Tag: nevin manimala

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2025 Dec 28;50(12):2392-2398. doi: 10.11817/j.issn.1672-7347.2025.250276.

ABSTRACT

OBJECTIVES: Glottal insufficiency can lead to persistent hoarseness and aspiration, and some patients require surgical intervention. Vocal fold injection can improve glottic structure, but the effect of postoperative voice therapy on voice quality remains to be evaluated. This study aims to analyze the clinical efficacy of vocal fold injection with fat and rectus abdominis fascia combined with voice training in the treatment of glottal insufficiency.

METHODS: Clinical data of 15 patients with glottal insufficiency treated in the Department of Otolaryngology-Head and Neck Surgery of the Second Affiliated Hospital of Nanchang University from August 2018 to December 2024 were retrospectively collected. Patients received injection of fat and rectus abdominis fascia into the middle portion of the paralyzed vocal fold, and voice training was initiated 2 weeks after surgery. Patients were evaluated and followed up before surgery and at 3, 6, and 12 months after surgery. The primary outcome indicator was the change in glottal gap. Secondary outcome indicators included voice acoustic parameters, including maximum phonation time (MPT), normalized noise energy (NNE), shimmer, and jitter, as well as the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale score.

RESULTS: In all treated patients, the injected vocal fold was fuller than before surgery, and no leakage of injected material occurred. The injected vocal fold appeared thickened and shifted medially. Hyperemia and edema were observed within 1 week after surgery, and redness and swelling subsided after 2 months. Compared with before treatment, glottal gap, NNE, shimmer, jitter, and GRBAS scores were significantly reduced at 3, 6, and 12 months after treatment, while MPT was significantly prolonged, with statistically significant differences (all P<0.05). With the increase in the number of voice training sessions, the therapeutic effect became more significant. No patient required secondary vocal fold injection during the 12-month follow-up period.

CONCLUSIONS: Vocal fold injection with fat and rectus abdominis fascia combined with voice training can improve glottal closure and voice quality in patients with glottal insufficiency during short- and mid-term follow-up, and is a feasible treatment.

PMID:42032998 | DOI:10.11817/j.issn.1672-7347.2025.250276

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2025 Dec 28;50(12):2378-2391. doi: 10.11817/j.issn.1672-7347.2025.250190.

ABSTRACT

OBJECTIVES: Sepsis is a highly heterogeneous syndrome. This study aims to identify potential phenotypes of sepsis based on commonly used clinical inflammatory parameters and to investigate the impact of vitamin C infusion therapy on survival outcomes in patients with different phenotypes.

METHODS: Patients with sepsis in the Intensive Care Medical Information Database IV were used as the study population, and the data were randomly divided into two groups of 7:3, which were used for derivation and validation, respectively. In the derivation cohort, the K-means clustering was employed to identify potential phenotypes based on three key feature parameters: white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), and temperature, and then assess the effect of infused vitamin C treatment on survival outcomes of each phenotype by Kaplan-Meier survival analysis and multifactorial Cox proportional risk model. The same analyses were used in the validation cohort to verify the clustering effect and the heterogeneity of vitamin C efficacy on each phenotype.

RESULTS: A total of 3 771 patients were included in the final analysis, 2 639 in the derivation cohort and 1 132 in the validation cohort. In the derivation cohort, patients with sepsis were categorized into three phenotypes: cluster A (n=471, 17.8%) was characterized by moderately elevated white blood cells (WBC), neutrophil-to-lymphocyte ratio (NLR), and hyperthermia; cluster B (n=1 812, 68.7%) was characterized by mildly elevated WBC, NLR, and essentially normal body temperature, and patients with this type had the relatively best clinical status and survival prognosis, and cluster C (n=356, 13.5%) was characterized by extreme elevation of WBC and NLR, and insignificant elevation of body temperature, and patients with this type had the most severe organ dysfunction and high mortality. Significant differences in age, vital signs, history of comorbidities, laboratory tests, pathophysiological scores and clinical prognosis were found between phenotypes and showed different responsiveness to vitamin C treatment (all P<0.05). A Kaplan-Meiersurvival analysis showed that intravenous vitamin C infusion was associated with a lower risk of death at 28 days only in patients with cluster A [hazard ratio (HR)=0.388, 95% confidence interval (CI) 0.166 to 0.906, P=0.023], and this protective effect remained statistically significant after correction for confounders by multivariate Cox regression (HR=0.353, 95% CI 0.165 to 0.755, P=0.007), whereas a beneficial effect of vitamin C on survival outcomes was not detected in the other phenotypes. This heterogeneous response yielded similar results in the validation cohort.

