Tag: nevin manimala

BMC Surg. 2025 May 27;25(1):231. doi: 10.1186/s12893-025-02965-y.

ABSTRACT

OBJECTIVE: To investigate the effects of the pneumoperitoneum positive-pressure exhaust technique on mesh fixation and postoperative recovery in laparoscopic transabdominal preperitoneal prosthetic (TAPP) hernia repair.

METHODS: A retrospective cohort analysis was conducted on 655 patients who underwent TAPP between January 2019 and December 2023. Patients were divided into a direct suture group (n=304) and a positive-pressure exhaust group (n=351) on the basis of preperitoneal space management. In the exhaust group, a 20G needle or drainage tube was placed percutaneously before peritoneal closure. After suturing, 12 mmHg pneumoperitoneum pressure was maintained to evacuate residual gas from the preperitoneal space through the externalized needle/tube. The primary outcomes included postoperative complications (bleeding, mesh infection, seroma, reoperation) and hospitalization duration.

RESULTS: Baseline characteristics were not significantly different (P>0.05). Although not statistically significant, there were clinically meaningful differences between the groups; the exhaust group had lower seroma (11.97% vs. 16.78%, P=0.079) and mesh infection (0.28% vs. 1.32%, P=0.189) incidence rates than the direct suture group did. The exhaust group had a significantly shorter hospital stay than the direct suture group (median 7 vs. 7 days, P=0.013) and had a 0% recurrence rate at the 1-year follow-up (vs. 1.32% for the direct suture group).

CONCLUSION: The positive-pressure exhaust technique facilitates mesh fixation by eliminating dead space through improved tissue apposition. This simple, cost-effective approach may reduce the risk of recurrence, although larger prospective studies are needed to validate its long-term efficacy.

PMID:40426184 | DOI:10.1186/s12893-025-02965-y

Cardiooncology. 2025 May 27;11(1):50. doi: 10.1186/s40959-025-00343-4.

ABSTRACT

BACKGROUND: The effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on reducing cardiovascular events in different subgroups of diabetic patients are under investigation. The current systematic review and meta-analysis investigated the effects of SGLT2 inhibitors on preventing cardiovascular events and mortality and their adverse events in patients with active cancer and diabetes undergoing cardiotoxic cancer treatment.

METHODS: We searched PubMed, Embase, Web of Science, and Scopus to find studies investigating the effects of SGLT2 inhibitors on patients with diabetes and confirmed cancer until 19 August 2024. Meta-analyses were conducted using the random-effects model to compare all-cause mortality, cancer-associated mortality, heart failure (HF) hospitalization, arrhythmia, and adverse event rates such as ketoacidosis, hypoglycemia, urinary tract infection, and sepsis between patients with or without SGLT2 inhibitors use. Risk ratios (RRs) with 95% confidence intervals (CI) were used to compare outcomes between SGLT2 inhibitors and non-SGLT2 inhibitors groups.

RESULTS: Eleven studies were included with 88,096 patients with confirmed cancer (49% male). Among the total population, 20,538 received SGLT2 inhibitors (age 61.68 ± 10.71), while 67,558 did not receive SGLT2 inhibitors (age 68.24 ± 9.48). The meta-analysis found that the patients who received SGLT2 inhibitors had a significantly lower mortality rate than those who did not receive SGLT2 inhibitors (RR 0.46, 95% CI 0.34 to 0.63, p-value < 0.0001). Similarly, the cancer-associated mortality rate was also lower (RR 0.29, 95% CI 0.27 to 0.30, p-value < 0.0001). Further analysis found that the SGLT2 inhibitor group had a lower rate of HF hospitalization, compared to controls (RR 0.44, 95% CI 0.27 to 0.70, p-value = 0.0007). Moreover, patients receiving SGLT2 inhibitors had a statistically lower rate of arrhythmia (RR 0.38, 95% CI 0.26 to 0.56, p-value < 0.0001). Finally, patients in the SGLT2 inhibitors group had a lower rate of adverse events (RR 0.51, 95% CI 0.42 to 0.62, p-value < 0.0001).

CONCLUSIONS: SGLT2 inhibitors are effective in reducing mortality (all-cause and cancer-associated), HF hospitalization, arrhythmia, and drug adverse events in patients with cancer. If confirmed in future studies, these agents could be a potentially ideal candidate to prevent cardiotoxicity of cancer therapies.

