Tag: nevin manimala

Neurosurg Rev. 2026 Jan 30;49(1):173. doi: 10.1007/s10143-025-04128-2.

ABSTRACT

BACKGROUND: Stent-assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for intracranial bifurcation aneurysms. However, studies comparing FDs and SAC were scarce. Thus, we performed a two-center, propensity score matched (PSM) cohort study to compare the FDs and SAC devices for intracranial bifurcation aneurysms.

METHODS: Consecutive patients with intracranial bifurcation aneurysms were treated with FDs or SAC at two advanced stroke centers were enrolled in the study. Propensity score matching (PSM) was employed to adjust for demographic and aneurysm characteristics. The perioperative and midterm follow-up outcomes were compared between the two devices.

RESULTS: A total of 131 patients with 131 intracranial bifurcation aneurysms were included. After PSM, 66 aneurysms treated with the FDs and SAC were matched (n = 33 in each group). At a median follow-up of 6-7 months, significant differences were observed in procedure time (105.00 min vs. 155.00 min, p < 0.001), rate of complete aneurysm occlusion (60.6% vs. 93.9%, p = 0.001) between the FDs and SAC group. There were no statistical differences in total perioperative complications (3.0% vs. 9.1%, p = 0.302), in-stent stenosis (9.1% vs. 9.1%, p = 1.000), device-related challenges (3.0% vs. 6.1%, p = 0.555) and follow-up mRS score of 3-5 (3.0% vs. 3.0%, p = 1.000) between the FDs and SAC group.

CONCLUSION: Compared with SAC, FDs provide a comparable rate of perioperative and clinical outcomes in unruptured intracranial bifurcation aneurysms. Nevertheless, a better occlusion status in the SAC group needs to be further verified over a longer follow-up period.

PMID:41612108 | DOI:10.1007/s10143-025-04128-2

Clin Rheumatol. 2026 Jan 29. doi: 10.1007/s10067-026-07936-z. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the value of combining chest muscle measurements, spleen density, and immunological serum indicators for predicting the occurrence of interstitial lung disease (ILD) in Sjögren’s syndrome (SS).

METHODS: A retrospective study was performed by SS patients admitted to the First Affiliated Hospital of Henan Medical University from January 2018 to June 2025 and 196 cases were included. Propensity score matching (PSM) was used to balance baseline characteristics, resulting in the Sjögren’s syndrome without interstitial lung disease (SS-NILD, n = 59) and Sjögren’s syndrome-associated interstitial lung disease (SS-ILD, n = 32) groups. Spearman correlation analysis was performed to assess variable relationships, and variance inflation factor (VIF) and tolerance (TOL) to quantify multicollinearity severity. Binary logistic regression was used to build models. The area under the receiver operating characteristic curve (AUC) was used to determine discriminatory ability and DeLong’s test to compare different models. Finally, model performance was assessed through calibration curves, decision curve analysis (DCA), and Bootstrap internal validation, and the contribution of imaging indicators was analyzed.

RESULTS: The occurrence of SS-ILD was associated with reduced spleen density (SD), decreased total pectoral muscle area (T-PMA), decreased right pectoral muscle area (R-PMA), lower CD4⁺T lymphocyte percentage (CD4⁺T%), lower CD4⁺/CD8⁺ ratio, and decreased complement C4 levels. There was significant collinearity between T-PMA and R-PMA, and potential collinearity between CD4⁺T% and CD4⁺/CD8⁺ ratio. Four models were constructed. Validation via calibration and decision curves confirmed that model 1 (T-PMA, SD, CD4⁺T%, and C4) had high predictive accuracy and clinical net benefit (AUC = 0.872, sensitivity = 0.813, specificity = 0.797, 95% CI: 0.800-0.945). Bootstrap internal validation indicated high stability for model 1 and analysis of model 1’s components showed enhanced predictive performance with imaging indicators.

