Tag: pubmed

Eur J Orthop Surg Traumatol. 2025 Sep 6;35(1):383. doi: 10.1007/s00590-025-04475-2.

ABSTRACT

INTRODUCTION: Accurate diagnosis of subscapularis tears remains challenging due to the limitations of physical examinations and imaging techniques. Therefore, specific radiological parameters have been proposed as predictors of atraumatic subscapularis tears to improve diagnostic sensitivity and accuracy. These parameters include coracohumeral distance (CHD), coracoglenoid angle (CGA), coracoid angle (CA), coracoid overlap (CO), and coracohumeral angle (CHA). However, well-accepted cutoff values are still lacking, and there is no consensus on its clinical usefulness.

MATERIALS AND METHODS: The PubMed, Scopus, and Cochrane Library databases were queried in July 2024. Inclusion criteria focused on studies that reported MRI-based radiological measurements of the coracoid process in patients with subscapularis tears versus controls. A meta-analysis was performed to evaluate outcomes, with data reported as raw mean difference (MD) and 95% confidence interval (CI).

RESULTS: Fourteen studies involving 1,692 patients with subscapularis tears and 1,648 controls were included. Significant findings include a smaller axial CHD in the subscapularis tear group compared to controls (MD, – 1.67; 95% CI, – 2.61 to – 0.72; P = 0.002). The sagittal CHD was also reduced in the tear group (MD, – 1.43; 95% CI, – 1.89 to – 0.98; P < 0.0001). The CGA was (MD, – 1.15; 95% CI, – 2.20 to – 0.10; P = 0.032), and the CA was also reduced (MD, – 18.63; 95% CI, – 35.60 to – 1.66; P = 0.042). The CO showed no significant difference between the tear and control groups (MD, 1.68; 95% CI, – 1.27 to 4.62; P = 0.21). In contrast, the CHA was increased in the tear group (MD, 3.71; 95% CI, 2.32-5.11; P < 0.01).

CONCLUSION: Several radiological parameters, including CA, CHA, CGA, and axial and sagittal CHD, demonstrated statistically significant differences between patients with and without atraumatic subscapularis tears. Among them, CHA appears to be the most promising due to its consistent association and low heterogeneity. However, substantial variability across studies and limited data for certain parameters underscore the need for further prospective research to validate their diagnostic value and establish standardized imaging protocols.

STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, III.

PMID:40914771 | DOI:10.1007/s00590-025-04475-2

Eur Radiol. 2025 Sep 6. doi: 10.1007/s00330-025-11643-9. Online ahead of print.

ABSTRACT

OBJECTIVES: Establishing paediatric DRLs is challenging due to sparse data availability. The objective was to assess paediatric fluoroscopic dose levels in Dutch clinical practice, as current diagnostic reference levels (DRLs) need updating following the European Guidelines on DRLs for Paediatric Imaging (PiDRL).

MATERIAL AND METHODS: Air Kerma-area Product (KAP) values were retrospectively collected from paediatric patients (0-18 years) who underwent fluoroscopic procedures in nine Dutch hospitals between 01-01-2017 and 01-06-2021. The protocols included were: micturating cystourethrography (MCU), upper gastrointestinal (Upper GI) and lower gastrointestinal with contrast enema (Lower GI). In accordance with the PiDRL recommendations for sparse data, the 75th percentiles of the median KAP values per age group from each hospital were fitted using an exponential dose-age curve, resulting in an age-dependent DRL curve. DRL values were compared to Dutch, other European national and European DRLs.

RESULTS: A total of 971 examinations were included. For MCU, the proposed DRL curve was lower than the Dutch DRLs. The proposed DRL curve for Upper GI was also lower than the UK DRLs. No DRL curve could be established for Lower GI due to limited data.

CONCLUSIONS: Paediatric fluoroscopic dose levels in this study are substantially lower than the current Dutch DRLs, indicating the need for new national Dutch DRLs for MCU. This study proposes using a DRL dose-age curve to update Dutch paediatric DRLs. Using the proposed curve method, more DRLs could be established than with the conventional method. The proposed DRL curves might serve as input for updating Dutch paediatric DRLs.