PMID:40426171 | DOI:10.1186/s40959-025-00343-4

BMC Public Health. 2025 May 27;25(1):1954. doi: 10.1186/s12889-025-23051-1.

ABSTRACT

BACKGROUND: The Washington Group/UNICEF Child Functioning Module (WG/UNICEF CFM) was developed to identify children and youth with disabilities by assessing functional difficulties. This study focuses on the cognitive, emotional, and behavioral components of the WG/UNICEF CFM, as these domains are particularly relevant to understanding child and youth mental health and developmental functioning. The objective of this study was to examine the latent structure of these domains using a graded response scale in a nationally representative sample of Canadian children and youth aged 5-17 years and to evaluate how this approach captures the dimensional nature of functional difficulties.

METHODS: Data for analyses come from the 2019 Canadian Health Survey on Children and Youth (n = 33,420). Survey data were collected by Statistics Canada using an electronic questionnaire that was either self-completed online or interviewer-administered by telephone. To assess the latent structure of the WG/UNICEF CFM, analyses were conducted in four linked phases focusing on the following 9 domains: self-care, communication, learning, remembering, concentrating, accepting change, behavior, relationships, and emotions. An exploratory factor analysis (EFA) was conducted first, followed by, confirmatory factor analysis (CFA), then evaluations of measurement invariance across age and sex and external validity using structural equation modeling and instrumental variables.

RESULTS: Results indicated that a two-factor model best described the data, χ2(26, N = 16,810) = 619.076, p < 0.002, CFI = 0.98, TLI = 0.97, RMSEA = 0.037). Factor one represented Cognitive, Behavioural and Interpersonal Functional Difficulties; while Factor two represented Emotional Functional Difficulties. The construct validity tests supported the distinction between the two factors by demonstrating stronger associations with instrumental variables measuring similar underlying constructs.

CONCLUSIONS: This study extends existing research by demonstrating the utility of the WG/UNICEF CFM in assessing cognitive, behavioral, interpersonal, and emotional functional difficulties at the population level in a high-income country. The measure’s strong psychometric properties, ease of use, and cost-free administration support its applicability in general population health surveys of children and youth. Findings highlight the value of a dimensional approach to functional difficulties, offering a more comprehensive understanding of population-level variations in functioning. Integrating this measure into large-scale surveys can facilitate trend monitoring, improve data-driven policy interventions, and support strategic planning for education, healthcare, and social services. These insights contribute to optimizing resource allocation and ensuring equitable access to services that address the diverse functional needs of children and youth.

PMID:40426169 | DOI:10.1186/s12889-025-23051-1

Crit Care. 2025 May 27;29(1):216. doi: 10.1186/s13054-025-05447-y.

ABSTRACT

BACKGROUND: Fluid management is an essential component of renal replacement therapy (RRT) in critically ill patients. Both a positive cumulative fluid balance (CFB) and a high net ultrafiltration (NUF) rate have been reported to be associated with adverse outcomes in epidemiological studies, although the overall trajectory of fluid balance after RRT initiation is not well-described. We aimed to characterize trajectories of fluid management parameters during RRT and analyse the effect of CFB/NUF on outcomes as a trajectory rather than single or aggregated time points over the first week after initiation of RRT.

METHODS: This is a secondary analysis using fluid balance data focusing on individuals enrolled in the standard-strategy arm of the STARRT-AKI trial who initiated RRT. Cumulative fluid balance (CFB) following RRT initiation and daily net ultrafiltration (NUF) adjusted for body weight during the first 7 days after initiation of RRT were the main independent exposures. We modeled the trajectory of fluid parameters using spline functions and used latent trajectory analysis methods to identify predominant trajectories to compare patients’ characteristics and outcomes. We employed logistic regression and multivariable joint longitudinal models to compare the odds and determine the time-dependent association between fluid parameters (CFB and NUF) and 90-day mortality across and within the trajectory classes identified.

