Category: Statistics

J Magn Reson Imaging. 2025 Jul 4. doi: 10.1002/jmri.29834. Online ahead of print.

ABSTRACT

BACKGROUND: Changes in interstitial fluid (ISF) dynamics are potential contributors to idiopathic normal pressure hydrocephalus (iNPH). Spectral diffusion analysis provides surrogate markers for ISF volume (F_int) and diffusivity (D_int).

PURPOSE: To compare F_int and D_int between patients with iNPH and healthy controls (HCs).

STUDY TYPE: Retrospective.

POPULATION: 34 patients with iNPH (24 males, 10 females; 76.9 ± 7.6 years) and 132 HCs (46 males, 86 females; 47.5 ± 16.9 years; three age groups: < 40 years, 40-59 years, and ≥ 60 years).

FIELD STRENGTH/SEQUENCE: 3.0 T/Single-shot spin-echo echo-planar imaging.

ASSESSMENT: F_int and D_int were computed using non-negative least squares and measured in eight regions, including the centrum semiovale (CSO), frontal white matter (FWM), and lenticular nucleus (LN). The regions of interest of iNPH were categorized as either periventricular hyperintensity (PVH) regions (iNPH_PVH group) or non-PVH regions (iNPH group). F_int and D_int were compared among groups, and correlations with age were analyzed.

STATISTICAL TESTS: Kruskal-Wallis test with Dunn’s multiple comparison post hoc test. Spearman correlation coefficient. p < 0.05 was considered statistically significant.

RESULTS: In the CSO, iNPH_PVH group F_int values (40.3% ± 18.4%) exceeded those of other groups, while D_int values (1.53 ± 0.63 [× 10^-3 mm²/s]) were significantly higher than those in younger HCs and the iNPH group. In the FWM, both F_int (53.0% ± 18.9%) and D_int (1.64 ± 0.50 [× 10^-3 mm²/s]) were significantly higher in the iNPH_PVH group than in the other groups. In the LN, F_int correlated positively with age, regardless of the iNPH group’s inclusion (without iNPH, ρ = 0.2114; with iNPH, ρ = 0.3044).

DATA CONCLUSION: Spectral diffusion analysis in iNPH demonstrated that ISF volume and diffusivity increased in PVH regions of the CSO and FWM, whereas ISF dynamics outside PVH regions may not differ significantly from those in HCs.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 1.

PMID:40614019 | DOI:10.1002/jmri.29834

Obes Surg. 2025 Jul 4. doi: 10.1007/s11695-025-08005-1. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary atelectasis is a significant complication of metabolic and bariatric surgery (MBS). Sugammadex enables rapid neuromuscular blockade reversal compared to neostigmine, but its impact on atelectasis prevention remains unclear.

METHODS: This retrospective multicenter study used the TriNetX database to analyze adult patients who underwent MBS between 2010 and 2024. Patients receiving rocuronium were divided into sugammadex and control (i.e., neostigmine use) groups. After propensity score matching, the outcomes were assessed at the 30-day follow-up. The primary outcome was the risk of pulmonary atelectasis, while secondary outcomes included pneumonia, respiratory failure, deep vein thrombosis (DVT), and intensive care unit (ICU) admission.

RESULTS: Among 19,606 propensity-matched pairs, sugammadex significantly reduced the risk of pulmonary atelectasis (0.83% vs. 1.33%, odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.51-0.76, p<0.001). The secondary outcomes showed no significant differences in pneumonia (0.36% vs. 0.45%, p=0.177), respiratory failure (0.36% vs. 0.40%, p=0.460), DVT (0.19% vs. 0.17%, p=0.722), or ICU admission (0.67% vs. 0.81%, p=0.111). Subgroup analyses demonstrated consistent protective effects of sugammadex against pulmonary atelectasis across different patient populations (with or without sleep apnea) and institutional settings (academic vs. non-academic centers). Female patients receiving sugammadex experienced significant reductions in both pulmonary atelectasis (OR: 0.59, p<0.001) and respiratory failure (OR: 0.64, p=0.028), whereas the benefit in male patients was not statistically significant.

CONCLUSION: Sugammadex use was associated with a 38% reduction in postoperative pulmonary atelectasis compared to neostigmine use, suggesting that it may be a beneficial strategy for improving respiratory outcomes in patients undergoing MBS.