KEY POINTS: Question Current Dutch diagnostic reference levels for paediatric fluoroscopy need updating, which is challenging due to sparse data availability. Findings Observed dose levels in this retrospective study indicate a potential decrease in Dutch diagnostic reference levels for paediatric fluoroscopy, using a dose-age curve method. Clinical relevance Updating Dutch paediatric fluoroscopic DRLs using a dose-age curve method allows for the establishment of DRLs in case of sparse data availability. This allows for further optimisation of radiation doses in the paediatric population.

PMID:40914762 | DOI:10.1007/s00330-025-11643-9

J Robot Surg. 2025 Sep 6;19(1):570. doi: 10.1007/s11701-025-02755-x.

ABSTRACT

A major cause of cancer death, colorectal cancer is becoming more common in younger people. The comparative effectiveness of robotic versus laparoscopic total mesorectal excision (TME) as surgical interventions for mid-low rectal cancer following neoadjuvant chemoradiotherapy (nCRT) remains uncertain. To systematically evaluate oncological, perioperative, and survival outcomes of robotic versus laparoscopic surgery for mid-low rectal cancer following nCRT. A PRISMA-compliant systematic review and meta-analysis included 20 non-randomized studies (13,212 patients) from Web of Science, PubMed, and Embase up to July 2025. Outcomes encompassed pathological completeness (circumferential resection margin, TME quality), perioperative metrics (operative duration, conversion rates), complications, and survival (5-year OS/DFS). Risk of bias was assessed via ROBINS-I; statistical synthesis utilized RevMan5.4 and hazard ratios derived from Kaplan-Meier curves. This meta-analysis of 20 non-randomized studies (13,212 patients) found no significant differences in 5-year overall survival (HR: 1.07, 95% CI 0.20-5.66, p = 0.94, I² = 98%) or disease-free survival (HR: 1.16, 95% CI 0.72-1.89, p = 0.54, I² = 0%) between robotic and laparoscopic TME after nCRT. Robotic surgery demonstrated superior technical outcomes, including higher rates of complete TME (OR: 1.97, p = 0.02) and reduced conversion to open surgery (OR: 0.46, p < 0.001), but required significantly longer operative time (WMD: + 42.09 min, p < 0.001). Perioperative metrics showed equivalence in intraoperative blood loss (p = 0.20), hospitalization duration (p = 0.78), and postoperative complications, including anastomotic leakage (5.4% vs. 6.5%, p = 0.28) and Clavien-Dindo III-IV events (OR: 1.11, p = 0.54). Pathological outcomes were comparable, with no differences in circumferential resection margin positivity (OR: 1.0, p = 1), distal margin length (p = 0.92), or lymph-node yield (p = 0.55). Local (OR: 0.85, p = 0.34) and distant recurrence rates (p = 0.99) were statistically indistinguishable. Risk-of-bias assessment revealed confounding risks in non-randomized designs, underscoring the need for RCT validation. Robotic and laparoscopic TME achieve equivalent long-term survival and oncological control after nCRT, with robotic advantages in technical precision counterbalanced by prolonged operative duration. The equivalence underscores nCRT’s dominant role in tumor control, while procedural differences highlight context-dependent surgical feasibility. High heterogeneity in survival data and reliance on non-randomized evidence necessitate validation through rigorously designed RCTs incorporating standardized protocols and patient-reported functional outcomes.

PMID:40914745 | DOI:10.1007/s11701-025-02755-x

Musculoskelet Surg. 2025 Sep 6. doi: 10.1007/s12306-025-00919-4. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the radiological-functional outcomes and rotator cuff (RC) status following humeral intramedullary nailing (IMN), comparing the anterolateral standard approach (group 1) and the percutaneous antero-acromial approach (group 2).

METHODS: This observational prospective monocentric study was conducted from August 2021 to March 2023. Inclusion criteria included: two-parts proximal (surgical neck) and diaphyseal Humeral fractures treated with IMN; 12-month follow-up; age between 18 and 85 years; good performance status (excluding neurologic deficits or mental disorders). Evaluations included RC status via ultrasound, Constant, DASH, and SPADI scores, as well as fracture healing times. A T-test was used or statistical analysis.

