Category: Statistics

Cureus. 2026 Jun 18;18(6):e111067. doi: 10.7759/cureus.111067. eCollection 2026 Jun.

ABSTRACT

Background Sinonasal malignancies are uncommon head and neck tumors that frequently present at an advanced stage due to their deep anatomical location and nonspecific early symptoms. Orbital involvement represents an important indicator of locally aggressive disease and has direct implications for staging and treatment planning. This study was conducted to analyze the clinicopathological profile, radiological patterns of orbital invasion, and management strategies in patients with sinonasal malignancies involving the orbit. Methods A retrospective observational study was carried out in the Department of ENT – Head and Neck Surgery at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Patients with histopathologically confirmed sinonasal malignancies and radiological evidence of orbital extension from April 2022 to March 2026 were included. Relevant demographic, histological, staging, orbital invasion patterns, treatment modalities, and discharge outcomes were extracted from hospital records. Data were analyzed using descriptive statistics, and associations were assessed using chi-square and Fisher’s exact tests where appropriate. Results A total of 78 patients were included. The mean age was 57.6 ± 12.2 years, and 45 (57.69%) were male. Squamous cell carcinoma was the most common histological subtype (28, 35.90%), followed by adenocarcinoma (18, 23.08%) and sinonasal undifferentiated carcinoma (13, 16.67%). All patients presented with advanced disease, including 16 (20.51%) at stage III and 62 (79.49%) at stage IV. Eye-related clinical features were common, with ocular pain/discomfort in 56 (71.79%), proptosis in 48 (61.54%), and epiphora in 44 (56.41%) patients. A significant difference in mean age was observed across histological subtypes (p = 0.003), while no significant associations were found with gender (p = 0.92), stage (p = 0.41), or pattern of orbital invasion (p = 0.95). The highest level of erosion seen on radiology showed that only lamina papyracea erosion was the most frequent orbital involvement (31, 39.74%), followed by periorbital tissue (18, 23.08%), extraconal fat (13, 16.67%), extraocular muscles (10, 12.82%), and orbital apex (6, 7.69%). Orbit-preserving surgery was performed in 53 (67.95%) patients, while 16 (20.51%) underwent exenteration and 9 (11.54%) received chemoradiotherapy. A significant association was noted between histological subtype and surgical management (p < 0.001), with higher exenteration rates in sinonasal undifferentiated carcinoma and adenoid cystic carcinoma. Conclusion Sinonasal malignancies with orbital involvement most commonly presented at an advanced stage (predominantly stage IV), with squamous cell carcinoma being the most frequent histological subtype and the lamina papyracea being the commonest route of orbital extension. A significant variation in mean age was observed across histological subtypes, whereas no significant association was found between histology and gender, stage, pattern of orbital invasion, or overall treatment modality. However, histological subtype showed a significant association with surgical management, particularly the need for orbital exenteration.

PMID:42472132 | PMC:PMC13379717 | DOI:10.7759/cureus.111067

Sleep Adv. 2026 Jun 22;7(3):zpag067. doi: 10.1093/sleepadvances/zpag067. eCollection 2026.

ABSTRACT

Operational environments such as naval vessels demand sustained coordination and precision under conditions that test both physical and psychological endurance. This study examined associations among fatigue-related factors, perceived social support, occupational context, and perceived team functioning among 26 438 active-duty US Navy personnel. Measures included self-reported sleep needed, sleep opportunity, and sleep obtained, which were used to calculate sleep deficit and sleep opportunity conversion, along with self-reported sleep disturbance, fatigue impairment (FI), perceived social support, and perceived team processes. Hierarchical regression analyses showed that FI was strongly associated with lower perceived team functioning (β = -0.35; 95% confidence interval [CI], -0.37 to -0.33; p < .001). Social support was positively associated with perceived team functioning (β = 0.31; 95% CI, 0.29 to 0.33; p < .001) and statistically attenuated the negative association between FI and perceived team functioning (β = 0.07; 95% CI, 0.05 to 0.09; p < .001). Quadratic analyses indicated that associations between fatigue-related factors and perceived team functioning were stronger at moderate-to-high levels of FI and calculated sleep deficit. Occupational rate accounted for additional contextual variance, with mechanical and deck rates reporting higher FI and lower perceived team functioning than administrative or medical rates. As all constructs were assessed using cross-sectional, single-source self-report data, findings should be interpreted as correlational associations with perceived team processes rather than objective performance effects or causal impacts of insufficient sleep.

