Tag: pubmed

Diagn Cytopathol. 2025 Jul 13. doi: 10.1002/dc.25497. Online ahead of print.

ABSTRACT

AIM: There are studies suggesting that the use of a uterine manipulator during minimally invasive surgery (MIS) may lead to tumor spread in endometrial cancer patients, and there is no clear consensus on the safety of uterine manipulator use. The aim of this study was to investigate the effect of uterine manipulator use on peritoneal cytology (PC) results obtained before and after hysterectomy in endometrial cancer patients.

METHODS: A single-center, prospective observational study was conducted, including 108 patients who were diagnosed with endometrial cancer and underwent surgical intervention. The patients were divided into three groups: Group 1 (n = 36), total abdominal hysterectomy (TAH); Group 2 (n = 41) laparoscopic hysterectomy with intrauterine manipulator (TLH with IUM); and Group 3 (n = 31) laparoscopic hysterectomy without IUM (TLH without IUM). PC samples were taken before and after the hysterectomy, and cytology results were compared among the groups.

RESULTS: Of the 108 patients included in the study, 33.3% (36/108) were in Group 1, 38% (41/108) were in Group 2, and 28.7% (31/108) were in Group 3. The clinical and demographic data among the groups were similar (p > 0.05). PC was positive in six of the 108 patients. In the TLH with IUM group, one patient with a negative cytology sample before the manipulation showed a positive result after the hysterectomy.

CONCLUSIONS: Although statistical significance was not reached, utilizing an IUM to manage endometrial cancer with MIS may enhance cytology positivity. This finding requires further validation through larger prospective studies.

PMID:40652525 | DOI:10.1002/dc.25497

J Med Entomol. 2025 Jul 13:tjaf082. doi: 10.1093/jme/tjaf082. Online ahead of print.

ABSTRACT

A Bayesian Procrustes analysis (BPA) was used to discriminate livestock-associated species: Culicoides innoxius Sen and Das Gupta, Culicoides peregrinus Kieffer, and Culicoides oxystoma Kieffer. BPA results were compared with classical geometric morphometric analysis (CGMA). Markov Chain Monte Carlo (MCMC) parameters, Kullback-Leibler (KL) divergence, Hellinger distance, and total variation distance were considered. BPA validation was further done using CGMA. BPA depicted significant differences at 95% credible intervals (CrIs) in their posterior distribution of Procrustes variance (σ) between the species with minimum overlap between closely related ones, C. innoxius and C. peregrinus, and no overlap between distantly related C. oxystoma and C. peregrinus; C. innoxius. MCMC posterior convergence plots supported the accuracy of the BPA. In the trace plots, the MCMC explored the parameter space effectively. For the estimation of divergence between the distribution of species, KL divergence, Hellinger distance, and total variance distance were calculated, which exhibited the highest dissimilarity between C. oxystoma and C. innoxius, followed by C. oxystoma and C. peregrinus and the lowest was between C. peregrinus and C. innoxius. The effectiveness of the BPA over CGMA was assessed by incorporating Culicoides regalis individuals within the analysis. In BPA, an erratic convergence plot indicated the presence of C. regalis within the C. innoxius dataset, whereas CGMA could not separate C. regalis. This is probably the first time the Bayesian approach has been used in Culicoides taxonomy. So far, the results have yielded reliable, sensitive, and accurate species identification.

PMID:40652506 | DOI:10.1093/jme/tjaf082

Neurol India. 2025 Jan 1;73(1):102-109. doi: 10.4103/neurol-india.Neurol-India-D-24-00350. Epub 2025 Feb 7.

ABSTRACT

OBJECTIVE: To use machine learning tool to predict visual outcomes.

METHODS: A retrospective cohort of 284 consecutive pituitary adenoma patients with preoperative visual deficit was used. Patient variables were collected. Preprocessing and classification was done in the open source ML tool box Weka (Ver 3.8.4). Four algorithms were used for classification-the J48 trees, LMT algorithm, the REP tree algorithm, and the Random Forest.

RESULTS: The study included a total of 284 patients. The mean duration of visual symptoms was 10.09 ± 4.3 months. There were 24 patients with uniocular involvement and 260 patients with binocular visual impairment: Vision improved in 89.78% patients, remained same in 9.86% and deteriorated in 0.3% patients and were same in 9.86% patients and deteriorated in 0.3% patient. Factors like extent of resection, preoperative visual acuity, tumor volume, and duration of symptoms were found to have statistically significant effect on postoperative visual outcome. The model predicting visual improvement had an AUC of 0.846; 88.94% accuracy, 78.4% specificity, and 93.7% sensitivity; 90.5% and 85.04% positive and negative predictive value, respectively; an F1 score of 0.921; and a Brier score of 0.291.

