Category: Statistics

Ann Biomed Eng. 2025 Nov 16. doi: 10.1007/s10439-025-03898-6. Online ahead of print.

ABSTRACT

PURPOSE: This paper investigates the well-known Empirical Wavelet Transform (EWT) and the recently introduced Empirical Fourier Decomposition (EFD) for the early diagnosis of Alzheimer’s disease (AD). Both synthetic signals and real EEG data are decomposed and reconstructed, particularly under noisy conditions.

METHODS: EWT and EFD were applied to decompose non-stationary EEG signals into five sub-bands (Delta, Theta, Alpha, Beta, and Gamma). From each sub-band, eight features were extracted and used to classify subjects into AD and Mild Cognitive Impairment (MCI) groups. Among the five classifiers tested, Random Forest (RF) yielded the best performance for both EWT and EFD. In addition to conventional evaluation metrics, Dynamic Time Warping (DTW) and the Kolmogorov-Smirnov (KS) statistic were used for algorithm assessment.

RESULTS: The results show that EFD outperforms EWT and achieves competitive performance compared to state-of-the-art approaches.

CONCLUSION: EFD is a novel decomposition method that demonstrates robust performance on both synthetic and real EEG signals, supporting its potential use in the early diagnosis of Alzheimer’s disease.

PMID:41243056 | DOI:10.1007/s10439-025-03898-6

J Robot Surg. 2025 Nov 17;20(1):20. doi: 10.1007/s11701-025-02974-2.

ABSTRACT

Open retroperitoneal lymph node dissection (O-RPLND) has historically been the established standard surgical procedure for managing retroperitoneal lymph node disease in testicular cancer. In recent years, however, the adoption of robotic surgical systems has led to a gradual shift in urological practice, with numerous procedures traditionally performed via open surgery being increasingly accomplished using robotic techniques. This study aims to systematically compare the perioperative safety and clinical efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus O-RPLND in the treatment of testicular cancer. Following the AMSTAR quality rating criteria and PRISMA principles, a thorough literature search was carried out. With no start date restrictions, databases such as Web of Science, Embase, PubMed, and the Cochrane Library were searched for pertinent papers until September 2025. The study was prospectively registered in PROSPERO with the registration number CRD420251147469. Statistical analyses were carried out with Review Manager version 5.4. WMD and OR were used as effect measures for continuous and dichotomous variables, respectively, with 95% CIs. This meta-analysis incorporated 10 comparative studies comprising 6,802 patients, including 587 who underwent RA-RPLND and 6,215 treated with O-RPLND. The analysis revealed that RA-RPLND was associated with significantly prolonged operative duration (WMD = 47.71 min; 95% CI: -0.62 to 96.04; P = 0.05), yet demonstrated advantages in reduced hospitalization period (WMD = -3.89 days; 95% CI: -4.89 to -2.88; P < 0.00001). The robotic approach also showed superior outcomes in terms of diminished intraoperative blood loss (WMD = -135.11 ml; 95% CI: -162.50 to -107.71; P < 0.00001) and lower transfusion requirements (OR = 0.11; 95% CI: 0.06 to 0.21; P < 0.00001). No statistically significant differences were observed between the surgical approaches regarding overall complications, major complications (Clavien-Dindo grade ≥ III), lymph node yield, nodal positivity rates, recurrence during surveillance, or postoperative ejaculatory function. ​​Conclusion:​​ Both RA-RPLND and O-RPLND demonstrate acceptable safety and efficacy profiles for patients with testicular cancer. While the robotic technique needs longer operational durations, it has some advantages, including less blood loss, fewer transfusions, shorter hospital stays, and faster recovery. RA-RPLND therefore offers a feasible alternative to traditional open surgery. However, more studies with longer follow-up periods are needed to establish its long-term oncological results and safety profile.

PMID:41243044 | DOI:10.1007/s11701-025-02974-2

J Robot Surg. 2025 Nov 17;20(1):21. doi: 10.1007/s11701-025-02964-4.

ABSTRACT

Robotic surgical platforms facilitate accurate dissection with the help of high-definition 3D camera and greater freedom of manoeuvrability of robotic instruments. Aim was to evaluate short-term results (mucosal integrity and hospital stay) and long-term outcomes [symptom improvement and Quality of life (QoL)] of patients undergoing Robotic Heller’s Cardiomyotomy (RHC). A retrospective analysis of data collected prospectively of achalasia patients undergoing primary RHC between July 2009 and June 2025 was performed. Information collected were demography, Eckardt symptom score (ESS), QoL scores with SF-36, type and stage of achalasia, peri and post-operative data. Sixty-eight patients underwent RHC (33-males). Median age was 46 years (18-82). Median length of myotomy was 8 cm (7-11). Median length of hospital stay was 2 days (1-28). One patient had aspiration pneumonia and DVT, and another had a postoperative leak needing emergency surgery. There was no mortality. Median follow-up was 102 months (3- 192). Twenty-one (31%) needed further intervention during follow-up. There was a significant improvement in ESS and in all components of QoL (p < 0.05). RHC can be performed accurately with a very low leak rate. RHC improves symptoms and quality of life and is an alternative to Laparoscopic Heller’s Cardiomyotomy or per-oral endoscopic myotomy (POEM) in the Modern Era.

