Tag: pubmed

Can Urol Assoc J. 2025 Oct 27. doi: 10.5489/cuaj.9286. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric and adult reconstructive urology remain underrepresented in global surgical efforts, despite their critical role in restoring genitourinary function. This global surgery initiative aimed to address the gap in specialized urologic care in low- to middle-income countries (LMICs) through a longitudinal, mentorship-based approach integrating augmented reality (AR) telementoring.

METHODS: This report describes an approach used to enhance global surgical expertise in LMICs and summarizes data documenting impact. A Global Surgery Partnership Initiative was launched by an academic surgeon from the University of Toronto to address the lack of specialized pediatric and reconstructive urologic training. Through collaboration with local institutions in the Philippines and Vietnam, the program employed a mixed-method approach that delivered longitudinal mentorship, combining virtual case conferences, in-person surgical mentoring, pilot of AR-supported telementoring, and continuous postoperative coaching. Patient outcomes were assessed and mentees self-reported pre- and post-intervention surveys evaluating comfort and technical understanding. Descriptive statistics and paired t-tests were used to analyze outcomes.

RESULTS: Thirty-eight pediatric and adult reconstructive urology cases were performed. Over time, operative times and length of stay decreased, with low complication rates (6/38, 12.7%) and Clavien-Dindo ≥3 complications (3/38, 8%). Mentee comfort and understanding significantly improved (mean comfort score: 3.06 to 6.77; technical understanding: 4.77 to 8.43; p<0.001). AR-assisted mentoring, introduced in 2022 and expanded in 2024, showed feasibility, with further enhanced intraoperative feedback and sustainability.

CONCLUSIONS: This structured, mixed-method model effectively improved surgical competencies and system-level capacity in LMICs. Unlike short-term missions, this initiative emphasized continuity, adaptability, and sustainability. It presents a scalable framework for integrating reconstructive urology into global health programs while leveraging AR to overcome geographic and resource limitations.

PMID:41191829 | DOI:10.5489/cuaj.9286

J Nerv Ment Dis. 2025 Nov 5. doi: 10.1097/NMD.0000000000001858. Online ahead of print.

ABSTRACT

INTRODUCTION: Epilepsy is associated with increased schizophrenia risk, but few large studies account for key factors. This study analyzed cohort data from Korea to assess schizophrenia risk postepilepsy diagnosis.

METHODS: Epilepsy patients were age-matched and sex-matched with controls. Schizophrenia was the primary outcome. Cox regression estimated adjusted hazard ratios (HRs), accounting for demographics and lifestyle factors (smoking, BMI, cholesterol, and income). Kaplan-Meier curves and log-rank tests assessed cumulative schizophrenia incidence.

RESULTS: The study included 2,770 epilepsy patients and 27,700 matched controls. The overall adjusted HR for schizophrenia among epilepsy patients was 9.44 (95% CI, 6.72-13.25). Subgroup analysis indicated the highest HR in men under 60 years at 13.44 (95% CI, 5.53-32.66), and in women aged 60 and older at 13.16 (95% CI, 7.09-24.44).

CONCLUSIONS: Epilepsy increases the risk of schizophrenia, especially in younger men and older women, highlighting the need for targeted mental health monitoring and early intervention.

PMID:41191815 | DOI:10.1097/NMD.0000000000001858

Ann Otol Rhinol Laryngol. 2025 Nov 5:34894251384882. doi: 10.1177/00034894251384882. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether otologic bone cements-hydroxyapatite (HAC) and glass ionomer cement (GIC)-cause facial nerve damage by evaluating their electrophysiological and histopathological effects in a rat model.

MATERIALS AND METHODS: All rats, except those in the control group, underwent surgical exposure of the facial nerve. Bone cement was applied in the intervention groups. Rats were randomly assigned to 6 groups (n = 10 each): (1) control; (2) sham; (3) HAC; (4) HAC with soft tissue graft; (5) GIC; and (6) GIC with soft tissue graft. In Groups 3 and 5, bone cement was applied directly onto the facial nerve trunk near the stylomastoid foramen. In Groups 4 and 6, the nerve trunk was first covered with a soft tissue graft to prevent direct contact. Facial nerve function was assessed using evoked electromyography (EMG) and video-based whisker movement analysis. Tissue samples from the facial nerve and surrounding structures were collected for histopathological evaluation.

