angles to explore its long-term impact on sexual function and aesthetics.

PMID:40976740 | DOI:10.1016/j.jpurol.2025.09.002

J Natl Med Assoc. 2025 Sep 20:S0027-9684(25)00315-3. doi: 10.1016/j.jnma.2025.09.002. Online ahead of print.

ABSTRACT

Black doctors have long navigated a medical field marked by exclusion, resistance and resilience. From legalized hospital segregation in the 19th and early 20th centuries to enduring racial and gender biases in contemporary residency programs, systemic barriers continue to drive the underrepresentation of Black physicians across specialties. Situating personal testimony within this historical context, this narrative examines statistical patterns in Black physician representation and the present-day challenges faced by Black residents through the lens of the Black narrative tradition of bearing witness and asserting truth. It honors the legacies of pioneering physicians-Drs. Daniel Hale Williams, Thomas R. Peyton, and Isabella Vandervall-whose lives exemplify both the persistence of structural inequality and a blueprint for achieving justice in medicine. Their influence resonates in the work of Black doctors today, who develop programs and initiatives (e.g., pipeline programs, racial affinity groups, and global health exchanges) that expand access, foster inclusion, and promote cross-cultural collaboration in medical education and training. By highlighting historical and contemporary strategies for overcoming systemic barriers, this article emphasizes the critical role of justice-oriented initiatives in transforming medical institutions and advancing equity, representation, and belonging across the profession.

PMID:40976718 | DOI:10.1016/j.jnma.2025.09.002

Environ Health Prev Med. 2025;30:74. doi: 10.1265/ehpm.25-00194.

ABSTRACT

BACKGROUND: Supporting the mental health of researchers is essential to maintaining human resources and advancing science. This study investigated the association between Japanese medical researchers’ perceptions of research evaluation processes and their psychological well-being.

METHODS: We performed a web-based self-administered questionnaire survey. The questionnaires were distributed to each academic society through the Japanese Association of Medical Sciences from December 2022 to January 2023. These questionnaires targeted medical researchers. Exposure was the medical researchers’ perceptions of quantitative indicators for evaluating medical research and researchers. The outcome was psychological well-being, measured using the Japanese version of the World Health Organization-Five Well-Being Index (WHO-5). Multivariable-adjusted logistic regressions were conducted to investigate the association between individual attitudes toward research evaluation and psychological well-being. Stratified analyses by research fields, i.e., clinical, basic, and social medicine, were also performed.

RESULTS: A total of 3,139 valid responses were collected. After excluding 176 responses from research fields of other than clinical, basic, or social medicine, 2,963 researchers (2,185 male, 737 female, and 41 other) were analyzed. Prevalence of poor well-being (WHO-5 score <13) was 28.3% in the researchers. The highest number of medical researchers was in clinical medicine (n = 500) followed by basic medicine (n = 217) and social medicine (n = 121). Medical researchers who considered research funding slightly important/not important for researcher evaluation had poorer psychological well-being than those who considered it especially important (slightly important: adjusted odds ratio (aOR) 1.33, 95% confidence interval (CI) 1.03-1.71; not important: aOR 1.53, 95%CI 1.10-2.12). This tendency was stronger among basic medical researchers than clinical or social medical researchers. The research field significantly modified the relationship between research funding received and interaction with poor psychological well-being both additively (P = 0.030) and multiplicatively (P = 0.024).

CONCLUSIONS: The discrepancy between medical researchers’ attitudes toward research evaluation and the current state of research evaluation in their research community may worsen their psychological well-being. The influence of this discrepancy differs among clinical, basic, and social medicine. Appropriate evaluation of medical research and researchers in each field can facilitate improving their psychological well-being via the resolution of this discrepancy.

PMID:40976704 | DOI:10.1265/ehpm.25-00194

BMJ Open. 2025 Sep 21;15(9):e095532. doi: 10.1136/bmjopen-2024-095532.

ABSTRACT

INTRODUCTION: Ischaemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide. Despite strong recommendations, the implementation rate of outpatient cardiac rehabilitation (CR) in Japan remains low. Mobile health technologies, such as Personal Health Record (PHR) applications combined with wearable devices, may enhance adherence to rehabilitation programmes. This study aims to evaluate the effectiveness of a continuous support programme that integrates a PHR app and counselling services in improving the continuation rate of outpatient CR and exercise tolerance in patients with IHD.