CONCLUSION: Model 1 (T-PMA, SD, CD4⁺T%, and C4) demonstrates potential for the early prediction of SS-ILD and carries substantial clinical translational value. Key Points • Developed a SS-ILD predictive model using pectoral muscle area, spleen density, CD4⁺T cell percentage, and complement C4. • Built via correlation heatmap, collinearity diagnosis, and propensity score matching for bias control, the model includes more indicators than prior studies and has reliable internal validation. • Identified the association of pectoralis muscle cross-sectional area with SS-ILD, and potential links of systemic immune dysregulation, muscle atrophy, splenic involvement to SS-ILD pathogenesis. • Selected indicators are easily accessible, facilitating clinical application and validation.

PMID:41612106 | DOI:10.1007/s10067-026-07936-z

JACC Cardiovasc Interv. 2026 Jan 21:S1936-8798(25)03198-X. doi: 10.1016/j.jcin.2025.12.003. Online ahead of print.

ABSTRACT

BACKGROUND: Right ventricular (RV)-pulmonary arterial (PA) coupling, a measure of RV function in relation to pulmonary afterload, has emerged as a promising prognostic marker in critically ill patients and can be readily assessed using echocardiography.

OBJECTIVES: The aim of this study was to evaluate the prognostic significance of RV-PA coupling in patients presenting with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.

METHODS: This post hoc analysis of a retrospective study analyzed 973 STEMI patients (derivation and validation cohorts) undergoing primary percutaneous coronary intervention between 2014 and 2023 (median follow-up duration 4.2 years; Q1-Q3: 2.1-6.7 years). RV-PA uncoupling was assessed using echocardiography via the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP). Using maximally selected log-rank statistics, a cutoff of 0.405 mm/mm Hg for TAPSE/sPAP ratio was identified, effectively stratifying patients into high- and low-risk groups.

RESULTS: As confirmed in an external validation cohort, patients with RV-PA uncoupling showed significantly higher 1-year all-cause mortality compared with those with preserved RV-PA coupling (33.30% [95% CI: 4.65%-53.40%] vs 3.04% [95% CI: 1.40%-4.65%]; HR for 1-year mortality: 12.60; 95% CI: 4.49-35.40; P < 0.001). TAPSE/sPAP ratio outperformed TAPSE alone in predicting 1-year mortality, as demonstrated by receiver-operating characteristic curve analysis (area under the curve: 0.732 [95% CI: 0.643-0.821] vs 0.643 [95% CI: 0.537-0.732]; P = 0.018). Multivariate analysis confirmed that RV-PA uncoupling independently predicted 1-year mortality.

CONCLUSIONS: This study highlights the importance of hemodynamic equilibrium between the RV and pulmonary circulation in STEMI patients. RV-PA uncoupling (TAPSE/sPAP ratio < 0.405 mm/mm Hg) is an independent predictor of 1-year all-cause mortality in these patients, aiding in early risk stratification.

PMID:41609536 | DOI:10.1016/j.jcin.2025.12.003

JACC Clin Electrophysiol. 2026 Jan 24:S2405-500X(25)01105-3. doi: 10.1016/j.jacep.2025.12.028. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnosis of carotid sinus syndrome requires the reproduction of spontaneous symptoms during carotid sinus massage (CSM) alongside clinical features indicative of a reflex mechanism. In contrast, the significance of asymptomatic asystolic carotid sinus hypersensitivity (CSH) remains uncertain, as it is frequently observed in older adults without syncope.

OBJECTIVES: This study aimed to evaluate the correlation between asymptomatic asystolic CSH and spontaneous events documented via implantable loop recorder (ILR).

METHODS: In this study, 92 reflex syncope patients with an asymptomatic pause >3 seconds during CSM (average 4.9 ± 1.7 seconds) received an ILR and were followed for a median of 23.1 months. The control group consisted of reflex syncope patients with negative CSM drawn from a historical ILR population and matched with the propensity score method to the CSH group based on clinical variables.

RESULTS: During the observation period, 38 (41.3%) CSH patients had recurrence of syncope, which was associated with asystole of 8.0 seconds (95% CI: 5.3-13.5 seconds) in 29 (76.3%) cases. Although the actuarial rate of total syncope recurrence in CSH group was similar to that in the control group (HR: 1.22; P = 0.40), CSH patients showed a higher rate of asystolic syncope (HR: 2.13; P = 0.011) and asystolic pauses (HR: 2.06; P = 0.009).