CONCLUSIONS: Postoperative visual outcomes of pituitary adenoma surgery and factors affecting it can be predicted with 88.94% accuracy using a machine learning approach. Based on this preliminary evaluation, ML appears promising in predicting visual outcomes after endoscopic resection of pituitary adenomas, thus improving patient-tailored care and counselling.

PMID:40652476 | DOI:10.4103/neurol-india.Neurol-India-D-24-00350

Neurol India. 2025 Jan 1;73(1):49-54. doi: 10.4103/ni.ni_1155_22. Epub 2025 Feb 7.

ABSTRACT

BACKGROUND: Traumatic brain injuries (TBI) pose a major public health challenge to the Indian health system. The trajectory of patients from the site of injury to definitive management needs to be understood to improve prehospital management.

OBJECTIVE: We conducted a prospective survey to review the epidemiological and pre-hospital characteristics of TBI patients requiring emergency surgical intervention at a level I neuro-trauma care center.

METHODS AND MATERIALS: Patients who underwent emergency neurosurgical management for TBI at the National Institute of Mental Health and Neurosciences (NIMHANS, Bangalore) between June 2021 and December 2021 were included in the study.

RESULTS: A total of 214 patients were included in the study (86% males). The most common cause of TBI was road traffic accidents (70%) which involved a motorized two-wheeler in 87% of the cases. No safety gear was used in 87% of the road traffic accidents. The median delay in first contact with any medical facility was 60 min. The median time of seeking care at NIMHANS was 6 h and 50 min after the injury. More than one-third of the patients had visited two or more health facilities before reaching NIMHANS for treatment.

CONCLUSION: Road traffic accidents without safety gear constitute the major cause of TBIs requiring emergency surgery. A major challenge exists in prehospital care and organized hospital transfer of acute TBI patients requiring emergency surgery.

PMID:40652468 | DOI:10.4103/ni.ni_1155_22

Neurol India. 2025 Jan 1;73(1):17-28. doi: 10.4103/neurol-india.Neurol-India-D-24-00263. Epub 2025 Feb 7.

ABSTRACT

Chronic subdural hematoma (cSDH) is a prevalent neurosurgical disorder with increasing incidence, especially among the geriatric population. Although surgical management has been the conventional approach, the optimal strategy remains debated. Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential alternative, but its efficacy and safety require thorough investigation. This systematic review and meta-analysis aimed to evaluate the role of TXA in the management of cSDH, focusing on its impact on recurrence rates, clinical outcomes, and adverse events. Randomized controlled trials (RCTs) reporting on the safety and efficacy of TXA in adult patients with cSDH were systematically searched in multiple databases. Primary outcomes included clinical and radiological recurrence requiring re-surgery, while secondary outcomes encompassed adverse events and mortality associated with TXA treatment. A comprehensive search yielded 35 articles, with four RCTs meeting the inclusion criteria. The meta-analysis, involving 148 patients, demonstrated no significant reduction in mean postoperative volume at follow-up or recurrence rates with TXA use. Heterogeneity was low to moderate, and no significant adverse events were observed. Although there is a trend toward early and more complete resolution of cSDH with TXA acid after burr hole drainage, the results lack statistical significance to advocate its routine use in post-surgical management. TXA appears safe in cSDH, emphasizing the need for further research to establish its definitive role in reducing recurrence rates.

PMID:40652463 | DOI:10.4103/neurol-india.Neurol-India-D-24-00263

Tech Coloproctol. 2025 Jul 13;29(1):139. doi: 10.1007/s10151-025-03167-7.

ABSTRACT

BACKGROUND: Patients with lateral lymph node metastasis (LLNM) present particular challenges for both diagnosis and treatment. This study aimed to assess whether indocyanine green (ICG)-assisted lymph node mapping with near-infrared imaging (NIRI) enhances the effectiveness of lateral lymph node dissection (LLND) by further categorizing the lateral lymph nodes in patients with mid-low rectal cancer.

METHODS: Submucosal indocyanine green injection was performed on the distal margin of the rectal cancer. In the ICG-LLND group, the lymphatic drainage pathway and distribution of lateral lymph nodes (LLNs) were explored using a laparoscopic NIRI system. Pathological evaluations were conducted for both the ICG-LLND group and the control group.

