Category: Statistics

BMC Surg. 2025 Nov 1;25(1):517. doi: 10.1186/s12893-025-03152-9.

ABSTRACT

INTRODUCTION: Acute appendicitis is a common surgical emergency worldwide. While the use of preoperative antibiotics has shown clear benefits in improving outcomes for uncomplicated appendicitis, the necessity of routine postoperative antibiotics remains a topic of debate. This meta-analysis evaluates the impact of preoperative and postoperative antibiotics on patient outcomes, adverse events, and hospital stay duration.

METHODOLOGY: A systematic review and meta-analysis were conducted, including 14 studies published over the past 15 years, focusing on patients aged 14-65 with uncomplicated appendicitis. Both experimental and observational designs were included. Statistical analyses were performed using SPSS, Excel, and RevMan to assess adverse effects, hospital stays, and antibiotic duration outcomes. The risk of bias was assessed using the Cochrane tool, with all included studies showing low risk across key domains. The study received no external funding and was not registered in any clinical trial database.

RESULTS: Preoperative antibiotic prophylaxis demonstrated significant benefits, including shorter hospital stays and reduced postoperative complications. Metronidazole was the most frequently prescribed antibiotic, followed by cefoxitin and cefuroxime. Conversely, the use of postoperative antibiotics was associated with increased rates of adverse events, including Clostridium difficile infections, deep surgical site infections, and urinary tract infections. Patients receiving only preoperative antibiotics experienced fewer complications and improved overall outcomes than those receiving postoperative antibiotics.

CONCLUSION: Preoperative antibiotics, such as metronidazole and cefoxitin, are sufficient to optimize outcomes in uncomplicated appendicitis. Postoperative antibiotics offer no additional benefit and are associated with a higher risk of adverse events. These findings support limiting antibiotic use to the preoperative phase, aligning with antimicrobial stewardship principles, and ensuring safer, more cost-effective patient care. A revision of clinical guidelines is recommended to reflect these findings and enhance evidence-based practices in managing uncomplicated appendicitis. Despite some heterogeneity in study design and follow-up variability, this meta-analysis remains robust due to consistent inclusion criteria, high-quality studies, a large sample size, and rigorous methods like the Mantel-Haenszel model.

PMID:41176598 | DOI:10.1186/s12893-025-03152-9

Support Care Cancer. 2025 Nov 1;33(11):1010. doi: 10.1007/s00520-025-10062-2.

ABSTRACT

This observational cross-sectional study aimed to evaluate swallowing in volunteers with and without a history of head and neck cancer using electromyographic amplitude, salivary flow, and quality of life. We analyzed 30 volunteers, 15 with a history of cancer (test group), and 15 without (control group), all wearing bimaxillary complete dentures for at least 6 months. Electromyographic amplitude of the masseter, temporal, and suprahyoid muscles was assessed during mandibular rest and during swallowing of nectar, liquid, pudding, and solid foods, using a surface electromyograph. Salivary flow was measured by collecting unstimulated saliva from volunteers while wearing their dentures. Dysphagia and its impact on quality of life were assessed using the MD Anderson Dysphagia Inventory (MDADI). Data were analyzed using normality tests (Shapiro-Wilk) and appropriate statistical tests (T Student or Mann-Whitney). No statistically significant differences were found between the test and control groups in electromyographic amplitude of the temporal, masseter, and suprahyoid muscles during rest (p = 0.468/0.663/0.619) and swallowing (p = 0.240/0.830/0.870 for nectar, p = 0.101/0.760/0.838 for liquid, p = 0.056/0.902/0.967 for pudding, p = 0.494/0.805/0.116 for solid). There was also no significant difference in salivary flow (p = 0.438). However, significant differences were found in MDADI scores (p < 0.001), especially in the emotional domain (p < 0.001), indicating a major impact of dysphagia on quality of life in these patients.

PMID:41176586 | DOI:10.1007/s00520-025-10062-2

Intern Emerg Med. 2025 Nov 1. doi: 10.1007/s11739-025-04161-5. Online ahead of print.

