Tag: pubmed

Int J Comput Assist Radiol Surg. 2025 Jun 8. doi: 10.1007/s11548-025-03417-x. Online ahead of print.

ABSTRACT

PURPOSE: Reliable and accurate 2D/3D registration is essential for image-guided navigation and surgical robotics, enabling precise spatial alignment. This work investigates uncertainty quantification and characterization, addressing challenges specific to 2D/3D registration. Despite a few degrees of freedom (DoF), uncertainty in 2D/3D registration is difficult to estimate and interpret since it lacks the dimensional consistency in 2D/2D or 3D/3D registration.

METHODS: We model 2D/3D registration as a Maximum A Posteriori (MAP) estimation over the posterior distribution of 3D object poses given 2D fluoroscopic images. Uncertainty is quantified by sampling from an approximate posterior distribution, derived from a similarity function-based likelihood and a prior over the 6DoF pose space, and computing summary statistics and entropy measures from these samples. To characterize this approach, we generate plausible 2D/3D pelvis registrations and conduct experiments to investigate the relationship between uncertainty metrics and registration error.

RESULTS: Ordinary least squares (OLS) regression, a linear model, failed to capture the relationship between uncertainty metrics and registration error (R-squared = 0.023), while XGBoost provided a significantly better fit (R-squared = 0.85). A paired t-test revealed significant differences in prediction accuracy across registration error groups. XGBoost, fit on registrations closer to the correct solution, showed stronger predictive accuracy than the “global” model, which included the full range of errors, and the importance of uncertainty metrics differed between the two models.

CONCLUSION: This work presents a novel method for uncertainty quantification and characterization in single-view 2D/3D registration. Our results reveal a nonlinear relationship between uncertainty and registration accuracy, with stronger correlations observed in low-error regimes. These insights offer a foundation for better understanding and improving registration reliability in image-guided interventions.

PMID:40483666 | DOI:10.1007/s11548-025-03417-x

Eur J Orthop Surg Traumatol. 2025 Jun 8;35(1):239. doi: 10.1007/s00590-025-04362-w.

ABSTRACT

PURPOSE: To determine the risk factors for reoperation to promote union for periprosthetic distal femur fractures (PDFF).

METHODS: This was a retrospective, multi-centered comparative study of patients with PDFF (AO 33A-C[VB1, C1, D1]) managed operatively with open reduction and internal fixation (ORIF) with a lateral locked plate (LLP). Exclusion criteria were acute management with a distal femur replacement, fixation other than LLP, less than 6 months of follow-up, and lack of injury or follow-up radiographs. The primary outcome measure was reoperation to achieve bony union. Univariate and multivariate analyses were made between cases that did and did not require a reoperation to achieve union.

RESULTS: A total of 52 patients met inclusion criteria, of which 7 (13.5%) required a reoperation for union. There were no differences between the groups for age, sex, body mass index, comorbidities, Su classification, or open injury. Multivariate analysis identified risks for reoperation to promote union including notching preoperatively (OR 1.26, CI 1.04-1.53, p = 0.007), increased number of screws through a fracture line (OR 1.27, CI 1.15-1.41, p < 0.001), plate length < 12 holes (OR 1.15, CI 1.00-1.33, p = 0.020), and lower number of proximal screws that were locking (OR 0.95, CI 0.9-1.0, p = 0.043). Conclusions The reoperation rate to promote union was 13.5%. While limited by total case number, this study identified notching preoperatively, presence of screws through the fracture line, plate length < 12 holes, and lower number of proximal screws that were locking to be independent risk factors for reoperation to promote union.

PMID:40483658 | DOI:10.1007/s00590-025-04362-w

Pediatr Surg Int. 2025 Jun 8;41(1):160. doi: 10.1007/s00383-025-06061-3.

ABSTRACT

PURPOSE: Cloacal exstrophy represents a significant challenge for pediatric surgeons. A critical component of treatment involves bladder closure and reconstruction of the urethra, genitalia and pubic symphysis. The objective of this study is to describe and compare outcomes of patients with cloacal exstrophy based on the type of closure employed and to propose a multidisciplinary management protocol.

METHODS: A retrospective descriptive study was conducted on patients with cloacal exstrophy treated between 2008 and 2024. Demographic, clinical, surgical, and immediate post-operative (< 30 days) variables were recorded. The analysis was stratified into two groups based on the surgical approach: staged closure (SC) versus direct closure (DC).

