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Efficacy and safety of robot-assisted pedicle screw placement in lumbar spondylolisthesis: a meta-analysis

J Robot Surg. 2025 Jul 10;19(1):369. doi: 10.1007/s11701-025-02558-0.

ABSTRACT

This systematic review and meta-analysis aimed to evaluate the differences in efficacy and safety between robotic navigated pedicle screw insertion and conventional free-hand techniques in the management of lumbar spondylolisthesis. Utilizing a predefined search strategy, we systematically searched four major biomedical databases-PubMed, Cochrane Library, Web of Science, and Embase-up to January 27, 2025. After rigorous screening, six eligible clinical studies (comprising prospective cohort studies and retrospective analyses) involving 260 patients in total were incorporated into the quantitative synthesis. The primary outcomes measured included screw placement accuracy, operative time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), and the incidence of complications. The results revealed that robot-assisted pedicle screw placement significantly outperformed traditional manual placement regarding screw placement accuracy, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and VAS score (P < 0.05). However, robot-assisted surgery was linked to a notably longer surgical duration compared to manual methods (WMD > 0, P < 0.05). To summarize, robot-assisted pedicle screw placement demonstrates significant advantages over traditional manual placement in the management of lumbar spondylolisthesis, with its safety and efficacy further validated.

PMID:40638017 | DOI:10.1007/s11701-025-02558-0

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Peripheral Inflammation In Adult ADHD: Sex Differences And Hematological Markers

Psychiatr Q. 2025 Jul 10. doi: 10.1007/s11126-025-10185-z. Online ahead of print.

ABSTRACT

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by impairments that persist into adulthood. Despite advancements in our understanding of ADHD, the factors influencing its course remain unclear. The inflammatory hypothesis suggests that immune dysregulation may contribute to ADHD pathophysiology. However, research examining inflammation in adult ADHD is limited. This cross-sectional study aimed to compare complete blood count (CBC) parameters and derived inflammatory indices between adult patients with ADHD and healthy controls, with particular attention to sex differences. The study included 72 drug-free adults with ADHD (aged 18-38 years) diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and 72 age- and sex-matched healthy controls. CBC parameters and inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), basophil-to-lymphocyte ratio (BLR), mean platelet volume (MPV), platelet distribution width (PDW), systemic immune-inflammatory index (SII), and pan-immune inflammatory value (PIV), were compared between the groups. Monocyte counts were significantly higher in the ADHD group than in the control group (p = 0.019). Sex-specific analysis revealed no significant differences in inflammatory parameters among females. However, male patients with ADHD showed significantly elevated leukocyte, neutrophil, and monocyte counts compared to male controls (p = 0.031, p = 0.049, and p = 0.038, respectively). These findings suggest that elevated monocyte levels, indicative of chronic inflammation, may have diagnostic implications in adult ADHD, particularly among males. These findings underscore the necessity to incorporate sex-specific biological mechanisms when investigating and developing therapeutic strategies for ADHD.

PMID:40638003 | DOI:10.1007/s11126-025-10185-z

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Female and Combined Male-Female Injury Risk Functions for the Anterior Pelvis Under Frontal Lap Belt Loading Conditions

Ann Biomed Eng. 2025 Jul 10. doi: 10.1007/s10439-025-03777-0. Online ahead of print.

ABSTRACT

PURPOSE: Iliac wing fractures due to lap belt loading have been observed in laboratory settings for 50 years and recent data suggest they are also occurring in the field. Automated driving systems (ADS) and other occupant compartment advancements are expected to offer enhanced flexibility in seating orientation, which could place a greater reliance on the seatbelt to restrain occupants. Such changes may increase seatbelt loads and create new challenges in successfully restraining occupants and mitigating injury to areas, such as the pelvis. Injury criteria exist for component-level male iliac wing fractures resulting from frontal lap belt loading, but not for females.

METHODS: This study explored female iliac wing fracture tolerance in the same loading environment as a previous study that explored the fracture tolerance of isolated male iliac wings. Male and female fracture data were combined to evaluate the effect of sex. Injury risk functions were created by fitting Weibull survival models to data that integrated censored and exact failure observations.

RESULTS: Twenty female iliac wings were tested; fourteen of them sustained fracture with known failure forces (exact), but the remaining six wings either (1) did not fracture or (2) fractured after an event that changed the boundary conditions (right-censored). The fracture tolerance of the tested specimens ranged widely (1134-8759 N) and averaged 4240 N (SD 2516 N).

CONCLUSION: Female data and combined male-female data were analyzed. Age was the only covariate investigated in this study that had a statistically significant effect and improved the predictive performance of the models.

