Category: Statistics

J Robot Surg. 2025 Dec 29;20(1):127. doi: 10.1007/s11701-025-03094-7.

ABSTRACT

The purpose of this study was to evaluate the safety and efficacy of perioperative outcomes of the KangDuo Surgical Robot System versus the Da Vinci System in robot-assisted renal surgery. We conducted a comprehensive systematic search in key databases including PubMed, the Cochrane Library, Embase, and Web of Science, encompassing studies in all languages, with the final search date being October 2025. We also excluded articles comprising reviews, letters, and single-arm studies. Variables were assessed using metrics of Weighted Mean Difference (WMD), Standardized Mean Difference (SMD), and Odds Ratio (OR). The statistical synthesis of the data, encompassing diverse outcome measures, was conducted utilizing the Review Manager software. Moreover, the protocol for this systematic review and meta-analysis is publicly available on PROSPERO (Registration number: CRD420251181530). In a pooled analysis of 370 participants from five trials, the KangDuo Surgical Robot System demonstrated a significantly extended docking time relative to the Da Vinci System (SMD = 1.55, 95% CI: 1.21-1.90; p < 0.00001). Conversely, comparisons of operative time, estimated blood loss, incidence of minor complications, ischemia time, and postoperative renal function (assessed by 4-week serum creatinine and eGFR) yielded comparable results, with no statistically significant differences. In this meta-analysis with limited sample size, geographic focus on Chinese centers, and short-term follow-up, the pooled data indicate that the KangDuo (KD) Surgical Robot System achieved non-inferiority to the Da Vinci System on several key perioperative metrics in robot-assisted renal surgery, although with a longer docking time. These findings support the KD system as a promising alternative in comparable settings, yet they should be interpreted within the constraints of the available evidence. Future research, particularly large-scale, multicenter randomized trials with long-term monitoring of survival and renal function, is necessary to confirm its efficacy and safety profile for widespread clinical adoption.

PMID:41460419 | DOI:10.1007/s11701-025-03094-7

J Gastrointest Cancer. 2025 Dec 29;56(1):247. doi: 10.1007/s12029-025-01369-8.

ABSTRACT

PURPOSE: Gallbladder cancer is the fifth most common gastrointestinal cancer worldwide, often diagnosed incidentally after cholecystectomy for presumed benign disease. Previous studies have reported geographic variations in the incidence of incidental gallbladder cancer (IGBC), but comprehensive pooled estimates examining multiple predictors of IGBC are lacking. The study aims to synthesize the risk factors and clinical predictors associated with IGBC in patients undergoing cholecystectomy for benign gallbladder conditions.

METHODS: This systematic review and meta-analysis assessed studies published between January 2010 and February 2024 in databases from EMBASE, PUBMED-MEDLINE, and Scopus. Eligible studies included observational study designs evaluating risk or predictive factors for IGBC diagnosed during or after cholecystectomy for presumed benign gallbladder disease. Heterogeneity across studies was assessed using the I² statistic. Sensitivity analyses were conducted to explore the robustness of the pooled estimates.

RESULTS: Of 2899 studies screened, 18 were included in the systematic review and 9 of these were included in the meta-analysis, covering 788,214 patients undergoing cholecystectomy. Advancing age (OR:1.09; 95% CI:1.07-1.12, I²=55.9%), female gender (OR:1.91; 95% CI:1.33-2.75, I² = 72.1% ), elevated alkaline phosphatase (OR:1.68; 95% CI:1.41-2.00, I² = 0%), polyp size > 10 mm (OR:8.63; 95% CI:1.95-38.26, I² = 0%), and open cholecystectomy (OR:9.20; 95% CI:5.68-14.89, I² = 83.5%) were found to have association with IGBC. Large gallstones (> 3 cm) showed no significant association. Risk of bias was low, and sensitivity analyses confirmed model robustness.

