Tag: pubmed

Graefes Arch Clin Exp Ophthalmol. 2025 Jul 5. doi: 10.1007/s00417-025-06898-3. Online ahead of print.

ABSTRACT

PURPOSE: Strabismus, including esotropia and exotropia, significantly affects binocular vision and presents challenges in clinical management and surgical correction. Although previous studies have explored the anatomical characteristics of horizontal rectus extraocular muscles (EOMs) in strabismus, large-scale analyses of insertional anatomy remain limited. This study investigates anatomical variations in the insertions of horizontal rectus EOMs in patients with esotropia and exotropia, aiming to understand their impact on strabismus management.

METHODS: A retrospective case-control study was conducted using clinical records from 4781 patients diagnosed with strabismus who underwent surgery at the Zhongshan Ophthalmic Center, Sun Yat-sen University, from June 2014 to August 2020. Anatomical measurements of horizontal rectus EOM insertions were taken using a Castroviejo caliper. Statistical analyses, including regression analysis, were performed to examine the relationship between EOM characteristics and clinical outcomes.

RESULTS: Significant anatomical differences were observed among esotropia, exotropia, and control groups. Esotropia patients exhibited shorter medial rectus (MR) insertion distances (mean: 4.81 mm) than both exotropia (5.09 mm) and controls (5.08 mm, p < 0.001), with moderate effect sizes. Exotropia subtypes showed wider MR and lateral rectus (LR) insertions, particularly in constant and pattern types (MR width p = 0.001, LR width p = 0.002). Regression analysis indicated that shorter MR insertion distance was significantly associated with greater esodeviation at both near (β = -13.60, p < 0.001) and distance (β = -12.76, p < 0.001), though with small effect sizes. Refractive error (SE) and age were also significant predictors of deviation magnitude and AC/A ratio.

CONCLUSION: Anatomical variations in the horizontal rectus EOMs are significantly associated with esotropia and exotropia. These findings enhance our understanding of strabismus pathophysiology and may help guide surgical strategies for severe cases, though further research is needed to refine clinical applications.

PMID:40616711 | DOI:10.1007/s00417-025-06898-3

Cancer Immunol Immunother. 2025 Jul 5;74(8):260. doi: 10.1007/s00262-025-04115-y.

ABSTRACT

BACKGROUND: Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide. While early-stage lesions can be definitively treated with local therapies, advanced stage cutaneous squamous cell carcinoma (cSCC) often requires systemic treatments such as PD-1 inhibitors. These treatments may be administered for prolonged durations; this practice may lead to an unnecessary physical and financial toxicity. The purpose of this study was to evaluate the patterns of disease progression after anti-PD-1 therapy discontinuation in this group of patients.

METHODS: This retrospective cohort study included patients diagnosed with advanced cSCC and treated with either cemiplimab or pembrolizumab from 2019 to 2024 at a single university-affiliated tertiary medical center.

RESULTS: The cohort included 131 patients, with a 73% overall response rate. Among the 86 patients with either partial or complete response as the best response included in the final analysis, 40 (47%) patients had a treatment break for at least 3 months, and 46 (53%) continued without discontinuation to a maximal duration of 2 years. After a median follow-up of 29.9 months, 24 (60%) patients in the break group remained progression-free, systemic treatment-free, and alive throughout the follow-up. Four patients (10%) experienced disease progression. Among these, the best overall response was PR in three patients and CR in one patient. Nine (22.5%) patients died due to non-oncological reasons, two (5%) patients died from an unknown cause, and one (2.5%) due to treatment toxicity. The percentage of patients achieving CR was statistically significantly higher in the break group compared to the no-break group.

CONCLUSIONS: Our findings advocate for a more tailored approach to the duration of PD-1 inhibitor therapy in cSCC, potentially reducing burdens of overtreatment. Future studies regarding establishing robust predictors for safe treatment discontinuation are required to enhance decision-making in clinical practice.