ABSTRACT

People with mental health issues (MHI) are disproportionately dependent on tobacco smoking and experience higher rates of smoking-related mortality compared to the general population. Mental health workers (MHWs) are well placed to address this burden, yet many lack the knowledge, confidence, or skills to support smoking cessation or tobacco harm reduction (THR). This study aimed to evaluate the impact of a structured THR training session on the knowledge and attitudes of mental health workers in Malawi. A quasi-experimental pre-post study was conducted among 48 mental health professionals at two psychiatric hospitals in Malawi. Participants attended a structured training session on tobacco harm reduction. Baseline and end-line surveys assessed demographics, prior tobacco harm reduction exposure, knowledge, and attitudes. Knowledge scores were analysed using the Wilcoxon signed-rank test, with descriptive statistics summarising categorical shifts and attitudinal changes. Only 25% of the participants had received prior training on tobacco harm reduction. A statistically significant increase in median knowledge scores from baseline (median = 6, interquartile range [IQR] = 5-7) to end line (median = 8, IQR = 7-9), Z = -5.72, p < 0.001, with a large effect size (r = 0.62) was observed. The proportion of participants classified as having ‘Good’ knowledge increased substantially from 21.3% at baseline to 68.1% at end line, while the ‘Poor’ knowledge category decreasing from 6.4 to 0%. A brief, well-structured training on tobacco harm reduction can help improve knowledge among mental health workers. Scaling up such training could help close a major gap in patient care for people with mental illness in Malawi and similar settings.

PMID:41176585 | DOI:10.1007/s11739-025-04161-5

Target Oncol. 2025 Nov 1. doi: 10.1007/s11523-025-01184-y. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) are now standard for various cancers, and preclinical studies suggest beta-blockers (BBs) may boost the efficacy of ICIs. However, prior clinical studies had small sample sizes, requiring large-scale validation.

OBJECTIVE: We aimed to evaluate the efficacy and safety of combining BBs with ICIs in patients with solid tumors through a systematic review and meta-analysis.

METHODS: A systematic search of PubMed/MEDLINE and Embase was conducted for studies on BBs plus ICIs for solid tumors up to July 2024. Outcomes of interest were overall survival, progression-free survival, and adverse events. Hazard ratios with 95% confidence intervals were pooled using a random-effects model meta-analysis, with heterogeneity assessed by I² statistics.

RESULTS: Overall, 12 clinical studies involving 4293 patients with solid tumors were included, with 1463 patients receiving both BBs and ICIs and 2830 patients receiving ICIs alone. The combination of BBs and ICIs was not associated with a longer overall survival (hazard ratio 1.02; 95% confidence interval 0.84-1.23; p = 0.87; I² = 69%) or progression-free survival (hazard ratio 0.98; 95% confidence interval 0.80-1.20; p = 0.81; I² = 71%). Subgroup analyses by cancer types and BB types showed no significant heterogeneity in the hazard ratios for overall survival across different cancer types (I² = 0%, p for heterogeneity = 0.44) and BB types ⁽I² = 0%, p for heterogeneity = 0.67). The combination of BBs plus ICIs did not seem to increase toxicity.

CONCLUSIONS: Despite positive preclinical findings, this meta-analysis showed that adding BBs to ICIs was not associated with longer survival. We await the results of ongoing prospective trials assessing this strategy. PROSPERO REGISTRATION: CRD42024574043.

PMID:41176581 | DOI:10.1007/s11523-025-01184-y

Mol Psychiatry. 2025 Nov 1. doi: 10.1038/s41380-025-03330-4. Online ahead of print.

ABSTRACT

Machine learning (ML) is revolutionising our ability to decode the complex genetic architectures of brain disorders. In this review we examine the strengths and limitations of ML methods, highlighting their applications in genetic prediction, patient stratification, and the modelling of genetic interactions. We explore how ML can augment polygenic risk scores (PRS) through advanced techniques and how integrating functional genomics and multimodal data can address challenges like rare variants and weak genetic effects. Additionally, we discuss the importance of embedding biological knowledge into ML models to enhance interpretability and uncover meaningful insights. With the ongoing expansion of phenotype-genotype datasets and advances in federated learning, ML is poised to compete with and surpass classical statistical methods in disease risk prediction and identifying genetically homogenous subgroups. By balancing the strengths and weaknesses of these approaches, we provide a roadmap for leveraging ML to unravel the genomic complexity of brain disorders and drive the next wave of discoveries.

PMID:41176580 | DOI:10.1038/s41380-025-03330-4

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09679-0. Online ahead of print.