RESULTS: Sixty-one patients were enrolled during the study period (34 in group 1; 27 in group 2). The mean bone healing time resulted 2.9 ± 0.5 months in group 1 and 2.4 ± 0.7 months in group 2, with a statistically significant reduction of 17% in favor of group 2 (p < 0.05). No significant differences were found in the Constant scores at 6 and 12 months of follow-up; however, significant differences were observed in DASH and SPADI scores (p < 0.05). Supraspinatus tears were detected in both groups: 6 in Group 1 (2 full-thickness and 4 partial) localized at the footprint, and 4 in Group 2 (1 full-thickness and 3 partial) assessed medially in the musculotendinous portion.

CONCLUSION: Intramedullary nailing with a percutaneous approach proved to be a minimally invasive technique with better functional outcomes and shorter fracture healing times. The impact on the RC was comparable to the standard approach.

PMID:40914742 | DOI:10.1007/s12306-025-00919-4

Mol Diagn Ther. 2025 Sep 6. doi: 10.1007/s40291-025-00814-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Sacituzumab govitecan, an anti-trophoblast cell surface antigen 2 (TROP2) antibody-drug conjugate, has been approved by both the US Food and Drug Administration and European Medicines Agency for patients with metastatic triple-negative breast cancer who have received two or more prior systemic therapies, including at least one of them for advanced disease. Although TROP2 evaluation is not required for patient selection, survival data from the ASCENT trial show improved response rates in patients with high TROP2 expression by immunohistochemistry. However, there is no standardized testing assay for these patients. This study evaluated the consistency of TROP2 expression analysis across different immunohistochemistry assays.

METHODS: Twenty-six triple-negative breast cancer samples were analyzed using three different immunohistochemistry assays on a Dako Omnis platform, according to manufacturer protocols. Specifically, ENZO-ABS380-0100 (assay A, used in ASCENT), Abcam SP295 (assay B, used in TROPiCS-02), and Santa Cruz B9-sc-376746 (assay C, used in cross-sectional studies). TROP2 expression on tumor cell membranes was quantified using the H-score, categorized as low (≤ 100), intermediate (> 101 to ≤ 200), and high (> 200). Assay agreement was evaluated using Cohen’s κ and Gwet’s AC2 statistics.

RESULTS: Assay A showed a broader range of TROP2 expression, with 57.7% of samples (n = 15) classified as low, 34.6% (n = 9) as intermediate, and 7.7% (n = 2) as high expressors. Assay B identified only n = 5 (19.2%) low expressors, n = 11 (42.3%) intermediate, and n = 10 (38.4%) high. While assay C identified n = 4 (15.4%) low expressors, n = 12 (46.2%) intermediate, and n = 10 (38.4%) high. Not surprisingly, assays B and C exhibited substantial agreement, with 80.8% of cases showing consistent results (κ = 0.81; p < 0.0001), indicating similar staining outcomes for TROP2 expression. The overall concordance between Assay A, B, and C was fair to moderate (AC2 = 0.35, p = 0.0067).

CONCLUSIONS: Our hypothesis-generating study highlights significant variability among TROP2 assays, suggesting differences in sensitivity and specificity for triple-negative breast cancer. We demonstrate that TROP2 expression is both heterogeneous and dynamic across samples and assays, highlighting the need for methodological improvements in testing. Future research integrating computational pathology with standardized immunohistochemistry protocols and quantitative scoring systems may enhance the clinical utility of TROP2 as a biomarker in triple-negative breast cancer.

PMID:40914741 | DOI:10.1007/s40291-025-00814-5

J Voice. 2025 Sep 5:S0892-1997(25)00299-1. doi: 10.1016/j.jvoice.2025.07.036. Online ahead of print.