METHODS AND ANALYSIS: This is a single-blind randomised controlled trial with a parallel-group design. A total of 72 participants with IHD will be recruited from the outpatient departments of Maebashi Red Cross Hospital, Gunma Saiseikai Maebashi Hospital, Okayama University Hospital, Okayama Red Cross Hospital, Momoyama-kai Ono Internal Clinic, Hiroshima University Hospital, Tshuyama Jifu-kai Tsuyama Chuo Hospital and Shinpu-kai Tamashima Chuo Hospital. Participants will be randomly allocated to either the intervention group, which will receive a wearable device, a PHR app, counselling services and a rehabilitation notebook, or the control group, which will receive a wearable device and a rehabilitation notebook without the PHR app and counselling. The primary outcome is the change in peak oxygen uptake from baseline to 150 days. Secondary outcomes include changes in anaerobic threshold, number of outpatient rehabilitation visits, daily steps and vital signs. Data will be analysed using a generalised estimating equations for primary outcomes and appropriate statistical tests for secondary outcomes, following an intention-to-treat approach.

ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the ethics committee of the Kyoto University Graduate School and Faculty of Medicine (C1669-1). In addition, permission to conduct the study was granted by the director of each participating institution. Participants will provide informed consent prior to participation. Findings will be disseminated through peer-reviewed journals, conferences and summary reports to stakeholders.

TRIAL REGISTRATION NUMBER: This trial is registered with the University hospital Medical Information Network (UMIN) Clinical Trials Registry (trial identifier: UMIN000055823).

PMID:40976676 | DOI:10.1136/bmjopen-2024-095532

BMJ Open. 2025 Sep 21;15(9):e093304. doi: 10.1136/bmjopen-2024-093304.

ABSTRACT

OBJECTIVE: This paper examines the impact of India’s National Publicly Funded Health Assurance Scheme, Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY), in Haryana on out-of-pocket (OOP) expenses and catastrophic health expenditure (CHE).

DESIGN: We conducted a case-control study using a stratified random sampling approach.

SETTINGS: Six districts in Haryana, based on utilisation, were selected: Mewat, Faridabad, Sonipat, Ambala, Kurukshetra and Karnal.

PARTICIPANTS: A total sample size of 772 individuals, that is, 386 PM-JAY beneficiaries (cases) and non-beneficiaries (controls) each.

INTERVENTION: Data were collected using a semistructured questionnaire covering household demographics and expenditure details. The interview gathered information on hospitalisation within the past year, types of ailments, the type of empanelled facility visited, expenditure details and borrowing/selling of assets for treatment.

PRIMARY AND SECONDARY OUTCOMES: Mean OOP expenditure was calculated for beneficiaries and non-beneficiaries based on the type of healthcare provider. The impact of PM-JAY on OOP expenditure was analysed using a generalised linear model controlling for religion, caste, type of house, type of family, morbidity patterns, type of disease, type of health facility, hospital stay duration, average distance to the facility and travel time. CHE was defined as OOP payments ≥30% of household income. Logistic regression was used to assess the determinants of CHE.

RESULTS: We found that direct medical expenses incurred for hospitalisations were 65% lower for beneficiaries (11 131 rupees) compared with non-beneficiaries (31 675 rupees). While OOP expenditures are similar for both groups in public empanelled hospitals, non-beneficiaries incur OOP costs three times higher than PM-JAY beneficiaries in private empanelled hospitals. Factors, including the disease type, average distance from home to the facility, average travel time and type of hospital, significantly influence these expenses. Furthermore, the prevalence of CHE is significantly lower among PM-JAY beneficiaries (13.3%) compared with non-beneficiaries (45.9%), with an OR of 7.15 (95% CI: 4.74 to 10.80; p<0.01).

CONCLUSIONS: Our analysis shows the scheme’s impact on decreasing OOP expenditure and CHE. To enhance the scheme’s effectiveness, the study highlights the necessity of addressing non-medical expenses and expanding coverage for indirect costs, such as food, accommodation and transportation. Additionally, strengthening the supply side through improved drug availability at healthcare facilities is crucial for enhancing financial protection and access to care.

PMID:40976675 | DOI:10.1136/bmjopen-2024-093304