Category: Statistics

Pediatr Cardiol. 2025 Jul 25. doi: 10.1007/s00246-025-03970-x. Online ahead of print.

ABSTRACT

The pulmonary artery pulsatility index (PAPi), calculated as (systolic pulmonary artery pressure – diastolic pulmonary artery pressure)/mean right atrial pressure). This study aimed to assess the clinical utility of PAPi in risk stratification for pediatric idiopathic pulmonary arterial hypertension (IPAH) and its performance in predicting the need for invasive intervention due to severe right heart failure. We analyzed clinical, echocardiographic, and right heart catheterization findings of 24 IPAH patients between April 2019 and November 2024. Statistical analyses included ROC curve analysis for PAPi’s diagnostic performance, Kaplan-Meier survival analysis, and Cox regression for identifying independent predictors of intervention. The study included 24 patients (mean age 8.2 ± 4.7 years, 66.7% female). Based on pediatric risk classification, 45.8% were lower-risk, and 54.2% were high-risk, with PAPi significantly lower in high-risk patients (p < 0.001). ROC analysis identified PAPi < 3.24 as a strong predictor of high-risk status (sensitivity = 92%, specificity = 82%). PAPi correlated positively with 6MWT (r = 0.802) and TAPSE (r = 0.812) and negatively with WHO-FC (r = – 0.692) and NT-proBNP (r = – 0.713) (p < 0.001). Over 22 ± 15.9 months, 37.5% (n = 9) required invasive interventions for syncope, WHO-FC III/IV symptoms, or right ventricular failure, including atrial septostomy (77.8%), partial ASD closure (11.1%), and reverse Potts shunt (11.1%). Post-intervention, all but one patient improved. Patients requiring intervention had lower PAPi (1.88 ± 0.71 vs. 3.95 ± 1.27, p < 0.001). Kaplan-Meier analysis confirmed PAPi > 3.24 was associated with longer event-free survival (p = 0.002). Cox regression showed higher PAPi independently predicted lower intervention risk (HR 0.36, p = 0.042). In conclusion, this study suggests that PAPi is a reliable prognostic marker for risk stratification and predicting the need for invasive intervention in pediatric IPAH.

PMID:40715799 | DOI:10.1007/s00246-025-03970-x

Braz J Microbiol. 2025 Jul 27. doi: 10.1007/s42770-025-01730-w. Online ahead of print.

ABSTRACT

Glanders, caused by Burkholderia mallei, is a zoonotic disease with profound socioeconomic and public health implications, affecting equines and humans. This study investigated glanders cases in Brazil from 2006 to 2023 to identify persistent clusters and analyze temporal trends, providing a foundation for the formulation of effective control policies. Official data were obtained from the National Animal Health Information System (SIZ) and Brazilian Institute of Geography and Statistics (IBGE), encompassing case notifications and equine population statistics by state and year. The incidence risk (IR) was calculated, and prospective spatiotemporal analyses were performed using the discrete Poisson model in SatScan software. Temporal trends were assessed through segmented regression in Joinpoint software. A total of 2,654 glanders cases were reported, with the Northeast region accounting for 52.19% of cases and Pernambuco presenting the highest IR (342.58/100,000). Primary clusters were detected in the Northeast (RR = 5.16), while secondary clusters were identified in the North, South, Central-West, and Southeast regions, with the most notable cluster in Amazonas (RR = 60.32). Temporal trend analysis revealed overall stability in Brazil but demonstrated increasing trends in the North, South, and Central-West regions. These results underscore the critical need for integrated epidemiological surveillance, stricter health regulations, and improved control of equine movement, particularly in regions at higher risk. Strengthening early diagnostic capabilities and implementing targeted educational initiatives are essential to curbing the spread of B. mallei and mitigating the socioeconomic and public health impacts of glanders in Brazil.

PMID:40715785 | DOI:10.1007/s42770-025-01730-w

Int J Gynaecol Obstet. 2025 Jul 26. doi: 10.1002/ijgo.70415. Online ahead of print.