RESULTS: We included 855 patients in the primary analysis. After excluding erroneous fluid balance data, we identified two distinct CFB/NUF trajectories. Class A (82.8%) was characterized by a slight increase in CFB and low/stable NUF during the week following RRT initiation while class B (17.2%) was characterized by an increasingly negative CFB with initially higher daily NUF during the first 4 days followed by a stabilization after day 4. In an adjusted analysis, individuals classified in class B were at lower risk for 90-day mortality (aOR: 0.48 CI 0.32; 0.70) p < 0.001) compared to class A. Time-dependent analysis revealed higher CFB was associated with mortality only in those with a class A trajectory (aHR 1.29, 95% CI 1.03-1.55, p = 0.03).

CONCLUSIONS: Distinct CFB/NUF trajectories convey prognostic information beyond single-day fluid balance or NUF values and should be considered when formulating or interpreting fluid management strategies.

PMID:40426163 | DOI:10.1186/s13054-025-05447-y

BMC Public Health. 2025 May 27;25(1):1949. doi: 10.1186/s12889-025-23212-2.

ABSTRACT

BACKGROUND: Although it is widely recognized that insulin resistance (IR) plays a critical role in the development of erectile dysfunction (ED), the specific relationship between IR and ED among non-diabetics has been little studied, and no relevant large-scale studies have been conducted. The purpose of this study is to examine the association between different IR surrogates and the risk of ED in non-diabetic populations.

METHODS: National Health and Nutrition Examination Survey (NHANES) 2001-2004 data were used for this cross-sectional analysis. Weighted multivariable logistic regression and restricted cubic spline curves (RCS) were performed to evaluate the relationship between homeostasis model assessment (HOMA-IR), triglyceride glucose (TyG), TyG with body mass index (TyG-BMI), TyG with waist circumference (TyG-WC) and TyG with waist-to-height ratio (TyG-WHtR), and ED risk. When segmenting effects were detected, recursive algorithms were used to determine potential inflection points. Then log-likelihood ratio test and weighted segmented regression were carried out. In the sensitivity analysis, stratified and interaction analyses were performed.

RESULTS: A total of 1569 (weighted: 76450963) individuals eventually were enrolled in the study. After adjusting for all confounders, the TyG did not correlate with ED (P > 0.05), whereas the other IR surrogates, HOMA-IR, TyG-BMI, TyG-WC, and TyG-WHtR, remained positively correlated with ED [ORs (95% CIs) were 1.02 (0.95, 1.10), 1.01 (1.00, 1.02), 1.00 (1.00, 1.01), 1.17 (0.84, 1.63), respectively; all P < 0.05]. Furthermore, we found the risk of ED was significantly higher when TyG-BMI > 328.94 or TyG-WC > 1128.25 or TyG-WHtR > 6.42 [the ORs (95% CIs) were 1.05 (1.02, 1.08), 1.02 (1.01, 1.03) and 51.30 (4.46, 453.64), respectively]. No interactions were found between these IR surrogates and the stratification variables.

CONCLUSIONS: In the non-diabetic population, ED risk was positively associated with elevated HOMA-IR, TyG-BMI, TyG-WC, and TyG-WHtR.

PMID:40426154 | DOI:10.1186/s12889-025-23212-2

BMC Oral Health. 2025 May 27;25(1):815. doi: 10.1186/s12903-025-06240-7.

ABSTRACT

OBJECTIVE: The purpose of this in vitro study was to investigate the shear bond strength of high translucent monolithic zirconia and titanium alloy (Ti6Al4V) after various surface treatments using resin cement.

MATERIALS AND METHODS: Ninety Ti6Al4V specimens were randomly allocated into six groups (n = 15 per group): untreated titanium (CT; control), 50-µm alumina airborne-particle abrasion (AB), 9.5% hydrofluoric acid (HF), anodization (AN), AB followed by AN (AB-AN), and HF followed by AN (HF-AN). Representative specimen from each group was examined using a scanning electron microscope and laser confocal microscopy. The specimens were bonded with 50-µm alumina air-abraded high translucent monolithic zirconia specimen using 10-methacryloyloxydecal dihydrogen phosphate (10-MDP)-containing primer and 10-methoxyl methyl methacrylate (MMA)-based resin cement. The failure mode of was classified using a stereomicroscope. Results were analyzed by one-way ANOVA with Tukey’s adjustment for multiple comparisons (p < 0.05).

