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“Randomized Controlled Trials of Carpal Tunnel Release: Robustness and Fragility Index of Published Literature”

Plast Reconstr Surg. 2025 Sep 30. doi: 10.1097/PRS.0000000000012481. Online ahead of print.

ABSTRACT

BACKGROUND: Many randomized controlled trials (RCTs) have studied outcomes after carpal tunnel surgery, but they have not been scrutinized collectively for their risk of bias or robustness of statistically significant findings. This study applies the fragility index (FI) and bias risk assessments on RCTs for carpal tunnel surgery.

METHODS: A PubMed search was designed to extract English-language carpal tunnel RCTs between 2003 and 2023. RCTs with dichotomous outcomes, statistically significant results, and a 1:1 parallel treatment arm were included. The FI, fragility quotient (FQ), and risk of bias for these trials were calculated and results were collectively analyzed.

RESULTS: Seven RCTs investigating 11 dichotomous variables were included in this study. The average FI was 1.36 (SD 1.12), the average FQ was 0.03 (SD 0.03), and the average Jadad score was 3 (SD 0.00). The risk of bias determined via the Cochrane Risk of Bias (RoB) tool was moderate in most studies, typically from non-blinding of the treating surgeon.

CONCLUSIONS: Dichotomous variables that are reported in carpal tunnel literature have fragility indices that are overall lower than the suggested threshold of 2, demonstrating poor overall robustness. The overall risk of bias in these trials was moderate and acceptable. This study indicates that more multi-center trials with larger sample sizes are required to ensure robustness of carpal tunnel RCTs.

LEVEL OF EVIDENCE: Level 1 – Systematic Review of Level I Studies (Randomized Controlled Trials).

PMID:41025811 | DOI:10.1097/PRS.0000000000012481

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Epigenetic motifs distinguishing endogenous from exogenous retroviral integrants

J Virol. 2025 Sep 30:e0077525. doi: 10.1128/jvi.00775-25. Online ahead of print.

ABSTRACT

Retroviruses are subject to epigenetic regulation by the host genome after integrating, similar to vertebrate genes. However, their patterns of integration, and therefore their likely epigenetic regulation, differ between genera. Beta- and gammaretroviruses are two types of simple retroviruses that have a strong tendency to infect germ cells and endogenize. While ancient endogenous retroviruses are often easy to spot due to mutations rendering them non-functional, more recent integrants can maintain the capacity for full viral production, making it sometimes difficult to discern which integrants are exogenous and likely more clinically relevant. Because endogenous retroviruses generally spend a longer time integrated and subject to host epigenetic regulation as proviral DNA, we hypothesized we could show these integrants exhibit sequence differences from their exogenous counterparts, likely resulting from DNA methylation and histone modifications, and that endogenous retroviruses would generally show habituation to host promoters. Therefore, we have used statistical analyses of publicly available sequence data to demonstrate that endogenous retroviral variants exhibit decreased CpG dinucleotide and altered trinucleotide frequencies over time, and that they will show evidence for loss of motifs associated with “active” histone modifications. Close examination of these patterns provides further clues for distinguishing endogenous and exogenous retroviral variants, potentially aiding in the study of retroviruses in less well-characterized wildlife species.

IMPORTANCE: Expression of vertebrate genes is regulated by chemical modifications made directly to the DNA or to the proteins associated with it, termed epigenetics. Because retroviruses integrate into DNA, they are subject to the same epigenetic modifications as regular genes. Retroviruses will tend to endogenize, meaning they will become a permanent part of a species’ genome when their hidden DNA is passed down to progeny during reproduction. However, sometimes it is difficult to discern whether a retroviral sequence is endogenous (permanently fixed) or exogenous (an infectious entity). We hypothesized that changes to the retroviral sequences over time after endogenization would result from epigenetic modifications, and that these changes could help distinguish an endogenous retrovirus from an exogenous one. In this paper, we show that changes to the viral sequences associated with epigenetics indeed take place after endogenization.

