Category: Statistics

Pediatr Surg Int. 2025 Jul 13;41(1):208. doi: 10.1007/s00383-025-06123-6.

ABSTRACT

PURPOSE: Ureteropelvic junction obstruction (UPJO) in duplex systems is rare, with laparoscopic pyeloplasty (LP) and laparoscopic pyelo-ureterostomy (LPU) being the main surgical options. However, guidelines for selecting the appropriate procedure based on anatomical variations are lacking. This study evaluates the outcomes of laparoscopic management of duplex UPJO in children, comparing LP and LPU.

METHODS: A retrospective review was conducted on children who underwent surgery for UPJO in duplex systems at two pediatric urology centers over 10 years. Preoperative imaging included ultrasound, diuretic renogram, voiding cystourethrography, and magnetic resonance urography when needed. Retrograde pyelography confirmed anatomy. LP was preferred for lower moiety (LM) UPJO, while LPU was performed for short-segment or hypoplastic incomplete duplex. All children had double J stents for 4-6 weeks. Statistical analysis used t tests and Chi-square tests.

RESULTS: Among 25 children (complete: 11, incomplete: 14), LP was performed in 9/11 complete and 3/14 incomplete cases (p = 0.01). LPU was performed in 11 incomplete cases. The mean operative time was 113 min for LP and 137 min for LPU (p = 0.01). The median hospital stay was 2 days. Two children had postoperative UTIs, and one had early stent expulsion. Outcomes were favorable in all cases.

CONCLUSION: Duplex UPJO consisted of only 3.2% of a large cohort of UPJO from two busy pediatric urology centers. LP was possible in most UPJO in complete duplex, while most UPJO in incomplete duplex had to be managed with LPU. Although LPU was more challenging with longer operative time than LP, both LP and LPU had comparably good results. We strongly recommend intraoperative RGP in all cases of suspected duplex to decide the best surgical option in each case.

PMID:40652413 | DOI:10.1007/s00383-025-06123-6

Eur J Orthop Surg Traumatol. 2025 Jul 13;35(1):302. doi: 10.1007/s00590-025-04433-y.

ABSTRACT

PURPOSE: To investigate the relationship between urinary toxicology screen and traumatic femoral shaft fractures treated with intramedullary fixation, as well as assessing their impacts on morphine milligram equivalents (MME) and hospital length of stay (LOS).

METHODS: Design: Retrospective Chart Review; Setting: Single center, non-academic community level II trauma center; Patient Selection Criteria: All patients who were 16 years or older, and admitted to the hospital following a trauma activation for a femoral shaft fracture were included in the study. Exclusion criteria included patients without a urine toxicology screen, with low energy mechanisms or pathologic fractures, or those with miscoded charts. Outcome Measures and Comparisons: The primary outcomes of this study were MME and hospital LOS. Patients were grouped based on whether or not they had a positive or negative urinary drug screen.

RESULTS: A total of 144 patients met inclusion criteria having sustained femoral shaft fractures treated with intramedullary fixation. 34 patients were excluded from the study for not meeting one or more inclusion criteria. A total of 110 patients met the criteria for analysis. No positive UDS was found to correlate significantly with hospital LOS, and amongst all drugs screened for, only opiates were found to have a statistically significant increase in morphine milligram equivalents per day. Additionally, a negative UDS for opiates showed statistically significant correlation with ICU admission (p value 0.0273).

CONCLUSIONS: Trauma patients with a positive UDS for opioid use, and a femoral shaft fracture treated with intramedullary nail, are at an increased risk for higher MME requirements during their hospitalization, independent of ISS.

PMID:40652410 | DOI:10.1007/s00590-025-04433-y

Ann Med. 2025 Dec;57(1):2529578. doi: 10.1080/07853890.2025.2529578. Epub 2025 Jul 13.

ABSTRACT

OBJECTIVES: This study was to compare the worldwide burden of musculoskeletal (MSK) disorders with the age and gender-specific trends of MSK disorders in China and globally between 1990 and 2021.

