Tag: nevin manimala

Jt Dis Relat Surg. 2026 May 1;37(2):390-401. doi: 10.52312/jdrs.2026.2500. Epub 2026 Mar 20.

ABSTRACT

OBJECTIVES: In this meta-analysis, we systematically compared the efficacy of the Allgöwer-Donati suture technique versus the interrupted vertical mattress suture technique in preventing postoperative incision complications following calcaneal fracture surgery.

MATERIALS AND METHODS: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from their inceptions up to May 2025. This study included randomized-controlled trials (RCTs) involving adults (18-80 years) with closed calcaneal fractures who underwent open reduction and internal fixation (ORIF) via a lateral incision. The primary outcomes were surgical suture time, wound suture time, drainage tube removal time, and the incidence of postoperative complications. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed-effect or random-effects models based on heterogeneity (I² statistic).

RESULTS: Eight RCTs comprising 640 patients were included. The Allgöwer-Donati technique significantly reduced surgical suture time (SMD = 0.81, 95% CI 0.22 to 1.39, p = 0.007; I² = 47%), drainage tube removal time (SMD = 4.94, 95% CI 4.42-5.47, p < 0.00001; I² = 65%), and wound suture time (SMD = -3.36, 95% CI -3.90 to -2.81, p < 0.00001; I² = 34%) compared to the interrupted vertical mattress technique. However, there was no significant difference in the overall rate of postoperative complications between the two techniques (OR = 1.32, 95% CI 0.95-1.82, p = 0.10; I² = 0%).

CONCLUSION: The Allgöwer-Donati suture technique offers significant advantages in operative efficiency by reducing suture times and drainage duration without increasing the risk of postoperative complications compared to the interrupted vertical mattress technique. It represents a promising suturing option for calcaneal fracture surgery, particularly in settings valuing procedural efficiency.

PMID:41906834 | DOI:10.52312/jdrs.2026.2500

Jt Dis Relat Surg. 2026 May 1;37(2):372-380. doi: 10.52312/jdrs.2026.2654. Epub 2026 Mar 16.

ABSTRACT

OBJECTIVES: This study aims to evaluate the osteogenic effect of platelet-rich fibrin (PRF) graft with periosteal repair on a bone defect of long bone in rabbits, compared to control group that underwent periosteal repair alone.

MATERIALS AND METHODS: A total of 12 female New Zealand white rabbits were used in this study. Two rabbits were designated for PRP preparation, mixed with a human thrombin agent to produce PRF. A bone defect (5 mm in diameter and 7 mm in depth) was created in both proximal tibiae of 10 rabbits. The defect site of the right proximal tibia was filled with PRF, followed by periosteal repair (PRF group). In contrast, only periosteal repair was performed on the left proximal tibia (control group). For histological evaluation, hematoxylin and eosin (HE) and Masson’s trichrome (MT) staining were performed at Weeks 4 and 8 after surgery. The bone healing ratio, defined as the proportion of newly formed bone area to surgically created defect area, was calculated to assess bone regeneration. For radiological examination, micro-computed tomography (micro-CT) was conducted at Week 8 after surgery.

RESULTS: A total of nine rabbits survived until the planned euthanasia time points (four rabbits at Week 4 and five at Week 8). At Week 4 postoperatively, HE staining revealed a higher bone healing ratio in the PRF group compared to the control group; however, the difference was not statistically significant (PRF group: 71.0 ± 15.6, control group: 59.5 ± 18.1, p = 0.34). At Week 8 postoperatively, histological analysis showed no difference in the bone healing ratio between the two groups (PRF group: 79.3 ± 8.7, control group: 75.9 ± 13.2, p = 0.55). Micro-CT analysis demonstrated a superior LaneSandhu score in the PRF group compared to the control group, although this difference was not statistically significant (p = 0.15).

CONCLUSION: The PRF graft with periosteal repair appears to promote improved early-stage new bone formation in bone defects of long bone in an animal model compared to periosteal repair alone, although it does not reach statistical significance.