PMID:42472125 | PMC:PMC13380305 | DOI:10.1093/sleepadvances/zpag067

Clin Cosmet Investig Dermatol. 2026 Jul 14;19:615985. doi: 10.2147/CCID.S615985. eCollection 2026.

ABSTRACT

PURPOSE: Hypertrophic scars (HS), common fibroproliferative disorders, predominantly affect younger individuals. To investigate potential causal associations between multiple genetically proxied biological aging indicators and the risk of HS using a two-sample Mendelian randomization (MR) approach.

PATIENTS AND METHODS: We used genome-wide association studies (GWAS) data to examine causal links between biological aging indicators (epigenetic clocks, telomere length, macroscopic aging) and HS. Primary analysis employed inverse-variance weighted MR, with sensitivity analyses (MR-Egger, weighted median, weighted mode) and multivariable MR adjusting for fibrogenic mediators. Results were validated in independent cohorts. Robustness was assessed via MR-PRESSO, Cochran’s Q, MR-Steiger, and leave-one-out analyses to detect statistical evidence of directional and horizontal pleiotropy.

RESULTS: Genetically predicted higher IEAA (Odds Ratio [OR]=0.926, 95% Confidence Interval [CI]: 0.878-0.976, P=0.004) and higher PhenoAge (OR=0.911, 95% CI: 0.848-0.979, P=0.011) were nominally associated with a decreased risk of HS. The PhenoAge association was consistently replicated in the independent validation cohort (OR=0.91, P=0.0059). However, these associations did not remain significant after False Discovery Rate correction. Negative control analysis showed no association with general skin fibrosis, suggesting specificity for hyper-proliferative scarring. Multivariable MR indicated that the protective effect of PhenoAge was independent of classical fibrogenic pathways. No significant causal associations were found for other aging indicators. No statistical evidence of directional or horizontal pleiotropy was detected in sensitivity analyses.

CONCLUSION: This MR study provides exploratory evidence suggesting that genetically proxied faster epigenetic aging may be nominally associated with a reduced risk of HS. These findings offer novel hypotheses regarding the complex interplay between aging processes and scar formation.

PMID:42472084 | PMC:PMC13380249 | DOI:10.2147/CCID.S615985

Drug Des Devel Ther. 2026 Jul 14;20:625824. doi: 10.2147/DDDT.S625824. eCollection 2026.

ABSTRACT

PURPOSE: To compare the efficacy and safety of dexamethasone alone versus dexamethasone combined with droperidol for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing gynecological day surgery under ciprofol-alfentanil general anesthesia.

PATIENTS AND METHODS: A total of 268 patients scheduled for gynecological day surgery were randomly assigned to the DD group (dexamethasone-droperidol, n=134) or the DN group (dexamethasone-normal saline, n=134). Before induction of anesthesia, the DD group received 5 mg dexamethasone plus 1 mg droperidol, while the DN group received 5 mg dexamethasone plus normal saline. Anesthesia induction: ciprofol 0.5 mg/kg, alfentanil 20 μg/(kg·h), and mivacurium 0.2 mg/kg. Anesthesia maintenance: ciprofol 1.25 mg/(kg·h), alfentanil 40 μg/(kg·h), with bispectral index (BIS) maintained at 40-60. The primary outcome was the incidence of PONV within 24 h postoperatively. Secondary outcomes included the incidence of adverse events within 24 h postoperatively, patient satisfaction, hemodynamic changes during anesthesia, BIS changes during anesthesia, and the incidence of intraoperative adverse events.

RESULTS: The incidence of PONV within 24 h postoperatively was significantly lower in the DD group than in the DN group (17.2% vs 31.9%), with a statistically significant difference. No significant differences were found between the two groups in the incidence of postoperative adverse events within 24 h, patient satisfaction, hemodynamic changes during anesthesia, BIS changes during anesthesia, or the incidence of intraoperative adverse events. No specific adverse effects of droperidol were observed in the DD group.