METHODS: Using publicly available data from the Global Burden of Disease (GBD) database from 1990 to 2021. Examined the features of the burden of MSK disorders in China and globally, including age and gender-specific trends in incidence, prevalence, mortality, disability-adjusted life years (DALYs), and related age-standardized measures of MSK disorders. To represent the trends in the burden of MSK disorders, the average annual percentage change (AAPC) was computed using Joinpoint. Age, gender were important parameters that were used a comparative study of the disparities in the burden of MSK disorders between China and the global.

RESULTS: The worldwide ASIR of MSK disorders rose from 4641.50 to 4358.54 between 1990 and 2021, and China fell from 4039.13 to 3634.09 per 100,000. The worldwide ASPR rose from 19178.47 to 19836.76, China, went from 16966.24 to 17358.70 per 100,000. The ASMR in China declined from 1.22 to 1.10, while the worldwide decreased from 1.55 to 1.47 per 100,000. The ASDR in China declined from 1615.73 to 1578.71, while the worldwide ASDR decreased from 1886.22 to 1916.21 per 100,000. The worldwide AAPC of ASIR, ASPR, ASMR, and ASDR was -0.21%, 0.11%, -0.25%, and 0.04%, respectively. China was -0.34%, 0.09%, -0.41%, and -0.07%, respectively. The burden of MSK disorders was influenced similarly by age and gender.

CONCLUSION: The burden of MSK disorders rose in China and globally between 1990 and 2021, and it varies with age. Women are more prone than men to acquire MSK disorders. Because of its vast and aging population, MSK disorders continue to be a major public health concern in China and globally.

PMID:40652401 | DOI:10.1080/07853890.2025.2529578

Ann Med. 2025 Dec;57(1):2527357. doi: 10.1080/07853890.2025.2527357. Epub 2025 Jul 13.

ABSTRACT

BACKGROUND: The benefits of robotic pancreaticoduodenectomy (RPD) over laparoscopic pancreaticoduodenectomy (LPD) remain less reported, this study aimed to evaluate the superiority of RPD over LPD.

METHODS: A retrospective 1:1 propensity score-matched (PSM) analysis of the characteristics and perioperative variables of patients who underwent RPD and LPD between January 2021 and June 2023 in a high-volume centre was performed.

RESULTS: The analysis included 193 patients who underwent RPD and 355 who underwent LPD. After PSM, 173 patients who underwent RPD were matched with 173 who underwent LPD cases. RPD was associated with a shorter operative time [341 (302-363) vs. 447 (380-510) min; p = 0.001], lower blood loss [105 (50-110) vs. 200 (105-200) ml; p < 0.001], and a shorter postoperative hospital stay [12 (10-23) vs. 15 (12-24) days; p = 0.031]. No significant differences were observed between the two groups in terms of complication grade (p = 0.227), number of lymph nodes harvested (19.01 ± 8.32 vs. 19.95 ± 9.42; p = 0.099). In patients with main pancreatic duct of small diameter (≤3 mm), RPD was associated with fewer grade B pancreatic fistula (16.3% vs. 32.0%; p = 0.045).

CONCLUSION: RPD is as safe and feasible a minimally invasive approach as LPD is. The robotic approach in pancreatoduodenectomy could decrease grade B pancreatic fistula rate in patients with a main pancreatic duct of small diameter and reduce the operative time, blood loss and postoperative hospital stays.

PMID:40652399 | DOI:10.1080/07853890.2025.2527357

Med J Aust. 2025 Jul 13. doi: 10.5694/mja2.52703. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the incidence, risk factors, and length of stay for hospitalisations, with and without amputations, of people with diabetes-related foot ulcers (DFU).

STUDY DESIGN: Prospective observational cohort study; secondary analysis of linked Diabetic Foot Services and Queensland Hospital Admitted Patient Data Collection data.

SETTINGS, PARTICIPANTS: All people with DFU who visited any of 65 outpatient Diabetic Foot Service clinics in Queensland for the first time during 1 July 2011 – 31 December 2017, followed until first DFU-related hospitalisation, ulcer healing, or death, censored at 24 months.

