Tag: pubmed

J Am Acad Orthop Surg Glob Res Rev. 2025 Nov 3;9(11). doi: 10.5435/JAAOSGlobal-D-25-00094. eCollection 2025 Nov 1.

ABSTRACT

BACKGROUND: Vitamin D deficiency has been linked to poor outcomes after spinal deformity correction, but it is unclear whether osteoporosis is the underlying factor. This study analyzed a national administrative database to clarify this association.

METHODS: The 2010 to Q1 2022 PearlDiver M161 database was queried for adult spinal deformity surgeries. Patients were stratified by not having versus having vitamin D deficiency diagnosis and matched 4:1 based on age, sex, and Charlson Comorbidity Index (CCI), and multivariate analysis (controlling for age, sex, and CCI) for 90-day postoperative adverse events was used to calculate odds ratios (ORs, Bonferroni correction, α < 0.00417). These methods were then repeated adding osteoporosis to the matching and multivariate controlling variables. Kaplan-Meier analysis comparing 5-year cumulative revision surgery rates was also performed for both sets of comparisons.

RESULTS: In the primary analyses matching for age, sex, and CCI, the vitamin D deficiency cohort showed a higher likelihood of osteoporosis. Multivariate analysis demonstrated that vitamin D deficiency was associated with increased odds of aggregated any (OR 1.34) and minor adverse events (1.39), as well as wound dehiscence (OR 1.91). The vitamin D deficiency group had a higher 5-year revision surgery rate (39.3% vs. 31.7%, P = 0.006).When osteoporosis was included as a matched/controlled variable, vitamin D deficiency was only associated with higher odds of aggregate any (OR 1.35) adverse events and urinary tract infection (OR 1.56). No difference in 5-year revision surgery rates was observed.

CONCLUSION: Following adult deformity surgery, many of the perioperative adverse outcomes were similar regardless of controlling for osteoporosis, but 5-year revisions seemed to be driven by the osteoporosis rather than vitamin D deficiency.

PMID:41187292 | DOI:10.5435/JAAOSGlobal-D-25-00094

J Am Acad Orthop Surg Glob Res Rev. 2025 Nov 3;9(11). doi: 10.5435/JAAOSGlobal-D-25-00091. eCollection 2025 Nov 1.

ABSTRACT

BACKGROUND: Complete and partial flexor tendon lacerations are challenging injuries to diagnose and manage. Imaging modalities can determine grade of laceration, and location of tendon ends preoperatively while detecting presence of adhesions, repair failure, and gap formation postoperatively. Despite these clear advantages, imaging modalities are underutilized because of issues with availability and concerns about accuracy.

METHODS: A systematic search of MEDLINE and Embase was conducted to identify papers examining the accuracy of ultrasonography (US) and MRI in preoperative and postoperative management of flexor tendon lacerations. COVIDENCE was used in blinded selection of papers for abstract and full-text review. R Studio was used for meta-analysis of pooled sensitivities and specificities, diagnostic odds ratios, and summary receiver operating curves of both US and MRI.

RESULTS: A total of 1197 papers were returned, with 40 being selected after full-text review and 24 being sufficient for statistical analysis. Significant heterogeneity existed for preoperative sensitivity of US and MRI, as well as preoperative specificity of US. MRI was more specific than US in the postoperative period (P < 0.01). Diagnostic odds ratios were >1 for all imaging modalities. The area under the curve for summary receiver operating curves in US preoperative, US postoperative, MRI preoperative, and MRI postoperative were 0.92, 0.81, 0.83, and 0.91, respectively.

CONCLUSION: MRI is likely more specific than US in postoperative detection of tendon adhesions, tendon rupture, and gap formation following tendon repair. Notable heterogeneities exist in the literature, highlighting the future need for standardized comparisons of imaging modalities in preoperative management.

PMID:41187290 | DOI:10.5435/JAAOSGlobal-D-25-00091

J Am Acad Orthop Surg Glob Res Rev. 2025 Nov 3;9(11). doi: 10.5435/JAAOSGlobal-D-25-00007. eCollection 2025 Nov 1.