RESULTS: The HAC and GIC groups showed significant histopathological changes compared to the control group in all parameters assessed-including foreign body reaction, granulation tissue, perineurium thinning, disorganized nerve fiber structure, axon-myelin swelling, and Schwann cell nuclear enlargement-except for necrosis. However, there were no statistically significant differences among groups in terms of EMG or whisker movement outcomes.

CONCLUSION: This study underscores the need for caution when using bone cement near neural structures. Although HAC and GIC did not impair facial nerve function, their histopathological effects highlight the importance of avoiding direct neural contact. Future research should explore improved surgical techniques and neurotoxin-sparing alternatives.

PMID:41190485 | DOI:10.1177/00034894251384882

Ann Otol Rhinol Laryngol. 2025 Nov 5:34894251384879. doi: 10.1177/00034894251384879. Online ahead of print.

ABSTRACT

OBJECTIVES: With the growing popularity of rhinoplasty, techniques for enhancing functional and aesthetic outcomes are evolving. This study aims to compare 2 methods in rhinoplasty-sutured scroll reconstruction versus no scroll repair-focusing on their effects on nasal breathing, aesthetic results, and patient satisfaction.

METHODS: This randomized controlled study at Taleghani Hospital in Tehran involved female patients aged 18 to 50 years undergoing primary rhinoplasties. Participants were assigned to 2 groups, and only 1 received sutured horizontal scroll ligament repair. Outcomes were assessed using the FACE-Q rhinoplasty module for patient satisfaction and rhinomanometry for nasal function, with independent surgeons evaluating aesthetic results via a Visual Analog Scale. For statistical analyses SPSS version 22.0 was used, with significance set at P < .05.

RESULTS: The study involved 164 female patients, with 82 in the sutured scroll ligament group and 82 in the no scroll repair group. The mean age was 26.32 ± 6.86 years (range = 19-46). No significant baseline differences were found. After a mean follow-up of 11.6 months, no patients required revision surgery. Post-operative FACE-Q scores and VAS ratings were higher in the sutured group. The mean postoperative peak inspiratory nasal flow (PNIF) was 116.42 ± 13.78 ml/minute in the sutured group versus 111.08 ± 15.67 ml/minute in the other group (P = .034).

CONCLUSION: This randomized clinical trial emphasizes on the positive effect of ensuring the scroll ligament repair using sutures on the facial aesthetics, quality of life, and functional capacity of patient after the surgery. Which is consistent with the prior studies indicating both cosmetic and functional benefits for scroll preservation/reconstruction.

PMID:41190484 | DOI:10.1177/00034894251384879

Elife. 2025 Nov 5;14:RP105734. doi: 10.7554/eLife.105734.

ABSTRACT

Numerous studies advocate for a rhythmic mode of perception. However, the evidence in the context of hearing remains inconsistent. We propose that the divergent conclusions drawn from previous work stem from conceptual and methodological issues. These include ambiguous assumptions regarding the origin of rhythmicity, variations in tasks and attentional demands, and differing analytical approaches for statistical testing. To address these points, we conducted a series of experiments in which human participants performed auditory tasks involving monaural targets presented against binaural white noise backgrounds, while also recording eye movements. These experiments varied in whether stimuli were presented randomly or required motor initialisation, the necessity of memory across trials, and the manipulation of attentional demands. Our findings challenge the notion of universal rhythmicity in hearing, but support the existence of paradigm- and ear-specific fluctuations in sensitivity and biases at multiple frequencies. The rhythmicity for sounds in the left and right ears appears independent among participants, and the rhythmicity in performance is possibly linked to oculomotor activity and attentional requirements. Overall, these results may help to resolve conflicting conclusions drawn in previous work and provide specific avenues for further studies into the rhythmicity of auditory perception.