PMID:41906832 | DOI:10.52312/jdrs.2026.2654

Jt Dis Relat Surg. 2026 May 1;37(2):360-371. doi: 10.52312/jdrs.2026.2558. Epub 2026 Mar 11.

ABSTRACT

OBJECTIVES: This meta-analysis aimed to systematically compare the clinical outcomes of cannulated screw tension band (CSTB) and Kirschner wire tension band (KWTB) fixation for patellar fractures.

MATERIALS AND METHODS: Comprehensive searches were conducted in the Cochrane Library, Web of Science, PubMed, Embase, and SpringerLink databases for studies published through July 2025. Search terms included “cannulated screw,” “Kirschner wire,” “tension band,” and “patellar fracture.” Mean differences (MDs) and odds ratios (ORs) were utilized as pooled effect measures, with 95% confidence intervals (CIs).

RESULTS: Eleven studies involving 1,358 patients with patellar fractures met the inclusion criteria. Meta-analysis revealed no statistically significant differences between the groups in terms of operative time (MD = 4.00; 95% CI -1.82~9.82; p = 0.18), fracture healing time (MD = 0.08; 95% CI -0.07~0.22; p = 0.28), or postoperative Visual Analog Scale scores (MD = 0.21; 95% CI -0.74~1.15; p = 0.67). However, CSTB fixation demonstrated significantly superior postoperative knee range of motion (ROM) (MD = -7.16; 95% CI -9.34~-4.98; p < 0.00001), higher Lysholm scores (MD = -4.80; 95% CI -6.62~-2.99; p < 0.00001), and significantly lower rates of reoperation (OR = 5.14; 95% CI 2.66~9.93; p < 0.00001) and overall complications (OR = 14.19; 95% CI 4.85~41.56; p < 0.00001) compared to KWTB.

CONCLUSION: For patellar fracture fixation, CSTB offers significant advantages over KWTB in terms of postoperative knee ROM, functional outcomes, reoperation rates, and overall complication rates.

PMID:41906831 | DOI:10.52312/jdrs.2026.2558

Jt Dis Relat Surg. 2026 May 1;37(2):344-350. doi: 10.52312/jdrs.2026.2642. Epub 2026 Mar 18.

ABSTRACT

OBJECTIVES: This study aims to compare the volume and impact of hidden blood loss (HBL) following total hip arthroplasty (THA) performed via the direct anterior approach (DAA) versus the posterolateral approach (PLA).

PATIENTS AND METHODS: Between January 2016 and January 2024, a total of 134 patients (63 males, 71 females; mean age: 69.7 ± 7.7 years; range, 48 to 79 years) who underwent primary THA were retrospectively analyzed. The patients were stratified into two cohorts according to surgical approach: DAA group (n = 63) and PLA group (n = 71). Preoperative blood volume and visible blood loss (VBL) were quantified for both cohorts. Total blood loss (TBL) was derived from hematocrit (Hct) levels measured preoperatively and on postoperative Day 3, which subsequently allowed calculation of HBL and its proportion relative to TBL. Intergroup comparisons were performed for these parameters.

RESULTS: The most common etiology for THA was hip osteoarthritis. The mean operative time was 120.4 ± 10.2 min in the DAA group and 117.7 ± 8.2 min in the PLA group, indicating no statistically significant difference between the two groups (p = 0.093). The mean TBL was 366.3 ± 54.3 mL in the DAA group and 477.0 ± 71.6 mL in the PLA group (p < 0.001), while the mean HBL was 206.3 ± 40.4 mL and 318.9 ± 44.9 mL, respectively (p < 0.001). The reductions in Hb and Hct were significantly lower in the DAA group compared to the PLA group (p < 0.001 for both).

CONCLUSION: During the perioperative period of THA, HBL represents a considerable clinical concern regardless of the surgical approach employed. Compared to the PLA, the DAA is associated with a significant reduction in both HBL and TBL.

