Category: Statistics

Int Braz J Urol. 2025 Mar-Apr;51(2):e20240630. doi: 10.1590/S1677-5538.IBJU.2024.0630.

ABSTRACT

PURPOSE: The accurate diagnosis of prostate cancer (PCa) remains challenging, particularly because standard biopsy techniques do not routinely include anterior zone, leading to potential missed diagnoses in this region. This study evaluates the accuracy and safety of biplanar stereotactic biopsy for diagnosing anterior clinically significant PCa (csPCa).

MATERIALS AND METHODS: After propensity score matching analysis, data from 256 patients were retrospectively analyzed, including 128 in the biplanar group (transrectal targeted biopsy with transperineal systematic biopsy) and 128 in the monoplanar group (transperineal targeted biopsy with transperineal systematic biopsy). PCa detection rates, lesion locations, csPCa, clinically insignificant PCa (ciPCa), and complication incidences were compared. Univariable and multivariable logistic regression models evaluated factors influencing biopsy outcomes.

RESULTS: No significant differences were observed in overall PCa detection, ciPCa, posterior lesions, or postoperative complications between biplanar and monoplanar groups. The biplanar group demonstrated a higher detection rate for anterior csPCa (P=0.025). The overall International Society of Urological Pathology grade group (ISUP GG) distributions for Prostate Imaging Reporting and Data System (PI-RADS) scores 3 to 5 were not significantly different. Logistic regression identified age and PSA levels as independent predictors of higher detection rates, while univariable analysis showed that prostate volume had a significantly smaller effect on PCa detection rates in the biplanar group compared to the monoplanar group. Postoperative complications showed no statistically significant differences.

CONCLUSIONS: In conclusion, biplanar stereotactic biopsy was superior to monoplanar biopsy in detecting anterior csPCa. Both methods demonstrated no significant differences in overall PCa detection rates and safety.

PMID:39913095 | DOI:10.1590/S1677-5538.IBJU.2024.0630

Int Braz J Urol. 2025 Mar-Apr;51(2):e20240565. doi: 10.1590/S1677-5538.IBJU.2024.0565.

ABSTRACT

BACKGROUND: Different modalities of percutaneous thermal ablation (PTA) have been used as possible minimally invasive nephron-sparing treatments for small renal masses (SRMs). The present study aimed to compare long-term outcomes of two guidelines-recommended ablative techniques, cryotherapy (CRYO) and radiofrequency ablation (RFA).

MATERIALS AND METHODS: Data of patients with single cT1 solid renal mass undergoing CRYO or RFA between 2004 and 2020 were retrospectively retrieved from a multi-institutional international database. Oncologic outcomes included “technical success”, local recurrence-free survival (RFS), distant metastasis-free survival (MFS), and overall survival (OS). Intraoperative and postoperative complications, length of stay (LOS), and re-admission rate within 30 days were registered. Major complications were defined as CD grade ≥III. Baseline features and treatment outcomes were analyzed using descriptive statistics. RFS, MFS, and OS were estimated using the Kaplan-Meier method.

RESULTS: Overall, 643 patients were included, of which 492 (71.2%) underwent CRYO, and 151 (21.8%) RFA, with a median follow-up of 43 and 37 months, respectively (p=0.07). Technical success was achieved in 96.5% of CRYO vs 93.4% of RFA (p=0.09). No difference in terms of overall (CRYO: 10.4% vs RFA: 6%; p=0.1) and “major” (CRYO: 0.8% vs RFA: 1.3; p=0.06) post-operative complications were observed. RFS (CRYO:85.7%; RFA:84.9%, p=0.2), MFS (CRYO: 96.9%; RFA: 95.8%, p=0.4) and OS (CRYO: 89%; RFA: 87.4%; p=0.8) were comparable.

CONCLUSIONS: CRYO and RFA are both valid minimally invasive options for the treatment of small renal tumors. They are particularly suitable for patients who are not good surgical candidates as they offer very low risk of major procedure-related complications. For the right indication, they both offer favorable mid to long term oncologic outcomes.

