Category: Statistics

Surg Endosc. 2025 Mar 31. doi: 10.1007/s00464-025-11676-7. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic-assisted and laparoscopic techniques are widely used for inguinal hernia repair. While robotic-assisted transabdominal preperitoneal (rTAPP) repair is believed to offer ergonomic advantages for surgeons, there is limited evidence comparing its ergonomic impact to conventional laparoscopic TAPP (cTAPP) repair. This study aims to assess the ergonomic strain on surgeons during these procedures using subjective and objective measures.

METHODS: This crossover observational study involved four experienced hernia surgeons who performed two procedures using each technique. Ergonomic strain was evaluated through self-reported perceived exertion (using the Borg scale), surface electromyography (sEMG) of select muscle groups, and posture analysis using rapid upper limb assessment (RULA) scores derived from kinematic data collected via Xsens Awinda. Statistical comparisons were conducted using the Wilcoxon rank-sum test, with adjustments for multiple comparisons.

RESULTS: Subjectively, surgeons perceived rTAPP as less physically demanding, with lower postoperative perceived exertion scores (median 1.5 vs. 3.0, p < 0.01). Objective measurements showed higher static muscle activity in the left erector spinae and median activity in the right trapezius during rTAPP (p = 0.016), but overall ergonomic strain, as indicated by RULA scores, was similar across modalities. Median RULA scores for both techniques were 3, and no significant differences were observed in work posture scores. Despite these findings, discomfort during cTAPP was more frequently reported, with surgeons citing the neck, shoulders, and lower back as affected areas.

CONCLUSION: While rTAPP was subjectively perceived as less physically demanding, objective metrics did not corroborate these perceptions, showing comparable ergonomic strain between techniques. These findings highlight a complex relationship between subjective and objective ergonomic measures and suggest a need for further research, incorporating broader assessments of cognitive and physical loads, to optimize surgeon ergonomics in minimally invasive procedures.

PMID:40164838 | DOI:10.1007/s00464-025-11676-7

Ophthalmologie. 2025 Mar 31. doi: 10.1007/s00347-025-02222-w. Online ahead of print.

ABSTRACT

BACKGROUND: Intravitreal injections (IVI) are the most commonly used procedure worldwide in the treatment of retinal vascular diseases.

OBJECTIVE: This study investigates the endophthalmitis rate, the frequency of subjective complaints and potential risk factors associated with IVI.

MATERIAL AND METHODS: In the first part of this monocentric study the number of cases of endophthalmitis and potential risk factors were analyzed based on routine hospital documentation of 123,373 IVI procedures from 2013 to 2022. In the second part, subjective complaints and potential risk factors following IVI were investigated through a survey involving 584 patients.

RESULTS: From 2013 to 2022 a total of 27 cases of endophthalmitis occurred following IVI (0.02%). The analysis of potential risk factors (age, gender, disinfection method, number of prior injections, day of the week, year, bilateral injection) revealed that none of these factors were associated with an increased risk of endophthalmitis. The initial identification of bilateral injection as a risk factor was disproven through further analysis and classified as a statistical artifact. More than 10% of patients reported complaints the day after the injection, such as foreign body sensation (18%), seeing air bubbles (17%), itching (12%) and reddening of the eyes (11%). Subconjunctival hemorrhage (4%) or severe pain the day after the injection (2%) occurred less frequently. Male patients reported severe pain the day after less often (odds ratio 0.18, 95% confidence interval 0.03-0.72). Nearly 2% of patients sought unplanned ophthalmologist visits or considered treatment discontinuation due to the complaints.

CONCLUSION: Subjective complaints are more prevalent than severe complications and can jeopardize treatment adherence. Therefore, providing information about expected discomfort is advisable.

PMID:40164833 | DOI:10.1007/s00347-025-02222-w

Lifetime Data Anal. 2025 Mar 31. doi: 10.1007/s10985-025-09649-y. Online ahead of print.

ABSTRACT

Double truncation commonly occurs in astronomy, epidemiology and economics. Compared to one-sided truncation, double truncation, which combines both left and right truncation, is more challenging to handle and the methods for analyzing doubly truncated data are limited. For the situation, a common approach is to perform conditional analysis conditional on truncation times, which is simple but may not be efficient. Corresponding to this, we propose a pairwise pseudo-likelihood approach that aims to recover some information missed in the conditional methods and can yield more efficient estimation. The resulting estimator is shown to be consistent and asymptotically normal. An extensive simulation study indicates that the proposed procedure works well in practice and is indeed more efficient than the conditional approach. The proposed methodology applied to an AIDS study.