PMID:40614004 | DOI:10.1007/s11695-025-08005-1

Environ Monit Assess. 2025 Jul 4;197(8):859. doi: 10.1007/s10661-025-14305-x.

ABSTRACT

Microplastics (MPs), small plastic particles increasingly accumulating in the environment and encountered by humans, pose a particular risk to children due to their heightened vulnerability compared to adults. This study pioneered biological monitoring of MPs and investigated the presence and potential exposure of MPs in the saliva and on the hands of young children attending kindergartens in Kerman, Iran. A sample of 100 children aged 3 to 6 years was randomly selected from five kindergartens across five districts (1, 2, 3, 4, and 5). Following sample digestion and filtration, MPs were identified and classified under an optical microscope. Micro-Raman spectroscopy was employed to analyze the composition of MPs. The study identified a total of 716 MPs, with the majority (299, 41.7%) being black. The number of microplastics on hands and saliva increased by 55.9% and 11.8%, respectively, after entering kindergarten. Most MPs observed were smaller than 100 µm. Micro-Raman spectroscopy analysis of six fibers revealed four composed of polystyrene (PS), one of nylon, and one of low-density polyethylene (LDPE). The average number of MPs on children’s hands upon kindergarten entry was 1.85 ± 1.39, increasing significantly to 4.2 ± 3.05 after kindergarten entry (p-value < 0.0001). This research highlighted the significant role of kindergarten flooring in determining MPs’ presence in children. Specifically, the presence of tatami flooring correlated with higher MPs’ levels.

PMID:40614002 | DOI:10.1007/s10661-025-14305-x

J Robot Surg. 2025 Jul 4;19(1):349. doi: 10.1007/s11701-025-02509-9.

ABSTRACT

Single Port (SP) surgery is the most relevant surgical innovation of the past six years. Few data are available on the advantages and disadvantages of SP Robotic-Assisted reconstructive urology. In the present systematic review, we summarize the results of available literature exploring the feasibility of SP reconstructive urological procedures and comparing the SP and Multi Port (MP) approaches. The MEDLINE, EMBASE and Cochrane Library Databases were systematically searched for articles evaluating outcomes of SP robotic-assisted pyeloplasty, ureteral reimplantation, Boari Flap, fistula repair, bladder diverticulectomy and vaginoplasty. After meticulous study selection, we conducted a meta-analysis to compare perioperative and postoperative outcomes of SP and MP robotic-assisted pyeloplasty (SP-RP and MP-RP). Regarding ureteric reimplantation, Boari Flap, bladder diverticulectomy, fistula repair and vaginoplasty, we underwent a structured narrative synthesis, since meta-analysis was not feasible due to heterogeneity or insufficient study numbers. The meta-analysis included a total of six retrospective cohort studies and 202 patients. SP-RP demonstrated significantly lower Estimated Blood Loss (EBL) (SMD – 0.45, 95%CI – 0.80 to – 0.09, p = 0.01, I² = 0%) and better cosmetic results (MD 1.83, 95%CI 0.98-2.68, p < 0.001). The mean length of hospital stay was shorter for patients submitted to SP-RP, but the difference did not reach significance (SMD = – 0.68, 95%CI – 1.43 to 0.07, p = 0.08, I² = 80%). There were no significant differences in terms of complication rates, operative times, success rate and renal function increase between the two approaches (p > 0.05). Respectively, a total of four, one, two, one and two articles evaluating robotic-assisted SP ureteral reimplantation, Boari Flap, bladder diverticulectomy, fistula repair, and vaginoplasty, were included for the final structured summary. The included studies consistently suggest the feasibility and safety of the SP approach, however, available evidence predominantly consists of small retrospective series or individual case reports, and statistical validation is not possible. SP-RP has been successfully described, with possible advantages in terms of shorter hospital stays, better pain control and cosmetic results. Although successful cases of other major reconstructive urological procedures are reported in the literature, the available evidence remains limited and of low quality. Hopefully, the encouraging findings regarding SP-RP will increase the popularity of the SP robotic system among reconstructive urologic surgeons and the availability of more robust data.

PMID:40613997 | DOI:10.1007/s11701-025-02509-9

Breast Cancer Res Treat. 2025 Jul 4. doi: 10.1007/s10549-025-07758-8. Online ahead of print.