RESULTS: Twelve patients were evaluated. In the DC group (n = 5), three (60%) were male, with a mean birth weight of 2401 (± 488) g. The median age at the time of surgery was 9 days [interquartile range (IQR): 5526 days]. Cecal plate rescue was successfully achieved in 80% of cases, and the mean pubic diastasis was 4.65 (± 2.84) cm. The most frequent complication observed was surgical wound infection. In the SC group (n = 7), five (71.4%) were female, with a mean birth weight of 2046.67 (± 489.8) g. The median age at surgery was 62.5 days (IQR: 1116 days). Cecal plate rescue was successful in six (85.7%) patients, and the mean pubic diastasis was 5.16 (± 2.74) cm. The most common complication was surgical wound infection associated with external fixation. No statistically significant differences were observed.

CONCLUSION: The outcomes of both techniques were comparable. In the DC group, males predominated, as this technique achieves greater phalloplasty length and was performed at an earlier age. The staged group included patients with higher risks of bladder closure dehiscence: lower birth weight, larger pubic diastasis, and associated cardiac comorbidities. This approach necessitates a specialized team of orthopedic surgeons for modern closure techniques, involving osteotomies and external fixators, which entail higher costs. Individualizing the surgical technique for bladder closure is critical. We recommend single stage closure for male neonates. A staged approach is advised for patients referred later in life with low birth weight, pubic diastasis > 5 cm, or hemodynamically significant cardiac comorbidities.

PMID:40483640 | DOI:10.1007/s00383-025-06061-3

Clin Rheumatol. 2025 Jun 8. doi: 10.1007/s10067-025-07512-x. Online ahead of print.

ABSTRACT

PURPOSE: The pan-immune-inflammation value (PIV) is a promising biomarker that reflects systemic inflammation and aids in disease prognosis. We sought to explore the potential association between PIV and hyperuricemia in the adult population of the USA.

METHODS: The data were collected from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. PIV was calculated as follows: (neutrophil × platelet × monocyte)/lymphocyte (10⁹/L). Hyperuricemia is defined as uric acid levels ≥ 420 mmol/L in males and ≥ 360 mmol/Ls in females. The association between PIV and the prevalence of hyperuricemia, as well as its impact on all-cause and cardiovascular mortality, was investigated.

RESULTS: A total of 31,151 adult participants were included in this study. The prevalence of hyperuricemia increased progressively with higher PIV levels (13.41% vs. 14.87% vs. 15.75% vs. 20.02%, P < 0.001). Participants in the fourth quartile of PIV had a greater risk of hyperuricemia compared to those in the first quartile (OR = 1.19, 95% CI: 1.07-1.32, P = 0.001). Smooth curve fitting also indicated a dose-response relationship between PIV levels and hyperuricemia risk. Additionally, elevated PIV levels were linked to an increased risk of all-cause and cardiovascular mortality in patients with hyperuricemia (P < 0.001).

CONCLUSIONS: PIV is an emerging biomarker reflecting systemic inflammation, with the potential for assessing hyperuricemia and its prognostic risk. Key Points • Pan-immune-inflammation value (PIV) holds potential as an epidemiological tool for analyzing immune-inflammatory responses tied to hyperuricemia and its long-term mortality risk.

PMID:40483638 | DOI:10.1007/s10067-025-07512-x

Sports Med Open. 2025 Jun 8;11(1):67. doi: 10.1186/s40798-025-00872-3.

ABSTRACT

BACKGROUND: Breast cancer survivors undergoing cancer therapy are at an increased risk of developing cardiovascular disease. As a result, exercise has become a research hotspot in preventing decreased cardiorespiratory fitness (CRF) in breast cancer survivors. However, there is no consensus on which type of exercise is the most effective in improving cardiorespiratory function of breast cancer survivors. Therefore, this network meta-analysis (NMA) aims to compare the effects of different exercise therapies and explore the possible optimal choice to improve CRF in breast cancer survivors.