PMID:40638001 | DOI:10.1007/s10439-025-03777-0

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The PD COMM Process Evaluation: Describing Interventions and Implementation in a UK Pragmatic Randomised Controlled Trial of Speech and Language Therapy for People With Parkinson’s-Related Dysarthria

Int J Lang Commun Disord. 2025 Jul-Aug;60(4):e70084. doi: 10.1111/1460-6984.70084.

ABSTRACT

BACKGROUND: As people with Parkinson’s experience progressive communication changes, effective, implementable speech and language therapy (SLT) interventions are needed. Process evaluations alongside pragmatic randomised controlled trials (RCTs) are of clinical value if they describe, compare and understand the implementation of trial interventions. This paper reports the PD COMM process evaluation. PD COMM was a large, UK multi-centre phase III pragmatic RCT of SLT in the National Health Service (NHS). It recruited 388 people with Parkinson’s who were randomised to Lee Silverman Voice Treatment (LSVT), Standard NHS SLT, or no dysarthria intervention.

AIMS: To describe and compare the content and service delivery components of the PD COMM SLT interventions; understand experiences of implementing LSVT; explain trial outcomes; and reflect on implications for practice and research.

METHODS AND PROCEDURES: We took a pragmatic, mixed methods approach. The intervention description team used a sub-sample of routine therapy notes and trial record forms, the Template for Intervention Description and Replication (TIDieR) and simple descriptive statistics to compare Individual Participant Therapy Data (LSVT n = 51; Standard NHS SLT n = 54). In parallel, informed by Normalisation Process Theory (NPT), the implementation team conducted qualitative interviews with a sub-sample of therapists (n = 20) and participants (n = 24) to understand the additional work of implementing LSVT. The core process evaluation team met to integrate the findings in relation to the trial outcomes.

OUTCOMES AND RESULTS: LSVT was largely delivered per protocol, tailored to participants’ interests and interactions. Dosage was a key difference between the two interventions, commonly achieved by two or more therapists delivering LSVT. Effective mechanisms were LSVT’s structured design, repetitive and social nature, practise requirements and focus on volume. Standard NHS SLT was eclectic, reflecting a range of clinical approaches at a lower intensity, including some techniques and activities in common with LSVT. Although focused on impairment therapy, including specific voice therapy techniques, it also featured cognitive-linguistic and psychosocial targets and low technology augmentative and alternative communication (AAC). The trial design may have limited opportunities for group intervention.

CONCLUSIONS AND IMPLICATIONS: Any LSVT roll-out needs service support and coordination, and should take an inclusive approach. Future research of Standard NHS SLT should explore a rationale for dosage and more explicit tailoring to individuals and their families. There is also a pressing need to deliver the benefits of LSVT in a cost-effective manner and to develop a range of evidence-based, implementable alternatives as people’s communication support needs change.

WHAT THIS PAPER ADDS: What is already known on the subject Lee Silverman Voice Treatment (LSVT) has a body of incrementally-developed evidence from effectiveness trials but has not previously been tested in a pragmatic randomised controlled trial (RCT) with an embedded process evaluation. What this paper adds to the existing knowledge This mixed methods process evaluation paper describes and compares content and service delivery components to understand similarities and differences between LSVT and Standard NHS SLT interventions and experiences of implementing LSVT in the UK NHS. What are the potential or actual clinical implications of this work? Services can use the findings to plan delivery of intensive interventions and to reflect on the content and service delivery aspects of locally Standard NHS SLT and how it might be improved.

PMID:40637984 | DOI:10.1111/1460-6984.70084

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Serum copper, zinc and selenium and their ratios as predictors of pneumonia death risk in men: the Kuopio Ischaemic Heart Disease Risk Factor Study

Infection. 2025 Jul 10. doi: 10.1007/s15010-025-02596-8. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the associations between serum concentrations of copper, zinc and selenium, and pneumonia death risk.

METHODS: Study included 2088 men from the Kuopio Ischaemic Heart Disease Risk Factor Study aged 42-60 years. Pneumonia deaths were collected by computer linkage to the national Causes of Death Register. Cox proportional hazards regression models, adjusted for multiple variables, were used for analysis.

RESULTS: During a mean follow-up of 21.7 years (SD 7.5 years), 139 pneumonia deaths occurred. The multivariable-adjusted hazard ratio for pneumonia death in the highest serum copper-to-zinc-ratio and copper concentration tertiles were 1.75 (95% CI: 1.13-2.71) and 1.64 (95% CI: 1.08-2.50), respectively. Serum zinc concentration showed a statistically significant association with pneumonia death, with the lowest risk observed in the second tertile and no further decrease in risk in the highest tertile. Serum copper-to-selenium ratio nor selenium concentrations were associated with pneumonia death risk.