PMID:40616706 | DOI:10.1007/s00262-025-04115-y

Pediatr Surg Int. 2025 Jul 5;41(1):202. doi: 10.1007/s00383-025-06100-z.

ABSTRACT

BACKGROUND: Intestinal atresia is a congenital anomaly characterized by a complete obstruction of the intestinal lumen. This study aims to identify factors influencing outcomes in affected infants to inform targeted interventions and improve their care.

METHODS: This study employed a hybrid cohort design combining retrospective chart review with prospective data collection of patients surgically managed with intestinal atresia at a tertiary center over 5 years. Statistical analysis was performed using SPSS version 25.0, and p value of < 0.05 was considered statistically significant.

RESULTS: 82 patients with intestinal atresia were included; females comprised 61% (F:M ratio 1.56:1). The mean birth weight was 2499 ± 705 g, and the mean gestational age was 36.5 ± 2.5 weeks. Prenatal diagnosis was made in 23.2%, while 43.6% had associated anomalies. Intraoperatively, findings revealed obstruction in the duodenum (37.8%), jejunum (29.3%), ileum (29.3%), and colon (3.6%). Duodenal atresia was primarily managed with diamond-shaped duodenoduodenostomy (90.3%), while jejunal, ileal, and colonic atresia were managed with resection and anastomosis. Mortality was 42.7%, and sepsis (28.6%) and respiratory insufficiency (26%) were the leading causes of death. Prematurity was significantly associated as an independent risk factor for mortality.

CONCLUSION: Neonatal survival in our country remains poor compared to developed nations, with mortality influenced by premature deliveries, inefficient perioperative care, and postoperative complications.

PMID:40616700 | DOI:10.1007/s00383-025-06100-z

Hernia. 2025 Jul 5;29(1):221. doi: 10.1007/s10029-025-03418-4.

ABSTRACT

TITLE: Cessation vs No Cessation of Acetylsalicylic acid Preoperatively in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair (CAPTAIN): Final Report from a Multi-Center, Single-Blinded, Randomized-Controlled Trial. The CAPTAIN trial is a prospective multi-center randomized-controlled trial evaluating the safety of continuing acetylsalicylic acid preoperatively in patients undergoing elective laparoscopic inguinal hernia mesh repair (LIHR).

METHODS: Patients undergoing LIHR were eligible for inclusion. Patients unfit for general anesthesia, patients who had obstructed hernias or patients who underwent open operation were excluded. Participants were randomized by the trial coordinator using allocation concealment to either acetylsalicylic acid-cessation or continuation group, without the surgeon knowing.

OUTCOME: Primary outcome was the incidence of bleeding complications evidenced by the presence of postoperative hematomas before the patient was discharged from hospital. Secondary outcomes include incidence of major cardiovascular events, post-operative thromboembolic events, seroma formation and length of hospital stay.

RESULTS: 100 patients were recruited between April 2016 and June 2024. 5 patients were excluded because they 3 underwent open operation, 1 withdrew consent and 1 had their operation cancelled, leaving 45 patients in the acetylsalicylic acid-continuation group and 50 patients in the cessation group.

OUTCOMES: We found that significantly more patients who continued acetylsalicylic acid had hematomas in the index admission (11 vs 5, p = 0.018). There was no difference in the amount of intraoperative blood loss between the two groups, 12.9 vs 9.3ml (p = 0.130). Both groups of patients had short postoperative stay-an average of less than a day. There were no postoperative thromboembolic events or major adverse cardiac events in either group. The rates of postoperative seroma were similar between both groups, 28.9% vs 26% (p = 0.755). At 30 days post operation, there were no hernia recurrence or readmissions in either group.

CONCLUSION: The increase in the rate of postoperative hematomas formation in the acetylsalicylic acid-continuation group though statistically significant; was not clinically significant as no blood transfusion was required and all hematomas resolved with conservative management by 90-days clinic review despite no cessation of acetylsalicylic acid. Thus, this randomized-controlled trial concludes that it is safe to continue acetylsalicylic acid perioperatively in selected patients undergoing LIHR. Larger scale randomized-controlled trials would be helpful to corroborate these findings.