CONCLUSIONS: This study identified three distinct sepsis phenotypes with different clinical characteristics based on three key parameters: WBC, NLR, and temperature. Each phenotype exhibits varying responsiveness to vitamin C therapy, with patients with type A sepsis benefiting from intravenous vitamin C treatment.

PMID:42032997 | DOI:10.11817/j.issn.1672-7347.2025.250190

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2025 Dec 28;50(12):2312-2324. doi: 10.11817/j.issn.1672-7347.2025.240565.

ABSTRACT

OBJECTIVES: 16S rRNA gene sequencing is an important method for studying microbial structure in samples. However, whether selecting different hypervariable regions for sequencing in the same sample affects the results remains unclear. This study aims to compare the sequencing results of 16S rRNA gene hypervariable regions V3 to V4 and V4 in children with obesity-related non-alcoholic fatty liver disease (NAFLD), and to provide evidence for scientifically evaluating gut microbiota detection results in obese children with NAFLD.

METHODS: Obese children with NAFLD and children with simple obesity who visited Hunan Children’s Hospital between January 2019 and September 2021 were selected as study subjects. Fecal samples were collected, and total DNA was extracted. After PCR amplification of the gut microbiota V3 to V4 region and V4 region, sequencing was performed. α-diversity, β-diversity, and microbial community structure differences between the 2 hypervariable regions were compared. Seven samples were selected for metagenomic sequencing as the gold standard to evaluate the performance of V3 to V4 and V4 region sequencing.

RESULTS: A total of 145 participants were included, including 92 in the case group and 53 in the control group. The number of operational taxonomic units (OTUs) obtained by V3 to V4 sequencing (16 977) was higher than that obtained by V4 sequencing (3 362). α-diversity analysis showed that in the overall population, the Shannon index (5.49±1.11) and Chao1 index (1 843.04±580.78) in the V3 to V4 region were higher than the Shannon index (4.98±0.65) and Chao1 index (379.59±47.27) in the V4 region (all P<0.001). β-diversity analysis showed overall differences in microbial community structure between the V3 to V4 and V4 regions, and the intergroup differences were greater than the intragroup differences (P<0.05). Welch’s t-test results showed that in the overall population, the numbers of differential taxa detected by V3 to V4 and V4 sequencing at the phylum, class, order, family, and genus levels were 2, 9, 35, 33, and 72, respectively; in the case group, the numbers were 1, 9, 32, 35, and 66; and in the control group, the numbers were 0, 7, 27, 21, and 0. Linear discriminant analysis effect size (LEfSe) analysis showed that V3 to V4 sequencing identified 29 differential taxa between the case group and control group, whereas V4 sequencing identified 7 differential taxa. Sensitivity analysis showed that the Shannon index obtained by V3 to V4 sequencing (5.41±1.62) was not significantly different from that of metagenomic sequencing (6.39±0.42) (P=0.169), while the Chao1 index (1 889.92±781.73) was lower than that of metagenomic sequencing (3 092.71±505.89), with a statistically significant difference (P<0.01). The Shannon index and Chao1 index obtained by V4 sequencing were both lower than those of metagenomic sequencing, with statistically significant differences (4.89±0.94 vs 6.39±0.42, 362.41±35.22 vs 3 092.71±505.89, respectively, both P<0.01).

CONCLUSIONS: Sequencing of the V3 to V4 and V4 regions of the 16S rRNA gene affects the results of gut microbiota structure analysis in obese children. The V3 to V4 region is more likely to detect differential taxa between case and control groups and provides a more accurate estimation of α-diversity. It may therefore be considered a preferred region for gut microbiota sequencing in children with NAFLD. However, there is currently no unified standard for selecting V regions in 16S rRNA gene sequencing, and the detection region and method should be selected comprehensively according to research objectives and sample characteristics.

