Tag: pubmed

Knee Surg Sports Traumatol Arthrosc. 2025 Jul 2. doi: 10.1002/ksa.12758. Online ahead of print.

ABSTRACT

PURPOSE: The durability and effectiveness of total knee arthroplasty (TKA) depend on secure implant fixation and efficient bone integration. While cemented tibial components provide immediate mechanical stability, the addition of a short stem may be indicated in selected cases to enhance fixation. However, the stem does not allow for biological integration. The advantages of cementation over press-fit fixation remain a subject of debate, particularly regarding their impact on periprosthetic bone mineral density (BMD) over time. This study aims to compare periprosthetic BMD changes between cemented and noncemented tibial stems in primary TKA.

METHODS: In this prospective, monocentric study, we compared periprosthetic BMD changes in 60 patients undergoing primary TKA, randomised into two groups: 30 with cemented and 30 with noncemented tibial stems. Dual-energy X-ray absorptiometry (DEXA) measured BMD preoperatively and at 3, 6, 12 and 24 months postoperatively across six zones: beneath the tibial tray (R1, R2), around the stem (R3, R4), at the apex (R5), and a control zone below the stem (R6). Statistical analyses included repeated measures analysis of variance and independent t-tests.

RESULTS: Cemented stems showed a significant increase in BMD at 12 months (+0.10 g/cm², p = 0.03) and 24 months (+0.12 g/cm², p = 0.04), outperforming noncemented stems (+0.06 g/cm², p = 0.12). Overall, cemented stems demonstrated greater BMD gains (+0.15 g/cm² vs. +0.08 g/cm², p = 0.03). Minimal changes were observed in both groups, with cemented stems showing slightly higher BMD retention (+0.05 g/cm² vs. -0.02 g/cm², p = 0.09). No statistically significant differences were recorded in certain regions.

CONCLUSION: Cemented stems demonstrated greater periprosthetic BMD retention, which may contribute to improved mechanical environment for the implant. These findings may help guide the selection of fixation methods in primary TKA, particularly for patients with compromised bone quality.

LEVEL OF EVIDENCE: Level I.

PMID:40601967 | DOI:10.1002/ksa.12758

Mil Med. 2025 Jul 2:usaf351. doi: 10.1093/milmed/usaf351. Online ahead of print.

ABSTRACT

INTRODUCTION: The Patient Health Questionnaire-8 (PHQ-8) is a measure of depression symptom severity that is the 8-item version of the more widely used Patient Health Questionnaire-9 (PHQ-9). However, the PHQ-8 lacks the question about suicide ideation and is often used when questions about suicide ideation cannot be administered. A recent review of the literature on the PHQ-9 indicates mixed findings on factor structure, with evidence for both a unidimensional model and a 2-factor model of somatic and non-somatic symptoms. To date, few studies have explored the factor structure of the PHQ-8, and none to our knowledge have examined this in military samples. This secondary analysis examined this in a sample of military sexual assault survivors given their heightened risk for depression.

MATERIALS AND METHODS: Service members and veterans who experienced assault (N = 346; 49.1% female) completed the PHQ-8 in a previously published study. The parent study was approved by the Utah State University Institutional Review Board (IRB) and secondary analyses were exempted from IRB review by the Arizona State University IRB. Five structural models were tested using confirmatory factor analysis, including 1 unidimensional factor model and 4 2-dimensional factor models. The following goodness of fit statistics were compared between models: Chi-squared testing, Comparative Fit Index (CFI), Tucker Lewis Index (TLI), root mean square error of approximation (RMSEA), Bayesian Information Criterion (BIC) and standardized root mean square residual (SRMR). Strong model fit was determined by a CFI and TLI ≥ .95, RMSEA ≤ .06, and SRMR ≤ .08.