PMID:39913094 | DOI:10.1590/S1677-5538.IBJU.2024.0565

Int Braz J Urol. 2025 Mar-Apr;51(2):e20240425. doi: 10.1590/S1677-5538.IBJU.2024.0425.

ABSTRACT

PURPOSE: Non-neurogenic overactive bladder (OAB) is a common problem in children. Antimuscarinics have been widely used as first-line medical treatment. However, their frequent side effects necessitate searching for therapeutic alternatives. We aimed to assess the efficacy and safety of the beta 3 agonist, mirabegron.

MATERIALS AND METHODS: A randomized controlled trial enrolled child with non-neurogenic OAB refractory to behavioral urotherapy. Patients were randomized to receive either Mirabegron 25/50 mg based on a 40-kg body weight cutoff or solifenacin 5 mg for 12 weeks. Patients were assessed using Dysfunctional Voiding Scoring System questionnaire (DVSS), 3-day voiding diary and uroflowmetry. Vital signs and adverse effects were recorded at baseline and follow-up. The study primary endpoint was ≥50% reduction of the baseline DVSS.

RESULTS: Among 128 patients screened, 72 patients (36 in each group) completed the study with a mean age of 9.2±2.3 years. Both groups had significant improvement of DVSS and voiding diary (p<0.001) at 12 weeks. In mirabegron group, 94.4% (34/36) had greater than 50% improvement of DVSS compared to 75% (27/36) of solifenacin group (P=0.02). Complete symptom resolution was observed in 22.2% (8/36) patients on mirabegron versus 8.3% (3/36) on solifenacin (P=0.1). Patients on mirabegron had less adverse effects (19.4% vs 47.2%; p=0.01).

CONCLUSION: Mirabegron is more effective with fewer adverse effects than solifenacin for treatment of children with OAB. Mirabegron treatment improves daytime symptoms and nocturnal enuresis with less risk of constipation. It may be considered as first-line pharmacotherapy in this patient population.

PMID:39913092 | DOI:10.1590/S1677-5538.IBJU.2024.0425

Int Braz J Urol. 2025 Mar-Apr;51(2):e20240332. doi: 10.1590/S1677-5538.IBJU.2024.0332.

ABSTRACT

PURPOSE: There is substantial literature demonstrating minimal to no increased risk of three-piece penile prosthesis (PP) complications for patients undergoing placement with concomitant reconstructive urologic procedures. However, there is a paucity of research investigating outcomes for patients suffering from erectile dysfunction (ED) who undergo concomitant non-reconstructive urologic procedures at the time of PP placement.

MATERIALS AND METHODS: We performed a retrospective review of patients undergoing PP placement and a second non-reconstructive urologic procedure performed concomitantly at our institution between January 2007 and July 2021. This was compared to a control cohort of 127 patients who underwent PP placement only. Outcomes of interest were complications and device infections. Comparative statistics were used to compare the two groups, and the Kaplan-Meier method was used to estimate the rate of complications and infections over time.

RESULTS: We identified 44 patients who underwent concomitant surgery and 127 patients who underwent single surgery only. The types of concomitant surgeries were as follows: 23 endoscopic (52.3%), 9 penile (20.5%), 10 scrotal (22.7%), 1 hardware placement (2.3%), and 1 oncologic (2.3%). Hypertension was the only comorbidity that was more prevalent in the concomitant group (65.9% vs. 43.8%, P < 0.01). Patients undergoing concomitant surgery had similar complication (4.6% vs. 3.6%, P=0.79) and device infection (2.3% vs. 0.7%, P=0.43) rates as the single surgery group.

CONCLUSIONS: In the largest study of its kind, we observed that patients undergoing concomitant non-reconstructive urologic procedures at the time of PP placement are not at an increased risk of adverse events.