CONCLUSION: This review identifies key demographic, and clinical factors associated with IGBC. These findings support the need for risk-based preoperative evaluation and careful intraoperative vigilance, particularly in patients with advanced age, female gender, elevated alkaline phosphatase, and larger gallbladder polyps. Incorporating these predictors into clinical decision-making may guide targeted histopathological examination policies, leading to earlier GBC detection and improved patient outcomes. PROSPERO Registration No: CRD42024528982.

PMID:41460407 | DOI:10.1007/s12029-025-01369-8

J Robot Surg. 2025 Dec 29;20(1):126. doi: 10.1007/s11701-025-03012-x.

ABSTRACT

This study aims to systematically examine how minimally invasive thymectomy-covering both video-assisted and robotic-assisted methods-compares with open thymectomy in terms of perioperative safety and effectiveness for treating large thymomas. We thoroughly searched several databases for relevant studies, including randomized controlled trials and cohort studies, published up until October 2025. Data on perioperative factors, including surgical duration, blood loss, length of hospitalization, complications, and recurrence rates, were extracted and analyzed using random-effects models in STATA 18. Seven studies involving 12,880 patients were included. open surgery showed significantly more blood loss (WMD = 110.43, 95% CI 105.83-115.03; P < 0.05), longer hospital stays (WMD = 2.04, 95% CI 1.38-2.7; P < 0.05) compared to MIT. No notable difference in surgical duration was observed. Moreover, minimally invasive thymectomy (MIT) was associated with a reduced rate of recurrence after surgery (OR = 0.54, 95% CI 0.35-0.84; P < 0.05) as well as fewer postoperative complications (OR = 0.27, 95% CI 0.19-0.39; P < 0.05). MIT offers significant advantages over open surgery for large thymomas, including reduced blood loss, shorter hospital stays, and lower rates of complications and recurrence, though operative time was similar. Further large-scale studies are needed to confirm these findings and assess long-term efficacy.

PMID:41460396 | DOI:10.1007/s11701-025-03012-x

Lifetime Data Anal. 2025 Dec 29;32(1):6. doi: 10.1007/s10985-025-09680-z.

ABSTRACT

We consider semiparametric random-effects models for recurrent events in the presence of a terminal event. The recurrent events have either a proportional marginal rate model (Cox in J Roy Stat Soc Ser B 34:406-424, 1972) or a proportional marginal mean model (Ghosh and Lin in Stat Sin 34: 663-688, 2002), while the marginal rate of the terminal event is given by a proportional model. The dependency between the recurrent events and the terminal event is described by two variants of random effects models that allow the processes to share the random effect, either fully or partly. The models are formulated as two-stage models, where the marginals can be fitted in an initial stage, and then subsequently random effects parameters can be estimated. The estimation of parameters does not require the choice of any tuning parameters, in contrast to procedures based on numerical integration, and the numerical procedure works well. Standard errors were computed by bootstrapping. The methods are applied to the Taichung Peritoneal Dialysis Study (Chen et al. in Biom J 57(2):215-233, 2015) that considered recurrent inflammations in dialysis patients.

PMID:41460389 | DOI:10.1007/s10985-025-09680-z

Lasers Med Sci. 2025 Dec 29;41(1):4. doi: 10.1007/s10103-025-04797-x.

ABSTRACT

This pilot study aimed to investigate the effects of intravascular laser irradiation of blood (ILIB) on anxiety levels and vital signs in patients undergoing third molar extraction. A randomized, placebo-controlled clinical trial was conducted with 26 patients who underwent mandibular third molar extraction. Participants were allocated to either the placebo group (n = 13) or the ILIB group (n = 13). ILIB was applied via transcutaneous over the radial artery for 30 min before the surgical procedure. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI-Y, state subscale) at baseline and four minutes after local anesthesia. Vital signs, including heart rate (HR), systolic and diastolic blood pressure, and oxygen saturation, were also recorded at these two time points. There was no significant difference in anxiety status between the ILIB and placebo groups. However, the ILIB group demonstrated a statistically significant HR stability after local anesthesia compared to the placebo group. All parameters remained within normal limits throughout the procedure. Despite its pilot nature and small sample size, this study indicates that ILIB is feasible in routine clinical practice. Although it did not reduce anxiety compared to a placebo, ILIB helped stabilize HR after local anesthesia, suggesting a potential physiological benefit. Further research is needed to assess its clinical relevance, especially in patients with severe anxiety or systemic conditions. Brazilian Clinical Trials Registry – REBEC no. RBR-9ycg67p. Registration, March 10^th, 2023.