PMID:40164827 | DOI:10.1007/s10985-025-09649-y

Discov Oncol. 2025 Mar 31;16(1):437. doi: 10.1007/s12672-025-02177-z.

ABSTRACT

BACKGROUND: The pathogenesis of hepatocellular carcinoma (HCC) involves a variety of environmental risk factors, some of which have yet to be fully clarified. Using the Mendelian randomization (MR) approach, this study comprehensively investigates the causal effect of genetically predicted modifiable risk factors on HCC.

METHODS: Genetic variants related to the 50 risk factors that had been identified in previous research were derived from genome-wide association studies. Summary statistics for the discovery cohort and validation cohort of HCC were sourced from the FinnGen consortium and the UK Biobank, respectively. Bidirectional MR analysis and sensitivity analysis were performed to establish causative risk factors for HCC.

RESULTS: Through the inverse variance weighted method, the results of the discovery cohort indicated that waist circumference, nonalcoholic fatty liver disease (NAFLD), alanine aminotransferase (ALT) levels, and aspartate aminotransferase (AST) levels were significantly linked to HCC occurrence risk. Furthermore, body fat percentage, glycated hemoglobin (HbA1c), obesity class 1-3, waist-to-hip ratio, iron, ferritin, transferrin saturation, and urate had suggestive associations with HCC. The validation cohort further confirmed that NAFLD and ALT levels were strongly related to HCC. Reverse MR indicated that genetic susceptibility to HCC was connected to NAFLD and transferrin saturation. Sensitivity analyses showed that most of the findings were robust.

CONCLUSION: This MR study delivers evidence of the complex causal relationship between modifiable risk factors and HCC. These findings offer new insights into potential prevention and treatment strategies for HCC.

PMID:40164825 | DOI:10.1007/s12672-025-02177-z

Can J Public Health. 2025 Mar 31. doi: 10.17269/s41997-025-01014-8. Online ahead of print.

ABSTRACT

OBJECTIVE: Using data from a population-based cross-sectional survey, we aim to measure the prevalence, risk factors, and impact of COVID-19 on household food insecurity, housing insecurity, and the double burden of experiencing both.

METHODS: Data were collected from July to November 2022. We used simple and multivariable logistic regression models to investigate the factors contributing to food insecurity, housing insecurity, and the double burden. Additionally, we computed the relative excess risk due to interaction (RERI) to determine whether any significant interactions contributed to the increased risk of experiencing the double burden.

RESULTS: Around 27% of our study participants were food insecure, 54% were housing insecure, and 22% were food and housing insecure (double burden). Respondents’ gender, age, ethnicity, education, and income were associated with experiencing the double burden of food and housing insecurity. Additionally, this study found a significant statistical interaction between residence location and employment status, with both employed and unemployed individuals in urban areas facing higher odds of experiencing the double burden of food and housing insecurity compared to retired individuals in either urban or rural areas; the relative excess risk due to interaction analysis suggests that increasing employment opportunities may have a more substantial impact on reducing this burden in urban areas.

CONCLUSION: Findings from this study provide important insights into addressing the issue of food and housing insecurity, especially through improving employment opportunities for vulnerable populations in Canada. Comprehensive systems-oriented intersectoral policies are much needed to improve households’ experience of multiple need insecurities.

PMID:40164803 | DOI:10.17269/s41997-025-01014-8

Pediatr Surg Int. 2025 Mar 31;41(1):103. doi: 10.1007/s00383-025-06005-x.

ABSTRACT

PURPOSE: To compare the outcomes of transvesicoscopic Cohen ureteral reimplantation (Cohen technique, Cohen group) and transvesicoscopic Politano-Leadbetter ureteral reimplantation (Politano-Leadbetter technique, Politano-Leadbetter group) in the treatment of ureterovesical junction obstruction (UVJO) in children.

METHODS: From March 2008 to January 2024, 105 patients underwent Cohen technique and 87 underwent Politano-Leadbetter technique. The demographic data, perioperative parameters, surgical outcomes, and postoperative complications of the two groups were analyzed and compared.

RESULTS: The operation time in the Cohen group was shorter than that in the Politano-Leadbetter group (128.2 ± 30.7 vs. 143.1 ± 31.5 min, p < 0.05), but the improvement in hydronephrosis 6 months after surgery in the Politano-Leadbetter group was better than that in the Cohen group (1.48 ± 0.73 vs. 1.63 ± 0.57 cm, p < 0.05). The success rates in the two groups were similar (97.1% vs. 96.6%, p = 0.855). There was no statistical difference in postoperative hematuria time, catheter retention time, hospital stay, and improvement in ureteral dilation between the two groups.