PMID:41025794 | DOI:10.1128/jvi.00775-25

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Is the General Factor of Personality an Entity? Testing Reflective, Formative, and Mixed Models of Polygenic Score Influence Using the English Longitudinal Study of Aging

Twin Res Hum Genet. 2025 Sep 30:1-8. doi: 10.1017/thg.2025.10024. Online ahead of print.

ABSTRACT

Leveraging a unique dataset (the English Longitudinal Study of Aging) containing polygenic scores (PGSs) – estimated using meta-analytically-derived single nucleotide polymorphisms (SNPs) for the Big Five (BF) – the General Factor of Personality’s (GFP) existence as a veritable psychometric entity was investigated. Exploratory tests involving a subsample of 200 participants revealed that while the BF PGSs were adequate for factor analysis, parallel analysis suggested the presence of zero factors, indicating no “genetic GFP” among these PGSs, but did indicate the presence of a robust latent GFP among the phenotypic BF. Confirmatory factor analysis involving an independent sample of 4,533 participants was used to compete three models: full mediation by the GFP of PGS effects on the BF (common pathway or reflective); full mediation by the BF of PGS effects on the GFP (independent pathways or formative); and a mixed model. All models exhibited good fit, with the reflective model having the greatest parsimony. Statistically significant covariances were also observed among the PGSs, potentially consistent with pleiotropy. Even though the reflective model fit best, the common paths were extremely weak (and could be set to zero in most cases), with only the (negatively signed) path from the extraversion PGS to the GFP reaching significance. This finding is (weakly) consistent with the hypothesis that the GFP is a valid entity.

PMID:41025778 | DOI:10.1017/thg.2025.10024

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Diagnosis, Prognosis, and Drug Target Discovery for Chronic Widespread Pain: A Large Proteogenomic Study

Adv Sci (Weinh). 2025 Sep 30:e07691. doi: 10.1002/advs.202507691. Online ahead of print.

ABSTRACT

Chronic widespread pain (CWP) remains challenging due to its heterogeneous causes and complex mechanisms. A total of 2920 plasma proteins are analyzed from 29,254 UK Biobank participants. A total of 256 proteins are identified as cross-sectionally correlated with CWP. A simple (top 10 proteins) and comprehensive (all significant proteins) proteomic-based score (ProtS) is created for CWP diagnosis, both outperforming and improving the existing clinical score (area under the curve, AUC: 0.801, 0.723, and 0.791 alone, and 0.856 and 0.880 in combination). In addition, the protein score predicted 13-years risk of pain-related traits over the body, including pain onset, progression, and intensity; Moreover, it has stronger associations with nociplastic pain and fibromyalgia compared to nociceptive and neuropathic pain, implying a unique protein signature of different pain mechanisms. Finally, among 434 candidate proteins prioritized in the observational analysis, 18 are corroborated with causal relevance by Mendelian randomization, and importantly, four (CA14, DPEP1, LGALS3, and TNF) showed potential as novel drug targets repurposed for treating CWP.

PMID:41025730 | DOI:10.1002/advs.202507691

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Impact of starting dose of tyrosine kinase inhibitors on outcomes following combination therapy of immune checkpoint inhibitors with tyrosine kinase inhibitors for previously untreated advanced renal cell carcinoma

Jpn J Clin Oncol. 2025 Sep 30:hyaf152. doi: 10.1093/jjco/hyaf152. Online ahead of print.

ABSTRACT

BACKGROUND: The impact of the starting dose of tyrosine kinase inhibitors (TKIs) following combination therapy of immune checkpoint inhibitors with TKIs (i.e. IO-TKI) for advanced renal cell carcinoma (RCC) remains unclear.

METHODS: We retrospectively evaluated clinical data from 155 patients treated with first-line IO-TKI for RCC. Patients were categorized into full-dose and reduced-dose groups based on their starting dose of TKIs. Effectiveness and safety profiles were compared between groups.