RESULTS: The ICG-LLND group demonstrated a significantly shorter postoperative hospital stay compared to the control group, both before (P < 0.001) and after (P = 0.001) matching. While blood loss and operating time were similar between groups, the ICG-LLND group had fewer cases of anastomotic leakage (P = 0.206). Postoperative lymph node harvesting was significantly higher in the ICG-LLND group, with more total lymph nodes (P = 0.001) and lateral lymph nodes (P = 0.002) harvested. The number of harvested lymph nodes in the obturator and internal iliac regions was also higher in the ICG-LLND group (P = 0.001), and the number of positive lymph nodes in these regions was significantly greater before (P = 0.027) and after (P = 0.013) matching. Univariate and multivariate analyses showed that ICG-LLND, nCRT, and positive pN stage were associated with increased lymph node harvest.

CONCLUSIONS: ICG-LLND improved lateral lymph node harvest, particularly obturator lymph nodes, and shortened postoperative hospital stay without increasing complications. This technique may enhance surgical outcomes in patients requiring lymph node dissection.

PMID:40652430 | DOI:10.1007/s10151-025-03167-7

J Comput Aided Mol Des. 2025 Jul 13;39(1):48. doi: 10.1007/s10822-025-00629-w.

ABSTRACT

Identifying orthosteric binding sites and predicting small molecule affinities remains a key challenge in virtual screening. While blind docking explores the entire protein surface, its precision is hindered by the vast search space. Cavity detection-guided docking improves accuracy by narrowing focus to predicted pockets, but its effectiveness depends heavily on the quality of cavity detection tools. To overcome these limitations, we developed Consensus Blind Dock (CoBDock), a machine learning-based blind docking method that integrates molecular docking and cavity detection results to enhance binding site and pose prediction. Building on this, CoBDock-2 replaces traditional docking tools by extracting 1D numerical representations from protein, ligand, and interaction structural features, and applying advanced ensemble feature selection techniques. By evaluating 21 feature selection methods across 9,598 features, CoBDock-2 identifies key molecular characteristics of orthosteric binding sites. CoBDock-2 demonstrates consistent improvements over the original CoBDock across benchmark datasets (PDBBind v2020-general, MTi, ADS, DUD-E, CASF-2016), achieving 77% binding site identification accuracy (within 8 Å), 55% ligand pose prediction accuracy (RMSD $\le$ 2 Å), a 19% reduction in the mean distance to ground truth ligands within the binding site, and an 18.5% decrease in the mean pose RMSD. Statistical analysis across the combined benchmark set confirms the significance of these improvements ( $\text{p}<0.05$ ). Notably, the Weighted Hybrid Feature Selection variant in CoBDock-2 further increases binding site accuracy to 79.8%, demonstrating the benefit of combining multimodel and ensemble feature selection strategies. Variability in predictions also decreased significantly, highlighting enhanced reliability and generalizability. Also, a low-bias hypothetical comparison with a state-of-the-art DiffDock + NMDN method was conducted to position CoBDock-2 relative to modern deep learning-based docking strategies.

PMID:40652425 | DOI:10.1007/s10822-025-00629-w

Pediatr Surg Int. 2025 Jul 13;41(1):208. doi: 10.1007/s00383-025-06123-6.

ABSTRACT

PURPOSE: Ureteropelvic junction obstruction (UPJO) in duplex systems is rare, with laparoscopic pyeloplasty (LP) and laparoscopic pyelo-ureterostomy (LPU) being the main surgical options. However, guidelines for selecting the appropriate procedure based on anatomical variations are lacking. This study evaluates the outcomes of laparoscopic management of duplex UPJO in children, comparing LP and LPU.

METHODS: A retrospective review was conducted on children who underwent surgery for UPJO in duplex systems at two pediatric urology centers over 10 years. Preoperative imaging included ultrasound, diuretic renogram, voiding cystourethrography, and magnetic resonance urography when needed. Retrograde pyelography confirmed anatomy. LP was preferred for lower moiety (LM) UPJO, while LPU was performed for short-segment or hypoplastic incomplete duplex. All children had double J stents for 4-6 weeks. Statistical analysis used t tests and Chi-square tests.