CONCLUSIONS: Two minimally invasive surgical methods via the bladder approach for UVJO have a similar results. Compared to Cohen technique, Politano-Leadbetter technique without change the direction of the ureter, but the surgical time is longer.

PMID:40164793 | DOI:10.1007/s00383-025-06005-x

J Assist Reprod Genet. 2025 Mar 31. doi: 10.1007/s10815-025-03446-0. Online ahead of print.

ABSTRACT

PURPOSE: Optimal endometrial preparation is essential for the transfer of a euploid embryo. Recent works have shown advantages of ovulatory cycle frozen-thawed embryo transfer (Ovu-FET) for simplicity, implantation rate, and reduction of hypertensive disorders of pregnancy; however, few women over age 40 years were included in these studies. This study compared pregnancy outcomes in patients aged 40-45 years between Ovu-FET and programmed cycle FET (PC-FET).

METHODS: Retrospective cohort study in a university-affiliated fertility center. Two hundred eighty-seven FET cycles with euploid embryo transfer between 2015 and 2022 were included, with 116 cycles utilizing the PC-FET and 171 the Ovu-FET protocol. The use of letrozole was permitted for patients with irregular cycles. The primary outcome was ongoing pregnancy rate with secondary outcomes including pregnancy rate, clinical pregnancy rate, biochemical rate, and clinical loss rate. Multivariate regression was utilized to adjust for potential covariates.

RESULTS: The ongoing pregnancy rates were similar between the Ovu-FET versus PC-FET groups (62.6% vs. 58.6%, P = 0.50). Pregnancy rates (77.2% vs. 82.8%, P = 0.25) and clinical pregnancy rates (69.5% vs. 68.1%, P = 0.79) were also similar. Clinical loss rates were similar between the two groups (7.0% vs. 9.5%, P = 0.41). Biochemical loss rates were slightly lower for the Ovu-FET versus PC-FET groups (7.6% vs. 14.7%, P = 0.06) without reaching statistical significance.

CONCLUSION: Our study supports the use of Ovu-FET in women aged 40 years and older undergoing euploid embryo transfers. The results should strengthen confidence in the use of Ovu-FET for older patients.

PMID:40164791 | DOI:10.1007/s10815-025-03446-0

J Assist Reprod Genet. 2025 Mar 31. doi: 10.1007/s10815-025-03464-y. Online ahead of print.

ABSTRACT

PURPOSE: Changing sperm donors after unsuccessful intrauterine insemination (IUI) cycles is a common yet understudied practice. This study evaluates whether switching sperm donors impacts the number of IUI cycles required to achieve pregnancy.

METHODS: This retrospective cohort study analyzed 312 women undergoing donor sperm IUI at Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, from 1992 to 2020. Participants were divided into two groups: Group A (conceived using only one donor) and Group B (switched donors after initial unsuccessful attempts). The primary outcome was the number of IUI cycles until pregnancy. Statistical analyses included t-tests, ANOVA, and multivariate analysis of covariance (MANCOVA).

RESULTS: Women in Group A required fewer cycles (mean 3.78 ± 1.90) to achieve pregnancy compared to Group B (mean 6.07 ± 2.95, P < .001). However, after switching donors, the mean number of cycles needed in Group B (2.23 ± 1.61) was significantly lower than the total cycles required by Group A (P < .001). Cumulative live birth rates were higher in Group A (50.5% after three cycles; 81.5% after six cycles) compared to Group B (26.0% after three cycles; 61.9% after six cycles).

CONCLUSION: Switching sperm donors after repeated unsuccessful IUI attempts significantly reduces the additional number of cycles needed to achieve pregnancy. These findings suggest that sperm-oocyte compatibility may influence IUI success. Clinicians should consider donor replacement after multiple failures. Prospective studies are required to confirm these results and investigate underlying biological mechanisms.

PMID:40164790 | DOI:10.1007/s10815-025-03464-y

Langenbecks Arch Surg. 2025 Mar 31;410(1):113. doi: 10.1007/s00423-025-03673-0.

ABSTRACT

BACKGROUND: Congenital heart disease (CHD) remains a critical concern in pediatric and adult cardiovascular care, requiring continuous advancements in surgical techniques and perioperative strategies. While survival rates have improved, challenges persist in optimizing long-term neurodevelopmental outcomes, addressing disparities in healthcare access, and overcoming systemic barriers to implementing best practices. This systematic review integrates recent evidence on predictive factors, perioperative innovations, and economic challenges affecting CHD management.

METHODS: A systematic review was conducted, analyzing data from 27 observational studies, including retrospective and prospective cohort studies, as well as case reports, sourced from diverse geographic and clinical settings. Studies were selected based on strict inclusion criteria, emphasizing clear surgical outcomes, perioperative advancements, and neurodevelopmental follow-up. Data were extracted and synthesized to identify key trends in CHD surgery, anesthetic management, and long-term patient care.

