Category: Statistics

Ann Gastroenterol Surg. 2025 Jul 16;10(1):67-76. doi: 10.1002/ags3.70067. eCollection 2026 Jan.

ABSTRACT

BACKGROUND: Radical gastrectomy with lymph node dissection is the primary treatment for gastric cancer. However, the overall complication rate remains approximately 10%-20%, with a postoperative mortality rate of 2.3%. Therefore, preoperative stratification of patients based on their expected surgical risks is important. This study aimed to develop a deep learning prediction model using big data from the National Clinical Database (NCD) to predict operative mortality after total gastrectomy.

METHODS: Patients aged 18 years or older who underwent total gastrectomy for gastric cancer and were registered in the NCD between January 2018 and December 2019 were included. A total of 62 variables, including age, sex, past medical history, preoperative blood test results, and tumor characteristics, were used as covariates, with operative mortality as the outcome variable. Deep learning models were developed using Python, TensorFlow and Keras. Hyperparameters were adjusted using the k-fold method with the training data. The model was evaluated using validation data.

RESULTS: Of the 14 980 eligible cases, 11 980 were used for training and 3000 for validation. The event rate was 1.2%. A four-layer, 5217-variable model was developed. The final C-statistic was 0.79 (95% confidence intervals: 0.74-0.83) for the training data and 0.74 (95% confidence intervals: 0.62-0.85) for the validation data.

CONCLUSION: We developed a deep learning model to predict operative mortality using big data from the NCD. To improve the accuracy, it is necessary to introduce new variables related to postoperative complications or factors that cannot be analyzed using conventional methods.

PMID:41488848 | PMC:PMC12757171 | DOI:10.1002/ags3.70067

Ann Gastroenterol Surg. 2025 Sep 11;10(1):167-177. doi: 10.1002/ags3.70091. eCollection 2026 Jan.

ABSTRACT

AIM: This study used Bayesian model averaging to develop an online dynamic nomogram for predicting colon cancer survival, showcasing its value in integrating key prognostic factors for clinical use.

METHODS: This retrospective study analysed surgical colon cancer cases from the Cabrini Monash colorectal neoplasia database using Bayesian model averaging to identify survival risk factors. Model performance was validated with data from Alfred Hospital, and dynamic online nomograms were developed using the DynNom R package.

RESULTS: The study analysed 2475 colon cancer patients (2010-2021), reporting an overall mortality rate of 6.4 per 100 (95% CI: 5.9-7.1) and post-relapse mortality of 7.0 per 100 (95% CI: 6.4-7.6), with 5-year overall and relapse-free survival probabilities of 0.75 and 0.74, respectively. Bayesian model averaging identified key predictors with posterior inclusion probabilities greater than 0.3, including age, ASA score, stage, chemotherapy, lymph node ratio and cancer side. The model showed strong performance (C-index: 0.84 training, 0.80 validation; AUCs: 0.88-0.91 training, 0.84-0.88 validation), good calibration and clinical utility across thresholds. A dynamic nomogram incorporating these factors was developed using the entire dataset as an accessible online tool to support personalised survival prediction in clinical practice.

CONCLUSION: This study showcases the robust capabilities of Bayesian model averaging in uncovering key prognostic factors for colon cancer survival. By integrating these predictors into a dynamic online nomogram, it delivers a powerful, clinician-friendly tool that significantly enhances prognostic accuracy and enables personalised, data-driven decision-making in oncology care.

PMID:41488843 | PMC:PMC12757156 | DOI:10.1002/ags3.70091

Front Glob Womens Health. 2025 Dec 18;6:1669950. doi: 10.3389/fgwh.2025.1669950. eCollection 2025.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection in women worldwide. Due to the high prevalence, communities need to know that the risk of HPV infection can be prevented by HPV vaccination.

AIM: This study aims to assess the knowledge and attitudes of female nursing students at Umm Al-Qura University regarding HPV infection and HPV vaccination.

MATERIALS AND METHODS: A descriptive cross-sectional quantitative study was conducted among 261 female nursing students using a self-administered online questionnaire. Data were collected through the validated 28-item Knowledge and Attitudes Toward HPV and Its Vaccination for University Students Scale, which was adapted and culturally modified to align with the Saudi context. The instrument comprised three parts: demographic information, general knowledge, and attitudes toward HPV vaccination. A non-probability purposive sampling technique was used. Data were analyzed using descriptive statistics and one-way ANOVA to explore differences across demographic variables.

RESULTS: Of the 261 participants, 49.4% demonstrated poor knowledge, 47.1% moderate knowledge, and 3.4% high knowledge. The mean attitude score was 2.79 ± 0.87, indicating a moderate level of acceptance toward HPV vaccination. Although most participants recognized its preventive importance, barriers remained, primarily related to parental consent and communication. One-way ANOVA results showed no significant differences in knowledge based on academic year or parental education, whereas living arrangement demonstrated a significant effect (F = 2.826, p = 0.025, η ² = 0.042).