PMID:41190483 | DOI:10.7554/eLife.105734

J R Soc Interface. 2025 Nov;22(232):20250649. doi: 10.1098/rsif.2025.0649. Epub 2025 Nov 5.

NO ABSTRACT

PMID:41190470 | DOI:10.1098/rsif.2025.0649

Ann Otol Rhinol Laryngol. 2025 Nov 5:34894251388843. doi: 10.1177/00034894251388843. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate extended outcomes up to 6 years following bipolar-cautery inferior turbinate reduction (ITR) in a large pediatric cohort.

METHODS: Retrospective case series of 326 children (mean age 9.0 ± 4.1 years) who underwent 12-W bipolar-cautery ITR between December 2017 and May 2024 at a single-surgeon tertiary practice. Concurrent procedures were performed in 82% of patients; 59 underwent ITR alone. Parent-reported nasal breathing improvement was assessed at regular intervals up to 6 years. Statistical analyses included Cochran’s Q tests and generalized estimating equations (GEE).

RESULTS: In the full cohort, nasal breathing improvement rates were: 95.4% at 3 months, 91.7% at 6 months, 90.2% at 1 year, 88.1% at 2 years, and 78.7% at 3 years. Sample sizes decreased beyond 3 years due to follow-up attrition. Cochran’s Q test showed significant changes over time through 3 years (Q = 60.101, P < .001). The ITR-only subgroup showed more marked decline: 98% improvement at 3 months to 69.0% at 3 years (P = .002), compared to more stable rates with concurrent surgery. GEE analysis confirmed significant time effects (P < .001). Compared to ITR alone, concurrent septoplasty (OR 0.39, P = .002) and sinus surgery (OR 0.34, P = .020) were each associated with significantly lower odds of reporting persistent symptoms (i.e., a greater likelihood of improvement). Complications remained low: minor bleeding (4.6%), major bleeding requiring intervention (1.2%), MRSA infection (0.3%), and synechiae (1.5%).

CONCLUSIONS: Bipolar-cautery ITR provides safe, effective symptom improvement with excellent short-term results (>90% at 1 year). However, efficacy declines over time, particularly in ITR-only patients (78.7% overall at 3 years). Concurrent airway procedures may provide more stable outcomes. These findings emphasize the need for long-term follow-up and appropriate patient selection.

PMID:41190463 | DOI:10.1177/00034894251388843

Liver Int. 2025 Dec;45(12):e70424. doi: 10.1111/liv.70424.

ABSTRACT

BACKGROUND AND AIMS: The effectiveness and safety of medications for alcohol use disorder (MAUD) in treating alcohol-associated cirrhosis have not been fully elucidated. This study aims to explore the clinical benefits and risks of MAUD in patients with alcohol-associated cirrhosis and persistent alcohol use.

METHODS: This retrospective cohort study utilised anonymised electronic health records (EHRs) from the TriNetX platform to evaluate the impact of MAUD on mortality, alcohol abstinence rates, hepatocellular carcinoma, hepatic decompensation and healthcare utilisation in patients with alcohol-associated cirrhosis.

RESULTS: This study evaluated 200 054 patients with alcohol-associated cirrhosis; after propensity score matching, 17 548 patients (8774 in each group) were analysed comparing those treated with MAUD to those without. At 3 years, patients treated with MAUD exhibited significantly lower mortality (21.6% vs. 29.3%, HR 0.731, 95% CI 0.688-0.776, p < 0.001), reduced hepatocellular carcinoma (2.6% vs. 3.3%, HR 0.794, p = 0.010) and fewer hospitalisations (16.7% vs. 24.8%, HR 0.635, p < 0.001). Subgroup analyses revealed that among 5083 patients treated with naltrexone, 3-year mortality was reduced (19.8% vs. 30.3%, HR 0.645, 95% CI 0.596-0.699, p < 0.001), hepatocellular carcinoma incidence was lower (2.6% vs. 3.3%, HR 0.790, p = 0.047) and hepatic decompensation decreased (18.4% vs. 21.1%, HR 0.843, p = 0.004). Among 4108 patients treated with acamprosate, 3-year mortality was reduced (22.6% vs. 29.0%, HR 0.799, 95% CI 0.733-0.871, p < 0.001) and hospitalisations and emergency department visits were significantly lower, though no reduction in hepatocellular carcinoma was observed.