PMID:39913091 | DOI:10.1590/S1677-5538.IBJU.2024.0332

Int Braz J Urol. 2025 Mar-Apr;51(2):e20240490. doi: 10.1590/S1677-5538.IBJU.2024.0490.

ABSTRACT

PURPOSE: Radical cystectomy (RC) is the standard of care for patients with bladder cancer, and pelvic lymph node dissection (PLND) is a pivotal step that can be carried out either before or after RC. Evidence on the optimal timing for PLND remains limited.

MATERIALS AND METHODS: We searched PubMed, Embase, Cochrane Central, Scopus and Google Scholar for studies comparing PLND before versus after RC. Outcomes assessed were total operative time, PLND time, RC time, number of lymph nodes (LN) dissected, and estimated blood loss. Mean differences (MDs) and 95% confidence intervals (CIs) were computed using a random-effects model. Subgroup analysis was conducted for robot-assisted RC (RARC).

RESULTS: A total of 801 patients from six studies were included, of whom 360 (44.94%) underwent PLND before RC. There were no significant differences in total operative time (MD -17.49; 95% CI -41.65,6.67; p = 0.16; I2 = 94%), PLND time (MD -14.91; 95% CI -44.91,15.09; p = 0.33; I2 = 96%), LN yielded (MD -1.13; 95% CI -4.81,2.55; p = 0.55; I2 = 83%), and estimated blood loss (MD 0.17; 95% CI -51.33,51.68; p = 0.99; I2 = 81%). However, RC time was significantly reduced (MD -28.89; 95% CI -42.84,-14.93; p < 0.0001; I2 = 75%) when PLND was performed prior to RC. In RARC studies, PLND before RC decreased total operative time, RC time, and estimated blood loss.

CONCLUSIONS: The timing of lymphadenectomy was not associated with a significant reduction in total operative time, PLND time, LN yield, and estimated blood loss.

PMID:39913090 | DOI:10.1590/S1677-5538.IBJU.2024.0490

Cerebellum. 2025 Feb 6;24(2):43. doi: 10.1007/s12311-025-01792-4.

ABSTRACT

Cerebellar functional connectivity changes have been reported in Alzheimer’s disease (AD), but a comprehensive framework integrating these findings is lacking. This retrospective study investigates the cerebello-thalamo-cortical (CTC) circuit in AD, using functional gradient analysis to elucidate deficits and potential biomarkers. We analyzed data from 246 participants enrolled in the Alzheimer’s Disease Neuroimaging Initiative (ADNI-3; NCT02854033), including 58 with AD, 103 with mild cognitive impairment (MCI), and 85 cognitively normal (CN) controls, matched for age and sex. All individuals underwent comprehensive neuropsychological assessments (MMSE, MoCA, ADAS-Cog) and MRI scans. We extracted mean time series for 270 brain regions (an extended Power atlas) and computed pairwise functional connectivity, focusing on CTC circuitry. Thalamic and cerebellar connectivity gradients were derived using voxel-wise correlation matrices and the BrainSpace toolbox, defining thalamic and cerebellar masks from the Melbourne subcortical atlas and AAL atlas, respectively. ANCOVA with post hoc analyses, controlling for age and sex, was conducted to assess abnormal CTC connectivity across AD, MCI, and CN groups. LASSO regression identified edges within the CTC circuitry that significantly differed between AD and CN, MCI and CN, AD and MCI, as well as was used to construct Logistic classification model. Pearson correlations were performed to examine relationships between mean CTC connectivity, individual edges, and cognitive scores (MMSE, MoCA, ADAS-Cog). To explore the hierarchical organization of the thalamus and cerebellum, global gradient distributions were compared across groups using two-sample Kolmogorov-Smirnov tests. Additionally, ANCOVA was applied to compare subfield- and functional-level gradients of the thalamus and cerebellum among AD, MCI, and CN. False discovery rate (FDR) corrections were used, setting the statistical significance threshold was set at P < 0.05. AD and MCI individuals exhibited increased CTC connectivity compared to CN (all P < 0.05). Average CTC connectivity did not correlate with cognitive scores (P > 0.05), but specific CTC edges were correlated. LASSO regression identified 20 discriminative edges, achieving high accuracy in AD-CN classification (AUC = 0.92 training, AUC = 0.80 test). Thalamic and cerebellar gradient distributions differed significantly across groups (all P < 0.05), with specific regions showing distinct gradient scores. Five cerebellar functional networks exhibited decreased gradient scores. Significant CTC hyperconnectivity in AD and MCI compared with CN suggests early thalamic and cerebellar dysregulation. Classification analyses effectively distinguished AD vs. CN but were moderate for MCI vs. CN and limited for MCI vs. AD. Gradient analyses revealed global- and subfield-level disruptions in AD, emphasizing the role of thalamic and cerebellar interactions in cognitive decline and offering potential diagnostic markers and therapeutic targets.