CONCLUSION: Nursing students had low to moderate knowledge of HPV and held a moderate level of acceptance toward the HPV vaccine highlighted the needs for targeted interventions and educational initiatives to enhance HPV vaccination uptake and promote overall well-being in the community.

PMID:41488811 | PMC:PMC12756078 | DOI:10.3389/fgwh.2025.1669950

Infect Chemother. 2025 Dec;57(4):596-601. doi: 10.3947/ic.2025.0056.

ABSTRACT

The association between varicella-zoster virus (VZV) reactivation and coronary artery disease (CAD) remains uncertain. We enrolled 107 patients (mean age 66.5±10.8 years; 72% male) who underwent coronary angiography due to suspected CAD and assessed subclinical VZV reactivation via salivary VZV PCR. Patients were divided into three groups: acute coronary syndrome, chronic coronary syndrome, and insignificant CAD. VZV DNA was detected in three patients (3%) -one in the acute group and two in the chronic group (P=0.469). Although not statistically significant, these findings warrant further investigation into the potential link between VZV reactivation and CAD.

PMID:41486444 | DOI:10.3947/ic.2025.0056

Eur J Nucl Med Mol Imaging. 2026 Jan 5. doi: 10.1007/s00259-025-07721-1. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the clinical impact of ¹⁸F-FDG PET/CT versus ⁶⁸Ga-FAPI-46 PET/CT in patients with advanced epithelial ovarian cancer (EOC), this study aims to investigate preoperative scoring criteria and establish a basis for the formulation of treatment plans tailored to this patient population.

METHODS: A total of forty-one treatment-naive patients with advanced epithelial ovarian cancer were recruited for this study between July 2022 and February 2024. Each participant underwent both ¹⁸F-FDG and ⁶⁸Ga-FAPI-46 PET/CT imaging. The study compared the diagnostic accuracy, PET/CT parameters, tumor staging, and the guidance provided for clinical treatment decisions by these two imaging modalities. Additionally, the tumor burden as assessed by both imaging techniques was evaluated to predict the likelihood of achieving R0 resection in subsequent surgical procedures.

RESULTS: In the context of peritoneal metastasis, various PET/CT parameters were analyzed, including Gross Tumor Volume (GTV), SUVmax, Total Lesion Glycolysis (TLG(FDG)), and Total Lesion-FAPI (TL-FAPI). The comparative analysis of the two imaging modalities revealed statistically significant differences (P < 0.001). ⁶⁸Ga-FAPI-46 PET/CT showed a higher PCI score and better sensitivity than ¹⁸F-FDG PET/CT (P = 0.03). Notably, the diagnostic accuracy of ⁶⁸Ga-FAPI-46 PET/CT for detecting pelvic, para-aortic, and extra-abdominal lymph nodes was superior to that of ¹⁸F-FDG PET/CT, demonstrating enhanced sensitivity, specificity, and overall accuracy. Following the application of ⁶⁸Ga-FAPI-46 PET/CT, tumor stages were upgraded in 22% (9 out of 41) of patients, while 39% (16 out of 41) exhibited alterations in their PET/CT scores relative to ¹⁸F-FDG PET/CT. Furthermore, the implementation of ⁶⁸Ga-FAPI-46 PET/CT influenced treatment decisions in 17.1% (7 out of 41) of cases. For patients undergoing primary debulking surgery (PDS), receiver operating characteristic (ROC) curve analysis indicated that the GTV derived from both ¹⁸F-FDG PET/CT (AUC = 0.784, P = 0.018) and ⁶⁸Ga-FAPI-46 PET/CT (AUC = 0.809, P = 0.010), along with TL-FAPI (AUC = 0.809, P = 0.010), demonstrated predictive value for incomplete resection during EOC debulking surgery.

CONCLUSION: In comparison to ¹⁸F-FDG, ⁶⁸Ga-FAPI-46 PET/CT presents significant advantages in the detection of peritoneal and lymph node metastases, thereby providing a more accurate reference for the clinical staging of patients with advanced epithelial ovarian cancer. Importantly, ⁶⁸Ga-FAPI-46 PET/CT has the potential to modify treatment decisions in nearly 20% of patients, facilitating the selection of more appropriate therapeutic strategies.

PMID:41486388 | DOI:10.1007/s00259-025-07721-1

Eur J Med Res. 2026 Jan 4. doi: 10.1186/s40001-025-03761-3. Online ahead of print.