RESULTS: The 2-dimensional model with anhedonia, depressed mood, feelings of worthlessness, concentration difficulties, and psychomotor agitation/retardation specified on the non-somatic factor, and sleep difficulties, fatigue, and appetite changes specified on the somatic factor had the most optimal fit (X2 [df] = 46.19 [19], CFI = 0.98, TLI = 0.97, RMSEA = 0.06, SRMR = 0.03, BIC = 6,130.98). Other models had adequate fit, though the fit for the unidimensional model was statistically inferior.

CONCLUSION: The use of 2-factor models of depression might be superior compared to the unidimensional model in samples of military sexual assault survivors which may provide clinical utility in treating specific depression symptom clusters. Studies that wish to examine potential differences in outcomes as a function of somatic and non-somatic depressive symptoms may consider this model. Future studies should examine model fit in samples that may not have been exposed to military sexual assault.

PMID:40601935 | DOI:10.1093/milmed/usaf351

Retina. 2025 Jun 24. doi: 10.1097/IAE.0000000000004577. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the retinal displacement and metamorphopsia in patients with primary rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) or scleral buckling (SB).

METHODS: This is a prospective non-randomized interventional study. A total of 107 patients were studied over a period of 6 months postoperatively. The vessel printing on the fundus autofluorescence (FAF) photos and the M-CHART were used to evaluate the retinal displacement and the metamorphopsia, respectively. We also assessed the vision-related quality of life, the postoperative visual acuity and the optical coherence tomographic (OCT) findings.

RESULTS: Sixty-five male and forty-two female patients were recruited in the study. The mean age was 54.8 years (SD 14.7, range 18-82). The proportion of eyes detected with retinal displacement at six months postoperatively was significantly lower in the SB group (4.3%) than in the PPV group (30.9%) (26.6% difference, 95% CI 13.1% – 40.1%, p<0.001). The SB group had significantly lower postoperative vertical and horizontal metamorphopsia (45.5% difference, 95% CI 28.3% – 62.7% p<0.001 and 38.2% difference 95% CI 20.7 % – 55.7%, p<0.001, respectively). There was no significant difference between the two study groups regarding the vision-related quality of life (1.19 difference, 95% CI -5.76, 7.70, p=0.783) and visual acuity (0.08 difference, 95% CI 0.00, 0.17, p=0.051).

CONCLUSION: Although scleral buckling is not superior in visual acuity improvement and quality of life, it improves anatomical outcomes with less retinal displacement and functional outcomes with less metamorphopsia.

PMID:40601930 | DOI:10.1097/IAE.0000000000004577

J Med Internet Res. 2025 Jul 2;27:e65226. doi: 10.2196/65226.

ABSTRACT

BACKGROUND: The use of web-based search and social media can help identify epidemics, potentially earlier than clinical methods or even potentially identifying unreported outbreaks. Monitoring for eye-related epidemics, such as conjunctivitis outbreaks, can facilitate early public health intervention to reduce transmission and ocular comorbidities. However, monitoring social media content for conjunctivitis outbreaks is costly and laborious. Large language models (LLMs) could overcome these barriers by assessing the likelihood that real-world outbreaks are being described. However, public health actions for likely outbreaks could benefit more by knowing additional epidemiological characteristics, such as outbreak type, size, and severity.

OBJECTIVE: We aimed to assess whether and how well LLMs can classify epidemiological features from social media posts beyond conjunctivitis outbreak probability, including outbreak type, size, severity, etiology, and community setting. We used a validation framework comparing LLM classifications to those of other LLMs and human experts.

METHODS: We wrote code to generate synthetic conjunctivitis outbreak social media posts, embedded with specific preclassified epidemiological features to simulate various infectious eye disease outbreak and control scenarios. We used these posts to develop effective LLM prompts and test the capabilities of multiple LLMs. For top-performing LLMs, we gauged their practical utility in real-world epidemiological surveillance by comparing their assessments of Twitter/X, forum, and YouTube conjunctivitis posts. Finally, human raters also classified the posts, and we compared their classifications to those of a leading LLM for validation. Comparisons entailed correlation or sensitivity and specificity statistics.