PMID:41906829 | DOI:10.52312/jdrs.2026.2642

Jt Dis Relat Surg. 2026 May 1;37(2):325-343. doi: 10.52312/jdrs.2026.2523. Epub 2025 Dec 29.

ABSTRACT

OBJECTIVES: This study aims to systematically evaluate the efficacy and safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) in promoting bone regeneration.

MATERIALS AND METHODS: A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted from inception to May 2024. Fifteen randomized-controlled trials involving 2,137 cases were included. Traditional and network meta-analyses were performed, machine learning techniques were applied to explore heterogeneity, and subgroup analyses were carried out to assess efficacy across anatomical sites including alveolar sockets, palatal clefts, and spinal fusion.

RESULTS: No significant difference was found in the overall bone healing rate between the rhBMP-2 and control groups (relative risk [RR] = 1.02, 95% confidence interval [CI] 0.87-1.20). However, rhBMP-2 demonstrated a significant advantage in spinal fusion (RR = 1.09, 95% CI 1.01-1.17) and a positive, although not statistically significant, trend in small oral and jaw bone defects. The incidence of serious adverse events was comparable (RR = 0.97, 95% CI 0.66-1.42). Network meta-analysis indicated that the overall success rate of bone regeneration with rhBMP-2 (odds ratio [OR] = 1.53, 95% CI 0.54-4.33) and other bone substitutes (OR = 1.42, 95% CI 0.39-5.21) did not significantly exceed autograft treatment, although both showed a trend toward superiority. Direct pairwise comparison revealed that rhBMP-2 was significantly more effective than autograft (OR = 1.54, 95% CI 1.02-2.33, p < 0.05), with low heterogeneity (I² = 0%).

CONCLUSION: While the overall healing rate was comparable to controls, rhBMP-2 showed significant efficacy in spinal fusion and a favorable safety profile. Its effectiveness was context-specific, influenced by anatomical site and patient factors. These findings support the selective use of rhBMP-2 in specific clinical contexts such as spinal surgery, while further research is needed to optimize its application in other indications.

PMID:41906828 | DOI:10.52312/jdrs.2026.2523

Jt Dis Relat Surg. 2026 May 1;37(2):291-298. doi: 10.52312/jdrs.2026.2556. Epub 2025 Dec 15.

ABSTRACT

OBJECTIVES: This study aims to quantify hidden blood loss (HBL) associated with minimally invasive pedicle screw placement and to compare HBL between the Wiltse approach and percutaneous pedicle screw techniques.

PATIENTS AND METHODS: Between January 2020 and December 2022, a total of 126 neurologically intact patients (63 males, 63 females; mean age: 43.0 ± 11.5 years; range, 18 to 65 years) with single-segment traumatic thoracolumbar fractures who underwent surgery were retrospectively analyzed. The patients were categorized into two groups based on surgical technique: the study group (Wiltse approach) and control group (percutaneous pedicle screw). Demographic and clinical data were collected. Perioperative laboratory values were recorded, and HBL was calculated using a combination of the Nadler, Gross, and Sehat formulas.

RESULTS: The Wiltse approach group demonstrated a significantly shorter surgical time and fewer intraoperative fluoroscopy uses compared to the percutaneous group (p < 0.001 for both). Although intraoperative visible blood loss (VBL) was higher in the Wiltse group (p < 0.001), this group showed a smaller postoperative hemoglobin loss (p = 0.025) and significantly less HBL in absolute volume (p=0.031).

CONCLUSION: In minimally invasive surgery for single-segment thoracolumbar fractures, perioperative HBL considerably exceeds VBL. Compared to the Wiltse approach, percutaneous pedicle screw fixation is associated with longer operation time, greater radiation exposure, and higher HBL. Therefore, spine surgeons should emphasize close monitoring of postoperative hemoglobin and appropriate management of anemia in patients undergoing percutaneous instrumentation.