PMID:41460388 | DOI:10.1007/s10103-025-04797-x

J Neurooncol. 2025 Dec 29;176(2):138. doi: 10.1007/s11060-025-05390-6.

ABSTRACT

INTRODUCTION: Cerebellar glioblastoma (cGBM) is a rare subtype, comprising of < 1% of patients with GBMs. This study sought to identify predictors of survival for patients with cGBM through an individual patient data (IPD) meta-analysis, focusing on the impact of chemoradiotherapy (CRT) and extent of resection (EOR).

METHODS: Following PRISMA-IPD guidelines, we conducted a systematic review and Individual Patient Data (IPD) meta-analysis of 13 retrospective studies (113 adults) with IDH-wildtype cerebellar glioblastoma. Variables included demographics, tumor location, KPS, MGMT, TP53, extent of resection (GTR, STR, PR, biopsy), and CRT. Kaplan-Meier estimated OS and PFS; unadjusted and adjusted Cox models assessed predictors. Hazard ratios for CRT vs. monotherapy and GTR vs. incomplete resection were pooled in a two-stage random-effects model (Hartung-Knapp). Analyses used R (v4.4.2) and JMP Pro 17.

RESULTS: Mean age was 54.9 years; 64% were male. GTR was performed in 37%, PR in 43%, STR in 11%, and biopsy in 10%. CRT was associated with improved OS (18 vs. 7 months; p = 0.02) and PFS (12 vs. 2.5 months; p = 0.0205) compared to monotherapy on Kaplan-Meier analysis. Two-stage IPD meta-analysis showed a 72% reduced risk of death with CRT (HR 0.28; 95% CI: 0.15-0.51; p = 0.0119), with similar significance in one-stage unadjusted Cox models (HR 0.49; 95% CI: 0.26-0.91; p = 0.0233). EOR comparisons were non-significant in meta-analyses, though GTR vs. biopsy showed early separation on Wilcoxon testing (p = 0.0422).

CONCLUSION: In this pooled IPD meta-analysis of cGBM, the use of CRT remained the only consistent and independent predictor of improved survival. GTR conferred a survival advantage over biopsy, likely reflecting the clinical benefit of debulking, however its advantage over subtotal resection was not statistically significant. These findings reinforce CRT as the maintstay of treatment highlighting the need for individualized strategies in cGBM. In selected cGBM patients, gross total surgical resection and adjuvant chemo-RT result in overall survival outcomes comparable with supratentorial GBM.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41460384 | DOI:10.1007/s11060-025-05390-6

Nurs Health Sci. 2026 Mar;28(1):e70272. doi: 10.1111/nhs.70272.

ABSTRACT

Acute pain and chronic pain represent major global public health challenges; however, no data on their prevalence and determinants have been available in Albania. This study aimed to estimate the prevalence of both acute and chronic pain by gender, and to identify sociodemographic factors associated with chronic pain. A nationwide cross-sectional study was conducted, using a random cluster sampling method to recruit a representative sample of 380 families across all the regions of Albania. A total of 1424 participants completed a structured questionnaire. Descriptive statistics, univariate, and multivariate logistic regression analyses were performed to explore associations between chronic pain and potential predictors. Acute pain was reported by 39.8% of respondents, while chronic pain affected 37.1% of the sample. Multivariate analysis revealed that chronic pain was significantly associated with female sex (adjusted odds ratio (aOR) = 1.99; 95% confidence interval (CI): 1.07-2.26), age over 60 years (aOR = 2.55; 95% CI: 1.15-5.38), in particular range between 31 and 50 years old (aOR = 2.58; 95% CI: 1.71-3.88), low annual income (< €1000; aOR = 2.35; 95% CI: 1.13-5.30), who smoke/alcohol use (aOR = 0.42; 95% CI: 0.18-0.97). Over weight (OR = 2.36; 95% CI: 1.24-4.60) and to be cancer affected (OR = 2.63; 95% CI: 1.59-4.40) only in univariate analysis are associated with chronic pain. In both cases, these results are not confirmed in the multivariate analysis. This is the first study to assess the prevalence and determinants of pain in Albania. The findings highlight a substantial burden of untreated pain and underscore the need for equity-oriented public health strategies, integrated pain services, academic education strategies, and targeted interventions for vulnerable groups.