RESULTS: We assessed 7 LLMs for effectively classifying epidemiological data from 1152 synthetic posts, 370 Twitter/X posts, 290 forum posts, and 956 YouTube posts. Despite some discrepancies, the LLMs demonstrated a reliable capacity for nuanced epidemiological analysis across various data sources and compared to humans or between LLMs. Notably, GPT-4 and Mixtral 8x22b exhibited high performance, predicting conjunctivitis outbreak characteristics such as probability (GPT-4: correlation=0.73), size (Mixtral 8x22b: correlation=0.82), and type (infectious, allergic, or environmentally caused); however, there were notable exceptions. Assessing synthetic and real-world posts for etiological factors, infectious eye disease specialist validations revealed that GPT-4 had high specificity (0.83-1.00) but variable sensitivity (0.32-0.71). Interrater reliability analyses showed that LLM-expert agreement exceeded expert-expert agreement for severity assessment (intraclass correlation coefficient=0.69 vs 0.38), while agreement varied by condition type (κ=0.37-0.94).

CONCLUSIONS: This investigation into the potential of LLMs for public health infoveillance suggests effectiveness in classifying key epidemiological characteristics from social media content about conjunctivitis outbreaks. Future studies should further explore LLMs’ potential to support public health monitoring through the automated assessment and classification of potential infectious eye disease or other outbreaks. Their optimal role may be to act as a first line of documentation, alerting public health organizations for the follow-up of LLM-detected and -classified small, early outbreaks, with a focus on the most severe ones.

PMID:40601927 | DOI:10.2196/65226

JMIR Res Protoc. 2025 Jul 2;14:e77927. doi: 10.2196/77927.

ABSTRACT

BACKGROUND: Atopic dermatitis (AD) is a recurrent, inflammatory, and chronic skin disease that influences over 200 million individuals around the world and is viewed as an important health problem due to its elevated prevalence, long course of disease, and heavy disease burden. WuSheZhiYang (WSZY) pills are composed of 11 Chinese herbs and have the effects of nourishing the blood, drying dampness, and relieving itching. In clinical practice, WSZY pills are recommended for itching skin diseases, but high-quality clinical trial evidence is still limited.

OBJECTIVE: In this study, we will implement a double-blind, randomized, placebo-controlled trial to evaluate the efficacy of WSZY pills for mild-to-moderate AD. We hypothesized that WSZY pills can effectively alleviate the disease condition of patients with mild-to-moderate AD.

METHODS: In this study, we will recruit 60 patients with mild-to-moderate in Shanghai Skin Diseases Hospital from December 2024 through December 2025. In this study, 60 male and female patients with AD aged 18 years to 65 years will be randomly assigned (2:1) to the treatment group (urea ointment and WSZY pills; n=40) or control group (urea ointment and placebo WSZY pills; n=20), and both groups will receive 4 weeks of treatment and 4 weeks of follow-up. The treatment group will receive 3 sessions of urea ointment and 7.5 g of WSZY pills each day for 4 weeks, and the control group will also receive 3 sessions of urea ointment and 7.5 g of placebo WSZY pills each day for 4 weeks. The primary indicator is the change in the objective Scoring Atopic Dermatitis (SCORAD) score between baseline and week 4. The secondary indicators include SCORAD at week 2 and week 8; Peak Pruritus Numerical Rating Scale (PP-NRS), Investigator’s Global Assessment (IGA), Patient-Oriented Eczema Measure (POEM), and Dermatology Life Quality Index (DLQI) at week 2, week 4, and week 8; and the proportion of participants receiving remedial treatment, amount of levocetirizine tablets used, and recurrence rate at week 8. In this study, we will analyze the full analysis set and per-protocol set using SAS software version 9.4, and a 2-tailed alpha level of .05 will be viewed as statistically significant.