MAIN OUTCOME MEASURES: First overnight hospitalisations for which the principal diagnosis was DFU-related (International Statistical Classification of Diseases, tenth revision, Australian modification; Australian Classification of Health Interventions codes), by amputation procedure type (none, minor [distal to ankle], major [proximal to ankle]).

RESULTS: Among 4709 people with DFU (median age, 63 years (interquartile range [IQR], 54-72 years); 3275 men [69.5%]; type 2 diabetes, 4284 [91.0%]), DFU-related hospitalisations were recorded for 977 people (20.7%): 669 without amputations (68.5%), 258 with minor amputations (26.4%), and 50 with major amputations (5.1%). The incidence of first DFU-related hospitalisations was 50.8 (95% confidence interval [CI], 47.7-54.1) per 100 person-years lived with DFU before healing, death, or loss to follow-up. The incidence of first DFU-related hospitalisation with no amputation was 39.0 (95% CI, 36.2-42.1), with minor amputation 18.0 (95% CI, 17.0-20.0), and with major amputation 5.3 (95% CI, 4.4-6.3) per 100 person-years with DFU. The median length of stay for DFU-related hospitalisations was six (IQR, 3-12) days with no amputations, ten (IQR, 5-19) days with minor amputations, and 19 (IQR, 11-38) days with major amputations. The risks of all DFU-related hospitalisation outcomes were higher for people with deep ulcers or severe peripheral artery disease. The risks of DFU-related hospitalisation with no amputations were also greater for people aged 37-59 years than for those aged 60 years, and for people with cardiovascular disease, infections, or previous amputations; with minor amputations for people who smoked, had end-stage renal disease, previous amputations, moderate to severe infections, or peripheral artery disease, or who were not receiving knee-high offloading or DFU debridement treatments; and with major amputations for people with end-stage renal disease, peripheral artery disease, or larger ulcers.

CONCLUSIONS: The incidence of DFU-related hospitalisations among people with DFU was high, and most did not involve amputations. Risk factor profiles differed between hospitalisations with or without amputation procedures. Our findings could assist services determine which people with DFU would benefit most from intensive interventions, potentially averting large numbers of diabetes-related hospitalisations.

PMID:40652397 | DOI:10.5694/mja2.52703

Public Underst Sci. 2025 Jul 13:9636625251351575. doi: 10.1177/09636625251351575. Online ahead of print.

ABSTRACT

Large language models (LLMs) have emerged as a novel form of media, capable of generating human-like text and facilitating interactive communications. However, these systems are subject to concerns regarding inherent biases, as their training on vast text corpora may encode and amplify societal biases. This study investigates overestimation bias in LLM-generated climate assessments, wherein the impacts of climate change are exaggerated relative to expert consensus. Through non-parametric statistical methods, the study compares expert ratings from the Intergovernmental Panel on Climate Change 2023 Synthesis Report with responses from GPT-family LLMs. Results indicate that LLMs systematically overestimate climate change impacts, and that this bias is more pronounced when the models are prompted in the role of a climate scientist. These findings underscore the critical need to align LLM-generated climate assessments with expert consensus to prevent misperception and foster informed public discourse.

PMID:40652388 | DOI:10.1177/09636625251351575

Knee Surg Sports Traumatol Arthrosc. 2025 Jul 13. doi: 10.1002/ksa.12795. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the distribution of coronal plane alignment of the knee (CPAK) phenotypes before and after medial closing-wedge distal femoral osteotomy (MCW-DFO) and assess their correlation with long-term clinical outcomes in valgus knee deformity.

METHODS: This retrospective analysis included patients who underwent MCW-DFO for valgus knee correction between 2007 and 2022. Preoperative and post-operative knee alignment was assessed using standard long leg weight-bearing radiographs, and clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner and visual analogue scale (VAS). Patients were stratified based on preoperative and post-operative CPAK classification phenotypes. Outcomes were compared between the most common preoperative and post-operative CPAK phenotypes.