METHODS: A systematic search was conducted in EMBASE, the Cochrane Library, PubMed, Web of Science, and CINAHL to identify relevant randomized controlled trials (RCTs). The analysis was then performed using R Version 3.5.1 and GEMTC software, employing a NMA with a Bayesian random effects model to synthesize the comparative effectiveness of different exercise schemes on CRF in breast cancer survivors. A network graph was constructed to visualize the relative relationship for each exercise therapy in relation to the others. Direct and mixed evidence were estimated with mean difference (MD) and 95% credible interval (CrI) and presented in a forest plot and league table. The cumulative rank plot was created and surface under the cumulative ranking (SUCRA) scores were calculated to rank the exercise schemes. Additionally, a network meta-regression analysis was conducted to evaluate if the different timing of exercise (during and after cancer treatment) has an influence on the effects found in this NMA.

RESULTS: The analysis included 41 eligible RCTs and a total of 2606 participants. The results indicated that moderate-intensity continuous aerobic training (MICT; MD: 1.6, 95%Cr 0.13 to 3.1), moderate-to-vigorous aerobic exercise (M-V; MD: 3.4, 95%CrI 1.9 to 5.0), high-intensity interval training (HIIT; MD: 2.9, 95%CrI 1.2 to 4.6), and moderate-to-vigorous aerobic training combined with resistance exercise (M-V + RE; MD: 4.3, 95%CrI 2.5 to 6.1) had better efficacy than usual care on CRF. M-V + RE was significantly better than MICT (MD: 2.7, 95%CrI 0.4 to 5.0). Amongst 12 exercise interventions, M-V + RE was shown to have the highest-ranking probability of being the best treatment (SUCRA: 88.15%). No statistical difference was observed for the relative effects of different timing of exercise for CRF improvement compared to usual care in network meta-regression analyses.

CONCLUSIONS: This NMA suggests MICT, M-V, HIIT, and M-V + RE as available options for improving CRF in breast cancer survivors, and M-V + RE is likely to be the optimal choice for improving CRF. Further high-quality studies are needed to continue to confirm the role of M-V + RE in improving CRF among breast cancer survivors.

PMID:40483630 | DOI:10.1186/s40798-025-00872-3

Sports Med Open. 2025 Jun 8;11(1):69. doi: 10.1186/s40798-025-00870-5.

ABSTRACT

BACKGROUND: Less-experienced runners are proposed to sustain more running related injuries (RRIs) than more-experienced runners because of differences in their gait biomechanics. However, the effects of running experience on biomechanics remain inconclusive. The objective of this systematic review was to examine the evidence concerning the influence of experience on running biomechanics and summarize the criteria used to classify running experience. A classification procedure for running experience was proposed based on the results.

METHODS: Five common databases were searched for relevant articles following PRISMA guidelines (PROSPERO_ID CRD42022296734) and the PICO framework. Peer-reviewed research reporting a statistical effect of running experience on running gait biomechanics in adults (18-65 years) were included. Exclusion criteria were: subjects with current pathologies or symptomatic injuries; reporting running only barefoot, in minimalist shoes, during sprinting, or incline/decline running; classified experience only through performance-related measures; or did not specify running experience group definition. Risk of bias was assessed with the Downs and Black checklist. Extracted data were organized in tables and synthesized descriptively due to study heterogeneity.

RESULTS: Twenty-eight studies with 916 total subjects were included. Although most studies found significance in their comparisons, no studies comparing similar gait variables found the same statistical result. Some variables compared between experience levels were examined in only one study. Experience classification criteria were inconsistent between studies; cut-offs for more-experienced ranged between 2 and 10 years and/or 15-50 km/week and cut-offs for less-experienced ranged between 0.5 and 3 years and/or 0-20 km/week. Meta-analysis was not possible due to heterogeneity among the included studies.

CONCLUSION: Effects of experience on running mechanics were inconsistent in the current literature. The lack of consistent findings may be due to the heterogeneous criteria used to classify runners into experience groups and the inconsistency of the variables investigated. Replication studies, heterogeneous study design, and longitudinal studies are needed to determine if or how running biomechanics change as runners gain experience. Heterogeneous study designs must begin with standard experience classification criteria for the effect of experience on running biomechanics to be identified. We propose an updated taxonomy to classify runners into groups considering three facets: exposure, performance, and intention.

TRIAL REGISTRATION: PROSPERO ID CRD42022296734. Registered 28 September 2022-Retrospectively registered, https://www.chictr.org.cn/bin/project/edit?pid=149714 .

PMID:40483619 | DOI:10.1186/s40798-025-00870-5

Intern Emerg Med. 2025 Jun 8. doi: 10.1007/s11739-025-04002-5. Online ahead of print.