CONCLUSION: For patients undergoing gynecological day surgery under ciprofol-alfentanil general anesthesia, the combination of dexamethasone and droperidol is significantly more effective than dexamethasone alone in preventing PONV, with no significant difference in safety between the two regimens.

PMID:42472077 | PMC:PMC13380276 | DOI:10.2147/DDDT.S625824

Ital J Pediatr. 2026 Jul 18. doi: 10.1186/s13052-026-02312-8. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric female dystrophinopathy may be asymptomatic at evaluation or may show skeletal muscle and cardiac manifestations, but childhood presentations are often subtle. We aimed to characterize the clinical spectrum, ascertainment pathways, subclinical muscle involvement, and inheritance patterns in this population.

METHODS: This single-center retrospective case series was conducted between January 2024 and December 2025 and included 35 girls with genetically confirmed DMD gene variants identified from existing clinical records. Primary ascertainment route was recorded separately from cross-sectional clinical status at evaluation and classified as symptom-driven presentation, incidental or unexplained hyperCKemia, family-based cascade screening, or incidental genomic discovery. Clinical status at evaluation was assigned after systematic clinical review with reference to published female dystrophinopathy classifications. Statistical analyses were exploratory.

RESULTS: The median age was 5 years (range, 1-10). Primary ascertainment routes were symptom-driven presentation in 8/35 (22.9%), incidental or unexplained hyperCKemia in 18/35 (51.4%), family-based cascade screening in 8/35 (22.9%), and incidental genomic discovery in 1/35 (2.9%). After systematic clinical review, clinical status at evaluation was classified as asymptomatic in 29 participants, BMD-like in 1, DMD-like in 3, and cardiac-symptom/CMR observations in 2. All 18 girls initially identified through incidental or unexplained hyperCKemia were classified as asymptomatic because no muscle weakness was documented on neurological examination, although some had exercise intolerance, easy fatigue, myalgia, or cramps. EMG abnormalities were identified in 14/34 participants, including definite myopathic findings in 5 and subtle short-duration motor-unit-potential changes in 9. Variants were apparently de novo in 15 cases, maternally inherited in 18, and paternally inherited in 2, including one case inherited from a father with low-level mosaicism in peripheral blood.

CONCLUSIONS: Pediatric female dystrophinopathy shows a broad childhood spectrum and may be recognized before objective muscle weakness is documented. Separating ascertainment route from clinical status highlights recurrent or persistent hyperCKemia and mild exercise-related complaints as practical entry points for targeted neuromuscular assessment and longitudinal follow-up. Earlier recognition in childhood may support timely neuromuscular and cardiac surveillance, parental evaluation when appropriate, family-based genetic counseling, and future reproductive planning.

PMID:42471751 | DOI:10.1186/s13052-026-02312-8

J Cardiothorac Surg. 2026 Jul 18. doi: 10.1186/s13019-026-04541-8. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary complications after coronary artery bypass surgery continue to be a significant problem, affecting 5-20% of patients, prolonging hospital stays and increasing costs. In this study, we investigated whether simple blood tests that measure inflammation, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), could help identify patients at risk before surgery.

METHODS: The records of 1034 patients who underwent elective coronary artery bypass grafting with heart-lung machine support between 2023 and 2024 were retrospectively reviewed. NLR, PLR, and SII values were calculated from routine blood tests performed the day before surgery. Patients who developed pulmonary complications were defined according to the European Perioperative Clinical Outcome (EPCO) definitions.

RESULTS: 114 patients (11%) developed PPC. Preoperative inflammatory markers were significantly higher in patients with complications (NLR: 3.55 ± 1.07 vs. 1.79 ± 0.54, PLR: 156 ± 47 vs. 120 ± 36, SII: 825 ± 248 vs. 548 ± 164; all p < 0.001). ROC analysis demonstrated excellent discrimination for NLR (AUC 0.939), good for SII (AUC 0.818), and fair-to-good for PLR (AUC 0.724). In multivariate analysis, NLR was by far the strongest independent predictor of PPC, together with COPD, diabetes, active smoking, CPB and ACC durations. PLR and SII also reached statistical significance, but with effect sizes very close to unity (adjusted OR 1.02 and 1.01 respectively), indicating that they offered minimal additional discriminatory value once NLR was taken into account.