CONCLUSIONS: Our findings suggest that a higher serum copper-to-zinc-ratio and higher serum copper concentration are associated with increased risk of pneumonia death, while a higher serum zinc concentration is linked to a decreased risk of pneumonia death in middle-aged and older men.

PMID:40637965 | DOI:10.1007/s15010-025-02596-8

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Complications in vertebral body tethering: what are the short term effects on patient reported outcomes?

Spine Deform. 2025 Jul 10. doi: 10.1007/s43390-025-01107-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Vertebral body tethering (VBT) has continued to gain popularity for the treatment of idiopathic scoliosis (IS); however, complication and reoperation rates have been reported as high as 25%. There is a paucity of data on the clinical and long-term outcomes of VBT. The purpose of this study is to determine how complications from VBT effect patient quality of life (QOL) up to three years after surgery.

METHODS: In this retrospective cohort study, the patients were identified via an analysis of multi-center electronic medical record data from the Pediatric Spine Study Group (PSSG). All patients who underwent VBT for IS were included. The dataset was screened to include only patients who had patient reported outcome data documented both before and after surgery. Patient demographics, surgery dates, complications, Early Onset Scoliosis Questionnaire (EOSQ) scores, and Scoliosis Research Society (SRS) scores were collected. Complications were classified using the modified Clavien-Dindo-Sink (mCDS) complication classification system. The analysis of QOL after surgery was determined comparing survey scores of patients with and without any complication over time. Additional analysis was similarly performed comparing patients with no or mild complications, defined as mCDS grade I and II, to those with severe complications, defined as mCDS grade IIIA or above.

RESULTS: The study consisted of 339 total surveys from 81 patients with EOSQ data and 293 total surveys from 101 patients with SRS data. Among the 81 patients with EOSQ data, 15 patients experienced a complication, with eight patients suffering a severe complication. Among the 101 patients with SRS data, 42 patients experienced a complication, and 22 patients suffered a severe complication. When comparing patients with a complication to those with without a complication, patients with complications had significantly lower total EOSQ scores at 2, 2.5, and 3 years after surgery (p = 0.009, 0.001, and < 0.001 respectively); however, there was no difference in total SRS scores at any time point. In comparing patients with severe complications to pts with mild complications/no complication, patients with severe complications had significantly worse total EOSQ at 2, 2.5, and 3 years after surgery (p = 0.018, 0.002, & < 0.001) and SRS scores at 2, 2.5, and 3 years after surgery (p = 0.040, 0.018, 0.010).

CONCLUSION: Patients with any complication from VBT had worse EOSQ scores at 2 years after surgery. Severe complications (mCDS > IIIA) following VBT manifest with decreasing EOSQ and SRS scores over time and become statistically significant at 2 years and beyond. The magnitude of difference in EOSQ and SRS scores between the groups also increases over time. Longer-term follow-up will ascertain whether these poorer QOL outcomes persist at time points greater than 3 years. Long-term follow up will be important following VBT to compare to PSF for improved patient and parent education.

PMID:40637961 | DOI:10.1007/s43390-025-01107-x

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Responding to the New Nursing Home Staffing Requirements: Focusing on Supervisor Support to Address Nurse Aide Shortages

J Appl Gerontol. 2025 Jul 10:7334648251319842. doi: 10.1177/07334648251319842. Online ahead of print.

ABSTRACT

In May 2024, new rules were established by the Centers for Medicare and Medicaid Services that require nursing homes to provide a specific number of nurse aide hours per nursing home resident day. Nursing homes (NHs) will have difficulty abiding by this rule if nurse aide (NA) turnover is high, which is currently found in many NHs. Research has shown that one factor influencing NA turnover is NA feelings of supervisor support (SS). Our objective is to identify characteristics that are associated with and appear to affect NA perceptions of SS. We surveyed 294 NAs working within 11 NHs in the north Texas region. A regression analysis identified five of 10 variables that had a statistically significant association with SS. Findings suggest that SS is created through NA participation in decision-making, ability to modify the work, information-sharing between NAs and supervisors, and supervisor feedback on NA suggestions.

PMID:40637025 | DOI:10.1177/07334648251319842

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Prioritizing relieving iliac venous compression contributes to treating varicose veins of lower extremities patients with May-Thurner syndrome

Vascular. 2025 Jul 10:17085381251360068. doi: 10.1177/17085381251360068. Online ahead of print.