PMID:39913059 | DOI:10.1007/s12311-025-01792-4

Eur J Health Econ. 2025 Feb 6. doi: 10.1007/s10198-025-01758-7. Online ahead of print.

ABSTRACT

BACKGROUND: Most of the studies investigate impact of affordability at national or regional levels with less attention being paid on changes in affordability and their impact on different socio-economic groups.

OBJECTIVES: The aim of this article is better understanding of variations in alcohol male mortality in different socio-economic groups by a careful examination of changes in disposable income and alcohol affordability in households of different education levels.

METHODS: Data (2004-2018) on disposable income per household member were taken from a survey – Statistics Poland. Mortality data were taken from the national death register of Statistics Poland based on death certificates. Linear regression models were used to establish relationship between income, affordability and mortality.

RESULTS: In the study period, disposable incomes increased substantially in the households with primary, vocational, and secondary education. In the households with university education, where incomes were much higher their pace of growth was much lower. Parallel, proportional alcohol male mortality increased substantially in three lower educational groups while remained almost stable among men with university education, in particular in the last ten years under the study. Clear, linear relationship was found within primary, vocational, and secondary education between proportional alcohol mortality and disposable income. Even, after inclusion into the model alcohol affordability, crucial role of changes in disposable income was confirmed as it explained much higher variation in mortality than affordability. No association was identified within households with university education.

CONCLUSIONS: The results of this study do not entirely confirm the relationship between alcohol affordability and mortality due to alcohol consumption in men as noted in the literature. Substantial and rapid increases in disposable income were shown as having much stronger impact. Policies which aim to reduce income disparities may produce negative unintended side-effects such as higher alcohol mortality among beneficiaries of these policies.

PMID:39913042 | DOI:10.1007/s10198-025-01758-7

Child Psychiatry Hum Dev. 2025 Jan 30. doi: 10.1007/s10578-025-01810-w. Online ahead of print.

ABSTRACT

Health-threatening underweight and poor growth is a frequent consequence of Avoidant restrictive food intake disorder (ARFID) and should be a priority for treatment in children and adolescents (young people, YP). Coexisting autism is more prevalent in YP with ARFID than in YP with other eating disorders. Treatment studies are still sparse for ARFID, and it is not known whether treatment response is lower in those with coexisting autism, as it is documented in other eating disorders. In this study we examined if family-based treatment for ARFID (FBT-ARFID) was associated with weight gain in underweight young people (YP) with ARFID and if coexisting autism affected weight gain. A clinical naturalistic prospective case series of 33 YP aged 6.3-18 years with ARFID presentations and underweight were offered a manualized FBT-ARFID with weight monitoring. We examined changes in body weight between start and end of treatment in those with and without diagnosed coexisting autism. The majority of participants (N = 26, 79%) had a weight gain between 1 and 15 kg, whereas 7 YP (21%) had a stable body weight between start and end of treatment (differences between – 0.6 kg and + 0.9 kg). At the group level, weight gain was statistically significant between start and end (Median = 3.9 kg (4.0, -0.6 -15.1) z = 4.491, p <.001). There was no significant difference in weight gain between participants with (N = 14, 42%) and without (N = 19, 58%) coexisting autism. Participants had a significant weight gain at the group level, suggesting that FBT-ARFID is associated with weight gain in the majority of underweight ARFID patients, both with and without coexisting autism. However, a subgroup may need additional interventions in order to secure weight rehabilitation.