ABSTRACT

PURPOSE: The standard-of-care neoadjuvant treatment for early-stage or locally advanced triple negative breast cancer (TNBC) is the KEYNOTE-522 regimen that combines pembrolizumab and chemotherapy. Although this approach has superior response and survival rates, high-grade adverse events (AEs) are common. Real-world data from a diverse patient population is needed to better understand practice patterns and the impact of immunotherapy in TNBC patients.

METHODS: Medical records from TNBC patients were retrospectively reviewed during neoadjuvant and adjuvant treatment with pembrolizumab and chemotherapy. CTCAE version 5.0 was used to grade AEs. Variables were reported with descriptive statistics, and AE, pCR and hospitalization rates were estimated with 95% confidence intervals.

RESULTS: We identified 415 patients from seven academic medical centers; 60% identified as White and 21% as Black. pCR rate was 52%. 88% of patients experienced an AE, 38% experienced a grade 3+ AE, and 31% stopped pembrolizumab early. Hospitalization rate was 26%. There were no statistically significant differences in AE, pCR or hospitalization rates between White and Black patients. Obese patients had a statistically significant higher hospitalization rate (p = 0.014). There were 18 deaths during treatment, mainly from progressive TNBC.

CONCLUSION: This is one of the largest real-world, diverse patient cohorts for TNBC patients treated with chemotherapy and pembrolizumab. pCR rate was lower than that reported in the KEYNOTE-522 study and in smaller real-world studies, potentially due to high rates of pembrolizumab and chemotherapy discontinuation. AEs and hospitalizations were common, with obese patients more likely to be hospitalized than patients with a normal BMI.

PMID:40613977 | DOI:10.1007/s10549-025-07758-8

Clin Rheumatol. 2025 Jul 4. doi: 10.1007/s10067-025-07483-z. Online ahead of print.

ABSTRACT

BACKGROUNDS: Lupus nephritis (LN) is a major cause of morbidity among patients with systemic lupus erythematosus (SLE). Unfortunately, some patients do not respond adequately to available therapies, and the gene expression changes underlying this refractory state are still poorly understood. Therefore, it is crucial to gain a better understanding of the molecular mechanisms involved in refractory LN.

METHODS: Integrated proteomic and transcriptomic analysis was conducted to characterize the unique gene expression profiles in patients with refractory LN. DEGs/DAPs were identified based on the concordance between transcriptome and proteome data. Subsequently, functional enrichment analyses and protein-protein interaction network analyses were performed. Module analysis was carried out using the Search Tool for the Retrieval of Interacting Genes and Cytoscape software. Additionally, the clinical features of these patients were explored. To identify potential therapeutic agents, the Connectivity Map L1000 platform was employed.

RESULTS: Seventeen patients were included in the study, 12 non-refractory LN and 5 refractory LN. There was no statistically significant difference in demographic data, clinical characteristics and laboratory findings. There were 1019 DAPs in non-refractory LN compared with refractory LN and 47 DEGs totally in glomeruli and tubulointerstitium from GSE200306 dataset between two groups. Finally, we obtained 7 DEGs/DAPs, including CD59, JAK1, VCAM1, C8A, PIGR, TGFBI and VTN. The functions and pathways associated with the DEGs/DAPs mainly associated with complement and coagulation cascades. We also found that T cells CD4 memory (activated) downregulated in refractory LN. In both proteomics and transcriptomics analysis, CD59 was downregulated in refractory LN. And CD59 positively correlated with Alb and negatively correlated with CH50. In addition, we discovered several chemicals as potential treatment options for refractory LN.

CONCLUSIONS: According to our research findings, we have discovered that abnormal activation and functional defects of the complement system play a significant role in refractory lupus nephritis. In particular, the decreased expression of CD59 indicates abnormal complement activation. Therefore, inhibiting complement activation may become a new strategy for treating refractory LN. Key Points • The first explore of specific gene expression changes associated with refractory LN combined transcriptomics and proteomics analysis. • The functions and pathways associated with the DEGs/DAPs mainly associated with complement and coagulation cascades. • CD59 was downregulated in refractory LN. CD59 positively correlated with Alb and negatively correlated with CH50.