ABSTRACT

INTRODUCTION: The prevalence of ossification of the posterior longitudinal ligament (OPLL) has been primarily studied in East Asian countries; its prevalence in Western populations remains to be elucidated. We aimed to determine the prevalence of OPLL in a Chilean population aged 60 years and older using fluorine-18 fluorodeoxyglucose positron emission tomography and CT (PET-CT) as screening tool.

METHODS: We evaluated patients between 60 and 73 years consecutively studied with PET-CT in a University Hospital. We assessed whole-body CT scans in both sagittal and axial views to detect the presence of OPLL. We used the Mann-Whitney test to analyze continuous variables, the Fisher test for categorical variables, and a logistic regression analysis to determine the independent effect of age and sex on the presence of OPLL.

RESULTS: We studied 1,009 patients (median age = 66 years); 597 were males (59.17%). Nineteen patients had OPLL, with a prevalence of 1.88% (1.04 to 2.72). OPLL was more prevalent in men (2.68%) than in women (0.73%; P = 0.02). All cases presented cervical involvement; only one had cervical and thoracic OPLL. The median age of patients with OPLL (64 years) and without OPLL (66 years) was not statistically different (P = 0.09). Male sex independently influenced the presence of OPLL (odds ratio = 3.85 [1.11 to 13.33]), age did not (odds ratio = 0.89 [0.78 to 1.02]).

DISCUSSION: This is the first study evaluating the prevalence of OPLL in Latin America. It shows a prevalence alike that in non-Asian populations in the United States and lower than the prevalence described in Asian populations.

PMID:41187288 | DOI:10.5435/JAAOSGlobal-D-25-00007

Interact J Med Res. 2025 Nov 4;14:e57731. doi: 10.2196/57731.

ABSTRACT

BACKGROUND: A growing body of evidence has identified that people’s physical health could influence self-rated health and quality of life (QoL). However, only focusing on physical health is not adequate for the well-being of older adults. Studies focusing on the impact of psychological well-being on self-rated health and QoL are still rare.

OBJECTIVE: This study aimed to identify the mediating effect of depression on the association between psychological well-being and self-rated health and QoL to comprehensively understand the relationship between them.

METHODS: We used a cross-sectional study design and secondary data analysis from the Chinese Longitudinal Healthy Longevity Survey of 2017 to 2018. Path analysis was applied to examine the research questions.

RESULTS: A large sample of 8839 older adults was included. Among them, more positive affect was found among those who were younger and had more years of schooling, higher household income, greater social security and social insurance, lower depression levels, and higher self-rated health levels. Depression had a partial mediation effect of psychological well-being on self-rated health and QoL, which explained 36% of the total variance (R2=0.36). In addition, psychological well-being had a statistically significant direct effect on self-rated health and QoL (β=0.290; P<.001).

CONCLUSIONS: Our results indicate that psychological well-being had both direct and indirect effects on self-rated health and QoL. Depression was an important mediator that regulated the effect pathway in older adults.

PMID:41187287 | DOI:10.2196/57731

J Magn Reson Imaging. 2025 Nov 4. doi: 10.1002/jmri.70158. Online ahead of print.

ABSTRACT

BACKGROUND: Gadolinium-based contrast agents (GBCAs) are used in MRI, yet concerns about gadolinium ion release, tissue retention, rare adverse events, and environmental persistence have encouraged the search for alternatives. Prior work on plant-based extracts has been largely confined to gastrointestinal luminal imaging, with limited exploration in extraluminal organs as contrast agents.

PURPOSE: To preclinically investigate the potentials of Betanin and beetroot-derived Betanin-based contrast agents (BBCA) in vitro and in vivo via oral, intravenous, and intraperitoneal administration, and to compare them with gadobutrol (a GBCA).

STUDY TYPE: Prospective preclinical experimental study.

SUBJECTS: In vitro studies on human and mouse fibroblast cell lines, and in vivo tests involving male Wistar albino rats (n = 15) and male New Zealand albino rabbits (n = 2).

FIELD STRENGTH/SEQUENCE: 3 T, spin echo, and gradient echo sequences.