RESULTS: The study received ethics permission in September 2024, and trial registration was completed in October 2024. Recruitment started in December 2024 and is expected to be completed by December 2025. As of June 2025, 30 participants with mild-to-moderate AD were enrolled. Data analysis will begin in January 2026. The main results of the trial are expected to be submitted for publication in peer-reviewed scientific journals in the summer of 2026.

CONCLUSIONS: This study will evaluate the efficacy of WSZY pills for AD and provide additional evidence, suggest new therapeutic options for patients, and reduce their disease burden.

TRIAL REGISTRATION: International Traditional Medicine Clinical Trial Registry ITMCTR2024000724; http://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=bda070f8-a733-4f52-87b0-39e4be57ac00.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/77927.

PMID:40601920 | DOI:10.2196/77927

Am J Phys Med Rehabil. 2025 Jul 2. doi: 10.1097/PHM.0000000000002793. Online ahead of print.

ABSTRACT

OBJECTIVE: Stroke is a major cause of disability, impacting mobility worldwide. Overground robotic-assisted gait training (o-RAGT) uses wearable exoskeletons to improve walking. This systematic review and meta-analysis assess its effectiveness versus conventional gait training in enhancing gait velocity and balance in post-stroke patients.

DESIGN: Our search was conducted in the Pubmed, Cochrane, ScienceDirect, Scopus and PEDro electronic databases for English journal articles about human randomized controlled trials (RCTs) of the last two decades, investigating o-RAGT effects on gait parameters of poststroke patients compared with conventional gait training.

RESULTS: A comprehensive literature search identified seven RCTs with a total of 288 participants. Meta-analysis results indicated that o-RAGT significantly improved post-intervention gait velocity (summary mean difference: 0.09 m/sec, 95% CI: 0.02-0.17), while other gait parameters, such as stride length and cadence, showed no statistically significant differences. The intervention was well-tolerated, with no major adverse events reported.

CONCLUSION: Despite the positive impact on gait speed, challenges remain, including high device costs and the need for further research to optimize training parameters. These findings support the potential of o-RAGT as an effective tool for gait rehabilitation in stroke survivors, highlighting the need for larger studies with long-term follow-up to refine its clinical application.

PMID:40601918 | DOI:10.1097/PHM.0000000000002793

Glob Public Health. 2025 Dec;20(1):2525960. doi: 10.1080/17441692.2025.2525960. Epub 2025 Jul 2.

ABSTRACT

Equitable access to healthcare is essential for achieving Universal Health Coverage (UHC) and improving health outcomes. This cross-sectional study examines patients’ perceived access to healthcare services in the West Bank, providing insights into patients’ perceptions of health disparities. Data were collected using stratified convenient sampling of 486 chronic patients at governmental primary healthcare centers in three governorates. A 5-points Likert scale questionnaire was used, based on the ‘6A’ dimensions for healthcare access: affordability, acceptability, accommodation, accessibility, availability, and awareness. The overall healthcare access mean score was 3.29 (SD = 0.46), with only 38.5% of participants reporting satisfactory access levels. Only acceptability (mean =3.75, SD = 0.55), and awareness (mean = 3.66, SD = 0.61) dimensions demonstrated significantly positive perceptions. Bivariate analysis identified income as the main significant determinant for access disparities (Kruskal-Wallis Test χ²= 75.9, p < 0.001). Place of residency, education and income significantly contributed to the disparities within the different access dimensions. The findings highlight significant challenges in healthcare access in the West Bank, particularly regarding services availability and financial affordability. These barriers extremely affect vulnerable populations, exacerbating existing health inequities and undermining efforts toward UHC. The findings emphasise the urgent need for policy interventions to address financial protection, expand service availability, and strengthen healthcare provision.

PMID:40601916 | DOI:10.1080/17441692.2025.2525960

Blood Adv. 2025 Jul 2:bloodadvances.2024015659. doi: 10.1182/bloodadvances.2024015659. Online ahead of print.