PMID:40613967 | DOI:10.1007/s10067-025-07483-z

Int Ophthalmol. 2025 Jul 4;45(1):276. doi: 10.1007/s10792-025-03641-z.

ABSTRACT

OBJECTIVE: To use a literature review methodology to assess the efficacy of three distinct approaches: enucleation, radiotherapy or radiotherapy prior to enucleation, in reducing patient mortality.

METHODS: Computers were used to search databases such as PubMed, Web of Science, Embase, Cochrane Library, and CNKI, as well as the references of pertinent literature. Data were extracted from the included research literature according to the pre-defined data extraction table, encompassing study characteristics, sample size, interventions, outcome measures, etc. The Cochrane risk of bias evaluation instrument was employed to assess the excellence of encompassed researches, and the RevMan software was utilized for conducting the meta-analysis.

RESULTS: 10 final articles were included, with 3 studies among them presenting the overall mortality rate at five-year follow-up. The homogeneity trial (P = 0.02, I² = 75%) showed remarkable heterogeneity, leading to the adoption of a random-effects model. The meta-analysis findings unveiled a distinction in the total mortality rate between the two groups (RR = 0.98, 95%CI was 0.81 ~ 1.18, P < 0.01). Five of the included studies reported mortality due to tumor metastasis during five-year follow-up. The homogeneity test (P = 0.03, I² = 64%) showed the presence of heterogeneity, leading to the utilization of a random effects model. The meta-analysis results revealed a remarkable disparity in mortality due to tumor metastasis between the two groups (RR = 0.88, 95%CI was 0.70 ~ 1.10, P < 0.01). Five of the included studies reported total mortality during a ten-year follow-up period. The homogeneity test (P = 0.99, I ² = 0%) demonstrated no heterogeneity, necessitating the adoption of a fixed model. The meta-analysis revealed no statistically significant difference in total mortality between the two groups (RR = 1.04, 95%CI = 0.92-1.17, P = 0.55). Four of the included studies reported mortality due to tumor metastasis at ten-year follow-up. The homogeneity trial (P = 0.41, I² = 0%) showed the absence of heterogeneity, prompting the application of a fixed effects model. The meta-analysis demonstrated no statistically significant difference in mortality due to tumor metastasis between the two groups (RR = 0.84, 95%CI = 0.67-1.05, P = 0.12).

CONCLUSION: There are disparities in the five-year overall mortality and mortality caused by tumor metastasis between enucleation and radiotherapy for CM. When selecting clinical treatment options, the patient’s condition, age, physical condition and personal preferences should be comprehensively taken into consideration, along with other factors, to determine the most appropriate treatment strategy.

PMID:40613960 | DOI:10.1007/s10792-025-03641-z

Naunyn Schmiedebergs Arch Pharmacol. 2025 Jul 4. doi: 10.1007/s00210-025-04408-0. Online ahead of print.

ABSTRACT

Triple-negative breast cancer (TNBC), characterized by the absence of estrogen receptors, progesterone receptors, and HER2 expression, is an aggressive subtype with limited treatment options, underscoring the need for novel therapeutic strategies. This study presents the development of chondroitin sulfate-conjugated, octadecylamine-modified PLGA lipid-polymer hybrid nanoparticles (CS-SAL-LPNPs) for targeted delivery of salinomycin (SAL), a Wnt/β-catenin pathway inhibitor, to sensitize TNBC cells to apoptosis induced by TRAIL through targeted CD44 receptor-mediated uptake. Successful nanoparticle conjugation was confirmed using FTIR and NMR spectroscopy, yielding nanoparticles of 172.36 ± 5.24 nm with a zeta potential of – 26.84 ± 0.25 mV, optimal for cellular uptake and stability. The cellular uptake of CS-SAL-LPNPs was significantly enhanced, as confirmed by confocal microscopy and flow cytometry, showing a statistically significant (p < 0.05; n ≥ 3) 1.45-fold higher fluorescence intensity compared to non-targeted systems. CS-SAL-LPNPs exhibited potent cytotoxicity, with a IC₅₀ of 3.5 µM, and effectively modulated apoptosis-related protein expression by downregulating anti-apoptotic proteins such as Bcl-2 and survivin while upregulating the pro-apoptotic protein caspase-3. These changes indicate disruption of the Wnt/β-catenin signaling pathway, enhancing TRAIL-mediated apoptosis in TNBC cells. These findings demonstrate promising in vitro therapeutic efficacy of CS-SAL-LPNPs, warranting further preclinical in vivo studies for comprehensive validation.