PMID:42032992 | DOI:10.11817/j.issn.1672-7347.2025.240565

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2025 Dec 28;50(12):2277-2289. doi: 10.11817/j.issn.1672-7347.2025.250566.

ABSTRACT

OBJECTIVES: Practice related to the traditional postpartum confinement custom “Zuo Yuezi” vary among individuals, and its relationship with postpartum depression (PPD) remains unclear. This study aims to explore the current practice and heterogeneity of “Zuo Yuezi” among Chinese women and to analyze its association with PPD.

METHODS: A cross-sectional study was conducted among 542 women from 3 hospitals between January and February 2016. Data were collected on whether participants practiced “Zuo Yuezi”, their willingness and attitudes toward “Zuo Yuezi”, demographic characteristics, adherence to specific “Zuo Yuezi” practices, emotional experiences during the “Zuo Yuezi” period, and PPD symptoms. Latent profile analysis (LPA) was used to identify heterogeneity in “Zuo Yuezi” practices, and multivariate logistic regression was used to analyze the association between practice patterns and PPD.

RESULTS: A total of 542 postpartum women completed the survey. About 98% (531/542) of participants reported practicing “Zuo Yuezi”, among whom 41.2% followed traditional customs and 29.5% followed parental advice. Approximately 95% of women practiced “Zuo Yuezi” for ≥30 days, and nearly half strictly followed a 30-day “Zuo Yuezi” period. Significant heterogeneity was observed in practice components and adherence levels, with the greatest heterogeneity in dietary practices and the lowest in hygiene practices. Latent profile analysis identified 4 levels of adherence to “Zuo Yuezi” practices: low, medium-low, medium, and high. Higher adherence was associated with belief in disease prevention, home-based “Zuo Yuezi” practices, and longer “Zuo Yuezi” duration. Lower adherence was associated with an increased risk of PPD (χ²=16.103, P<0.05).

CONCLUSIONS: The practice of “Zuo Yuezi” is widespread but heterogeneous. Lower adherence to “Zuo Yuezi” practices may increase the risk of postpartum depression, highlighting the need for culturally sensitive and individualized perinatal care.

PMID:42032989 | DOI:10.11817/j.issn.1672-7347.2025.250566

Confl Health. 2026 Apr 25. doi: 10.1186/s13031-026-00792-3. Online ahead of print.

ABSTRACT

BACKGROUND: Contraception is a vital component of reproductive health, yet refugee women often face multiple barriers to accessing family planning (FP) services. This study aimed to explore contraception experiences, practices, and adherence among Syrian refugee women in Lebanon and to identify key sociodemographic predictors influencing contraceptive use.

METHODS: A descriptive, cross-sectional study was conducted between November 2023 and March 2024 among 790 married Syrian refugee women aged 18-50 across four Lebanese governorates. Structured face-to-face interviews were conducted using a validated questionnaire. Descriptive statistics and logistic regression were used to analyze the data.

RESULTS: Nearly 45% had experienced an unplanned pregnancy, with 27.4% resulting in spontaneous miscarriage and 11.3% ending in medical or surgical abortion. About 67.1% were using contraception, with withdrawal (33.2%), intrauterine devices (30.4%), and oral contraceptive pills (OCPs) (19.8%) being the most frequently used method. Among OCP users, 40% were unaware of the medication name, though adherence was generally high (mean score = 21.95 ± 3.68 on a 25-point scale). Logistic regression showed that higher parity (adjusted odds ratio [AOR] = 41.03), residing in Lebanon more than ten years (AOR = 1.57), and employment (AOR = 1.49) were significant predictors of contraceptive use (p < 0.001). Primary barriers to non-use included the desire for more children (31.9%) and spousal opposition (20.4%). More than half of the participants (52.8%) reported at least one chronic condition, with migraine with aura, hypertension, and cardiovascular disease being most common.