CONCLUSIONS: Patients with asymptomatic asystolic CSH were more likely to experience spontaneous asystolic syncope than those without CSH. Among CSH patients who experienced a recurrence of syncope documented by an ILR, the positive predictive value of an asystolic pause detected during CSM was 76.3%.

PMID:41609532 | DOI:10.1016/j.jacep.2025.12.028

Int J Dermatol. 2026 Jan 29. doi: 10.1111/ijd.70306. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis is a chronic immune-mediated disease associated with multiple systemic comorbidities. Biologic therapies have transformed the management of moderate-to-severe psoriasis; however, their high cost remains a major barrier for uninsured and socioeconomically disadvantaged individuals. The Psoriasis Biologics Center for Indigent Patients at Jackson Memorial Hospital provides a structured dermatology access model for underserved populations.

METHODS: We conducted a descriptive retrospective cohort study of patients with moderate-to-severe psoriasis receiving biologic therapy through a dedicated safety-net access program between 2005 and 2025. Patient demographics, comorbidities, and management strategies were obtained from electronic medical records and standardized intake questionnaires. Only descriptive statistics were performed; standardized disease severity and quality-of-life measures such as the Psoriasis Area and Severity Index (PASI) or the Dermatology Life Quality Index (DLQI) were not available.

RESULTS: A total of 450 patients (mean age 52.6 years; 54% female) were included. Nearly half (49.8%) presented with at least one systemic comorbidity. The most common were psoriatic arthritis (35.1%), hypertension (31.3%), diabetes mellitus (20%), cardiovascular disease (19.1%), obesity (13.8%), and dyslipidemia (12.2%). Psychiatric comorbidities included depression (9.6%) and anxiety (3.8%). Infectious conditions occurred at higher-than-expected frequencies, including hepatitis B/C (3.8%), latent tuberculosis (3.6%), and human immunodeficiency virus (HIV) (2.7%). Care delivery was organized within a structured safety-net model that incorporated standardized screening protocols, referral pathways, and multidisciplinary coordination to support biological access for uninsured patients.

CONCLUSIONS: This 20-year descriptive cohort characterizes comorbidity burden and biologic access within an indigent psoriasis population. This study does not assess clinical outcomes or treatment effectiveness. These findings describe a care delivery framework that may inform future health system and health equity-focused initiatives.

PMID:41609515 | DOI:10.1111/ijd.70306

Clin Cancer Res. 2026 Jan 29. doi: 10.1158/1078-0432.CCR-25-2916. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the efficacy and safety of poly(ADP-ribose) polymerase inhibitor (PARPi) rechallenge combined with bevacizumab as maintenance therapy in patients with platinum-sensitive recurrent ovarian cancer previously treated with a PARPi.

EXPERIMENTAL DESIGN: KGOG 3056/NIRVANA-R is a multicenter, single-arm, phase II trial that enrolled 44 patients with platinum-sensitive recurrent ovarian cancer who had received ≥2 prior lines of platinum-based chemotherapy and prior PARPi maintenance. Eligible patients achieving a response to the most recent platinum therapy received daily niraparib and triweekly bevacizumab until disease progression or unacceptable toxicity. The primary endpoint was the 6-month progression-free survival (PFS) rate, analyzed using Simon’s two-stage design with adaptive statistical inference.

RESULTS: The primary endpoint was met, with 26 of 44 patients (59.1%) remaining progression-free at 6 months. The estimated 6-month PFS rate was 68% [95% confidence interval (CI), 55%-85%], and the median PFS was 11.5 months [95% CI, 7.9-not reached]. Subgroup analyses suggested greater benefit in patients with a longer treatment-free interval after the penultimate chemotherapy and in those who achieved a complete response to the most recent chemotherapy. Grade ≥3 treatment-related adverse events occurred in 27.3% of patients, with no treatment-related deaths or new safety signals observed.