CONCLUSION: This study demonstrates the significant benefits of MAUD in patients with alcohol-associated cirrhosis, including reduced mortality, lower healthcare utilisation and improved alcohol abstinence rates, supporting its integration into standard care protocols.

PMID:41190460 | DOI:10.1111/liv.70424

J Neuropsychol. 2025 Nov 5. doi: 10.1111/jnp.70020. Online ahead of print.

ABSTRACT

Reassessments with the Rey Auditory Verbal Learning Test (RAVLT) may generate learning effects, compromising the validity of the results. In Brazil, there are still no comparative studies between adapted versions of the test in healthy individuals. This study compared scores obtained on versions A and B of the RAVLT-A, routinely used in the neuropsychological assessment of patients with epilepsy and investigated the effects of age, education and version used. A prospective study with 188 cognitively healthy adults was randomly assigned to two groups (version A or B). Comparative analyses between groups and multivariate linear regression models were conducted to examine the impact of age, education and version on RAVLT-A scores. No significant differences were observed between versions A and B of the RAVLT-A (p > .05). Regression indicated a significant influence of age and, especially, education on performance on the test variables. The version used had no statistically relevant impact on the scores. This is the first Brazilian study to examine two adapted versions of the RAVLT-A in healthy adults. The findings demonstrate comparability between versions A and B, supporting their alternate use in reassessments to reduce practice effects. Age and, especially, education significantly influenced performance, emphasizing the need for normative data stratified by both variables, since those commonly used in Brazil are stratified only by age.

PMID:41190450 | DOI:10.1111/jnp.70020

Cancer Rep (Hoboken). 2025 Nov;8(11):e70396. doi: 10.1002/cnr2.70396.

ABSTRACT

BACKGROUND AND OBJECTIVES: Existing literature on ovarian masses necessitating intervention in children by pediatric surgeons and gynecologists in Low- and Middle-Income Countries is sparse and lacks collaborative standardization in management between the two subspecialties. Therefore, this study seeks to assess the range of ovarian masses presenting to these two specialties and to explore variations in management.

METHODS: A 15-year retrospective review of surgically biopsied or excised ovarian masses between subspecialties at two academic hospitals in Johannesburg.

RESULTS: We identified 288 patients, six with bilateral disease and 294 ovarian masses. The mean age was 13.34 years (SD ±5.12). The most common presentation was abdominal pain in 149/288 (51.74%); 117 patients (40.62%) were from pediatric surgery and 171 (59.38%) from gynecology departments. There were 127/288 (44.09%) non-neoplastic and 161/288 (55.90%) neoplastic lesions, of which 110/161 (68.33%) were benign and 51/161 (31.67%) malignant. The neoplastic lesions consisted of 107/161 (66.45%) germ cells, 28/161 (17.39%) surface epithelial tumors, and 26/161 (16.14%) sex cord-stromal tumors. Ovarian-sparing surgery was done in 56/288 (19.44%) patients, 22/117 (18.80%) in pediatric surgery, and 34/171 (19.88%) in gynecology. Laparoscopy was done in 57/288 (19.79%) patients, 24/117 (20.51%) in pediatric surgery, and 19/171 (19.29%) in gynecology. The survival rate in benign masses was 100%, and 86.28% in malignancies.

CONCLUSION: This study highlights the diverse spectrum of ovarian masses managed by pediatric surgeons and gynecologists. A laparoscopic approach combined with ovarian preservation, which was comparable between specialties, should be the preferred method for managing benign lesions whenever feasible. These findings underscore the need for standardized, collaborative guidelines between pediatric surgeons and gynecologists to ensure consistent and optimal management of ovarian masses in children.

PMID:41190447 | DOI:10.1002/cnr2.70396