ABSTRACT

Obstetric anal sphincter injuries (OASIs) constitute a significant complication in vaginal childbirth, affecting up to 26% of deliveries and representing the leading cause of anal incontinence among women. Despite their prevalence and serious long-term consequences, OASIs remain widely underreported, partly because of clinicians’ hesitancy linked to fear of litigation, peer criticism, and a pervasive culture that discourages disclosure of adverse events. Recent evidence emphasizes that underreporting exacerbates rather than mitigates legal risks and patient harm, underscoring the urgent need for systemic changes. This article reviews critical factors contributing to OASI underreporting, including inadequate clinical training, inconsistent national guidelines, variable litigation landscapes, and differing diagnostic practices across European healthcare systems. Examples from the UK, Poland, Sweden, Norway, France, Italy, the Czech Republic, and Belgium demonstrate significant variations in prevention strategies, diagnostic accuracy, and management protocols, reflecting uneven progress and highlighting opportunities for standardized care improvements. These national discrepancies in OASI definitions, classification, and reporting thresholds may lead to significant inconsistencies in both clinical outcomes and statistical comparisons across healthcare systems. Implementing structured training, standardized protocols, multidisciplinary collaboration, and transparent reporting systems are essential for improving maternal outcomes and reducing litigation risks. Encouraging an institutional culture of accountability and openness will support continuous improvement, ensuring enhanced patient safety and quality care across global healthcare systems.

PMID:40715780 | DOI:10.1002/ijgo.70415

Arch Gynecol Obstet. 2025 Jul 26. doi: 10.1007/s00404-025-08131-2. Online ahead of print.

ABSTRACT

PURPOSE: To compare and analyze surgical outcomes and postoperative pregnancy outcomes between electrotomy and cold instruments for hysteroscopic myomectomy.

METHODS: This study included patients who were diagnosed with submucosal fibroids (FIGO 0-2) in our center and underwent hysteroscopic myomectomy from January 2022 to November 2024. Hysteroscopic myomectomy was performed by either bipolar system or cold instruments. Surgical and postoperative pregnancy outcomes were recorded and analyzed.

RESULTS: A total of 36 patients underwent hysteroscopic myomectomy at our center during the 3-year period, 21 in the cold instruments group and 15 in the electrotomy group. The mean age of the patients in the cold instruments group was significantly higher than that of the electrotomy group (39.00 ± 5.18 vs 35.20 ± 3.45, P = 0.019). In the electrotomy group, four patients found residual fibroids and required a second surgery. The incidence of residual fibroids and a second procedure were significantly higher than those in the cold instruments group (4/15(26.67%) vs 0, P = 0.023). The postoperative biochemical pregnancy rate and clinical pregnancy rate were higher in patients in the cold instruments group, but the difference was not statistically significant (14/21 (66.67%) vs 8/15 (53.33%), P = 0.644; 10/21(47.62%) vs 5/15(33.33%), P = 0.607).

CONCLUSION: Cold instruments for hysteroscopic myomectomy seem to be a safe and feasible surgical procedure. It has an advantage over electrotomy in terms of complete removal of submucosal fibroids. Moreover, cold instruments for hysteroscopic myomectomy have no electrothermal damage to normal endometrium, which is favorable for pregnancy as soon as possible after surgery.

PMID:40715777 | DOI:10.1007/s00404-025-08131-2

Am J Cardiovasc Drugs. 2025 Jul 27. doi: 10.1007/s40256-025-00744-x. Online ahead of print.

ABSTRACT

BACKGROUND: Higher quality scaled-up evidence on pulmonary arterial hypertension (PAH), a rare and life-threatening disease, is needed to support informed decision-making. We aimed to map the current knowledge of PAH treatments and evaluate the methodological quality of published systematic reviews.

METHODS: An overview with literature searches in PubMed and Embase (May 2025) was performed (CRD42023414469). The methodological and reporting quality of the eligible records was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist, respectively. Association analyses between tools’ scores with key variables (article publication date, journal impact factor, country/region) were performed (SPSS v.28). An evidence map summarizing the most reported treatments and outcomes was also built.