RESULTS: A reduced starting dose was administered to 52 patients (34%). These patients were older (P = 0.0137) and received pembrolizumab plus axitinib more frequently, while lenvatinib plus pembrolizumab was less used (P = 0.0258) compared to the full-dose group. Progression-free survival and overall survival did not significantly differ between the full-dose and reduced-dose groups (P = 0.202 and P = 0.309, respectively). Although the objective response rate appeared higher in the full-dose group, the difference was not statistically significant after adjusting for other covariates (P = 0.0588). Safety profiles were comparable, with no significant differences in TKI dose reduction, drug interruption or discontinuation, or glucocorticoids use (P > 0.05). However, adverse events of grade ≥3 were more frequent in the full-dose group, although not statistically significant (P = 0.121).

CONCLUSION: The starting dose of TKIs did not significantly impact clinical outcomes following IO-TKI for RCC. These findings suggest a potential for the optimization of the starting dose of TKIs; however, prospective studies are warranted to confirm these findings.

PMID:41025729 | DOI:10.1093/jjco/hyaf152

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Clinical Outcomes of First Metatarsophalangeal Joint Arthrodesis Using the BOFAS Registry: A Prospective Cohort Study

J Foot Ankle Res. 2025 Dec;18(4):e70084. doi: 10.1002/jfa2.70084.

ABSTRACT

BACKGROUND: This study investigated the quality and clinical outcomes of the British Orthopaedic Foot and Ankle Society (BOFAS) registry first metatarsophalangeal joint (MTPJ) arthrodesis pathway.

METHODS: A prospective cohort study using data derived from the BOFAS registry. Adults aged ≥ 18 years with a record of undergoing first MTPJ arthrodesis in the UK from 29/08/2014 to 31/10/2019. The pre- and post-treatment pathway was evaluated by analysing Patient Reported Outcome Measures (PROMs) at baseline, 6 months and 12 months intervals. Consistency of data capture and completeness were explored using means, SD, medians and IQR for continuous variables and frequencies for categorical variables.

RESULTS: The mean age of the study population (n = 459) was 64.1 (± 12.1) years and 98.9% of the study cohort were female. Completeness of data collection was low for some items (e.g., medication 46%, surgical procedures 52%). Baseline completion of PROMs was moderate with 52.5% of participants providing MOXFQ (Manchester-Oxford Foot Questionnaire) pain and walking/standing scores at baseline. However, follow-up response rates declined substantially to 27.2% at 6 months and 15.7% at 12 months. Improvement in PROMs by 12 months following surgery was statistically and clinically significant (p < 0.001), with median scores of 10 [IQR: 0-20] for MOXFQ pain, 5.5 [0-21] for walking/standing, 0 [0-19] for social interaction, 5 [1-31] for NRS pain and 0.8 [0.7-1.0] for EQ-5D-5L.

CONCLUSION: The analysis highlights the clinical benefits of first metatarsophalangeal joint (first MTPJ) fusion surgery, with improvements in pain intensity, walking/standing ability, social interaction and quality of life. The BOFAS registry serves as a valuable tool for collecting patient-reported outcome measure (PROM) data, providing important insights into treatment effectiveness and participant well-being. Strengthening the data collection capabilities of the BOFAS registry could further enhance our understanding of the benefits of first MTPJ fusion and inform future treatment strategies.

PMID:41025702 | DOI:10.1002/jfa2.70084

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Evaluation of the serum creatinine to total bilirubin ratio in psoriasis patients treated with biological agents: Significant reduction following IL-17 inhibitor therapy

Biomarkers. 2025 Sep 30:1-13. doi: 10.1080/1354750X.2025.2568858. Online ahead of print.

ABSTRACT

INTRODUCTION: High serum creatinine to total bilirubin ratio has been associated with an increased risk of developing hypertension. We evaluated the effect of biological agents on serum creatinine to total bilirubin ratio in patients with psoriasis.