CONCLUSIONS: This is the first report of PARPi rechallenge with bevacizumab as maintenance therapy in this setting. The combination demonstrated promising efficacy, particularly in patients with favorable platinum responsiveness, and warrants further investigation in biomarker-driven studies.

PMID:41609513 | DOI:10.1158/1078-0432.CCR-25-2916

J Trauma Acute Care Surg. 2026 Jan 29. doi: 10.1097/TA.0000000000004930. Online ahead of print.

ABSTRACT

BACKGROUND: Teaching hospitals serve as referral centers for pediatric trauma care. However, the impact of interhospital transfer on outcomes in pediatric traumatic brain injury (TBI) within urban teaching hospitals remains unclear. Hence, we examined whether transferred pediatric TBI patients to urban teaching hospitals experienced different outcomes from directly admitted patients, hypothesizing that results would be comparable.

METHODS: We conducted a cross-sectional study of pediatric TBI hospitalizations from 2016 to 2021 using the National Inpatient Sample database. Patients were categorized as direct admissions or transfers. Propensity score matching (1:2 with replacement) was performed using demographic, clinical, and hospital-level variables. Outcomes included in-hospital mortality, medical complications, length of stay (LOS), and postdischarge rehabilitation referral.

RESULTS: Out of 28,548 total patients, 15,324 were successfully matched with 7,239 (47.2%) interhospital transfers. Baseline demographics, clinical, and hospital characteristics were well balanced between the two groups (all standardized mean differences <10%). Unadjusted in-hospital mortality was similar between transferred and directly admitted patients (3.6% vs. 3.4%, p = 0.49). However, transferred patients experienced longer LOS (median, 2 days; interquartile range, 1-6; p < 0.001), fewer discharges to rehabilitation (5.7% vs. 6.7%, p < 0.001), and higher complications (deep vein thrombosis, 1.2 vs. 0.9; p = 0.04; urinary tract infection, 1.6 vs. 1.1; p = 0.005). After multivariable adjustment, transfer status was not associated with mortality (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.89-1.28) and rehabilitation discharge (OR, 0.92; 95% CI, 0.80-1.06). However, transfer remained independently associated with longer LOS (OR, 1.31; 95% CI, 1.24-1.39) and higher complications (OR, 1.25; 95% CI, 1.09-1.44).

CONCLUSION: Interhospital transfer was not associated with mortality or rehabilitation discharge among pediatric TBI patients treated at urban teaching hospitals. However, longer LOS and higher complications among transferred patients raise equity and system efficiency concerns. While statistically significant, these differences were modest and may not be clinically meaningful, warranting further research with more granular data.

LEVEL OF EVIDENCE: Original article, cross-sectional study; Level III.

PMID:41609509 | DOI:10.1097/TA.0000000000004930

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002018. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cohort study.

OBJECTIVE: To identify factors associated with minimally invasive surgery (MIS) utilization and compare inpatient outcomes between MIS and open fusion for traumatic thoracic vertebral fractures using a multicenter trauma registry.

SUMMARY OF BACKGROUND DATA: MIS is increasingly utilized in spine surgery due to its potential to reduce perioperative morbidity. However, its role in managing traumatic thoracic vertebral fractures remains unclear, and large-scale comparisons of MIS versus open fusion in this setting are limited.

METHODS: Adult patients (≥18 y) who underwent thoracic fusion for traumatic thoracic fractures between 2019 and 2021 were identified from the American College of Surgeons Trauma Quality Program database using ICD-10 codes. Patients were stratified by surgical approach (MIS vs. open), and demographic, injury, and clinical characteristics-as well as inpatient outcomes-were compared using chi-squared and t-tests. Multivariable logistic regression was performed to identify patient and injury factors associated with MIS utilization. A P-value < 0.05 was considered statistically significant.

RESULTS: Of 8999 patients undergoing thoracic fusion, 370 (4.1%) received MIS. MIS utilization was associated with older age, lower Injury Severity Scores, and less severe neurological impairment. The number of vertebral levels fused did not differ by approach. MIS patients had significantly shorter length of stay, higher home discharge rates, and lower rates of complications, intensive care unit admission, and mechanical ventilation.