TRIAL REGISTRATION: Ethics approval was obtained from our healthcare cluster’s Domain Specific Review Board (reference number 2015/00512). The study protocol was registered on ClinicalTrials.gov (registration number NCT02604732).

PMID:40616699 | DOI:10.1007/s10029-025-03418-4

Environ Monit Assess. 2025 Jul 5;197(8):866. doi: 10.1007/s10661-025-14324-8.

ABSTRACT

Droughts are one of the most severe natural hazards, and its occurrences are increasingly exacerbated due to climate change. While numerous studies have analyzed drought occurrences using multi-model ensembles (MME) developed considering uniform weights to general circulation models (GCMs), biases inherent in these models impeded the attainment of reliable predictions. Also, studies conducted were region specific and were limited to considering a specific socio-economic pathway (SSP). The inconsistency in findings drawn across different SSPs limits the applicability of these results to implement best management practices to combat drought effectively. In this study, Drought Prone Index (DPI) built on the mathematical framework of Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) has been proposed. This index represents the frequency and severity of the possible drought events considering near future (2024-2060) and far future (2061-2100). Further, to overcome the limitation of bias, a multi-criteria decision-making (MCDM) framework integrating CRiteria Importance Through Intercriteria Correlation (CRITIC) and analytical hierarchy process (AHP) methods has been proposed to create differential weighted multi-model ensemble. The proposed framework is demonstrated considering India as study area. Findings of our study indicate a significant increase in rainfall and temperature ranging between 100-440 mm, and 0.75-3.5 °C across different SSP scenarios. Alongside a decline in rainfall in certain regions of Northeast India and the Western Ghats is observed from the derived spatial maps created using the data of developed MME. Spatial variation of DPI computed at a district level indicates that though the frequency of drought occurrences in the near and far future periods does not substantially increase, the severity of droughts is found to be intense. Findings highlight that it is imperative to consider the influence of climate change while assessing the droughts. These findings can assist policymakers and stakeholders in prioritizing resource allocation and implementing targeted mitigation strategies.

PMID:40616693 | DOI:10.1007/s10661-025-14324-8

Clin Oral Investig. 2025 Jul 5;29(7):372. doi: 10.1007/s00784-025-06450-x.

ABSTRACT

OBJECTIVES: This study aimed to compare the clinical efficacy of a novel apical barrier technique (N-ABT) and a traditional apical barrier technique (T-ABT).

MATERIALS AND METHODS: A randomized controlled clinical trial was conducted. Forty-seven patients with 50 teeth meeting the inclusion criteria of large root canals and incompletely developed apical foramina were enrolled. Teeth were randomly assigned to either the N-ABT or T-ABT group in a 1:1 ratio and were followed for 24 months. N-ABT employed 3D printing technology to design personalized pluggers and to calculate the precise volume of barrier material, while T-ABT used a standard commercial plugger without volume control. Randomization was performed using a computer-generated sequence, and the study was conducted in a single-blind manner.

RESULTS: A total of 45 teeth completed the 24-month follow-up (22 in the N-ABT group and 23 in the T-ABT group), with no significant adverse events reported. All cases were considered clinically successful, defined by the absence of symptoms and a reduction in apical radiolucency. Success was further classified as healed (complete disappearance of apical radiolucency) or healing (reduction in apical radiolucency). At the 12-month follow-up, the N-ABT group showed a slightly higher healed rate (22.7% vs. 17.4% in the T-ABT group), and at the 24-month follow-up, a trend toward a higher healed rate was observed (68.2% vs. 47.8% in the T-ABT group), although the differences were not statistically significant. However, N-ABT significantly improved filling efficiency by reducing the number of obturation attempts from 1.41 ± 0.50 to 1 and the filling time from 99.31 ± 25.08 s to 38.78 ± 15.56 s. Additionally, N-ABT significantly increased the no overfilling rate from 8.7 to 40.9%.