ABSTRACT

ObjectiveWe suspect that the May-Thurner syndrome (MTS) is the main etiology of secondary varicose veins of the lower extremities (VVLE). However, there is no definitive agreement on the priority and necessity of relieving iliac vein compression when treating patients with VVLE and MTS.MethodIn this study, according to the results of anterograde venography of lower extremity, 99 patients were divided into two groups, namely, simple VVLE (n = 66) and VVLE-MTS groups (n = 33). The patients in the former group only received sclerotherapy, while the patients in later group received the combination treatments of intravascular balloon dilatation, stent placement of iliac vein, and sclerotherapy. After surgery, we applied VVCS score, postoperative recanalization rate, and improvement in clinical symptom to assess therapeutic effects.ResultsVCSS score: At 1 week, 1 month, 3 months, and 6 months after operation, there were significant differences between group A and group B (p < 0.01), the difference of VCSS: compared with preoperation, there was statistical difference between group A and group B at 1 week after operation (p < 0.01), there was no statistical difference 6 months after operation (p = 0.052); Postoperative recanalization: cumulative trunk recanalization events 6 months after surgery There was no statistical difference between (p = 0.192) and branch recanalization events (p = 0.207). When the two events were combined to increase the positive rate, no statistical difference was found. However, after stratifying patients, mild (CEAP2-3) and moderate (CEAP4) patients were obtained. There was no statistical difference in the incidence of recanalization events between the two groups, but there was a statistical difference between severe (CEAP5-6) groups (p = 0.025).ConclusionIt was great of importance and necessity of solving iliac vein compression prior to treating VVLE when handling patients with VVLE and MTS, especially for the cases with high CEAP score.

PMID:40637000 | DOI:10.1177/17085381251360068

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The beating heart technique during frozen elephant trunk total arch repair

Perfusion. 2025 Jul 10:2676591251359908. doi: 10.1177/02676591251359908. Online ahead of print.

ABSTRACT

IntroductionOur aim was to evaluate the beating heart technique during frozen elephant trunk (FET) total arch replacement.MethodsBetween 03/2013 and 01/2023, 357 patients underwent FET total arch replacement in one aortic centre. Patient characteristics, intra- and postoperative data were compared between 290 patients (81%) undergoing FET repair during cardioplegic arrest and 67 patients (19%) operated on using the beating heart technique after propensity score matching.ResultsAfter propensity score matching there were no statistically significant differences in preoperative characteristics, the underlying pathology, and regarding arterial inflow-cannulation or concomitant cardiac procedures. Aortic cross-clamp (p = .042) and cerebral perfusion (p = .003) times were significantly shorter in the beating heart group. Postoperative cardiac biomarkers were lower, but the difference did not reach statistical significance. In-hospital mortality was numerically lower (1 [2%] vs 4 [7%], p = .346), and the incidence of postoperative renal replacement therapy was significantly lower (p = .027) in the beating heart group. Usage of the beating heart technique was not a significant variable in our logistic regression model for in-hospital mortality, while an acute aortic pathology was highly predictive for the outcome (p = .006, odds ratio: 3.319).ConclusionsThe beating heart technique has the potential to improve postoperative outcome following FET total arch replacement. The approach may be helpful for patients with reduced left ventricular function because of shorter aortic cross-clamp times.

PMID:40636994 | DOI:10.1177/02676591251359908

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Medicinal cannabis for tics in adolescents with Tourette syndrome

BJPsych Open. 2025 Jul 10;11(4):e145. doi: 10.1192/bjo.2025.35.

ABSTRACT

Medicinal cannabis has been trialled for Tourette syndrome in adults, but it has not been studied in adolescents. This open-label, single-arm trial study evaluated the feasibility, acceptability and signal of efficacy of medicinal cannabis in adolescents (12-18 years), using a Δ9-tetrahydrocannabinol:cannabidiol ratio of 10:15, with dose varying from 5 to 20 mg/day based on body weight and response. The study demonstrated feasibility of recruitment, acceptability of study procedures, potential benefits and a favourable safety profile, with no serious adverse events. Commonly reported adverse events were tiredness and drowsiness, followed by dry mouth. Statistically significant improvement was observed in parent and clinician reports on tics (paired t-test P = 0.003), and behavioural and emotional issues (paired t-test P = 0.048) and quality of life as reported by the parent and young person (paired t-test P = 0.027 and 0.032, respectively). A larger-scale, randomised controlled trial is needed to validate these findings.

PMID:40636988 | DOI:10.1192/bjo.2025.35