PMID:40613939 | DOI:10.1007/s00210-025-04408-0

Langenbecks Arch Surg. 2025 Jul 4;410(1):214. doi: 10.1007/s00423-025-03756-y.

ABSTRACT

BACKGROUND: Hepaticojejunostomy (HJ) is a crucial reconstructive step in upper gastrointestinal (UGI), pancreaticoduodenectomy (PD), and Hepaticobiliarypancreatic (HBP) surgeries. The optimal suturing technique remains debated, with conflicting evidence regarding operative efficiency, costs, and complications. This meta-analysis compares continuous and interrupted suturing to provide evidence-based recommendations.

METHODS: A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane Library. Primary outcomes were anastomotic time and costs, while secondary outcomes included bile leakage, anastomotic stricture, morbidity, cholangitis, hospital stay, and re-exploration rates. A random or fixed-effects model was applied based on heterogeneity. We included randomized controlled trials and non-randomized cohort studies. The risk of bias was assessed using the Cochrane ROB 2 tool, Newcastle-Ottawa Scale (NOS), and MINORS instrument as appropriate. Additionally, the quality of evidence for each outcome was evaluated using the GRADE approach. Sensitivity analyses were performed using the leave-one-out method.

RESULTS: Seven studies (1,159 patients) were included (continuous: 388, interrupted: 771). Continuous suturing significantly reduced anastomotic time (MD = -13.06 min, 95% CI: -17.37 to -8.75, P < 0.001) and costs (SMD = -4.89, 95% CI: -6.10 to -3.67, P < 0.001). However, no significant differences were observed in bile leakage, anastomotic stricture, morbidity, cholangitis, hospital stay, or re-exploration rates (P > 0.05). Sensitivity analyses confirmed these findings.

CONCLUSION: Continuous suturing reduces anastomotic time by ~ 13 min and costs by ~ $90 without increasing complications. While these differences may be statistically significant, their clinical relevance can vary depending on the surgical context. Surgical choice should consider surgeon expertise, institutional protocols, and patient factors. Further randomized controlled trials are necessary to validate these findings.

PMID:40613910 | DOI:10.1007/s00423-025-03756-y

Skeletal Radiol. 2025 Jul 4. doi: 10.1007/s00256-025-04961-y. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of a dynamic ultrasound-based diagnostic protocol designed to improve the diagnosis of slipping rib syndrome in the largest cohort of pediatric patients to date.

MATERIALS AND METHODS: A retrospective chart review was conducted for patients who presented to Phoenix Children’s Hospital with suspected slipping rib syndrome who underwent dynamic ultrasound-based evaluation from March of 2017 to May of 2022. A focused history and detailed imaging were performed, and dynamic ultrasound exam was conducted and compared with surgical and physical exam findings from pediatric surgeons specializing in slipping rib syndrome. Statistical analyses were performed.

RESULTS: Two hundred twenty-seven patients were evaluated for slipping rib syndrome during the study period, resulting in 301 ultrasound evaluations, with 78% of patients undergoing a single evaluation and 22% undergoing multiple assessments. There were 159 (70%) female and 68 (30%) male subjects. Average age and BMI were 17.4 years and 22.4 kg/m², respectively. Dynamic ultrasound accurately detected slipping rib in 97.4% (220/226; 94.3%, 99.0%) and correctly found no evidence in 88.7% (63/71; 79.0%, 95.0%) of studies, respectively. The combined right and left-sided sensitivity and specificity for morphology was 55.1% (50.2%, 60.0%) and 88.0% (83.0%, 92.9%); for the crunch maneuver, was 54.1% (49.2%, 59.0%) and 92.6% (88.6%, 96.6%); and, for the push maneuver, was 54.8% (50.0%, 59.7%) and 90.7% (86.2%, 95.2%).

CONCLUSION: Dynamic ultrasound imaging of the ribs is an effective and reproducible tool for the diagnosis of slipping rib syndrome, demonstrating high sensitivity and specificity in pediatric patients.

PMID:40613897 | DOI:10.1007/s00256-025-04961-y