ABSTRACT

To this day, the assessment of human voices remains a challenge due to (i) inconsistencies in subjective ratings and (ii) the lack of objective measurements for the perceptual impressions of voice characteristics. This can lead to significant consequences in applied fields such as speech therapy, where the assessment of voices is crucial for a successful treatment. In this paper, we address the explanation of voice and its characteristics from two different angles: In a first study, 22 speech therapists in training assessed a set of 20 non-pathological voices regarding 20 voice characteristics before and after receiving an expert explanation. Although the expert explanation did not lead to an improvement in overall rating performance, the analysis still yielded valuable insights into the particular challenges for novice voice practitioners in their characterization of voices. A second study aimed at a better understanding of the link between perceived voice characteristics and acoustic features. A data set of 295 voice samples of the same corpus was labeled by an expert with regard to the same 20 voice characteristics as in the first study. Afterwards, we analyzed the speech samples using a set of acoustic features, which were then used as predictors in statistical models of the annotated characteristics. This analysis yielded a unique set of significant acoustic features as main effects predicting each individual voice characteristic, although the model fits were overall modest. Furthermore, all of the voice characteristic models showed interactions with the speakers’ gender. These results suggest a necessity for paying special attention to gender differences when assessing voice. Interestingly, we obtained a tendency for a higher model accuracy for those voice characteristics that have also shown to be rated more accurately and consistently by human listeners.

PMID:40914724 | DOI:10.1016/j.jvoice.2025.07.036

Pain Manag Nurs. 2025 Sep 5:S1524-9042(25)00243-7. doi: 10.1016/j.pmn.2025.08.001. Online ahead of print.

ABSTRACT

PURPOSE: To compare the effects of cervical stabilization exercise training via telerehabilitation (CSET-T) in addition to standard treatment on pain, forward head posture, cervical mobility, muscle performance, functional status, sleep quality, and quality of life in individuals with migraine in comparison to the standard treatment alone.

METHODS: The control group (n = 20) received standard treatment alone (medication+recommendations). The stabilization group (n = 20) was given CSET-T in addition to standard treatment 3 days a week for 8 weeks. Pain characteristics were assessed by using a pain diary, whereas forward head posture and cervical mobility were measured using a goniometer, cervical muscle performance (CMP) by using a pressure biofeedback unit, functional status by using the Migraine Disability Assessment Scale (MIDAS), sleep quality by using the Jenkins Sleep Scale (JSS), and quality of life by using the Headache Impact Test-6 (HIT-6).

RESULTS: Given the group-time interaction, it was found that pain frequency, intensity, duration, MIDAS, JSS, and HIT-6 scores decreased more significantly in the stabilization group when compared to the control group (p < .05). Moreover, the craniovertebral angle, cervical range of motions, and CMP values increased significantly more in the stabilization group (p < .05). It was found that there was no statistically significant difference between the groups in terms of compliance with standard treatment (p = .665).

CONCLUSIONS: The study revealed that CSET-T in addition to standard treatment is superior to standard treatment alone in reducing pain, improving forward head posture, cervical mobility, muscle performance, functional status, and quality of life in individuals with migraine.

PMID:40914685 | DOI:10.1016/j.pmn.2025.08.001

J Orthop Sci. 2025 Sep 5:S0949-2658(25)00262-3. doi: 10.1016/j.jos.2025.08.006. Online ahead of print.

ABSTRACT

BACKGROUND: The Stoppa approach was modified to manage fractures of the anterior column as an alternative to the ilioinguinal approach to reduce complications. A debate persists regarding the superiority of one approach over the other. Therefore, in the present study we performed a randomized controlled trial (RCT) to investigate the following hypotheses: (1) Whether the modified Stoppa approach leads to reduced blood loss, (2) Whether the functional and radiological outcomes with the modified Stoppa approach are superior to those with the ilioinguinal approach, and (3) Whether the complication rates differ between the two approaches.

METHODS: A total of 92 patients were initially enrolled in the study. After applying exclusion criteria and obtaining informed consent, 60 patients with acetabular fractures were randomly allocated into two groups and underwent internal fixation at our tertiary care hospital using either the ilioinguinal approach or the modified Stoppa approach. Bleeding and surgical time was evaluated intraoperatively. Post-operative evaluation of wound drainage and neurovascular status was done. Post-operative radiographs reduction assessment of reduction was done as per Matta scoring and clinically Merle D’Aubigne score was compared at 12 months. All data were statistically analyzed with non-parametric tests by using SPSS 20.0 software.