ABSTRACT

Measurement of patient-reported outcomes (PROs) and health-related quality of life (HrQOL) are crucial for comprehensive, patient-centered cancer care. Both PROs and HrQOL have been under-studied in patients with Erdheim-Chester disease (ECD), a rare cancer with protean manifestations, dense symptomatology, and frequent diagnostic delay. We sought to evaluate the longitudinal evolution of symptom burden and unmet supportive care needs in patients with ECD, and to identify associations between these PROs and HrQOL. A registry-based cohort of patients with ECD completed a PRO battery including the Functional Assessment of Cancer Therapy-General (FACT-G) and other validated PRO measures. Descriptive statistics were used to characterize the distribution of PROs and FACT-G scores; PROs were modeled by univariable linear regression with FACT-G total score as the dependent variable at (1) registry enrollment and (2) 12-month time points. Changes in FACT-G total score (the difference between the 12-month and enrollment scores) were correlated with changes in PROs using univariable linear regression analysis. In 158 patients, mean total FACT-G was 70.8, lower than observed across multiple cancer cohorts. Higher levels of pain and fatigue, presence of neurologic symptoms, and greater number of unmet needs were all associated with worse HrQOL. Improvement in pain, fatigue, and unmet needs over 12 months was significantly associated with improvement in HrQOL. In patients with ECD, HrQOL is substantially diminished, even when considering other patients with cancer. Mitigation of symptoms and addressing unmet supportive care needs represent opportunities for intervention to improve HrQOL in ECD.

PMID:40601910 | DOI:10.1182/bloodadvances.2024015659

J Clin Oncol. 2025 Jul 2:JCO2501041. doi: 10.1200/JCO-25-01041. Online ahead of print.

NO ABSTRACT

PMID:40601891 | DOI:10.1200/JCO-25-01041

JCO Oncol Pract. 2025 Jul 2:OP2500462. doi: 10.1200/OP-25-00462. Online ahead of print.

ABSTRACT

PURPOSE: Advances in breast cancer treatment have reduced mortality and toxicity, but it remains unclear which patients receive updated care and when. We aimed to identify factors associated with receiving updated breast cancer care.

METHODS: We analyzed patients age 65-85 years with local or regional breast cancer, diagnosed between 2010 and 2018, using the SEER-Medicare database. We included patients who were continuously enrolled in Medicare for 1 year after diagnosis and were eligible for one of four updated treatments: (1) adjuvant paclitaxel-trastuzumab (APT) for human epidermal growth factor receptor 2 (HER2)-positive local disease, (2) pertuzumab for HER2-positive regional disease, (3) neoadjuvant chemotherapy for triple-negative or HER2-positive regional disease, and (4) omission of chemotherapy for hormone receptor-positive, HER2-negative regional disease. We examined the association between treating oncologist specialization (percent of SEER-Medicare patients with breast cancer) and receipt of updated care using multivariable analysis.

RESULTS: Of the 21,575 patients eligible for one of these four updated care approaches, use of the APT regimen increased from 30% (95% CI, 23% to 37%) to 72% (95% CI, 67% to 77%), pertuzumab from 0% to 71% (95% CI, 66% to 76%), neoadjuvant chemotherapy from 23% (95% CI, 18% to 28%) to 60% (95% CI, 56% to 65%), and omission of chemotherapy from 54% (95% CI, 52% to 57%) to 61% (95% CI, 59% to 64%) from 2010 to 2018. In multivariable analyses, higher median income of residence county and greater specialization of treating oncologist were statistically significantly associated with receipt of updated care for all four treatment scenarios. Patients from lower-income areas who received care from more specialized oncologists were as likely to receive updated care as those from higher-income areas.

CONCLUSION: Patients from lower-income areas were less likely to receive updated care, but specialized oncologists helped mitigate this disparity. Care models that expand consultative access to specialized oncologists should be prioritized for evaluation.

PMID:40601879 | DOI:10.1200/OP-25-00462