ASSESSMENT: Betanin and BBCA compositions were characterized by mass spectrometry. Safety was assessed by in silico modeling, cytotoxicity, flow cytometry, histology, and blood biochemistry tests. Images of phantom solutions were used to characterize the paramagnetic features via MR relaxation times and relaxivities. In vivo contrast behavior in organs was evaluated following oral, intraperitoneal, and intravenous administrations.

STATISTICAL TESTS: The quantitative data were analyzed with Microsoft Excel and GraphPad Prism 9.0; p value < 0.05 was significant.

RESULTS: Betanin had greater molecular binding efficiency and therapeutic capacity. BBCA was less cytotoxic than gadobutrol. Some elements in BBCA were present in larger amounts than Betanin. T₁ and T₂ decreased with an increase in BBCA concentration, and r₁ and r₂ were estimated as 0.0014 and 0.0224 mmol^-1 s^-1, respectively. Both agents demonstrated contrast enhancements not only in the gastrointestinal lumen but also in the parenchymal organ, as well as in the vascular structure, with lower toxicity and antioxidative benefits. In particular, the enhancement in the liver was noteworthy.

DATA CONCLUSION: Betanin and BBCA may be considered as viable options for contrast-enhanced abdominal MRI.

PMID:41186973 | DOI:10.1002/jmri.70158

Int J Cancer. 2025 Nov 4. doi: 10.1002/ijc.70219. Online ahead of print.

ABSTRACT

In stages II and III hormone receptor positive (HR+) breast cancer, selecting patients for primary surgery (PS) or neoadjuvant therapy remains challenging. This study assessed the occurrence of minimally invasive surgery in the case of PS, neoadjuvant endocrine therapy (NET), and neoadjuvant chemotherapy (NACT). This cohort study included women diagnosed with stages II and III, HR+ breast cancer in 2020-2022 in the Netherlands. Women with positive human epidermal growth factor receptor 2 (HER2+) cancer were excluded. Outcomes focused on surgical techniques and additional treatment. Of the 7809 patients, 4046 (51.8%) underwent PS, 956 (12.2%) received NET and 2807 (35.9%) NACT. NET patients were older (median: 71 years [33-94]), while NACT patients had larger tumors and more lymph node involvement (p < .001). Breast-conserving surgery (BCS) was the first procedure in 2153 (53.2%) PS women, in 694 (72.6%) NET women and 1564 (55.7%) NACT cases. There was no difference regarding free surgical margins in NET versus NACT patients (p = .421). After adjusting for T-stage, BCS occurred significantly more frequently after NET (p < .001). Minimal invasive surgery on the axilla was common after NET (83.9%) and NACT (81.5%). In the PS group, 85% received adjuvant systemic therapy. Optimizing patient selection for neoadjuvant strategies could reduce surgical morbidity. NET was frequently associated with BCS, showed comparable surgical margin outcomes to NACT, and contributed to reduced axillary surgery. These findings suggest that NET is an effective strategy, compared to PS, to facilitate less invasive surgery on the breast and axilla, in HR+/HER2-, stages II and III breast cancer.

PMID:41186970 | DOI:10.1002/ijc.70219

J Magn Reson Imaging. 2025 Nov 4. doi: 10.1002/jmri.70162. Online ahead of print.

ABSTRACT

BACKGROUND: Access to prostate MRI remains limited due to resource constraints and the need for expert interpretation.

PURPOSE: To develop machine learning (ML) models that enable risk-based triage for prostate MRI (ProMT-ML) in the evaluation of prostate cancer.

STUDY TYPE: Retrospective and prospective.

POPULATION: A total of 11,879 retrospective MRI scans for suspected prostate cancer from a multi-hospital health system, divided into training (N = 9504) and test (N = 2375) sets. A total of 4551 records for prospective validation.

FIELD STRENGTH/SEQUENCE: 1.5T and 3T/Turbo-spin echo T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE).

ASSESSMENT: Prostate Imaging Reporting and Data System (PI-RADS) scores were retrieved from MRI reports. The Boruta algorithm was used to select final input features from candidate features. Two models were developed using supervised ML to estimate the likelihood of an abnormal MRI, defined as PI-RADS ≥ 3: Model A (with prostate volume) and Model B (without prostate volume). Models were compared to PSA. Prostate biopsy pathology was assessed to evaluate potential clinical impact.