PMID:41243042 | DOI:10.1007/s11701-025-02964-4

Egypt Heart J. 2025 Nov 16;77(1):107. doi: 10.1186/s43044-025-00705-4.

ABSTRACT

BACKGROUND: Ischaemic heart disease (IHD) is a leading cause of mortality and morbidity globally. Coronary angioplasty has a vital role in treating coronary artery disease. However, this is associated with a small risk of serious side effects, including contrast-induced nephropathy, vascular complications and arrhythmia. Contrast-induced nephropathy (CIN) is a serious and common complication of coronary angioplasty that can lead to renal failure and major adverse cardiac and renal outcomes.

METHODS: We conducted a systematic review and meta-analysis by searching multiple databases, including PubMed, Scopus, Embase, Google Scholar, and ScienceDirect, as well as other sources. The inclusion and exclusion criteria are described in detail later in this article. Two independent reviewers performed the literature search in September 2024 and identified 282 articles. The study was conducted following the population, intervention, comparator, and outcome (PICO) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 17 studies were included in the final analysis after applying the inclusion and exclusion criteria. The exclusion criteria were guidelines, case reports, qualitative research, and letters to the editor, commentaries, conference proceedings, gray literature, opinions, policy papers, and case series. Articles published after 2010 were included in this meta-analysis, and data analysis was performed using Rayyan statistical software.

RESULTS: This study demonstrated that nicorandil was associated with protective effects against CIN. The total number of patients in the Nicorandil and placebo groups were 3836 and 3858 respectively. The occurrence of CIN was 5.14% in the nicorandil group, compared with 13.15% in the control group. This study also confirmed the dose-dependent effect of nicorandil on CIN. Among 662 patients enrolled in three studies, 3,9% in the double dose (DD) group presented with CIN, compared with 8,4% in the standard dose (SD) group. The occurrence of MACE was 5.7% in the Nicorandil group and 8.2% in the control group. However, there was no statistically significant protective effect against major adverse cardiovascular events (MACE) or major adverse kidney events (MAKE). Only a few studies measured the impact on MAKE, and the findings may not be truly representative of its effects.

CONCLUSION: This study demonstrated the renoprotective effects of nicorandil in preventing CIN in patients undergoing coronary angioplasty, and this relationship was also evident from the double-dose response. Further larger size randomised controlled trials are recommended to assess the efficacy of nicorandil in preventing CIN in patients undergoing coronary angioplasty.

PMID:41243041 | DOI:10.1186/s43044-025-00705-4

J Robot Surg. 2025 Nov 17;20(1):16. doi: 10.1007/s11701-025-02975-1.

ABSTRACT

The present research provides a comprehensive systematic review of the safety and effectiveness of robotic-assisted artificial urinary sphincter (AUS) implantation in treating urodynamic stress incontinence. In line with the PRISMA framework and a protocol registered in PROSPERO, we conducted a comprehensive search of PubMed, Web of Science, and the Cochrane Library for relevant studies published from inception to August 2025. Key perioperative parameters-operative time, estimated blood loss, hospital stay, continence rate, and complication rate-were extracted. Data analysis was carried out using STATA software, with heterogeneity assessed by the I² statistic and sensitivity by leave-one-out analysis. Eight studies involving 328 patients were included. Among three comparative cohorts (n = 224), operative time did not differ between robotic and open AUS (WMD = 7.62, 95% CI [-57.94, 73.17], I²=97.4).The robotic group showed significantly more blood loss (WMD = 293.5, 95% CI [81.4, 505.75], I²=95.2), more perioperative complications (OR = 3.9, 95% CI [1.75, 8.66], I²=35.5), and more hospital stay (WMD = 4.71, 95% CI [2.26, 7.16], I²=87.5). Pooled analysis of robotic cases indicated a mean operative time of 197.06 min(95% CI [177.82, 216.29], I²=86.9), mean blood loss of 19.8 mL (95% CI [14.05, 25.55], I²=0.3), hospital stay of 4.85(95% CI [4.12, 5.57], I²=88) days, and an overall complication rate of 37%(95% CI [0.27, 0.5], I²=16.6). Robot-assisted AUS implantation is a safe and effective option for treating urodynamic stress incontinence, with benefits such as reduced blood loss and faster recovery. However, the moderate risk of bias and high heterogeneity among studies limit the reliability of the findings. Larger, high-quality trials are needed to confirm its long-term efficacy.