ABSTRACT

PURPOSE: Intraoperative identification of parathyroid adenomas can be challenging due to their anatomical variability and the limitations of preoperative imaging. This study aimed to evaluate the impact of indocyanine green (ICG) fluorescence imaging on operative efficiency and surgical outcomes in parathyroidectomy, employing a standard near-infrared (NIR) endoscopic system.

METHODS: We conducted a prospective interventional study with retrospective controls. Patients undergoing parathyroidectomy for primary hyperparathyroidism were included. The study group received intravenous ICG for intraoperative fluorescence imaging to aid parathyroid gland identification. Standard protocols, including preoperative imaging, intraoperative quick parathyroid hormone (qPTH) measurements, and frozen section analysis, were followed in both groups. Operative times and clinical outcomes were compared between ICG-assisted and standard procedures.

RESULTS: Seventy-six patients were included: 19 in the ICG group and 57 in the control group. The median net operative time (cutting-to-end) was significantly shorter in the ICG group (59 vs. 79 min; p = 0.002), while entry-to-cutting time was slightly longer (44 vs. 35 min; p = 0.014). Although the total operative time was shorter in the ICG group (109 vs. 123 min), this difference was not statistically significant (p = 0.060). A ≥ 50% reduction in qPTH was achieved in 94.7% vs. 89.5% (p = 0.672), and adenoma confirmation was 100% vs. 96.5% (p = 1.0), respectively.

CONCLUSION: ICG fluorescence is a cost-effective adjunct to standard parathyroidectomy, offering real-time gland visualization and potentially reducing operative times. Its integration into the routine surgical workflow may enhance intraoperative efficiency and outcomes.

PMID:41176564 | DOI:10.1007/s00405-025-09679-0

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09547-x. Online ahead of print.

ABSTRACT

OBJECTIVE: We conducted this systematic review and meta-analysis to investigate the efficacy and safety of the use of serial intralesional steroid injection (SILSI) in patients with subglottic stenosis (SGS).

DATA SOURCES: PubMed, Web of Science, and Scopus databases, from inception until December 2024.

REVIEW METHODS: Database search used the following keywords: “Subglottic stenosis” AND “Intralesional.” The meta-analysis pooled the mean difference (MD) and standardized mean difference (SMD) for outcomes measured on different scales, based on pre-operative and post-operative values, with 95% confidence interval (CI). For categorical variables, we used Open MetaAnalyst software to calculate the rate of different outcomes and the effect estimates. Heterogeneity was assessed using the I² statistic.

RESULTS: The use of SILSI in SGS patients increases the surgery-free survival duration with a MD = 395.27 days (95% CI: 166.14, 624.39, p = 0.0007), I² = 81%, p = 0.0003. Additionally, the use of SILSI was associated with an increase in peak expiratory flow (PEF: MD = 30.6; 95% CI: 16.1, 45.1; p < 0.0001), I² = 100%, p < 0.00001. The effect estimates for categorical outcomes were success rate (0.92; 95% CI: 0.872, 0.969), adverse events (0.257; 95% CI: -0.043, 0.556), and recurrence rate (0.451; 95% CI: -0.058, 0.960).

CONCLUSION: SILSI has shown a high success rate, extended surgery-free survival, and improved PEF, with a relatively low recurrence rate and minimal risk of adverse events. Given this high efficacy and favorable safety profile, SILSI is recommended for use in SGS.

PMID:41176560 | DOI:10.1007/s00405-025-09547-x

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09785-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to compare the evaluation of obstructive sleep apnea (OSA) by ten super-experts using responses from a 10-question survey answered by 3 different artificial intelligence chatbots, Chat GPT-3.5, Chat GPT-4.0, Gemini, and a panel of 100 otolaryngologists specialized in sleep medicine.

METHODS: A 10-question survey regarding OSA management was answered by Chat GPT-3.5, Chat GPT-4.0, Gemini, and a panel of 100 otolaryngologists. The responses were assessed by ten super-experts in sleep medicine for their agreement with expert consensus, using a Likert scale. Statistical analyses were performed to evaluate the level of agreement and significance.

RESULT: Expert consensus had the highest mean score (4.5 ± 0.9), significantly outperforming all AI models. ChatGPT-3.5 was the best among AI systems, with a score of 4.1 ± 1.2 (p=0.003), followed by ChatGPT-4 with 3.9 ± 1.4 (p<0.001) and Gemini with 3.6 ± 1.5 (p<0.001). Perfect agreement with expert consensus was achieved in specific scenarios, particularly regarding indications for bariatric surgery and lateral pharyngoplasty. However, there were significant differences in complex clinical scenarios that required integration of multiple factors, particularly in therapeutic management questions where the performance of AI models was significantly below that of expert consensus (p<0.01).