CONCLUSIONS: In this single-center retrospective cohort, preoperative NLR, PLR and SII were associated with PPC, with NLR accounting for most of the predictive signal. Because they are measured at a single preoperative timepoint, these indices reflect baseline inflammatory tone and cannot capture the acute, surgery-induced inflammatory response that drives postoperative pulmonary complications. In view of the single-center retrospective design, the absence of external validation, and the lack of comparison with validated risk scores such as EuroSCORE II or the STS score, these indices are not yet suitable to guide clinical decision-making on their own. Given their simplicity and ready availability, however, they appear to be promising candidate markers that merit further evaluation in prospective, multicenter studies also incorporating specific inflammatory mediators measured dynamically throughout the perioperative period.

PMID:42471737 | DOI:10.1186/s13019-026-04541-8

J Cardiothorac Surg. 2026 Jul 19. doi: 10.1186/s13019-026-04616-6. Online ahead of print.

ABSTRACT

OBJECTIVES: A systematic review and meta-analysis was performed to observe the incidence of perioperative stroke associated with selective and non-selective carotid ultrasound (CU) screening in the isolated coronary artery bypass grafting (CABG) population.

METHODS: PubMed, Scopus and CENTRAL databases were searched for studies published between January 1995 and October 2025. Inclusion criteria for the review focused on studies reporting primary data related to perioperative stroke in adult patients scheduled to undergo non-emergency isolated CABG who underwent either selective or non-selective preoperative CU screening. The primary outcome was perioperative stroke. Study quality was assessed using the ROBINS-I tool. Data related to the primary outcome was synthesised using an exploratory random-effects model meta-analysis. This review was reported as per PRISMA guidelines.

RESULTS: 2398 studies were identified to undergo title and abstract screening; 63 studies were identified to undergo full-text screening of which 15 studies were eligible for inclusion within the review (Total N = 25,931). For the 13 studies utilising a non-selective screening strategy, the pooled perioperative stroke rate was 1.78% (95% CI: [1.28;2.48]). Independently, the two cohorts utilising a selective screening strategy reported perioperative stroke rates of 1.16% and 1.23%. Due to the structural limitations of the existing literature these findings are presented as independent descriptive cohorts.

CONCLUSIONS: This review provides a descriptive synthesis of perioperative stroke rates across the two previously mentioned screening cohorts and does not establish comparative effectiveness. Although the low absolute event rates observed within the selective screening cohort align with current guideline recommendations, the structural limitations and high disproportion of the available evidence base prevent definitive comparison.

PMID:42471735 | DOI:10.1186/s13019-026-04616-6

Biol Sex Differ. 2026 Jul 18. doi: 10.1186/s13293-026-00954-1. Online ahead of print.

ABSTRACT

Hypoxia research has significantly advanced our understanding of how the human body responds to low-oxygen environments, yet women are still frequently studied without adequate consideration of hormonal status or reproductive life-course stage. This review examines the complex interactions between hormonal status across the female life course and the specific physiological responses of women to acute and chronic hypoxia, focusing on the menstrual cycle, hormonal contraception, pregnancy, menopausal status, hormone replacement therapy, gender-affirming hormone therapy, and reproductive health in high-altitude environments. Estrogen and progesterone significantly modulate ventilatory, cardiovascular, hematological, vascular, and muscular/metabolic responses to hypoxia, with distinct effects across different menstrual cycle phases, contraceptive regimens, and life-course states. Menopause introduces additional complexities, as declining hormone levels alter the body’s ability to acclimatize to low-oxygen conditions. Additionally, we examine how chronic and lifelong hypoxia impacts reproductive health, including fertility and pregnancy outcomes, in women living at high altitudes, highlighting both physiological adaptations and contextual factors. While current research has made progress, further studies are needed to better understand these sex-specific responses. We propose that future research should integrate stratified approaches, accounting for hormonal status (cycle phase, contraceptive use, pregnancy, HRT, GAHT) and reproductive status, to optimize health and performance recommendations for women exposed to hypoxic environments.