RESULTS: Fifty-one patients (54 knees) were included in the study, with a mean age of 48.7 ± 13.2. The overall mean follow-up was 97 ± 57 months. Statistically significant improvements were observed in all clinical scores, and a statistically significant radiological correction of valgus was achieved following MCW-DFO. According to preoperative CPAK phenotype, the most prevalent groups, CPAK 6 and 3, showed no significant differences in clinical outcomes (final IKDC CPAK 3: 60.7 ± 12.2, CPAK 6: 62.9 ± 17 [p = 0.67]; final KOOS CPAK 3: 76.8 ± 6.9, CPAK 6: 77.3 ± 14.9 [p = 0.37]). Similarly, stratification by post-operative CPAK showed no significant differences between CPAK 5 and 8 (final IKDC CPAK 5: 63.3 ± 15.7, CPAK 8: 71.1 ± 10.2 [p = 0.12]; final KOOS CPAK 5: 79.8 ± 7.9, CPAK 8: 82.3 ± 9.3 [p = 0.53]). During the study period, one patient (1.8%) sustained a peri-implant fracture, one patient (1.8%) underwent re-intervention due to pseudoarthrosis and three patients (5.5%) underwent total knee arthroplasty.

CONCLUSIONS: MCW-DFO is a safe, effective treatment for symptomatic valgus knee deformity. Surgical correction achieved a neutral mechanical axis (CPAK 5 and 8), with no clinical differences for different JLO values.

LEVEL OF EVIDENCE: Level III, case-control study.

PMID:40652370 | DOI:10.1002/ksa.12795

Ann Otol Rhinol Laryngol. 2025 Jul 12:34894251356306. doi: 10.1177/00034894251356306. Online ahead of print.

ABSTRACT

OBJECTIVE: We evaluated the 5-year graft success rate and incidence of iatrogenic cholesteatoma following endoscopic cartilage-perichondrium sandwich myringoplasty for the repair of large central tympanic membrane perforations.

MATERIALS AND METHODS: This retrospective study included patients with large central perforations who underwent endoscopic cartilage-perichondrium sandwich myringoplasty. Graft integrity and the presence of iatrogenic middle ear cholesteatoma were assessed at a 5-year postoperative follow-up.

RESULTS: In total, 86 patients were included in the final analysis. The mean follow-up duration was 6.4 ± 1.2 years (range, 5-7 years). The graft take rates were 96.5% at 3 months, 94.2% at 6 months, and 93.0% at 5 years postoperatively. At 6 months postoperatively, 2.44% of patients demonstrated no change in hearing, whereas 3.66% experienced a deterioration in conductive hearing. In the remaining 93.90% of patients, the improvement in hearing was statistically significant; the mean air-bone gap decreased from 25.1 ± 4.6 dB preoperatively to 14.9 ± 3.1 dB postoperatively (P < .05). At the 5-year follow-up, high-resolution computed tomography (HRCT) revealed well-pneumatized mastoid and middle ear cavities in 93.02% of patients, eliminating the need for magnetic resonance imaging (MRI). HRCT revealed soft tissue opacities in the mastoid region in 4 patients who had undergone canal wall up mastoidectomy (CWUM) and in 2 patients without CWUM; however, subsequent MRI excluded mastoid cholesteatoma in all 6 cases. Notably, a small graft cholesteatoma was detected in 1 patient (1.16%).

CONCLUSIONS: Five-year imaging follow-up demonstrated that endoscopic cartilage-perichondrium sandwich myringoplasty, performed without removal of the epithelium from the tympanic membrane remnant, achieved a stable graft success rate in the repair of large central perforations. The procedure was associated with a minimal risk of graft cholesteatoma and no observed risk of middle ear cholesteatoma.

PMID:40652319 | DOI:10.1177/00034894251356306

Phys Ther. 2025 Jul 13:pzaf093. doi: 10.1093/ptj/pzaf093. Online ahead of print.