CONCLUSION: The high prevalence of unplanned pregnancy (44.5%) and reliance on traditional methods (33.2%) highlight critical gaps in reproductive healthcare. For women with an unmet need for contraception, cultural, informational, and systemic barriers hinder access to modern methods. Improving education, engaging men in FP initiatives, strengthening healthcare infrastructure, and enhancing access to affordable contraceptive methods are essential for advancing reproductive autonomy and health in this vulnerable population.

PMID:42032755 | DOI:10.1186/s13031-026-00792-3

J Orthop Surg Res. 2026 Apr 24. doi: 10.1186/s13018-026-06863-8. Online ahead of print.

ABSTRACT

AIMS: To compare the clinical outcomes and complication profiles of open reduction and internal fixation with plate (ORIF-P) versus reduction and internal fixation with threaded Kirschner wire (ORIF-TKW) for midshaft clavicular fractures (MCFs).

METHODS: A retrospective analysis was conducted on patients with MCFs who underwent either ORIF-P or ORIF-TKW between January 2012 and October 2023. Based on the surgical technique, patients were divided into ORIF-P and ORIF-TKW groups. The two groups were compared in terms of intraoperative blood loss, operative duration, radiographic union duration, shoulder function (Constant-Murley score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), complication rates, and implant removal characteristics.

RESULTS: Of 128 eligible patients, 85 received ORIF-P and 43 received ORIF-TKW. The ORIF-TKW group demonstrated more favorable peri‑operative metrics: shorter operative time (51.5 ± 6.4 vs. 63.6 ± 5.7 min, p < 0.001), less blood loss (38.7 ± 5.6 vs. 56.2 ± 10.1 ml, p < 0.001), and smaller incision length (3.9 ± 0.7 vs. 8.8 ± 0.9 cm, p < 0.001). Radiographic union occurred earlier in ORIF-TKW (median 5.0 vs. 6.0 months, p < 0.001). All 43 patients in the ORIF‑TKW group underwent planned implant removal, with minimal operative time and blood loss, whereas in the ORIF‑P group, only 50 patients (58.8%) underwent removal, exclusively for symptomatic reasons or patient request, with significantly more invasive removal procedures (p < 0.001). Functional outcomes at 6 months were equivalent. Complication rates did not differ significantly between groups. Two refractures in the ORIF P cohort were successfully revised using ORIF TKW.

CONCLUSION: In this single-center retrospective study, ORIF-TKW was associated with superior peri-operative outcomes, earlier radiographic union, and a less invasive planned removal procedure compared with ORIF-P, while functional recovery was similar. A post-hoc analysis demonstrated statistical comparability in fracture complexity within the 2B subgroup, partially mitigating concerns regarding selection bias. However, these findings remain hypothesis-generating and subject to residual confounding; prospective randomized trials with stratification based on fracture morphology are required before any change in routine practice can be recommended. The limited revision experience (2 cases) is insufficient to endorse threaded K-wire fixation as a routine salvage strategy.

PMID:42032746 | DOI:10.1186/s13018-026-06863-8

Trials. 2026 Apr 24. doi: 10.1186/s13063-026-09731-2. Online ahead of print.

ABSTRACT

BACKGROUND: Adenomyosis, an estrogen-dependent condition characterized by endometrial invasion into the myometrium, is associated with reduced live birth rates and increased miscarriage risk in women undergoing assisted reproductive technologies (ART). Gonadotropin-releasing hormone agonists (GnRH-a) are commonly used for pretreatment before frozen-thawed embryo transfer (FET) in adenomyosis patients, but optimal duration remains unclear. Letrozole, an aromatase inhibitor, may enhance GnRH-a efficacy by mitigating its flare-up effect and reducing peripheral estrogen production, yet high-level evidence on their combined effect is lacking. This study aims to compare the live birth rate and other pregnancy outcomes between one and two doses of GnRH-a pretreatment with or without letrozole supplementation in women with adenomyosis undergoing FET.