METHODS: Serum creatinine and total bilirubin levels of patients were reviewed between June 2018 and October 2023.

RESULTS: This study included 302 patients, 143 (47.4%) females and 159 (52.6%) males with a mean age of 49.46 ± 13.82 years. The creatinine to total bilirubin ratio was higher in males than in females (p = 0.028), and in patients with comorbidities compared to those without (p = 0.031). Six months after biological agent treatment, serum total bilirubin levels increased (p = 0.010), while the creatinine to total bilirubin ratio significantly decreased (p = 0.038) in all patients. Serum creatinine to total bilirubin ratio decreased (p = 0.031) in patients who received IL-17 inhibitors after 6 months. Among them, patients treated with ixekizumab showed a statistically significantly decrease in creatinine to total bilirubin ratio (p = 0.015).

CONCLUSION: The decrease in creatinine to total bilirubin ratio after 6 months of treatment was statistically significant only in patients treated with IL-17 inhibitors, particularly ixekizumab. Therefore, we suggest that IL-17 inhibitors may have a protective role against hypertension in patients with psoriasis.

PMID:41025689 | DOI:10.1080/1354750X.2025.2568858

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Oral hygiene habits are risk factors of oral cavity cancer: a short communication

Eur J Cancer Prev. 2025 Nov 1;34(6):559-562. doi: 10.1097/CEJ.0000000000000966. Epub 2025 Oct 1.

ABSTRACT

Poor oral hygiene is a well-established risk factor for oral cavity cancer. However, the specific association between oral hygiene practices and oral cancer risk remains unclear. This study aimed to investigate the relationship between oral hygiene habits and the risk of oral cavity cancer. A case-control study was conducted involving 231 participants: 94 oral cavity cancer patients (case group) and 137 controls with other head and neck cancers. Oral health status was assessed using the Revised Oral Assessment Guide – Jönköping (ROAG-J), and a structured questionnaire was used to collect data on oral hygiene practices and lifestyle factors. The case group exhibited poorer oral hygiene practices, including lower rates of toothbrushing (68.1 vs. 90.5%) and food debris removal (38.3 vs. 63.5%), higher rates of smoking (66 vs. 11.7%) and alcohol consumption (58.5 vs. 14.6%), and poorer oral health (ROAG-J grade 2 or 3: 94.7 vs. 40.2%) compared with the control group. Multivariable logistic regression model has three independent risk factors for oral cavity cancer: smoking [odds ratio (OR): 9.77, 95% confidence interval (CI): 4.21-22.61], alcohol consumption (OR: 3.47, 95% CI: 1.48-8.10), and the presence of chronic diseases (OR: 2.90, 95% CI: 1.37-6.12), whereas food debris removal (OR: 0.25, 95% CI: 0.12-0.51) was a protective factor. Our findings highlight the importance of maintaining good oral hygiene practices in preventing oral cavity cancer. Future studies with larger sample sizes and collection of potential confounding factors are needed to confirm our findings.

PMID:41025686 | DOI:10.1097/CEJ.0000000000000966

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Differential Expression of hsa-miR-144-3p and hsa-miR-125b-5p in Gestational Toxoplasmosis

Parasite Immunol. 2025 Oct;47(10):e70032. doi: 10.1111/pim.70032.