ABSTRACT

IMPORTANCE: Identifying patients most likely to benefit from physical therapy in the hospital could aid physical therapists in optimizing treatment allocation for the purpose of increasing discharge to home.

OBJECTIVE: The aims of this study were to develop and externally validate a predictive model for discharge to home on the basis of physical therapy frequency for patients who were hospitalized.

DESIGN: A predictive model was developed using retrospective cohort data collected between April 2017 and August 2022, with external validation conducted in a separate sample.

SETTING: The setting was a large health system.

PARTICIPANTS: Participants were adult patients who were hospitalized and received physical therapy.

MAIN OUTCOME AND MEASURES: Predictors were extracted from the electronic health record and included demographics, clinical characteristics, and therapist-entered variables such as home set-up and prehospital level of function. Physical therapy frequency was quantified as once daily, defined as ≥5 times per week. The outcome was discharge to home. Variables were included in the final multivariable logistic regression model on the basis of associations with physical therapy frequency and/or outcome and clinical relevance. Calibration and discrimination of the models were assessed.

RESULTS: The development sample included 205,659 adult patient (average age = 72.2 [SD = 14.3] years; 55.3% female) hospitalizations, with 52.5% of patients receiving physical therapy daily and an overall proportion of 67.1% being discharged to home. The final multivariable model included 8 variables, with good calibration and discrimination. Internal validity was established with an optimism-corrected concordance statistic of 0.874 (95% CI = 0.872-0.875). The external sample included 102,311 patient (average age = 67.7 [SD = 16.5] years; 50.9% female) admissions, with 64.5% of patients receiving physical therapy daily and 77.8% being discharged to home. Predictive performance was high (calibration slope = 0.908), and discrimination was good (concordance statistic = 0.851).

CONCLUSIONS AND RELEVANCE: This study developed and externally validated the underlying prediction model for a clinical decision support tool, termed Physical Therapy Frequency Clinical Decision Support Tool (PT-PENCIL), to identify patients most likely to benefit from daily physical therapy to discharge to home. Future work will evaluate the implementation of PT-PENCIL to determine its effect on patient-centered outcomes.

PMID:40652311 | DOI:10.1093/ptj/pzaf093

Sleep. 2025 Jul 13:zsaf194. doi: 10.1093/sleep/zsaf194. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Large muscle group movements during sleep (LMMS) have recently been recognized as a prevalent feature in patients with Restless Legs Syndrome (RLS), yet their autonomic profile remains insufficiently characterized. This study aimed to compare heart rate (HR) changes associated with LMMS to those accompanying short-interval (SILMS), periodic (PLMS), and isolated leg movements (ISOLMS) during non-REM sleep in RLS.

METHODS: Thirty drug-free RLS patients (20 women, mean age 57.6 ± 12.73 years) underwent full-night polysomnography. For each subject, five arousal-associated events per movement type were selected, provided they were isolated by at least 30 seconds of motor/arousal-free sleep. HR changes were analyzed by computing R-R intervals and expressing them as a percentage of baseline, synchronized to movement onset. The area under the curve (AUC, -10 to +20 s), HR change peak, and movement durations were statistically compared using non-parametric tests.

RESULTS: LMMS were significantly longer than other movement types (mean duration: 9.3 s vs. <3.0 s for others) and induced the highest HR response (peak: 129.6%, AUC: 369.3%), followed by SILMS (peak: 125.4%, 266.3%), ISOLMS (peak: 118.2%, 173.4%), and PLMS (peak: 118.5%, 166.9%). SILMS and LMMS were associated with rapid and sustained HR increases, without post-peak bradycardia, while PLMS and ISOLMS showed a modest transient bradycardia following the peak.

CONCLUSIONS: LMMS are associated with strong autonomic activation indicating parasympathetic withdrawal and/or sympathetic activation, distinguishing them from other sleep-related leg movements in RLS. The absence of post-peak bradycardia suggests reduced parasympathetic buffering, potentially reflecting more sustained arousal mechanisms.

PMID:40652310 | DOI:10.1093/sleep/zsaf194