RESULTS: The mean bond strength of AB (36.9 ± 1.6 MPa) and HF (32.5 ± 3.4 MPa) groups were statistically significantly higher than other groups (p < 0.05). The AN group showed the lowest bond strength (29.55 ± 3.62 MPa); however, there was no significant difference between CT, AN, AB-AN, and HF-AN. The stereomicroscopic analysis revealed that the AN, AB-AN, and HF-AN groups predominantly showed mixed failure modes.

CONCLUSION: The surface treatment of Ti6Al4V with either 50-µm alumina airborne-particle abrasion or 9.5% hydrofluoric acid improved the bond strength between Ti6Al4V and high translucent monolithic zirconia. Anodization did not improve the bond strength, regardless of the surface treatments.

PMID:40426153 | DOI:10.1186/s12903-025-06240-7

BMC Public Health. 2025 May 27;25(1):1950. doi: 10.1186/s12889-025-23192-3.

ABSTRACT

BACKGROUND: Despite extensive research into the health effects of adverse childhood experiences (ACEs), there remains a need for nationally representative data to assess the associations between ACEs and both adult health and behaviors, focusing on the mediating role of socioeconomic inequality.

METHOD: Using data from the 2019-2022 Behavioral Risk Factor Surveillance System (BRFSS) (N = 249,186 adults), ACE exposure was categorized into five groups (0, 1, 2, 3, and 4 or more ACEs). Socioeconomic inequality was assessed based on income levels. Binary logistic regression was employed to quantify the associations of ACEs/socioeconomic inequality with adult health and behaviors. Mediation models were used to evaluate the mediating effect of socioeconomic inequality on the relationships of continuous ACE scores with adult health and behaviors.

RESULTS: Each unit increase in ACE score was associated with a 4-34% increase in the odds of adverse health outcomes or unhealthy behaviors. Compared to participants with no ACE exposure, those with ≥ 4 ACEs exhibited a higher likelihood of experiencing asthma, arthritis, cancer, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, disability, depression, more days of poor physical and mental health, and engagement in drinking, smoking and high-risk HIV behavior, with odds ratios ranging from 1.26 (95% CI: 1.22-1.31) for diabetes to 4.87 (95% CI: 4.72-5.02) for depression. Socioeconomic inequality mediated more than 5% of associations between ACE scores and diabetes, disability, COPD, and CVD.

CONCLUSIONS: This study reveals a broad spectrum of negative health impacts associated with ACE exposure, with socioeconomic inequality demonstrating a significant mediating effect on these associations. The findings emphasize the need for public health interventions targeting both ACEs and socioeconomic inequality to alleviate the burden of chronic diseases and improve adult health conditions.

PMID:40426152 | DOI:10.1186/s12889-025-23192-3

BMC Musculoskelet Disord. 2025 May 27;26(1):523. doi: 10.1186/s12891-025-08671-3.

ABSTRACT

INTRODUCTION: This study conducted statistical analysis of clinical data from cases of acute hematogenous osteomyelitis (AHO) with or without concomitant septic arthritis, with the objective of identifying factors that are indicative of concomitant septic arthritis. Predictive models will be developed to predict coexisting infections, with one that is independent of MR findings and another that incorporates MRI data.

METHODS: A retrospective review of 127 children (132 cases of AHO) treated for AHO was performed. All patients underwent MRI. The data encompassed various demographic, clinical, and diagnostic factors. Graphical and logistical regression analysis was used to determine variables independently predictive of adjacent infection. Optimal cutoff values were determined for each variable and a prediction model was created. Finally, the model was applied to our patient database and each patient with isolated AHO, or concomitant infection was stratified based upon the number of positive predictive factors.

RESULTS: The overall incidence of coexisting septic arthritis in patients with AHO was 52.2% (69/132). Four risk factors (age below 4 years, a history of preceding infection, platelet count > 390.5 × 10^9/L, and absolute neutrophil count < 5.45 × 10^3 cells/ml) were found to be predictive of concomitant infection and were included in the algorithm. Patients with ≥ 2 risk factors were classified as high risk for AHO with concomitant infection (Sensitivity: 79.41% (95% CI: [64.10%, 94.71%]), Specificity: 76.56% (95% CI: [58.61%, 94.51%]), Positive Predictive Value (PPV): 78.26% (95% CI: [63.43%, 93.09%]), and Negative Predictive Value (NPV): 77.78% (95% CI: [61.02%, 94.54%]). In MRI, joint effusion was the primary indicator of concomitant septic arthritis in patients with AHO, followed by the absence of subperiosteal abscess. The presence of subperiosteal abscess in the absence of joint effusion was highly correlated with isolated AHO, showing a 100% occurrence rate (39/39).