PMID:39913038 | DOI:10.1007/s10578-025-01810-w

Geroscience. 2025 Feb 6. doi: 10.1007/s11357-025-01549-1. Online ahead of print.

ABSTRACT

Current European Stroke Organisation (ESO) guidelines recommend extended time window reperfusion therapies (4.5-9 h for thrombolysis, 6-24 h for thrombectomy) based on advanced imaging. However, the workload and clinical benefit of this strategy on a population basis are not known. To determine the caseload, treatment rates, and outcomes in the extended as compared to the standard time windows. All consecutive ischaemic stroke patients within 24 h of last known well between 1st March 2021 and 28th February 2022 were included in a prospective single-centre study. Treatment eligibility in the extended time windows or wake-up strokes recognized within 4 h was based on current ESO guideline criteria using MRI DWI-PWI or DWI-FLAIR mismatch. MRI was only available during working hours (8-20 h); otherwise, CT/CTA was used. Clinical outcome in treated patients was assessed at three months. Among the 777 admitted patients, 252 (32.4%) had MRI. The thrombolysis rate was 119/304 (39.1%) in standard and 14/231 (6.1%) in the extended time window. The thrombectomy rate was 34/386 (8.8%) in standard and 15/391 (3.8%) in the extended time window. Independent clinical outcomes (mRS ≤ 2) were not statistically different in early and late-treated patients both for thrombolysis (48% vs. 28.6%, p = 0.25) and thrombectomy (38.4% vs. 33.3%, p = 0.99). Even with a limited availability of advanced imaging extending therapeutic time windows resulted in an 11.7% increase in thrombolysis and a 44% increase in thrombectomy with comparable clinical outcomes in early and late-treated patients at the price of a twofold burden in clinical and advanced imaging screening.

PMID:39913034 | DOI:10.1007/s11357-025-01549-1

Aging Clin Exp Res. 2025 Feb 6;37(1):36. doi: 10.1007/s40520-025-02935-7.

ABSTRACT

BACKGROUND: Low physical activity is a major risk for sarcopenia. Whether training according to physical activity guidelines accompanied with cognitive training is effective on sarcopenia, remains unclear.

AIMS: We investigated whether the effects of 12-month physical and cognitive training (PTCT) and physical training (PT) on grip and knee extension strength, muscle mass, and walking speed differed between older adults with and without sarcopenia.

METHODS: Community-dwelling older adults (N = 314, mean age 74.5 ± 3.8 years, 60% women) who did not meet physical activity guidelines were randomized to PTCT and PT groups. PT for both groups included supervised and home-based multicomponent physical training. Cognitive training (CT) included computer-based exercises for executive functioning. Sarcopenia was determined according to the European Working Group on Sarcopenia in Older People 2019 criteria. Generalized estimation equation analysis were conducted.

RESULTS: Compared to PT, PTCT had no additive effect on strength, muscle mass, or walking speed in participants with or without sarcopenia. In pooled data (PT + PTCT) change in the grip strength was greater in sarcopenia (n = 49) group compared to non-sarcopenia (n = 264) group (interaction, p =.014). Both groups improved knee extension strength, and walking speed, but no statistically significant difference between the groups were observed. Muscle mass did not change in either group.

CONCLUSION: Physical training according to physical activity recommendations improves muscle strength, walking speed, and maintains muscle mass in sarcopenia. Additional cognitive training had no benefits on these outcomes.

TRIAL REGISTRATION NUMBER: ISRCTN52388040 and date of registration 20/1/2017.

PMID:39913030 | DOI:10.1007/s40520-025-02935-7