RESULTS: Overall, 57 systematic reviews (n = 52; 91.2% with meta-analysis) published between 1997 and 2025 (median year 2017), authored mostly by countries from Asia (n = 35; 61.4%) and North America (n = 12; 21.1%), were included. The classes of phosphodiesterase type-5 inhibitors, endothelin receptor antagonists, and prostanoids and combination therapies were each assessed in one-third of the studies each. Over 20 different outcomes were reported, with the most common surrogate endpoints being 6-min walking distance (n = 42; 73.7%) and mean pulmonary arterial pressure (n = 33; 57.9%). Most studies were classified as having critically low methodological quality (n = 48; 84.2%), with only three presenting high-quality methodology according to AMSTAR 2. The mean PRISMA score was 21.3 ± 2.9, indicating an adherence rate of 78.9% to the checklist among authors. Although there was an improvement over time in the quality of the reviews (p = 0.016 for AMSTAR; p = 0.002 for PRISMA), no correlations were found based on country nor journal impact factor.

CONCLUSIONS: Methodological weaknesses remain common in systematic reviews of PAH; therefore, enforcing compliance with guidelines and standardizing outcome measurements through a core outcome set is crucial for improving data comparability and clinical application.

REGISTRATION: PROSPERO identifier no. CRD42023414469.

PMID:40715772 | DOI:10.1007/s40256-025-00744-x

Arch Gynecol Obstet. 2025 Jul 26. doi: 10.1007/s00404-025-08136-x. Online ahead of print.

ABSTRACT

PURPOSE: In vitro fertilization and embryo transfer (IVF-ET) has become crucial for infertile couples. Previous studies have suggested that multiple ETs are associated with increased risks of preterm birth and low birth weight. The current study aims to investigate this association.

METHODS: PubMed, Cochrane Library, EMBASE, ScienceDirect, and China National Knowledge Infrastructure databases were systematically searched. Network meta-analysis was performed to compare the associations between different numbers of embryo transfers (≥ 2) and the incidence rates of preterm birth and low birth weight. Consistency and inconsistency models were applied to ensure reliability. Frequentist statistical methods used data integration. The surface under the cumulative ranking curve (SUCRA) value was used to rank the risks of preterm birth and low birth weight associated with varying numbers of ETs.

RESULTS: There was a significant difference in the incidence of low birth weight between the 2-ET and 4-ET groups. The 4-ET group had the highest risks for preterm birth and low birth weight.

CONCLUSION: Multiple ETs are associated with increased risks of preterm birth and low birth weight. This study highlights the need for tailored clinical strategies to optimize pregnancy outcomes and mitigate complications.

PMID:40715771 | DOI:10.1007/s00404-025-08136-x

Drugs Real World Outcomes. 2025 Jul 26. doi: 10.1007/s40801-025-00509-7. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Anticholinergic medications are known to affect the prognosis of older nursing home residents. Various anticholinergic scales were developed to measure the cumulative anticholinergic burden; among them, the CRIDECO Anticholinergic Load Scale (CALS) has recently emerged as a new tool to identify patients with cognitive impairment due to anticholinergic burden. This study aimed to externally validate the CALS and to evaluate the association of CALS and the anticholinergic cognitive burden (ACB) scales with baseline cognitive and functional impairment, as well as with 3-year mortality rates.

METHODS: A prospective cohort of 600 nursing home residents (mean age 80.4 ± 8.0 years; 69.8% women) underwent a comprehensive geriatric assessment. Anticholinergic burden was assessed at baseline using both CALS and ACB scales. Cognitive impairment (Mini-Mental State Examination < 24) and physical disability (one or more impaired activities of daily living) were evaluated cross-sectionally using a logistic regression model. Cox proportional hazards models were used to estimate the association between anticholinergic burden and 3-year mortality, adjusting for age, sex, multimorbidity, nutritional status, and cognitive and functional status.