PMID:41243039 | DOI:10.1007/s11701-025-02975-1

J Expo Sci Environ Epidemiol. 2025 Nov 16. doi: 10.1038/s41370-025-00807-w. Online ahead of print.

ABSTRACT

BACKGROUND: The prevalence of nontuberculous mycobacterial (NTM) pulmonary infection (NTM PI) varies geographically in the United States (US). Previous studies indicate that trace metals in environmental source water increase NTM PI risk.

OBJECTIVE: To examine the effect of trace metals, chromium (Cr), cobalt (Co), molybdenum (Mo), strontium (Sr), and vanadium (V) in public distribution system water on NTM PI risk among susceptible persons in the US.

METHODS: We studied NTM PI risk as a function of trace metal exposure from public distribution system water in two US patient populations: (1) The Cystic Fibrosis Foundation Patient Registry. (2) The Centers for Medicare and Medicaid Services. Patient data were extracted for the period 2010-2019. We obtained data on trace metal concentrations from the US Environmental Protection Agency, Third Unregulated Contaminant Monitoring Rule dataset. We used logistic and negative binomial generalized linear models to estimate NTM PI risk as a function of trace metal exposure in treated drinking water at the county level. Our models were adjusted for patient demographics, source water type, climate variables, and the type of disinfectant used.

RESULTS: Our cystic fibrosis (CF) population comprised 14,251 persons with CF, including 4020 NTM cases and 10,231 controls. Our Medicare population comprised 27,146,753 beneficiaries, including 84,075 NTM cases. In the Medicare analysis, V was associated with increased NTM PI risk in the Midwest, South, and West, while Mo increased NTM PI risk in the West. In the CF analysis, V increased NTM PI risk in the South, while Mo was associated with increased NTM PI risk in the West. In both the CF and Medicare populations, using chloramine as a disinfectant significantly increased NTM PI risk.

SIGNIFICANCE: Mo and V in treated water was associated with increased risk among persons susceptible to NTM PI. The effect of trace metals varies by geographic region IMPACT: The incidence and prevalence of NTM, a waterborne pulmonary infection, have been increasing in the US and have been shown to vary geographically. Our study has shown that trace metals, specifically molybdenum and vanadium, in treated drinking water significantly increase the risk of NTM pulmonary infection across the US. Our study also shows that the effect of trace metals varies by geographic region. Our research may lead to the monitoring of trace metals in drinking water as well as in susceptible populations, and ultimately, may be incorporated into a framework for NTM prevention efforts.

PMID:41243028 | DOI:10.1038/s41370-025-00807-w

Eur Arch Otorhinolaryngol. 2025 Nov 16. doi: 10.1007/s00405-025-09816-9. Online ahead of print.

ABSTRACT

BACKGROUND: Cochlear implantation (CI) is a proven treatment for severe-to-profound hearing loss, yet outcomes vary widely due to individual, device, and surgical factors. Intracochlear changes, such as fibrosis and neo-ossification, influence electrode impedance and device performance, potentially affecting speech perception.

PURPOSE: This study investigates the effects of early activation (EA) versus standard activation on intracochlear impedance telemetry across different electrode types (lateral vs. perimodiolar). It aims to assess whether EA reduces the impedance and improves CI outcomes.

METHODS: This study involved 38 participants (54 CI ears) with Cochlear slim-straight or slim perimodiolar electrodes. Impedance telemetry was measured at four key time points, ranging from intra-operative to 12 months post-activation. Mixed-effects regression models evaluated the influence of activation timing and electrode type on impedance levels, with statistical significance determined using Bonferroni-corrected thresholds.

RESULTS: Perimodiolar electrodes demonstrated significantly lower impedances compared to lateral electrodes, particularly in EA cases. EA consistently resulted in reduced impedances across all cochlear regions, with the greatest reductions observed in the apical and middle regions at 3-6 months (p < 0.0001). By ≥ 1 year, impedance differences between activation modes diminished but remained significant in select regions (p = 0.012).

CONCLUSION: EA, particularly with perimodiolar electrodes, optimizes the electrode-tissue interface, reducing impedance and potentially improving CI performance. These findings highlight the clinical benefits of EA in enhancing CI outcomes and support its consideration in routine CI protocols.

PMID:41243018 | DOI:10.1007/s00405-025-09816-9

Eur Arch Otorhinolaryngol. 2025 Nov 16. doi: 10.1007/s00405-025-09836-5. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the efficacy of preoperative embolization (EMB) and its impact on complication rates in patients undergoing surgery for carotid body tumors (CBT) at a tertiary referral center.