STATISTICAL TESTS: Area under the receiver operating characteristic curve (AUC) was the primary performance metric.

RESULTS: A total of 5580 (46.9%) subjects had a PI-RADS score ≥ 3. After feature selection, Model A included age, PSA, body mass index, and prostate volume, while Model B included age, PSA, body mass index, and systolic blood pressure. Both models A (AUC 0.711) and B (AUC 0.616) significantly outperformed PSA (AUC 0.593). Compared to PSA threshold > 4 ng/mL, Model A demonstrated significantly improved specificity (28.3% vs. 21.9%) and no significant difference in sensitivity (89.0% vs. 86.7%). Among false negatives (Model A: 8.0% (62/776); Model B: 16.8% (130/776)), most (Model A: 87%; Model B: 69%) had benign or clinically insignificant disease on biopsy. On prospective validation, both versions of ProMT-ML significantly outperformed PSA.

DATA CONCLUSION: ProMT-ML provides personalized risk estimates of abnormal prostate MRI and can support triage of this test.

TECHNICAL EFFICACY: Stage 4.

PMID:41186967 | DOI:10.1002/jmri.70162

JAMA Netw Open. 2025 Nov 3;8(11):e2541321. doi: 10.1001/jamanetworkopen.2025.41321.

NO ABSTRACT

PMID:41186952 | DOI:10.1001/jamanetworkopen.2025.41321

JAMA Netw Open. 2025 Nov 3;8(11):e2540730. doi: 10.1001/jamanetworkopen.2025.40730.

ABSTRACT

IMPORTANCE: The choice of first line hormonal therapy in metastatic hormone-sensitive prostate cancer (mHSPC) is often based on comorbidities or physician preference due to the lack of data comparing abiraterone and enzalutamide in clinical trials and in clinical practice settings, especially in African American patients.

OBJECTIVE: To compare clinical outcomes in patients with mHSPC treated with abiraterone acetate or enzalutamide.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included all patients with mHSPC diagnoses in the US Veterans Affairs Health Care system who initiated abiraterone or enzalutamide between July 2017 and April 2023. Data were analyzed from April 2024 to March 2025.

EXPOSURES: Receipt of abiraterone acetate or enzalutamide.

MAIN OUTCOMES AND MEASURES: Drug outcomes were established by estimating rates of tumor growth (g-rates) using prostate-specific antigen (PSA) values while receiving therapy and measuring overall survival (OS). Two different matching analyses were performed: inverse probability weighting (IPW) and 1:1 exact matching.

RESULTS: A total of 1258 patients (median [IQR] age, 73 [69-79] years; 314 [25.0%] African American, 857 [68.1%] White, and 87 [6.9%] with other or unknown race) who received abiraterone and 311 patients (median [IQR] age, 74 [69-79] years; 84 [27.0%] African American, 207 [66.6%] White, and 20 [6.4%] with other or unknown race) who received enzalutamide were included. In the unweighted analysis, the abiraterone cohort had median (IQR) g-rate of 0.000137/d (0.000094-0.001519) and the enzalutamide cohort, 0.000137/d (0.000098-0.001815); median (IQR) OS was 36.2 (32.8-38.8) months for abiraterone and 36.2 (34.1-40.5) months for enzalutamide, with a median (IQR) follow-up of 28.7 (15.6-45.6) and 30.8 (16.1-39.1) months, respectively. In IPW analysis, using abiraterone as reference, the weighted median OS was comparable between abiraterone and enzalutamide in the full cohort (36.2; 95% CI, 32.8-38.8 vs 35.5; 95 % CI, 32.9-40.4 months; hazard ratio [HR], 1.09; 95% CI, 0.92-1.30; P = .32), African American veterans (39.7; 95% CI, 34.3-46.6 vs 40.3; 95% CI, 34.3-not reached months; HR, 0.98; 95% CI, 0.72-1.34; P = .90) and those with cardiovascular disease (31.5; 95% CI, 28.1-35.5 vs 35.0; 95% CI, 30.7-38.9; HR, 1.12; 95% CI, 0.91-1.37; P = .30). In 1:1 matched analysis, both the abiraterone and enzalutamide groups had 279 patients with 63 (23%) who were African American; these patients had a median (IQR) follow-up of 27.3 (15.3-40.8) and 31.1 (16.8-39.9) months, respectively. The 1:1 matched cohort consisted of 158 patients (57%) in each group with an initial Gleason score of 8 or higher, and 224 patients (80%) in each group with a PSA value of 50 ng/mL or higher at treatment initiation. For the 1:1 matched cohort and its subgroups of African American patients, patients with Gleason scores of 8 or higher, and patients with a starting PSA level of 50 ng/mL or higher, no statistically significant difference in median g-rate and OS was observed.