RESULTS: Among 600 nursing home residents included in the study, 72.0% had cognitive impairment and 56.3% had at least one activity of daily living limitation. The CALS and ACB scores were significantly correlated ( ρ = 0.76), but CALS identified a higher number of residents with moderate-to-high anticholinergic burden. Multivariate logistic regression showed that CALS ≥ 2 was independently associated with cognitive impairment (odds ratio 1.84, 95% confidence interval 1.02-3.34), whereas ACB ≥ 2 was not. Both scales were associated with activities of daily living disability, with a stronger gradient and better goodness of fit for CALS than ACB. During the 3-year follow-up, 25.3% of residents died. Cox regression analyses showed that residents with CALS or ACB ≥ 2 had significantly lower survival over 3 years. In fully adjusted Cox models, both CALS ≥ 2 (hazard ratio 1.93, 95% confidence interval 1.07-3.46) and ACB ≥ 2 (hazard ratio 1.69, 95% confidence interval 1.02-2.83) remained associated with increased mortality. Prognostic performance was similar (CALS C-index: 0.783; ACB: 0.781), but the model fit favored CALS.

CONCLUSIONS: In this cohort of nursing home residents, anticholinergic burden as measured by both CALS and ACB was associated with baseline physical impairment and 3-year mortality, but CALS showed a better goodness of fit. Between the two scales, CALS only was independently associated with baseline cognitive impairment. These findings support the clinical utility of CALS in assessing anticholinergic-related risk among frail older adults in institutional settings.

PMID:40715770 | DOI:10.1007/s40801-025-00509-7

Evid Based Dent. 2025 Jul 26. doi: 10.1038/s41432-025-01181-0. Online ahead of print.

ABSTRACT

A COMMENTARY ON: Rokhshad R, Banakar M, Shobeiri, P, Zhang P. Artificial intelligence in early childhood caries detection and prediction: a systematic review and meta-analysis. Pediatr Dent. 2024;46:385-394.

DATA SOURCES: A literature search was performed in May 2024 via PubMed, Scopus, Embase, Web of Science, Institute of Electrical and Electronics Engineer database sources, and across the grey literature. Further studies were identified after analysis of reference lists. The research question was defined using the population-intervention-comparison-outcome (PICO) framework.

STUDY SELECTION: Studies published between 2010 and 2024 were included, that used artificial intelligence (AI) algorithms including machine learning (ML), deep learning (DL) and neutral networks (NN) for detecting and predicting early childhood caries (ECC). Exclusion occurred where the full text was inaccessible and non-English papers. Two independent reviewers screened titles and abstracts, with the use of a third reviewer in the case of any disagreement. The process was then repeated with the full texts to assess eligibility, again with a third reviewer where necessary. A total of 21 studies were used in the final analysis following assessment, 7 of which described ECC detection, and 14 for ECC prediction.

DATA EXTRACTION AND SYNTHESIS: The extracted data included author, publication year, study objectives, data modalities, datasets, annotation procedures, follow ups, ML test, AI model architecture, outcome measures and evaluation metrics. The findings were summarised descriptively. Quantitative synthesis was performed on six studies that reported sensitivity and specificity. Summary receiver operator characteristic curves were used to assess discriminatory ability. Statistical analysis was completed.

RESULTS: A total of 21 studies were included in the final analysis. It revealed that AI based methods, especially DL algorithms showed promising results in detecting ECC, with accuracy range of 78-86%, sensitivity of 67-96%, and specificity from 81-99%. ECC prediction had accuracy range of 60-100%, sensitivity of 20-100%, and specificity of 54-94%. The pooled sensitivity and specificity of these studies was 80% and 81% respectively, with confidence intervals of 95%, indicating statistically significant effects.

CONCLUSIONS: AI has demonstrated substantial potential in the detection and prediction of ECC. Further research is required to refine the technology and establish its application in paediatric dentistry.

PMID:40715738 | DOI:10.1038/s41432-025-01181-0

Am J Clin Dermatol. 2025 Jul 26. doi: 10.1007/s40257-025-00967-3. Online ahead of print.

ABSTRACT

BACKGROUND: Cholinergic urticaria (CholU) is characterized by pruritic papular wheals induced by various temperature-elevating stimuli such as exercise, bathing, and emotional stress. Although it is considered important to classify CholU into subtype on the basis of the pathogenesis and clinical features for better management, few studies have evaluated the rash type as a clinical feature.

AIM: This study aimed to investigate the associations between different types of rashes in CholU and their clinical phenotypes, and to consider the mechanisms underlying each type of rash.