PMID:42471728 | DOI:10.1186/s13293-026-00954-1

World J Surg Oncol. 2026 Jul 18;24(1):302. doi: 10.1186/s12957-026-04496-z.

ABSTRACT

INTRODUCTION: Seroma is the most common postoperative complication following mastectomy and may result in additional postoperative interventions and increased treatment burden. However, its etiology and predictive factors remain insufficiently understood. This study aimed to identify predictors of postoperative seroma formation.

MATERIALS AND METHODS: We conducted a retrospective analysis of 245 patients (301 breasts) who underwent conventional mastectomy or skin-/nipple-sparing mastectomy, with or without immediate implant reconstruction and axillary surgery, at the University Hospital Leipzig between 2019 and 2023. Variables analyzed included epidemiological characteristics, neoadjuvant chemotherapy, tumor status, perioperative factors, and wound drainage output. Seroma formation was assessed via drains placed in the breast and axilla. Statistical analyses included univariable and multivariable regression and random forest modeling.

RESULTS: In univariable analyses, higher body mass index (BMI), longer surgical duration, diabetes mellitus, hypertension, advanced tumor stage, and elevated C-reactive protein levels were associated with increased breast seroma formation. Random forest analysis identified BMI, number of resected lymph nodes, surgical duration, hypertension, and diabetes as key predictors, all of which remained significant in multivariable models. For axillary seroma, BMI, number of resected lymph nodes, and tumor stage were significant in univariable analyses, while BMI and number of resected lymph nodes remained significant in multivariable models.

CONCLUSION: Seroma formation is primarily influenced by BMI, extent of lymph node removal, and surgical duration, with hypertension and diabetes as additional risk factors for breast seroma.

PMID:42471711 | DOI:10.1186/s12957-026-04496-z

BMC Med Inform Decis Mak. 2026 Jul 18. doi: 10.1186/s12911-026-03709-5. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and internally validate an interpretable prognostic model for cumulative clinical pregnancy in women with diminished ovarian reserve (DOR), and to explore, as a hypothesis-generating secondary aim, whether protocol-associated pregnancy rates differ across model-defined baseline-prognosis risk strata.

DESIGN: Retrospective cohort study.

SETTING: A single tertiary reproductive medicine center.

PATIENTS: 1,251 oocyte-retrieval cycles in women with DOR (AMH ≤ 1.1 ng/mL) at a single tertiary centre, January 2019-July 2024. Each record is one retrieval cycle; no patient identifier was available.

METHODS: From 37 candidate predictors, random-forest selection (training set only) retained eight; six algorithms were compared for discrimination (AUC, DeLong), calibration (slope, intercept, Brier) and clinical utility (decision-curve analysis), with SHAP for interpretability. Discrimination was further assessed by out-of-time validation (train ≤2022, test 2023-2024). Within model-defined risk strata, protocols were compared (chi-square/Fisher; bootstrap CIs; FDR and Bonferroni correction), with a pre-treatment-variable-only sensitivity analysis.

RESULTS: A parsimonious logistic regression gave the highest test AUC (0.739, 95% CI 0.688-0.790; Brier 0.200), not significantly better than more complex algorithms (DeLong p>0.10), and held up on out-of-time validation (AUC 0.726). The five most influential predictors (SHAP) were embryo quality, female age, male age, estradiol and AMH. In the exploratory analysis, low-probability cycles showed no protocol differences; among high-probability cycles only one association survived correction (long-acting GnRH-agonist fresh transfer vs HRT frozen transfer; absolute difference +48%, 95% CI 28-67%; FDR p=0.002), persisting in the baseline-only analysis.

CONCLUSIONS: In women with DOR, an interpretable logistic-regression model provided moderate, internally and temporally validated discrimination for cumulative clinical pregnancy at the pre-transfer decision point, though calibration drifted over time and warrants recalibration before use. The single protocol-related association is hypothesis-generating only. The model is best regarded as a pre-transfer prognostic counselling tool, not a basis for protocol selection, and requires prospective external validation.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42471694 | DOI:10.1186/s12911-026-03709-5