PMID:41906824 | DOI:10.52312/jdrs.2026.2556

Pacing Clin Electrophysiol. 2026 Mar 30. doi: 10.1111/pace.70217. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines recommend the use of combined oral anticoagulants and antiplatelet agents in patients with acute myocardial infarction (AMI) and atrial fibrillation (AF), especially for those at high risk. In real-world clinical practice, adherence to anticoagulant therapy is often suboptimal, and some patients do not routinely receive it.

METHODS: Patients diagnosed with AMI and AF who were prescribed dual antiplatelet drugs in Tianjin, China, from August 2016 to June 2023 were enrolled. The primary outcomes were stroke, ischemic stroke, and hemorrhagic stroke.

RESULTS: A total of 1,026 patients were identified (mean age: 73.7, standard deviation: 9.12; 39% female), which included 132 rivaroxaban users and 894 non-users. Over a median follow-up of 922 days, 298 patients died and 367 patients suffered from stroke. After adjusting for multiple variables, rivaroxaban users had a lower risk of any stroke (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43-0.90) and ischemic stroke (HR, 0.63; 95% CI, 0.43-0.92), compared to non-users. In the propensity matched cohort, rivaroxaban users had a lower risk of stroke and ischemic stroke with no significant difference in bleeding or major bleeding. Multivariable competing risk models were consistent with the above results. No statistically significant association was found for rivaroxaban use and bleeding, major bleeding, all-cause mortality, or cardiovascular mortality.

CONCLUSIONS: Concomitant rivaroxaban use is associated with lower risks of stroke, especially ischemic stroke, but with no significant increase in the risks of bleeding and major bleeding in patients with AMI and preexisting AF taking dual antiplatelet drugs.

TRIAL REGISTRATION: Registration number: ChiCTR2400094021.

PMID:41906822 | DOI:10.1111/pace.70217

Nat Prod Res. 2026 Mar 30:1-15. doi: 10.1080/14786419.2026.2645753. Online ahead of print.

ABSTRACT

Tetraclinis articulata (Vahl) Masters (Cupressaceae) is a coniferous species native to the Mediterranean and North African regions. Its resin, commonly known as sandarac, has a longstanding history of ethnomedicinal use for treating respiratory disorders, wound healing, and ritual practices. Despite its traditional significance, comprehensive pharmacological and toxicological evaluations of its chemical constituents and safety profile remain limited. This study aimed to assess the general toxicity of sandarac resin methanolic extract (SRME) using the Artemia salina L. lethality bioassay, alongside detailed phytochemical profiling through qualitative screening and LC-MS/MS analysis. The antioxidant activity of SRME was assessed using the DPPH• radical scavenging method, while its total antioxidant capacity (TAC) was determined using the phosphomolybdenum assay. The total phenolic content (TPC) of SRME was determined using a modified Folin-Ciocalteu colorimetric method. Phytochemical screening confirmed the presence of phenolics and flavonoids, whereas alkaloids, tannins, and saponins were absent. LC-MS/MS analysis identified key phenolic acids, including caffeic acid (1222 mg/kg) and gallic acid (26.44 mg/kg), as well as other constituents such as cinnamic acid, rutin, and myricetin. Although SRME contained diverse bioactive compounds, the DPPH• and TAC assays demonstrated very limited antioxidant activity, with statistically significant DPPH• radical scavenging observed only at 25 µg/mL (4.32%), while no total antioxidant capacity was detected at any concentration. In contrast, ascorbic acid exhibited strong antioxidant activity, reaching 67.28% and 52.10% in the DPPH• and TAC assays, respectively. Toxicity assays demonstrated a dose- and time-dependent increase in A. salina larval mortality, particularly at high concentrations, suggesting potential toxic effects at supra-traditional doses. These findings indicate that SRME is relatively safe at traditional usage levels, while higher concentrations may pose risks. Further studies isolating active constituents and elucidating toxicodynamic mechanisms are warranted to inform the safe pharmacological application of T. articulata resin.