ABSTRACT

Aspiration pneumonia (AP) is common in patients with pneumonia evaluated in Emergency Department (ED). The therapeutic management of these patients often involves secretion suctioning through two main techniques: laryngotracheal aspiration (LTA) and fibrobronchoscopic aspiration (FBA). Despite both techniques being employed, there are no studies comparing the clinical outcomes. This prospective single-center observational case control study was conducted in the ED of Careggi University Hospital in Italy. Adult patients with radiological evidence of pneumonia, clinical diagnosis of AP and need for oxygen therapy were included from the 12th December 2023 to the 31st December 2024. The primary endpoints were 30 day-mortality and the length of hospital stay. Secondary endpoints included admission setting, changes in Horowitz index and O2 delivery device, and procedure-related complications. Statistical analysis was conducted on the entire sample and subsequently on a selected population using propensity score matching (PSM). 257 patients with a mean age of 78.0 ± 15.2 years were included in the study. There were no significant differences between LTA and FAB groups regarding 30-day mortality (37.7% FBA group vs 32% LTA group; p = 0.28) and length of hospital stay (11.8 ± 11.0 days FBA vs 9.5 ± 9.1 days LTA group; p = 0.45). No significant differences were observed for all secondary outcomes among the two groups. Also considering selected population based on PSM, no significant differences were observed. No significant differences were found in terms of mortality, length of hospital stay, morbidity and procedure-related complications among patients with AP treated with LTA or FBA.

PMID:40483618 | DOI:10.1007/s11739-025-04002-5

J Robot Surg. 2025 Jun 8;19(1):276. doi: 10.1007/s11701-025-02460-9.

ABSTRACT

Total mesorectal excision (TME) is the gold standard for rectal cancer surgery. Robotic (RoTME) and transanal (TaTME) approaches have gained popularity, but their comparative effectiveness remains uncertain and previous meta-analysis include many retrospective studies which are prone to biases. This meta-analysis aims to bridge this gap. A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Scopus, Embase, and Web of Science were searched for prospective studies comparing RoTME and TaTME. Meta-analysis was performed using random-effects models. Sensitivity analysis included a “leave-one-out” approach. Subgroup analysis was performed for overweight patients. Five non-randomized prospective studies (n = 1941) were included. RoTME and TaTME had no significant differences regarding operative duration (MD: 27.29, 95% CI -56.18 to 110.76, P = 0.29, I² = 95%) and comparable hospital stay (MD: 3.12, 95% CI -6.14 to 12.39, P = 0.27, I² = 98%). Blood loss was similar (MD: -22.70, 95% CI -145.80 to 100.40, P = 0.42, I² = 89%). Conversion rates favored TaTME (OR: 2.39, 95% CI 0.39 to 14.69, P = 0.04, I² = 26%) but with a wide confidence interval, limiting significance. Sphincter preservation favored TaTME (OR: 0.44, 95% CI 0.17 to 1.16, P < 0.0001, I² = 32%), but with wide confidence interval, limiting significance. No significant differences were noted for minor complications (OR: 0.88, P = 0.51, I² = 37%), major complications (OR: 1.21, P = 0.24, I² = 7%), anastomotic leakage (OR: 1.35, P = 0.09, I² = 0%), mortality (OR: 1.15, P = 0.82, I² = 0%), and morbidity (OR: 1.26, P = 0.75, I² = 95%). R0 resection was significantly higher in RoTME (OR: 1.70, 95% CI 0.92 to 3.16, P = 0.02, I² = 0%), but with wide confidence interval limiting its significance. No difference was found in lymph node yield (MD: 1.83, 95% CI -2.57 to 6.24, P = 0.06, I² = 51%). Sensitivity analysis revealed that excluding specific studies reduced heterogeneity and affected operative duration and anastomotic leakage trends. In the overweight subgroup, only hospital stay was significantly shorter in TaTME (MD: 1.50, 95% CI 1.07 to 1.92, P < 0.00001, I² = 0%). RoTME and TaTME yield comparable perioperative, postoperative, and short-term oncological outcomes. While the pooled results for conversion rate and sphincter preservation numerically favored TaTME, the confidence intervals crossed the line of no effect, indicating that these differences were not statistically significant. Sensitivity analysis highlighted variability among studies. In overweight patients, TaTME reduced hospital stay, though data were limited. Due to the limited number of identified studies and moderate risk of bias, no recommendations can be made to surgeons, patients and healthcare policy makers. Future large-scale RCTs are needed to clarify long-term outcomes, cost-effectiveness, and functional results and determine superiority of either approach. PROSPERO registration: CRD420250654891.