CONCLUSIONS: N-ABT clinically improve clinical outcomes (> 20%) during the observation period, it also demonstrated enhanced filling quality and efficiency and reduced technical sensitivity.

CLINICAL RELEVANCE: The novel apical barrier technique demonstrated superior filling quality and efficiency compared to the traditional apical barrier technique, reduced technical sensitivity, and showed potential for future automated filling procedures, enhancing clinical applicability.

CLINICAL TRIAL REGISTRATION: This study was registered on www.chictr.org.cn (Identifier: ChiCTR2200058635;Trial title: Personalized Root Canal Barrier Technique Using 3D Printing Technology).

PMID:40616689 | DOI:10.1007/s00784-025-06450-x

J Orthop Traumatol. 2025 Jul 5;26(1):44. doi: 10.1186/s10195-025-00864-9.

ABSTRACT

BACKGROUND: Few studies have investigated the relationship between the chronicity of anterior cruciate ligament (ACL) tears and the incidence of ramp lesion subtypes. The purpose of this study was to evaluate the relationship between the chronicity of ACL tears and the new subtypes of ramp lesions for treatment selection.

METHODS: Between May 2015 and April 2023, 367 patients who underwent primary ACL reconstruction were evaluated. Meniscal repair was performed in cases where a ramp lesion was identified. According to the exclusion criteria, 96 patients who underwent repair of ramp lesion were divided into three groups (PR type: pure ramp lesion, RR type: red-red ramp lesion, and DL type: double longitudinal ramp lesion), and the groups were compared for chronicity of ACL tears and time from injury (TFI).

RESULTS: Of the 30 patients classified as having PR type lesions, 11 (36.7%) had chronic ACL tears. Likewise, of the 37 patients classified as having RR type lesions, 14 (37.8%) had chronic ACL tears. In contrast, among the 29 patients classified as having DL type lesions, 20 (69.0%) had chronic ACL tears, indicating a statistically significant difference (p < 0.05). This distinction was significant up to 12 months after injury.

CONCLUSIONS: Pure ramp lesions accounted for only 31% of all ramp lesions in ACL tears. In addition, chronic ACL tears are more frequently accompanied by double longitudinal tears than by red-red zone longitudinal tears or pure ramp lesions of the meniscus posterior horn.

STUDY DESIGN: case series, level of evidence IV.

PMID:40616683 | DOI:10.1186/s10195-025-00864-9

Environ Monit Assess. 2025 Jul 5;197(8):865. doi: 10.1007/s10661-025-14282-1.

ABSTRACT

Surface water pollution driven by land use practices and soil erosion remains a persistent challenge in tropical river basins of East Africa. Despite its socio-economic importance, the transboundary Sio Malaba Malakisi River Basin (SMMRB), shared by Kenya and Uganda, lacks comprehensive data on spatial and seasonal water quality dynamics. This study provides the first year-long baseline assessment of surface water quality in the SMMRB, using water samples collected from 12 monitoring sites across three distinct hydrological seasons: dry, short rainy, and long rainy. Twelve physicochemical parameters were analyzed following standardized protocols from the American Public Health Association (APHA), resulting in 854 data points. Multivariate statistical techniques: agglomerative hierarchical clustering, Wilk’s lambda analysis, and exploratory factor analysis (EFA), were used to identify patterns and key drivers of water quality variation. Three distinct spatial clusters, corresponding to the Sio, Malaba, and Malakisi sub-catchments, were identified, each exhibiting unique water quality profiles. Elevated concentrations of total phosphorus (TP), soluble reactive phosphorus (SRP), and total suspended solids (TSS) were observed, exceeding typical background levels for unpolluted rivers. Seasonal differences highlighted the role of sediment transport and dilution processes, particularly during the rainy seasons. These findings provide novel insights into nutrient transport and hydrogeomorphological influences in a tropical, data-scarce, transboundary basin. The results offer a scientific basis for setting up targeted monitoring stations and adaptive water management strategies. Future studies should assess long-term interactions between sediment and nutrients. Evaluating the effectiveness of soil and water conservation practices will also be important for improving water quality.