PMID:41906815 | DOI:10.1080/14786419.2026.2645753

Child Care Health Dev. 2026 May;52(3):e70266. doi: 10.1111/cch.70266.

ABSTRACT

OBJECTIVES: This study aimed to quantify associations between chronic conditions and mental illness; investigate potential moderating effects of child age, sex, health functioning, mental health service contact and household income on these associations; and explore the potential mediating effect of family functioning.

METHODS: This study conducted secondary data analyses on a sample of 6242 children aged 4-17 years from the 2014 Ontario Child Health Study (OCHS). Chronic conditions were assessed using a standard list of conditions developed by the Statistics Canada. Mental illness was assessed with the Emotional Behavioural Scales (EBS). The Health Utility Index Mark III measured health functioning. Logistic regression models quantified associations between chronic conditions and mental illness. Moderating effects were tested with product-term interactions in logit models and interpreted using average marginal effects. Mediating effects were explored using the product of coefficients method.

RESULTS: Having a chronic condition was associated with mood disorder (OR = 2.25 [95% CI: 1.36-3.74]). For children who have better health functioning, average marginal effects indicated that children with chronic conditions are 29% more likely to have any mental illness (p < 0.01), 21% more likely to have anxiety disorders (p < 0.05) and 21% more likely to have ADHD (p < 0.05) than children with no conditions. For children who have poorer health functioning, there was no association between chronic conditions and mental illnesses. Family functioning did not mediate any associations between chronic conditions and mental illness outcomes.

CONCLUSION: The association between chronic conditions and mental illness in children is nuanced, with health functioning moderating this association for any mental illness, anxiety disorders and attention-deficit hyperactivity disorder specifically. Mental health screening programs should ensure children with chronic conditions who have better health functioning are routinely assessed and upstream interventions initiated early to reduce the incidence of physical-mental multimorbidity.

PMID:41906801 | DOI:10.1111/cch.70266

Child Care Health Dev. 2026 May;52(3):e70264. doi: 10.1111/cch.70264.

ABSTRACT

BACKGROUND: Parents caring for children with neurodevelopmental disorders (NDD) face unique and ongoing challenges that impact family well-being. Peer support from individuals with shared lived experiences can offer recognition, shared understanding and empowerment. Despite its promise, peer support for parents of children with NDD remains largely informal, under-researched and poorly integrated within standard healthcare, limiting its potential accessibility and impact. Little is known about what parents seek in peer support, how they experience it, and which factors facilitate meaningful engagement. This study therefore aimed to explore parents’ perceptions of peer support, focusing on uptake, impact and conditions influencing its effectiveness.

METHODS: A survey co-created with parent-carers collected quantitative and qualitative data on perceptions, needs, concerns and barriers related to peer support. The online survey was distributed via parent organisations. Descriptive statistics summarised participant characteristics and peer support uptake, while thematic analysis identified key experiential themes from open-ended responses.

RESULTS: Among the 225 participating parents (89% mothers), 77.3% expressed a need for peer support, mostly because friends and family did not fully understand their situation. Of these parents, 65.6% reported finding peer support, mostly informal initiatives. Thematic analysis of participants’ comments revealed four key categories describing the experience with and need for peer support: (1) support, (2) mutual learning, (3) connection by recognition and (4) experiencing no judgement. Also included in the results are concerns reported by parents and factors facilitating or hindering successful peer support.

CONCLUSION: Parents of children with NDD valued peer support for emotional connection, practical advice and shared understanding. Preferences are highly individual, emphasising the need for tailored peer support. These findings may guide the design and implementation of peer support initiatives aligned with parents’ needs and preferences. Future research should focus on how the full potential of peer support for these parents can be unlocked.

PMID:41906793 | DOI:10.1111/cch.70264