PMID:40483613 | DOI:10.1007/s11701-025-02460-9

Eur Arch Paediatr Dent. 2025 Jun 8. doi: 10.1007/s40368-025-01069-8. Online ahead of print.

ABSTRACT

PURPOSE: Early childhood caries is a major public health issue worldwide. Midwives, as primary healthcare providers for young children, play an essential role in promoting oral health practices. This study aimed to assess the knowledge of midwives in France regarding early childhood caries, their prevention, and dietary risk factors for dental caries in young children.

METHODS: A national online survey via self-administrated questionnaire was conducted among midwives in France, with a focus on their understanding of oral health recommendations, including the timing of the first dental examination, fluoride use, and dietary habits.

RESULTS: The results revealed that while midwives demonstrated knowledge of basic oral hygiene practices, there were gaps in their understanding of the timing of the first oral examination and the use of fluoride toothpaste. In addition, many midwives did not recognise breastfeeding, especially night-time breastfeeding, as a cariogenic factor. Moreover, a statistically significant difference between generations was identified in the approach to oral health prevention during prenatal and postnatal consultations.

CONCLUSION: This study highlights the need for improved oral health training for midwives and a greater integration of oral health education into their professional practice to enhance early prevention of early childhood caries.

PMID:40483611 | DOI:10.1007/s40368-025-01069-8

J Vasc Surg. 2025 May 30:S0741-5214(25)01005-5. doi: 10.1016/j.jvs.2025.04.043. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate and compare the outcomes of transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (tfCAS) in patients with nonatherosclerotic carotid diseases, including dissection, trauma, and fibromuscular dysplasia.

METHODS: Patients who underwent TCAR and tfCAS for nonatherosclerotic carotid diseases between 2016 and 2024 were identified in the Vascular Quality Initiative (VQI) database. Patients were classified into TCAR or tfCAS based on the procedure performed. Baseline characteristics, demographics, and operative details were collected. Primary outcomes included stroke, death, and major adverse cardiovascular events (MACE), which was defined as the composite of stroke, myocardial infarction, and death. Secondary outcomes included perioperative complications. Descriptive statistics, univariable comparisons, and multivariable logistic regression analyses were performed to evaluate the association between procedure type and outcomes. A two-tailed P value of <.05 was considered statistically significant.

RESULTS: Six hundred seventy six patients were identified (tfCAS, n = 503; TCAR, n = 173). TCAR patients were older (64 ± 14 years vs 56 ± 16 years; P < .001), and had higher rates of hypertension (74% vs 60.4%; P = .001) and coronary artery disease (34.1% vs 22.2%; P = .002). Dissection was the most common etiology (TCAR, 77.5%; tfCAS, 77.9%), followed by fibromuscular dysplasia (TCAR, 14.5%; tfCAS, 10.5%) then trauma (TCAR, 8.1%; tfCAS, 11.5%). Intraoperatively, TCAR patients had shorter fluoroscopy times (5 minutes vs 18.25 minutes; P < .001) and required less radiocontrast (30 mL vs 95 mL; P < .001), but had slightly longer procedure times (75.5 minutes vs 69 minutes; P = .055). When analyzed by procedure type, TCAR was associated with significantly lower rates of MACE (1.2% vs 7%; P = .004) and stroke/death (1.2% vs 6.4%; P = .007) compared with tfCAS. Furthermore, when stratified by symptomatic status, TCAR consistently had lower rates of MACE and stroke/death. On multivariate analysis, TCAR was independently associated with a significantly lower risk of MACE (odds ratio, 0.09; 95% confidence interval, 0.01-0.74; P = .025) and stroke/death (odds ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .045).

CONCLUSIONS: TCAR was associated with superior perioperative outcomes compared with tfCAS in the treatment of nonatherosclerotic carotid diseases. These findings highlight TCAR’s potential to be a safer and more effective treatment option for this challenging patient population.

PMID:40483606 | DOI:10.1016/j.jvs.2025.04.043