CONCLUSIONS: Although AI models are promising in the management of OSA, especially for well-defined clinical scenarios, they at present serve best as complementary tools rather than replacements for expert clinical judgment. Most surprisingly, ChatGPT-3.5 outperformed its newer versions in many aspects, indicating that model updates with general capabilities may not always lead to better performance in specialized medical domains. These findings emphasize the potential of AI as a supportive resource while emphasizing the continuing need for human expertise in complex clinical decision-making.

PMID:41176557 | DOI:10.1007/s00405-025-09785-z

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09793-z. Online ahead of print.

ABSTRACT

BACKGROUND: The auricular cough reflex (Arnold’s reflex) is a vagally mediated somato-visceral response triggered by stimulation of the external auditory canal (EAC). While classically considered rare, its clinical relevance in otologic procedures remains underexplored.

OBJECTIVE: This study aimed to evaluate the prevalence, lateralization, and potential risk factors of the Arnold reflex during routine otologic examinations, with particular attention to examiner handedness, hearing aid use, and EAC inflammation.

METHODS: In this prospective observational study, 404 consecutive patients undergoing bilateral ear wax removal in a university otology clinic were assessed for reflex-induced coughing. Reflex occurrence, laterality, instrument type, hearing aid use, signs of local infection, age, and sex were documented. Statistical analyses included chi-square tests, logistic regression, and McNemar’s test.

RESULTS: A cough reflex was elicited in 52 patients (12.9%), predominantly right-sided (73.1%, p < 0.001). The reflex was most frequently triggered by curettes (84.6%). No significant association was found between reflex presence and hearing aid use, local infection, age, or sex. The strong right-ear predominance, observed exclusively with a right-handed examiner, suggests that handedness and canal wall anatomy may influence reflex induction.

CONCLUSION: The Arnold cough reflex occurs more commonly than historically reported, with a notable right-sided predominance potentially linked to examiner handedness and procedural factors. Routine otologic variables such as age, sex, hearing aid use, and local inflammation had no measurable effect. These findings underscore the importance of examiner awareness and gentle technique in the EAC. Future studies should explore anatomical mapping, neurophysiological mechanisms, and the potential role of habituation in chronic ear stimulation.

PMID:41176556 | DOI:10.1007/s00405-025-09793-z

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09756-4. Online ahead of print.

ABSTRACT

PURPOSES: Allergic rhinitis (AR) is increasingly recognized for its broader impacts on health, including possible links to various vestibular disorders. This study aims to investigate the association between prior AR and peripheral vestibular disorder (PVD) within Taiwan’s National Health Insurance system.

METHODS: Utilizing the Longitudinal Health Insurance Database 2010, this case-control study analyzed data from patients diagnosed with PVD (n=78,503) and 235,509 propensity-score-matching controls. To evaluate the association between prior AR and PVD, we carried out multiple logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS: The Chi-squared test indicates a notable contrast in prior AR occurrence between individuals with PVD and those under control (32.2% vs. 22.8%, p<0.001). Furthermore, our findings reveal significant statistical differences in AR prevalence among patients with Meniere’s disease (32.1% vs. 22.8%, p<0.001), benign paroxysmal positional vertigo (32.2% vs. 22.8%, p<0.001) as well as vestibular neuritis (32.6% vs.22.8, p <0.001) relative to controls. The adjusted OR for prior AR among sampled PVD patients was found to be 1.605 (95% CI=1.577~1.634). After making similar adjustments for MD, BPPV, and VN cases; we discovered that adjusted ORs of AR were respectively recorded as: 1.598 (95% CI=1.530~1.668), 1.597 (95% CI=1.534~1.662), and finally at 1.636 (95 % CI =1.552 ~1.725).

CONCLUSION: The study suggests a significant link between prior AR and the occurrences of PVD. However, given the distinct pathophysiological mechanisms of these disorders and the high prevalence of AR in the general population, the findings should be interpreted with caution. These results are hypothesis-generating and underscore the need for prospective and mechanistic studies to clarify whether the observed associations reflect causal relationships or coincidental comorbidity.

PMID:41176555 | DOI:10.1007/s00405-025-09756-4