PMID:41457309 | DOI:10.1111/nhs.70272

Ital J Pediatr. 2025 Dec 28. doi: 10.1186/s13052-025-02148-8. Online ahead of print.

ABSTRACT

BACKGROUND: Head and neck area abscesses are severe bacterial infections that commonly arise as complications of viral upper respiratory tract infections in pediatric patients. These infections can affect various anatomical structures, including the tonsils, retropharyngeal spaces, paranasal sinuses, middle ear, and salivary glands. The most frequent clinical presentations include otomastoiditis, retropharyngeal abscesses, and periorbital cellulitis. Although traditionally considered rare in developed countries, in recent years, particularly in the post-COVID-19 (COronaVIrus Disease 19) pandemic period, we have observed a notable increase in these complications at our center.

METHODS: We conducted a retrospective, single-center epidemiological study on our cases of septic complications involving the head and neck region, comparing two three-year periods (from January to December): 2017-2019 and 2022-2024. Cases were classified into four categories: otomastoiditis, periorbital cellulitis, retropharyngeal abscesses, and other abscesses (including lateral cervical and cerebral abscesses). For each year the incidence rate of these complications was calculated in relation to the total number of hospital admissions. Statistical comparison was performed using the Chi-square test.

RESULTS: The comparison between the two three-year periods (2017-2019 vs. 2022-2024) revealed a dramatic increase in head and neck suppurative infections: 8 cases in 2017-2019 compared to 56 cases in 2022-2024. The incidence rose from 0.32% to 2.42%, a statistically significant difference (p < 0.01). The incidence rate peaked in 2024, reaching 3.3%. The most frequent complication was periorbital cellulitis, followed by otomastoiditis. Notably, in 2022, a case of cerebral abscess occurred, requiring transfer to intensive care.

CONCLUSIONS: Our study highlights an unexpected increase in head and neck suppurative-inflammatory complications. While recent publications have documented a rise in pediatric respiratory infections in the post-COVID-19 era, specific studies addressing the surge in these conditions remain scarce. This trend may be linked to the so-called COVID-19 immunity gap and/or to emerging patterns of antimicrobial resistance. However, given the retrospective observational design of our study, establishing a causal link is not possible. Pending further scientific evidence, enhanced surveillance remains essential to promptly identify these conditions, given their rapid progression and high morbidity.

PMID:41457294 | DOI:10.1186/s13052-025-02148-8

Parasit Vectors. 2025 Dec 29. doi: 10.1186/s13071-025-07217-9. Online ahead of print.

ABSTRACT

BACKGROUND: Mosquito-borne diseases cause significant burdens in rural areas of Southeast Asia. The lack of data on vector bionomics hinders disease control and elimination. The objectives of this study were to assess the diversity and biting behaviours of mosquito species biting humans and their livestock in the forest hills of Karen state, Myanmar, and to assess the patterns of species co-occurrence and the effects of the environment on vector abundance.

METHODS: Mosquitoes were captured over 24-h diel cycles in six villages in September 2019 using the human landing catch and cow-baited trap collection methods. Collected specimens were identified to the species level using dichotomous morphological keys. Environmental data were acquired through remote sensing. The analysis of biting times was performed with circular statistics. Species co-occurrence patterns and the effects of environmental variables on species abundance were assessed with a generalized linear latent variable model.