ABSTRACT

BACKGROUND: Prophylaxis of norepinephrine (NE) at a constant rate has been demonstrated to be as efficacious as prophylaxis of phenylephrine (PE) at equivalent doses for the prevention of maternal hypotension during cesarean section. Nevertheless, the impact of prophylactic infusion of NE or PE at a constant rate on pregnant women on fetal outcomes remains to be elucidated.

METHODS: 90 women scheduled for caesarean section under spinal or combined spinal-epidural anesthesia were randomly assigned to either the NE or PE group. The “study drug” (NE or PE) was administered intravenously at a rate of 15 mL/h from the time of injection of subarachnoid solution until the time of delivery of the fetus. Fetal umbilical artery (UA) blood was collected for blood gas analysis. The primary outcome of the study was base excess, and the incidence of fetal acidosis (Defined as base excess < 6 mmol/l) and blood glucose levels were also assessed.

RESULTS: The UA base excess mean (standard deviation) was not different from the NE group, – 1.6 (2.6) versus – 2.4 (2.9) in the PE group (P = 0.223). The incidence of fetal acidosis was 4.7% (NE) versus 14.3% (PE), with no statistically significant difference (P = 0.308). However, fetal blood glucose levels were significantly lower in the NE group, 3.16 (0.43) versus 3.43 (0.60) in the PE group (P = 0.019).

CONCLUSIONS: Prophylactic infusion of equivalent doses of NE at a constant rate resulted in fetal base excess values and an incidence of acidosis comparable to that of PE. However, a lower fetal UA blood glucose value was observed in the NE group, a finding that warrants further investigation.

PMID:41486377 | DOI:10.1186/s40001-025-03761-3

Eye (Lond). 2026 Jan 5. doi: 10.1038/s41433-025-04196-0. Online ahead of print.

ABSTRACT

The Hydrus Microstent (HM) and iStent inject W are two widely used trans-trabecular bypass devices and can be combined with phacoemulsification for glaucoma patients undergoing cataract surgery.

AIM: To compare the efficacy and safety of the HM with triple iStent inject W devices (TiSW) devices combined with phacoemulsification in a real-world setting over 3 years of follow-up.

METHODS: A prospective, consecutive, quasi-experimental, longitudinal study was conducted on open-angle glaucoma patients at a subspecialty cataract and glaucoma private practice in Brisbane, Australia. Outcomes included yearly changes from preoperative values in mean IOP and mean number of glaucoma medications; proportional shifts across IOP and number of glaucoma medication categories at preoperative and yearly time points, and hazard ratio for time to failure based on the American Academy of Ophthalmology combined minimally invasive glaucoma surgery criteria. Multi-level mixed effects regression modelling with inverse probability of treatment weighting was used to estimate the treatment effect while accounting for repeated measurements, clustering, confounding, and imbalances in baseline covariates.

RESULTS: Of the 105 cases, 56 (53.3%) phacoemulsification cases were combined with the HM and 49 (46.7%) were combined with the TiSW. At 3 years, the mean IOP reduction in the HM was 2.6 mmHg (from 15.1 to 12.5 mmHg), while the TiSW showed a reduction of 2.0 mmHg (from 15.2 to 13.2 mmHg). No significant between-group differences in estimated changes in mean IOP from preoperative values were found at years 1, 2, and 3 (all Holm adjusted p = 1.00). Significant reductions in the estimated mean number of medications were observed in both groups at 3 years. The changes in mean number of medications from preoperative values at yearly timepoints were not statistically significant between groups (all Holm adjusted p = 1.00). The 3-year reduction was 1.3 medications in the HM (from a total of 2.3 to 1.0) and 1.4 medications in the TiSW (from a total of 2.2 to 0.8), resulting in a difference of 0.1 (95% CI: -0.6, 0.8). The proportions of eyes that were medication-free at 3 years were 54.3% in the HM group and 61.2% in the TiSW group. The intraoperative safety of the HM and TiSW was good, with no significant complications.

CONCLUSION: This study has shown that both HM and TiSW provide effective IOP reduction and medication reduction in glaucoma patients undergoing combined cataract surgery at up to 3 years follow-up. Both devices were well-tolerated. Surgeon preference may guide device selection, with specific considerations for patients such as extremes of ocular size or anticoagulation therapy.

PMID:41486375 | DOI:10.1038/s41433-025-04196-0

Eur J Med Res. 2026 Jan 5. doi: 10.1186/s40001-025-03717-7. Online ahead of print.

ABSTRACT

BACKGROUND: The association between infection or inflammation of prostate and the risk of prostate cancer (PCa) remains a contentious issue. This article aims to assess the relationship between infection or inflammation of prostate and the risk of PCa.

METHODS: We performed a cross-sectional study utilizing the 2001-2010 National Health and Nutrition Examination Survey data. The dataset encompasses 7,981 male participants from the United States with an age exceeding 40 years. Weighted statistical population descriptors, univariate analysis, and multivariate regression analysis were employed for the analysis. Subgroup analyses were conducted to further validate the stability of this association across different groups.