METHODS: We conducted a retrospective study of 64 patients diagnosed with CholU who visited the Dermatological Institute of Kobe University Hospital. Clinical and photographic data obtained after exercise provocation and/or thermoregulatory sweat tests were reviewed and used to classify patients into the red wheal/erythema group (n = 44) or the goosebumps group (n = 20). Intradermal tests, namely the autologous sweat skin test (ASwST) and autologous serum skin test (ASST), were performed to assess sweat and serum reactivity, respectively. The presence of atopic dermatitis and hypohidrosis was evaluated in accordance with established guidelines. Univariable logistic analyses were conducted to assess the associations between rash types and clinical features, namely age, sex, ASwST and ASST results, atopic dermatitis, hypohidrosis, pruritus, and pain. Multivariable logistic analysis was performed using only sex and age. Statistical analyses were performed using GraphPad Prism 10, with significance set at P < 0.05.

RESULTS: The red wheal/erythema group had typical punctate or coalescent erythematous wheals, while the goosebumps group had follicular, goosebump-like rashes with or without erythema. Compared with the red wheal/erythema group, the goosebumps group had a higher proportion of males (85% versus 38.6%) and higher prevalences of hypohidrosis (89.4% versus 35.7%) and pain (89.5% versus 37.8%). In contrast, the red wheal/erythema group had significantly higher prevalences of ASwST positivity (68.4% versus 20%), atopic dermatitis (58.1% versus 5.3%), and pruritus (78.4% versus 10.5%). Univariable analysis revealed that ASwST positivity, atopic dermatitis, and pruritus were significantly associated with the red wheal/erythema group, while hypohidrosis and pain were significantly associated with the goosebumps group. Multivariable logistic analysis showed that male sex was significantly associated with the goosebumps group.

CONCLUSIONS: Patients with CholU develop rashes with varying coloration and shapes. Goosebump-like rashes, which differ from typical wheals, were often accompanied by hypohidrosis. The type of rash may help to differentiate the clinical subtypes of CholU.

PMID:40715731 | DOI:10.1007/s40257-025-00967-3

World J Urol. 2025 Jul 26;43(1):459. doi: 10.1007/s00345-025-05756-5.

ABSTRACT

PURPOSE: Due to its physical properties, endoscopic enucleation of the prostate (EEP) with the pulsed solid-state Thulium: YAG laser (pulsed ThuLEP) presents a promising alternative to the widely used Holmium: YAG laser (HoLEP). This study aims to compare perioperative parameters of EEP performed using a novel 100 W pulsed Thulium: YAG laser with high peak power versus a standard 100 W Holmium: YAG laser in patients with benign prostatic hyperplasia (BPH).

METHODS: A retrospective analysis was conducted on 312 patients undergoing laser EEP, comprising 80 pulsed ThuLEP and 232 HoLEP procedures. Outcomes were adjusted for key perioperative variables (age, American Society of Anesthesiologists score, hemoglobin, preoperative prostate volume, prostate-specific antigen levels) through multivariable regression analysis. Comparisons between the two techniques utilized adjusted means and marginal contrast analysis.

RESULTS: Baseline characteristics were comparable across groups. Pulsed ThuLEP demonstrated significantly shorter operative times, with a reduction of 6.23 min in total surgery time (p = 0.006) and 4.36 min in enucleation time (p = 0.001) compared to HoLEP. Although pulsed ThuLEP showed faster enucleation speed, it did not reach statistical significance (p = 0.095). Laser energy consumption was comparable (p = 0.191). Additionally, pulsed ThuLEP was associated with reduced hospitalization time (4.19 vs. 4.65 days, p < 0.001) and lower maximum postoperative pain scores (0.78 vs. 4.23, p < 0.001).

CONCLUSION: The novel pulsed solid-state Thulium: YAG laser offers a viable and effective alternative to the established Holmium: YAG laser for EEP. Advantages of pulsed ThuLEP include shorter operative duration, reduced length of hospital stay, and significantly lower postoperative pain, making it a compelling option for surgical management of BPH.

TRIAL REGISTRATION: German Clinical Trials Register number: DRKS00031676.

PMID:40715722 | DOI:10.1007/s00345-025-05756-5