RESULTS: Key findings include: • Neurodevelopmental Outcomes: Long-term follow-up studies identified associations between prolonged ICU stays, intraoperative cerebral oxygenation deficits, and developmental delays. Hearing loss was reported in 21.6% of post-surgical patients, significantly impacting cognitive and language abilities. • Predictive Factors for Postoperative Outcomes: Hemoglobin saturation, lactate levels, and platelet counts were statistically associated with adverse postoperative outcomes (p < 0.05), reinforcing the need for preoperative risk stratification. • Fast-Track Extubation and Resource Optimization: Early extubation protocols reduced ICU stays by an average of 20%, with a 15% decrease in postoperative complications. However, financial disincentives and inadequate reimbursement models limited their widespread adoption, particularly in low-resource settings. • Tailored Anesthetic Techniques: Individualized anesthesia strategies, including neuroprotective approaches and blood conservation techniques, improved outcomes in high-risk CHD populations, reducing complication rates by up to 10%. • Global Disparities in CHD Care: Studies from low-income countries revealed significantly higher rates of malnutrition, delayed surgical interventions, and postoperative complications. These disparities highlight the urgent need for global policy reforms to improve healthcare equity in CHD management.

CONCLUSION: This review highlights the necessity of integrating predictive analytics, multidisciplinary approaches, and healthcare system reforms to enhance CHD management. While advancements in surgical techniques and perioperative care yield promising outcomes, persistent challenges-including healthcare disparities, financial constraints, and long-term neurodevelopmental risks-require targeted interventions. Future research should focus on personalized care models, global health policy adjustments, and innovative technologies to optimize CHD patient outcomes.

PMID:40164780 | DOI:10.1007/s00423-025-03673-0

Autism. 2025 Mar 31:13623613251328484. doi: 10.1177/13623613251328484. Online ahead of print.

ABSTRACT

A growing body of research suggests that mindfulness-based interventions may be a valuable method for reducing internalizing symptoms in autistic individuals. The current study extends this work using an effectiveness-implementation hybrid type 1 study. In this parallel randomized controlled trial, we examined a novel telehealth intervention for autistic adolescents and their caregivers. MINDful TIME includes eight weekly group meetings and regular use of a commercially available mindfulness meditation app. Participants were 42 adolescent-parent dyads randomized to the treatment or delayed treatment control (DTC) group. The program was implemented with fidelity (91.24%-94.78%), and 90% of treatment group dyads completed the program. On average, participants attended >90% of sessions and reported high acceptability. Treatment group adolescents demonstrated statistically and clinically significant reductions in parent-reported depression symptoms relative to DTC (F(1, 34) = 7.31, p = 0.01, ηp2 = 0.18). Female adolescents in the treatment group showed significant reductions in parent-reported anxiety symptoms (F(1, 34) = 4.22, p = 0.05, ηp2 = 0.11). Exploratory analyses indicated treatment-related improvements in adolescent executive functioning, parent mindfulness and well-being, and adolescent-parent relationship dysfunction. Findings warrant future examination of MINDful TIME to address well-documented challenges with mental health in this population. This trial was registered on clinicaltrials.gov (NCT05685589).Lay abstractPrevious research studies have found that mindfulness (i.e. focused attention on, and acceptance of, the present moment) training programs can reduce stress, depression, and anxiety. However, more research is needed to understand whether mindfulness strategies are helpful for autistic teens. We examined a new telehealth intervention for autistic teens and their caregivers. MINDful TIME is an 8-week group program that meets weekly through Zoom meetings. Participants learn mindfulness strategies through didactic lessons and using a commercially available mindfulness meditation mobile app. We randomly assigned 42 teens (ages 13-18 years) with an autism diagnosis and their parents to complete MINDful TIME or an 8-week wait period before beginning the program. Ninety percent of teens and parents assigned to MINDful TIME completed the program and reported that they found the program to be acceptable. Teens who completed MINDful TIME showed large reductions in depression symptoms, whereas teens in the wait period group did not. Females who completed MINDful TIME also showed reductions in anxiety symptoms, whereas males who completed MINDful TIME and females and males in the wait period group did not. Parents who completed MINDful TIME with their teens showed increased mindfulness traits, well-being, and adolescent-parent relationship functioning. Findings suggest that MINDful TIME is a promising program that may improve accessibility of mindfulness strategies for autistic teens and their caregivers. Future research with a larger sample size is needed to fully understand the benefits of the program.

PMID:40160168 | DOI:10.1177/13623613251328484