CONCLUSION: This multicenter cohort study identifies key patient and injury characteristics associated with MIS utilization in thoracic trauma. While MIS was associated with some favorable inpatient outcomes, this may be due to selection bias rather than procedural effect. Further prospective studies are needed to clarify appropriate indications and long-term outcomes.

PMID:41609462 | DOI:10.1097/BSD.0000000000002018

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002028. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: The purpose of our study is to identify CT characteristics of unilateral cervical spine facet fractures that are predictive of instability on MRI.

SUMMARY OF BACKGROUND DATA: Management of isolated subaxial cervical spine facet fractures is typically based on the neurological status of the patient and perceived stability of the injury. It has been shown that the degree of ligamentous instability can help predict instability and need for surgery, and MRIs are increasingly being used to evaluate these injuries, but not always. While there are studies that evaluate radiographic characteristics of facet fractures on CT, there are few that specify which CT findings predict instability on MRI.

METHODS: A retrospective review of 49 patients with unilateral cervical facet fractures during a 7-year period from a level I trauma center was performed. All patients had a CT and an MRI performed. Measurements of fracture fragments were obtained from CT scans. MRIs were examined by an independent radiologist and assigned an instability score. CT measurements were compared with MRI instability scores to determine which parameters were predictive of the need for operative stabilization.

RESULTS: Forty-nine patients were identified with unilateral cervical spine facet fractures. Thirty patients initially were treated nonoperatively, and 19 patients underwent surgical stabilization. One patient failed nonoperative management, having neurological deficits and pain at follow-up, and underwent a C6-C7 ACDF later. The average instability score in the operative group was 3.34, versus 1.06 in the conservative treatment group (P<0.001). Fracture displacement (P=0.013), multifragmentary fractures (P<0.001) and MRI instability score (P<0.001) were correlated with a statistically significant increased likelihood of operative necessity.

CONCLUSIONS: Fracture size did not directly correlate with ligamentous injury. Displacement and multifragmentary fractures on CT scan were had the highest correlation with instability scores on MRI. This suggests that patients with subaxial cervical facet fractures that are comminuted or have significant displacement may require operative stabilization.

LEVEL OF EVIDENCE: Level III.

PMID:41609460 | DOI:10.1097/BSD.0000000000002028

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002030. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To compare the advantages and disadvantages of two different foraminoplasty methods.

SUMMARY OF BACKGROUND DATA: Foraminoplasty is one of the most important steps in FELD surgery. In recent years, different surgical instruments for foraminoplasty have been invented, mainly, including reamer/trephine and bone drill. Different foraminoplasty methods have different effects and limitations on the surgical outcome.The aim of this study was to compare surgical outcomes, anesthesia satisfaction, and learning curves between two different foraminoplasty procedures.

PATIENTS AND METHODS: A total of 109 patients with lumbar disc herniation (LDH) treated with full endoscopic lumbar discectomy (FELD) by the same group of physicians from October 2020 to February 2022. Patients underwent foraminoplasty with bone drill were divided into group A, while foraminoplasty with trephine as group B. Back and leg visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated at different time follow-up for evaluating surgical outcomes. Different types of anesthesia were recorded, and patients’ intraoperative pain assessment was evaluated. Learning curve was presented with operation time in chronological order.

RESULTS: There were statistically differences between VAS-back postoperative (P=0.0077) on 6 months. There was also a statistical difference in back pain symptom scores under the interaction between groups and time (P=0.147). The intraoperative VAS score of group A was significantly higher group B (P=0.008). Migration herniated discs and foraminoplasty method were the main factors affecting intraoperative pain. The operation time of group A was shorter than that of group B, while there was no statistical difference (P=0.782).

CONCLUSIONS: Both surgical techniques can achieve good curative effect (excellent rate: 87.7% vs. 89.1%). Patients in group A recovered faster on postoperative function. Patients in group B had better intraoperative experience.

PMID:41609454 | DOI:10.1097/BSD.0000000000002030