METHODS: This is a 2 × 2 factorial, multi-center, open-label, randomized controlled trial (RCT) conducted at three reproductive medical centers in China, with a planned enrollment of 432 women aged 20-38 years with sonographically diagnosed adenomyosis scheduled for single blastocyst FET. This study is designed as a superiority trial. Recruitment will be conducted by trained clinical research coordinators. Participants are randomized in a 1:1:1:1 ratio to four arms: one dose of GnRH-a (3.75 mg), two doses of GnRH-a, one dose of GnRH-a with letrozole (2.5 mg daily for 28 days), or two doses of GnRH-a with letrozole (2.5 mg daily for 28 days). The primary outcome is live birth rate. Secondary outcomes include fertility outcomes, pregnancy and obstetric outcomes, and neonatal outcomes. Safety outcomes, including the incidence and severity of low-estrogen-related adverse events (e.g., hot flashes, bone loss, vaginal dryness) and other serious adverse events, will be collected and compared. An internal pilot phase will assess procedural feasibility when approximately 25 participants are randomized per arm. Data are collected via medical records and follow-up assessments up to 6 months postpartum.

DISCUSSION: This factorial RCT is the first to assess the synergistic effects of GnRH-a dosage and letrozole supplementation, overcoming limitations of single-factor studies. By comprehensively evaluating pregnancy outcomes, the study aims to optimize pretreatment strategies, inform clinical guidelines, and improve pregnancy outcomes for adenomyosis patients undergoing FET.

TRIAL REGISTRATION: ClinicalTrials.gov NCT07065539. Registered on 14 July 2025. https://clinicaltrials.gov/study/NCT07065539. The first participant was enrolled in August 2025.

PMID:42032741 | DOI:10.1186/s13063-026-09731-2

J Cardiothorac Surg. 2026 Apr 24. doi: 10.1186/s13019-026-04235-1. Online ahead of print.

ABSTRACT

BACKGROUND: The increasing detection of pulmonary nodules through low-dose computed tomography screening has necessitated precise preoperative localization techniques. While local anesthesia is routinely used for CT-guided pulmonary nodule localization, it inadequately addresses deep tissue pain during pleural penetration. This study is to evaluate the analgesic efficacy and safety of ultrasound-guided erector spinae plane block (ESPB) during CT-guided pulmonary nodule localization.

METHODS: This single-center, prospective, randomized controlled trial was conducted from June 2024 to January 2025, enrolling 82 patients undergoing preoperative CT-guided pulmonary nodule localization. Participants were randomly assigned to either control group (local anesthesia with 4 ml 1% lidocaine) or ESPB group (ultrasound-guided ESPB with 20 ml 0.375% ropivacaine plus local anesthesia). The primary outcome was numerical rating scale (NRS) score during pleural penetration. Secondary outcomes included anxiety levels, radiation exposure, procedural time, hemodynamic parameters, pneumothorax incidence, and patient satisfaction. Statistical analysis was performed using independent-sample t-test and Mann-Whitney U test.

RESULTS: The ESPB group demonstrated significantly lower NRS scores during pleural penetration compared to the control group (2.68 ± 1.52 vs. 5.17 ± 1.32). Patients receiving ESPB exhibited reduced preoperative anxiety (44.71 ± 3.45 vs. 50.63 ± 3.74), decreased radiation exposure (401.06 ± 266.01 vs. 875.36 ± 377.45 mGy*cm), shorter fluoroscopy time (55.10 ± 10.54 vs. 117.39 ± 20.68 s, ), and lower pneumothorax incidence (4.88% vs. 19.51%), all P < 0.05. Post-procedural comfort scores and patient satisfaction were significantly higher in the ESPB group.

CONCLUSIONS: Ultrasound-guided ESPB improves analgesia, reduces anxiety, radiation exposure and complications while enhancing patient satisfaction during CT-guided pulmonary nodule localization, representing a valuable adjunct for thoracic interventional procedures.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06441071, registered May 8, 2024.

PMID:42032730 | DOI:10.1186/s13019-026-04235-1

Acta Neuropathol Commun. 2026 Apr 24;14(1):101. doi: 10.1186/s40478-026-02240-y.

NO ABSTRACT

PMID:42032706 | DOI:10.1186/s40478-026-02240-y

Environ Health. 2026 Apr 24. doi: 10.1186/s12940-026-01297-5. Online ahead of print.

NO ABSTRACT

PMID:42032672 | DOI:10.1186/s12940-026-01297-5