CONCLUSIONS: Our study successfully identified several risk factors and radiologic signs associated with concomitant septic arthritis in patients with AHO. These findings can assist clinicians in early recognition and management of coexisting infections, especially in situations where MRI is not readily available or when its findings are inconclusive. Timely identification of these factors is crucial for appropriate treatment planning and improved patient outcomes.

PMID:40426147 | DOI:10.1186/s12891-025-08671-3

BMC Nurs. 2025 May 27;24(1):604. doi: 10.1186/s12912-025-03224-4.

ABSTRACT

BACKGROUND: Due to the theory-practice gap, new ICU nurses often struggle to manage critically ill patients and high-risk conditions. While structured training programs exist, they lack standardized content and implementation path. This study aims to explore the impact of clinical pathway teaching combined with OSCE on new ICU nurses’ nursing performance and clinical competence.

METHODS: Used sampling, a quasi-experimental with non-randomized two-group study design. We selected new nurses (n = 52) who joined their ICU from August 2020 to January 2022 and divided the subjects chronologically into two groups. The experimental group used clinical pathway teaching combined with the OSCE evaluation, while the control group took the routine method. We used the six-dimension scale of nursing performance scale (6-D) and the Nursing Clinical Competence Questionnaire (CNCQ) to collect the new ICU nurses’ data before and after a two-month training cycle. Statistical analysis was performed using t-tests and χ2-test, with a significance level set at P < 0.05.

RESULTS: After training, the nurses of the experimental group had higher scores on the Nursing Clinical Competence Questionnaire (93.46 ± 11.20) compared to the control group (85.92 ± 12.19), and this difference was significant (P < 0.05). The nurses of the experimental group had lower scores on the 6-D scale before training (154.19 ± 38.32) compared to the control group (187.15 ± 32.20), the difference was significant(P < 0.05), but there was no significant difference after training (P>0.05).

CONCLUSION: Clinical pathway teaching combined with OSCE improve the clinical competence of new ICU nurses, and promote nursing performance. However, job experience and clinical environment might influence nursing performance.

PMID:40426134 | DOI:10.1186/s12912-025-03224-4

Biomed Eng Online. 2025 May 27;24(1):66. doi: 10.1186/s12938-025-01397-2.

ABSTRACT

PURPOSE: Design an algorithm to calculate the bending angle of the puncture needle for transjugular intrahepatic portosystemic shunt (TIPS) procedures and achieve three-dimensional visualized path planning.

MATERIALS AND METHODS: Based on enhanced CT images, a thresholding segmentation method was used to perform three-dimensional reconstruction of the hepatic vasculature, with the target puncture point selected by the interventional physician. The puncture needle was modeled using second-order Bézier curves and arcs. Subsequently, the bending points were selected, and the optimal bending angles were calculated based on the target puncture point. The puncture pathway was then verified and visualized in three dimensions using Mimics software. Data from 32 patients who successfully underwent TIPS procedures were retrospectively collected for clinical validation and statistical analysis.

RESULTS: The error between the tip position of the puncture needle catheter modeled with Bézier curves and the actual puncture needle was 0.15 cm, while the error for the arc modeling was 0.19 cm. The optimal bending angle of the puncture needle calculated by this algorithm was validated in Mimics software, successfully achieving path planning. Among the 32 patients, the difference between the actual bending angle of the puncture needle and the calculated bending angle was 1.06° ± 1.82° (95% CI 0.41-1.72°). The equivalence test results indicated that there was a significant equivalence between the measured angle and the angle calculated by the algorithm (p < 0.001).

CONCLUSION: This study successfully designed an algorithm for calculating the bending angle of the puncture needle in TIPS procedures, which demonstrated equivalence with the clinically observed bending angles.

PMID:40426132 | DOI:10.1186/s12938-025-01397-2