METHODS: A retrospective analysis was performed on 44 patients who underwent surgical resection of carotid body paragangliomas between January 2000 and June 2024. 13 patients with tumor size less than 3 cm, which is the recommended criterion for preoperative embolization, were excluded from the study. Patients who underwent preoperative embolization (EMB group) were retrospectively compared with patients who did not undergo preoperative embolization (NEMB group). The effects of embolization on cranial nerve injuries, internal carotid artery (ICA) repair, blood loss, operative time, transfusion requirements, and hospital stay duration were evaluated.

RESULTS: Preoperative EMB was not performed in 21 patients (67.7%), and EMB was performed in 10 patients (32.3%) with a CBT > 3 cm. No differences were observed between the two groups in terms of age, gender, tumor size, or Shamblin classification. Additionally, there was no significant difference regarding cranial nerve injury, ICA repair, external carotid artery ligation, or overall complications (p > 0.05). Hemoglobin decrease, operative time, and transfusion requirements were also comparable between the groups (p > 0.05). When the preoperative hospitalization period for embolization was excluded, the mean hospital stay was 4.19 ± 1.37 days in the NEMB group and 4.40 ± 2.46 days in the EMB group with no statistically significant difference (p = 0.761).

CONCLUSION: Preoperative EMB did not significantly alter overall complication rates in CBT surgery but may offer particular benefits for large tumors. Given the variability in tumor characteristics among patients, decisions regarding embolization should be individualized.

PMID:41243017 | DOI:10.1007/s00405-025-09836-5

Support Care Cancer. 2025 Nov 17;33(12):1070. doi: 10.1007/s00520-025-10118-3.

ABSTRACT

PURPOSE: This study aims to assess the effectiveness of psychological prehabilitation in reducing postoperative complications and length of hospital stay in patients undergoing cancer surgery.

METHODS: A comprehensive electronic search was conducted in CINAHL, Cochrane Library, Medline, PsycINFO, AMED and Embase databases from inception to December 2023. Randomised controlled trials assessing the effectiveness of psychological prehabilitation compared to control in patients undergoing abdominal, pelvic, and/or thoracic cancer surgery were included. The primary outcome measures were postoperative complications and length of hospital stay. Two independent reviewers extracted relevant information and assessed the risk of bias. Random-effect meta-analyses were used to pool outcomes, and the quality of evidence was assessed using GRADE.

RESULTS: A total of 18 trials were identified (N = 1612) and 11 (N = 923) analysed, including eight multimodal (N = 719), one bimodal (N = 90) and two unimodal (N = 189). There was high-quality evidence that trials including psychological prehabilitation significantly reduced the incidence of overall postoperative complications in all cancer types included in the studies (relative risk: 0.73; 95% CI: 0.60 to 0.89) and abdominal cancer subgroup (relative risk: 0.65; 95% CI: 0.48 to 0.88) compared to control. Psychological prehabilitation was not effective in reducing length of hospital stay (mean difference: – 0.78; 95% CI: – 1.72 to 0.17).

CONCLUSION: Psychological prehabilitation appears effective in reducing postoperative complications in cancer patients. Future studies should investigate the optimal preoperative psychological interventions according to individual cancer groups undergoing surgery.

PMID:41243006 | DOI:10.1007/s00520-025-10118-3

Clin Oral Investig. 2025 Nov 17;29(12):571. doi: 10.1007/s00784-025-06649-y.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the efficacy of a single preoperative 15 mg sublingual dose of melatonin in reducing surgical discomfort, pain, edema, and trismus following mandibular third molar extraction.

MATERIALS AND METHODS: A randomized, double-blind, placebo-controlled trial was conducted with 46 patients allocated to receive melatonin (n = 22) or placebo (n = 24) 45 min before surgery. The primary outcomes were intraoperative pain and discomfort and postoperative pain. Secondary outcomes included patient-perceived edema (VAS-Edema, days 1-5), trismus (5-point scale, days 1-5; interincisal measurement, day 7), and rescue medication consumption.

RESULTS: No statistically significant differences were observed between the melatonin and placebo groups for any outcome. Intraoperative discomfort (QCirDental total score, p = 0.54) and pain (VAS, p = 0.67) were comparable. Similarly, postoperative pain levels across all time points (p = 0.67), edema over five days (p = 0.26), and trismus based on self-assessment (all days p > 0.50) and clinical measurement (p = 0.79) did not differ.

CONCLUSION: Within the limitations of this clinical trial, a single 15 mg preoperative dose of sublingual melatonin was not superior to placebo in alleviating surgical discomfort, pain, edema, or trismus after third molar extraction.

CLINICAL RELEVANCE: Clinically, these findings suggest that melatonin may have limited effectiveness in managing common complications in oral surgery.

PMID:41243001 | DOI:10.1007/s00784-025-06649-y