RESULTS: Among the studied population, 48.3 % cases (21.6 % and 26.7 % with ilioinguinal and modified Stoppa approach, respectively) of all patients exhibited excellent radiological outcomes. Additionally, 33.3 % (15 % with the ilioinguinal approach and 18.3 % with the modified Stoppa approach) achieved an excellent clinical score based on the Merle D’Aubigne criteria at 12 months. However, no significant difference was found between two approaches. Both the approaches offer adequate exposure however; quadrilateral surface is directly visualised with the modified Stoppa approach. Considering two significant findings, i.e., reduced intra-operative blood loss and shorter surgical duration was associated with the modified Stoppa approach.

CONCLUSION: Notably, in the context of the ongoing debate between proponents of these two approaches, our study presents a valuable contribution. Overall, the modified Stoppa approach is a better choice in treating anterior acetabular fractures.

PMID:40914680 | DOI:10.1016/j.jos.2025.08.006

Rev Infirm. 2025 Aug-Sep;74(313):14-15. doi: 10.1016/j.revinf.2025.07.005. Epub 2025 Aug 11.

ABSTRACT

Functional neurological disorders are characterized by a variety of neurological symptoms that are not explained by an identifiable organic pathology. Despite their significant prevalence and major impact on quality of life, their recognition and management remain inadequate. Formerly known as hysteria, modern criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition [DSM-5]) allow a positive diagnosis, distinct from malingering. These disorders often lead to long periods of misdiagnosis, high levels of care consumption and significant socio-economic repercussions, including frequent loss of employment. Improving the training of professionals, developing specific treatments, reducing stigmatization and providing support for patients are crucial to meeting this public health challenge.

PMID:40914611 | DOI:10.1016/j.revinf.2025.07.005

Int J Radiat Oncol Biol Phys. 2025 Sep 4:S0360-3016(25)06201-7. doi: 10.1016/j.ijrobp.2025.08.053. Online ahead of print.

ABSTRACT

PURPOSE: This study examined head and neck cancer treatment outcome priorities in patients with human papillomavirus-associated oropharyngeal cancer (HPVOPC) before and 12 months (12m) after (chemo)radiotherapy ([C]RT).

METHODS AND MATERIALS: Eligible patients were diagnosed with HPVOPC suitable for curative-intent primary [C]RT. Study data included responses to a modified version of the Chicago Priorities Scale (CPS-modified) and select items from the MDASI Head and Neck Cancer Module (MDASI-HN). Analysis included descriptive statistics, McNemar’s test for binary matched-pairs and general linear models.

RESULTS: The CPS-modified was completed by 99 patients before [C]RT, 91 12m after [C]RT and 90 at both assessments. Treatment outcomes classified as top priorities were comparable before and 12m after [C]RT: ‘being cured of my cancer’ (cure, 93%/91%), ‘living as long as possible’ (survival, 69%/66%), ‘being able to swallow all foods and drinks’ (swallow, 56%/56%), ‘having a normal amount of energy’ (energy, 51%/48%) and ‘having no pain’ (pain, 51%/48%). After [C]RT, cure and survival were ranked highest (1 of 13) by 65/90 (72%) and 12/90 (13%) patients, respectively, and swallow was ranked above cure, survival, pain, energy, ‘keeping my normal sense of taste and smell’ (senses) and ‘having a comfortably moist mouth’ (moist mouth) by 14%, 36%, 47%, 55%, 56% and 66% of patients, respectively. More patients identified senses and moist mouth as a top priority 12m after [C]RT than before [C]RT (26%/44%, p=0.002; and 19%/39%, p=0.003, respectively). Select MDASI-HN symptom severity scores did not differ by CPS-modified priority groupings (top versus middle/lower) 12m after [C]RT (all p>0.05).

CONCLUSIONS: For HPVOPC patients, the most important treatment outcome priorities are stable before and 12m after [C]RT. After C[RT], only 56% of HPVOPC survivors considered swallowing a top priority. Patient priorities should be considered when designing future de-escalation treatment strategies, considering the excellent outcomes with standard treatment.

PMID:40914539 | DOI:10.1016/j.ijrobp.2025.08.053