ABSTRACT

This study investigated whether miRNAs and cytokines could be markers of gestational and/or congenital toxoplasmosis (TX). A total of 172 clinical samples collected from women were investigated. For gestational TX, 63 plasmas from pregnant women were analysed: 44 with gestational TX (GT-PW), 11 with asymptomatic TX (AsT-PW) and 8 healthy pregnant women (H-PW). For controls, 68 plasmas: 34 healthy women (HW) and 34 with asymptomatic TX (AsT). For congenital TX, 41 amniotic fluid (AF) samples were tested: 29 with negative qPCR in AF and 12 with positive PCR. Nine miRNAs were assayed by qPCR in plasma and AF samples. IFN-γ, TNF-α and IL-10 detection in plasmas was performed by ELISA. Statistical analyses were determined by F-test and ROC curves. Among the 9 hsa-miRNAs studied, only hsa-miR-125b-5p was significantly expressed in the AsT-PW group. hsa-miR-144-3p was more expressed in the GT-PW group. In AF samples, hsa-miR-125b-5p was more expressed in 29 AF samples with Neg-qPCR and hsa-miR-144-3p in AF samples with Pos-qPCR. Pregnant women from the GT-PW group had lower IFN-γ, TNF-α, and IL-10 production than the other groups. The in silico analyses identified pathways for hsa-miR-144-3p and hsa-miR-125b-5p and were related to the pathogenesis and immune response in toxoplasmosis. These findings suggest that hsa-miR-125b-5p could be related to infection regulation and to be characterised as a potential marker for asymptomatic toxoplasmosis. On the other hand, the hsa-miR-144-3p could be related to the exacerbation of the infection since gestational and/or congenital TX groups expressed high expression of hsa-miR-144-3p and low expression of IFN-γ, TNF-α and IL-10.

PMID:41025671 | DOI:10.1111/pim.70032

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Dronedarone hydrochloride targets cardiolipin and phosphatidylglycerol to increase colistin susceptibility in gram-negative pathogens

Microbiol Spectr. 2025 Sep 30:e0119625. doi: 10.1128/spectrum.01196-25. Online ahead of print.

ABSTRACT

Treating multidrug-resistant (MDR) infections has become progressively dependent on limited therapeutic options, particularly polymyxins, such as colistin. This reliance has precipitated a concerning epidemiological trend: the emergence and global propagation of plasmid-mediated (mcr) as well as chromosome-mediated polymyxin resistance. Consequently, escalating resistance rates will certainly lead to diminished clinical efficacy of colistin, correlating with elevated mortality in septic patients who already face therapeutic limitations. Utilizing antimicrobial potentiators to restore the sensitivity of resistant pathogens to polymyxins represents a promising pharmacological strategy for reinvigorating the clinical utility of these agents. Here, we demonstrate that dronedarone hydrochloride (DH) exhibits significant synergistic bactericidal activity with colistin against colistin-resistant strains. DH enhances the antibacterial potency of colistin by approximately 32-fold (MIC from 8 μg/mL to 0.25 μg/mL in ExPEC ECQ001), effectively reversing resistance phenotypes. In vivo therapeutic efficacy studies demonstrated that combination therapy achieved a statistically significant reduction in bacterial burden compared to colistin therapy alone. Mechanistic studies revealed that DH has the capacity for specific molecular interactions with two critical phospholipid components: cardiolipin and phosphatidylglycerol (PG) in bacterial membranes. This binding induces membrane disruption, impairs energy production, and stimulates oxidative stress, which collectively augment the bactericidal activity of colistin. These findings position DH as a viable antibiotic adjuvant with translational potential for combination therapies against MDR pathogens. The dual targeting of membrane integrity and redox homeostasis presents a strategic advantage in circumventing conventional resistance mechanisms, thereby extending the application potential of colistin in contemporary antimicrobial regimens.IMPORTANCEColistin remains a last resort antibiotic for treating infections caused by extensively drug-resistant pathogens. However, the emergence of colistin resistance has significantly compromised its clinical utility. Our research identifies and characterizes that dronedarone hydrochloride (DH) restores bacterial sensitivity to colistin by binding to cardiolipin (CL) and phosphatidylglycerol (PG). Mechanistic studies revealed that DH bound specifically to CL and PG, thereby enhancing membrane disruption, impairing energy production, and stimulating oxidative stress levels, which collectively augment the bactericidal activity of colistin. These findings present DH as a lead compound for combating colistin resistance, while offering novel mechanistic insights into its role as a colistin potentiator.

PMID:41025656 | DOI:10.1128/spectrum.01196-25