RESULTS: A total of 36,607 mosquitoes were captured, and 96 species in 16 genera were identified. The most abundant genera were Anopheles, Culex and Downsiomyia. Multiple malaria, arboviruses and lymphatic filariasis vector species were detected, and their biting behaviours were reported. Generalized linear latent variable modelling revealed two clusters of species that were positively correlated with one another. The first cluster included many Culex and Anopheles species, and Mansonia annulata, which breed in shallow, stagnant or slow-moving water, such as marshes, swamps, rice fields and the margins of streams and puddles. These species were negatively associated with elevation, slopes and forests and positively associated with grasslands, shrubs and crop fields. The second cluster included many rainforest mosquitoes of the genera Armigeres, Heizmannia, Downsiomyia, Anopheles dirus, An. jeyporiensis, Culex bitaeniorhynchus and Aedes pseudoalbopictus, which breed in tree canopies and in natural surface water and containers such as bamboo stumps, tree holes and rainwater pools. These species were positively associated with elevation, slope, dense forests, surface water and wetlands and negatively associated with crop fields, grasslands and shrubs.

CONCLUSIONS: Transmission dynamics are particularly complex in this setting where people are exposed to bites of numerous vector species throughout the diel cycle. Environmental factors shape the assembly of mosquito species communities and largely determine the risk of exposure to vector bites.

PMID:41457278 | DOI:10.1186/s13071-025-07217-9

BMC Med. 2025 Dec 28. doi: 10.1186/s12916-025-04604-y. Online ahead of print.

ABSTRACT

BACKGROUND: To explore the associations between clustering of cardiometabolic risk factors, physical activity (PA), and digital exclusion with depressive symptoms trajectories, and to assess whether PA and digital exclusion mediate these associations.

METHODS: This study included 8999 participants from the Health and Retirement Study (HRS, n = 4380) and the English Longitudinal Study of Ageing (ELSA, n = 4519). Cardiometabolic risk factors included waist circumference, high-density lipoprotein (HDL) cholesterol, systolic and diastolic blood pressure, type 2 diabetes mellitus, glycated hemoglobin (HbA1c), and C-reactive protein (CRP). Depressive symptoms, PA, and digital exclusion were assessed via self-report. Statistical analyses used multinomial logistic regression and the Karlson-Holm-Breen (KHB) method.

RESULTS: We identified three clustering of cardiometabolic risk factors and four depressive symptoms trajectories. Compared to participants classified as healthy obesity, those in the obesity-hypertension group had an OR of 1.26 (95% CI: 1.09-1.46) for the moderately severe depressive symptom trajectory, while those in the complex cardiometabolic group had an OR of 1.31 (95% CI: 1.08-1.58), 1.79 (95% CI: 1.45-2.23), or 2.19 (95% CI: 1.66-2.90) for the moderate, moderately severe, or severe depressive symptom trajectory, respectively. Compared to those with PA insufficiency and digital exclusion, among PA sufficient participants, the OR of being in the moderate, moderately severe, or severe depressive symptom trajectory was 0.74 (95% CI: 0.65-0.84), 0.57 (95% CI: 0.50-0.66), or 0.35 (95% CI: 0.20-0.61), respectively; among digitally engaged participants, the OR of being in the moderately severe or severe trajectory was 0.63 (95% CI: 0.53-0.75) or 0.42 (95% CI: 0.33-0.54), respectively. Compared with the healthy obesity group, those with sufficient PA or digital inclusion in obesity-hypertension and complex cardiometabolic groups had lower odds of depressive symptoms trajectories. Mediation analysis showed that PA and digital inclusion accounted for 12.5% and 6.67% of the association between clustering of cardiometabolic risk factors and the severe depressive symptom trajectory, respectively.

CONCLUSIONS: The obesity-hypertension was only associated with increased odds of the moderately severe depressive symptom trajectory, while the complex cardiometabolic pattern was associated with increased odds of depressive symptoms trajectories; in contrast, sufficient PA and digital inclusion were associated with reduced odds.

PMID:41457269 | DOI:10.1186/s12916-025-04604-y