RESULTS: Among 25 children (complete: 11, incomplete: 14), LP was performed in 9/11 complete and 3/14 incomplete cases (p = 0.01). LPU was performed in 11 incomplete cases. The mean operative time was 113 min for LP and 137 min for LPU (p = 0.01). The median hospital stay was 2 days. Two children had postoperative UTIs, and one had early stent expulsion. Outcomes were favorable in all cases.

CONCLUSION: Duplex UPJO consisted of only 3.2% of a large cohort of UPJO from two busy pediatric urology centers. LP was possible in most UPJO in complete duplex, while most UPJO in incomplete duplex had to be managed with LPU. Although LPU was more challenging with longer operative time than LP, both LP and LPU had comparably good results. We strongly recommend intraoperative RGP in all cases of suspected duplex to decide the best surgical option in each case.

PMID:40652413 | DOI:10.1007/s00383-025-06123-6

Eur J Orthop Surg Traumatol. 2025 Jul 13;35(1):302. doi: 10.1007/s00590-025-04433-y.

ABSTRACT

PURPOSE: To investigate the relationship between urinary toxicology screen and traumatic femoral shaft fractures treated with intramedullary fixation, as well as assessing their impacts on morphine milligram equivalents (MME) and hospital length of stay (LOS).

METHODS: Design: Retrospective Chart Review; Setting: Single center, non-academic community level II trauma center; Patient Selection Criteria: All patients who were 16 years or older, and admitted to the hospital following a trauma activation for a femoral shaft fracture were included in the study. Exclusion criteria included patients without a urine toxicology screen, with low energy mechanisms or pathologic fractures, or those with miscoded charts. Outcome Measures and Comparisons: The primary outcomes of this study were MME and hospital LOS. Patients were grouped based on whether or not they had a positive or negative urinary drug screen.

RESULTS: A total of 144 patients met inclusion criteria having sustained femoral shaft fractures treated with intramedullary fixation. 34 patients were excluded from the study for not meeting one or more inclusion criteria. A total of 110 patients met the criteria for analysis. No positive UDS was found to correlate significantly with hospital LOS, and amongst all drugs screened for, only opiates were found to have a statistically significant increase in morphine milligram equivalents per day. Additionally, a negative UDS for opiates showed statistically significant correlation with ICU admission (p value 0.0273).

CONCLUSIONS: Trauma patients with a positive UDS for opioid use, and a femoral shaft fracture treated with intramedullary nail, are at an increased risk for higher MME requirements during their hospitalization, independent of ISS.

PMID:40652410 | DOI:10.1007/s00590-025-04433-y

Ann Med. 2025 Dec;57(1):2529578. doi: 10.1080/07853890.2025.2529578. Epub 2025 Jul 13.

ABSTRACT

OBJECTIVES: This study was to compare the worldwide burden of musculoskeletal (MSK) disorders with the age and gender-specific trends of MSK disorders in China and globally between 1990 and 2021.

METHODS: Using publicly available data from the Global Burden of Disease (GBD) database from 1990 to 2021. Examined the features of the burden of MSK disorders in China and globally, including age and gender-specific trends in incidence, prevalence, mortality, disability-adjusted life years (DALYs), and related age-standardized measures of MSK disorders. To represent the trends in the burden of MSK disorders, the average annual percentage change (AAPC) was computed using Joinpoint. Age, gender were important parameters that were used a comparative study of the disparities in the burden of MSK disorders between China and the global.

RESULTS: The worldwide ASIR of MSK disorders rose from 4641.50 to 4358.54 between 1990 and 2021, and China fell from 4039.13 to 3634.09 per 100,000. The worldwide ASPR rose from 19178.47 to 19836.76, China, went from 16966.24 to 17358.70 per 100,000. The ASMR in China declined from 1.22 to 1.10, while the worldwide decreased from 1.55 to 1.47 per 100,000. The ASDR in China declined from 1615.73 to 1578.71, while the worldwide ASDR decreased from 1886.22 to 1916.21 per 100,000. The worldwide AAPC of ASIR, ASPR, ASMR, and ASDR was -0.21%, 0.11%, -0.25%, and 0.04%, respectively. China was -0.34%, 0.09%, -0.41%, and -0.07%, respectively. The burden of MSK disorders was influenced similarly by age and gender.

CONCLUSION: The burden of MSK disorders rose in China and globally between 1990 and 2021, and it varies with age. Women are more prone than men to acquire MSK disorders. Because of its vast and aging population, MSK disorders continue to be a major public health concern in China and globally.

PMID:40652401 | DOI:10.1080/07853890.2025.2529578