CONCLUSIONS AND RELEVANCE: This cohort study found that abiraterone and enzalutamide had comparable outcomes in a first-line mHSPC setting, with similar g-rates and OS in both White and African American patients. There were no differences in survival or g-rate between treatment based on race, comorbidities, and prostate cancer features, including Gleason score, PSA, and volume of disease.

PMID:41186950 | DOI:10.1001/jamanetworkopen.2025.40730

JAMA Netw Open. 2025 Nov 3;8(11):e2541255. doi: 10.1001/jamanetworkopen.2025.41255.

ABSTRACT

IMPORTANCE: Advanced imaging to diagnose pulmonary embolism (PE) during pregnancy increases costs, ionizing radiation exposure, and the risk of overdiagnosis. D-dimer testing can exclude PE and compression ultrasonography can diagnose deep vein thrombosis (DVT), both reducing advanced imaging needs. How these 2 strategies are used in community PE diagnostics is unknown.

OBJECTIVE: To analyze the use and efficiencies of D-dimer and ultrasonography for the diagnosis of antenatal PE.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was performed in 21 US community hospitals from October 1, 2021, to March 31, 2023. Participants included pregnant patients who underwent D-dimer testing, compression ultrasonography, or advanced imaging for suspected PE.

EXPOSURES: D-dimer testing or ultrasonography.

MAIN OUTCOMES AND MEASURES: The main outcome was avoidance of advanced imaging, measured by the number needed to test (NNT) to avoid 1 advanced imaging study using low to intermediate D-dimer values or a positive ultrasonography finding. Variables associated with D-dimer and ultrasonography were evaluated using quasi-Poisson regression reported as adjusted relative risks (ARRs).

RESULTS: A total of 720 outpatient encounters in 699 patients were included in the analysis (median age, 30.2 [IQR, 24.3-36.1] years). D-dimer testing was obtained in 524 patients (72.8%). Advanced imaging was not pursued in 149 of 155 patients (96.1%) with low (<0.5 mg/L) and 82 of 179 (45.8%) with intermediate (0.5 to <1.0 mg/L) D-dimer values, yielding an NNT to avoid 1 advanced imaging study of 2.3 (95% CI, 2.0-2.6). No 90-day venous thromboembolism or death occurred following rule-outs. D-dimer testing was less commonly used in third (vs first) trimester (ARR, 0.85; 95% CI, 0.75-0.97); with unilateral signs or symptoms of DVT (vs none) (ARR, 0.67; 95% CI, 0.54-0.82), and during labor and delivery unit (vs emergency department) evaluation (ARR, 0.27; 95% CI, 0.20-0.35). Compression ultrasonography was performed in 229 patients (31.8%), with DVT diagnosed in 3 (1.3%). Advanced imaging was not pursued in 2 of these patients, yielding an NNT to avoid 1 advanced imaging study of 115 (95% CI, 32-417). Ultrasonography use and results varied by DVT symptoms. Among 55 patients with DVT symptoms, 46 (83.6%) underwent ultrasonography, with positive findings in 3 (yield of 6.5%). Among 665 patients without symptoms, 183 (27.5%) underwent ultrasonography, with negative findings in all (yield of 0).

CONCLUSIONS AND RELEVANCE: In this cohort study, use of D-dimer testing was efficient and safe with opportunities for expansion across settings and patients. These findings suggest that ultrasonography efficiency was low but could be improved with symptom-driven use in antenatal PE diagnostics.

PMID:41186948 | DOI:10.1001/jamanetworkopen.2025.41255