RESULTS: The results revealed that individuals with infection or inflammation of the the prostate had a hazard ratio of 4.0 for developing PCa compared to those without such history, indicating a 300% increased risk of PCa (OR = 4.0; 95% CI: 1.1, 10.6; P < 0.001). After adjusting for confounding factors, individuals with infection or inflammation of prostate still exhibited a significant hazard ratio of 2.8 for developing PCa compared to those without such conditions, representing a 180% increased risk (OR = 2.8; 95% CI: 1.3, 6.1; P = 0.011); subgroup analysis demonstrated that within the age range of > = 40 and < 60 years, individuals with infection or inflammation of prostate had a hazard ratio of 2.8 for developing PCa, signifying a 180% heightened risk of PCa (OR = 2.8; 95% CI: 1.4, 5.1; P = 0.004); within the age range of > = 60 years, individuals with infection or inflammation of prostate had a hazard ratio of 5.0 for developing PCa, indicating a 400% increased risk of PCa (OR = 5.0; 95% CI: 1.3, 19.0; P = 0.020).

CONCLUSION: This study indicates that among American males aged over 40, those with infection or inflammation of the the prostate exhibit an increased risk of developing PCa, particularly in the older age group (age > = 60), and this association remains significant even after adjusting for pertinent confounding factors.

PMID:41486368 | DOI:10.1186/s40001-025-03717-7

Colorectal Dis. 2026 Jan;28(1):e70355. doi: 10.1111/codi.70355.

ABSTRACT

AIM: Rectopexy is the preferred abdominal intervention for rectal prolapse. Despite similar procedural steps – rectal mobilisation, prolapse reduction, and fixation – techniques vary widely, and onsensus on the optimal approach is lacking. This study aimed to assess global surgeon preferences and practices in rectopexy.

METHODS: An international 28-item online survey was distributed between November 2023 and March 2024 through professional networks and social media. Questions addressed surgeon demographics, perioperative strategies, and technical approaches to rectopexy. Responses were analysed descriptively and stratified by region and specialty.

RESULTS: A total of 226 surgeons from 36 countries across four continents completed the survey. Most respondents (79.6%) administered preoperative intravenous antibiotics, and 80.5% used some form of mechanical bowel preparation. Minimally invasive approaches predominated (81%), with laparoscopy being most common. Posterior dissection was preferred by 61.5%, while 38.5% favoured ventral (anterior) dissection. Two-thirds (68.1%) routinely used mesh, predominantly synthetic. Only 15% performed rectopexy as a day-case procedure. Regional and specialty-related variations were evident in approach, mesh type, and perioperative protocols.

CONCLUSION: This international survey reveals marked variability in rectopexy practice worldwide. Despite common principles, surgeon preference and regional factors strongly influence decision-making. The findings emphasise the need for updated international guidelines to harmonise technique selection and perioperative management in rectal prolapse surgery.

PMID:41486360 | DOI:10.1111/codi.70355

J Dig Dis. 2026 Jan 4. doi: 10.1111/1751-2980.70021. Online ahead of print.

ABSTRACT

OBJECTIVES: Primary liver cancer (PLC) is a leading cause of global cancer-related mortality, with rising incidence and survival disparities. We aimed to analyze its long-term survival trends that likely help establish future prevention and treatment strategies for PLC.

METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) Program (1975-2019), we assessed long-term survival rates of PLC patients stratified by age groups, sex, race, and SEER tumor stage using period analysis. Model-based period analysis was employed to predict the 5-year relative survival rates (RSRs) during 2020-2024. Survival statistics included observed survival rates (OSRs), RSR, conditional RSR (CRSR), and age-standardized RSR (ARSR).

RESULTS: From 2015 to 2019, female patients with PLC had a higher 5-year ARSR of 27.26% compared to male patients (24.81%). The 5-year CRSR improved to 72.17% in women and 70.05% in men. The 5-year RSR declined with age and from localized tumor stage (41.45%) to distant cancer (5.52%) in men. In addition, black male patients had the lowest 5-year ARSR (19.61% vs. 23.86% in white males and 31.22% in men of other races). Long-term trends during 1975-2019 showed rising survival rates, yet disparities persisted. Projections for 2020-2024 estimated an overall 5-year RSR of approximately 30%, with persistent gaps for patients aged ≥ 75 years and black males.

CONCLUSIONS: Despite improved PLC survival over the 45 years, persistent disparities in age, sex, race, and tumor stage underscore the need for early detection and equitable care. The converging prognosis among long-term survivors highlights the value of survivorship programs.

PMID:41486356 | DOI:10.1111/1751-2980.70021