PMID:40616682 | DOI:10.1007/s10661-025-14282-1

Environ Monit Assess. 2025 Jul 5;197(8):868. doi: 10.1007/s10661-025-14310-0.

ABSTRACT

Precise source tracing and risk quantification of multi-source heavy metals (HMs) contamination in soil pose significant challenges for regional environmental management. This study proposed an innovative dynamic coupling model that combines a self-organizing map (SOM) and positive matrix factorization (PMF), overcoming the limitations of single models. The geo-accumulation index (I_geo) and the initial ecological risk index (RI) were integrated with human health risks to form a comprehensive evaluation chain of “pollution source-exposure pathway-risk contribution.” The results showed that the average concentrations of eight HMs in soil exceeded background levels, with Cd exhibiting the highest exceedance ratio (0.67 mg/kg, 4.17 × background value). Cd, Zn, and As are influenced by human activities, as evidenced by variation coefficients greater than 70%. The SOM-PMF model successfully identified five pollution sources and their respective contribution rates (contribution/main elements): agricultural sources (8.48%, As), traffic sources (30.24%, Pb, As, Cr), natural background sources (23.04%, Ni, Cu, Cr), industrial sources (18.34%, Cd, Pb, Zn), and smelting sources (19.91%, Mn). Ecological risk assessments have indicated that Cd represents the most significant environmental cumulative risk ( I ¯ _geo = 1.52) and potential ecological risk ( RI ¯ _{microorganism} = 0.34). However, source-risk coupling analysis reveals that agricultural activities (47.3% of As) contribute 24% to the biological risk, with As replacing Cd as the priority element for control. Traffic sources are the primary contributors to health risks, with Pb and As being the main elements (with proportions of 65.18% and 45.52%, respectively), followed by agricultural sources primarily associated with As (47.3%). These sources contribute over 42% to both carcinogenic and non-carcinogenic risks. As was the major contributor to health risks in the study area, with carcinogenic and non-carcinogenic risks in children significantly higher than in adults (3.28 and 4.24 times, respectively). This study provides a scientific basis and technical support for the zonal management and collaborative control of multi-source soil HM pollution.

PMID:40616676 | DOI:10.1007/s10661-025-14310-0

Clin Oral Investig. 2025 Jul 5;29(7):373. doi: 10.1007/s00784-025-06455-6.

ABSTRACT

OBJECTIVES: The study aims to compare methods for 3D volumetric assessment of unilateral alveolar clefts using CBCT, evaluating their accuracy and analysing clinical applicability, and to provide recommendations for improved precision in treatment planning and scientific research.

MATERIALS AND METHODS: Two methods were used to assess the volumes of 20 patients with unilateral alveolar clefts. One was based on anterior nasal spine (ANS) and greater palatine foramen (GPF); while the other was based on ANS and posterior nasal spine (PNS), regarding the palatal plane (PP) as the reference plane. Reliability for the different outcome variables was analyzed with intra-class correlation (ICC) and by calculating a paired Student’s t tests and Pearson’s correlation coefficient.

RESULTS: The mean volume measured by the ANS&PNS based method (957.70 ± 174.25 mm³) was higher than the one measured by the combined method based on ANS&GPF (786.74 ± 146.10 mm³) with statistically significant difference (P < 0.001). The Pearson correlation coefficient between the groups showed good stability in the differences (r = 0.957, P < 0.001).

CONCLUSIONS: The volumetric assessment of alveolar clefts varies with the reference plane used. The method based on palatal plane offers relatively easier identification of landmarks, closely reflecting actual alveolar bone volume.

CLINICAL RELEVANCE: The refined method for alveolar cleft assessment could improve treatment planning for orthodontics and alveolar bone grafting in patients with UCLP, while also supporting research on alveolar cleft morphology and its developmental mechanisms.

PMID:40616672 | DOI:10.1007/s00784-025-06455-6