Category: Statistics

World J Urol. 2025 Dec 15;44(1):41. doi: 10.1007/s00345-025-06137-8.

ABSTRACT

PURPOSE: Thiazide (THZ) and thiazide-like (TL) diuretics are routinely prescribed and considered to be the gold-standard prophylaxis for kidney stones (KS) recurrence in current guidelines despite having limited evidence. Thus, we aimed to investigate the efficacy and safety of different doses of THZ and TL diuretics in preventing KS recurrence.

METHODS: We searched for randomised controlled trials in PubMed, Web of Science, Embase, CENTRAL, and clinical trials registries from their inception through January 2025. The clinical or radiological KS recurrence was the primary endpoint, while the occurrence of adverse effects at any time was the secondary endpoint. We estimated odds ratio (OR) in a frequentist random-effects network meta-analysis with P < 0.05. This study was prospectively registered (CRD42025650062).

RESULTS: Nine trials (n = 999) were included. Chlorthalidone 50 mg/d (OR: 0.18, 95% confidence interval [CI] 0.04-0.88), hydrochlorothiazide 50 mg/d (OR: 0.52, CI 0.29-0.93), and trichlormethiazide 4 mg/d (OR: 0.26, CI 0.10-0.68) were different from placebo in terms of KS recurrence. There was no evidence of dose-dependent effect when comparing hydrochlorothiazide 50 mg/d to 12.5 mg/d (OR: 0.58, CI 0.25-1.34) or 25 mg/d (OR: 0.65, CI 0.28-1.48), nor comparing chlorthalidone 50 mg/d to 25 mg/d (OR: 0.80, CI 0.12-5.20). Only trichlormethiazide 4 mg/d (OR: 49.96, CI 1.78-1 402.80) provoked more adverse effects than placebo.

CONCLUSION: Although some therapies were statistically different from placebo, the current evidence does not support their use in preventing KS recurrence due to several limitations, indicating that THZ and/or TL diuretics should not be routinely prescribed. Further well-designed trials are urgently needed to address head-to-head comparisons and provide high-quality evidence.

PMID:41396435 | DOI:10.1007/s00345-025-06137-8

J Craniofac Surg. 2025 Nov-Dec 01;36(8):2805-2810. doi: 10.1097/SCS.0000000000011828. Epub 2025 Oct 28.

ABSTRACT

BACKGROUND: Cranial vault remodeling (CVR) for craniosynostosis is associated with high transfusion rates and related complications, yet factors contributing to transfusion risk remain incompletely defined. This study aimed to identify patient-level and procedure-level predictors of transfusion and assess their association with postoperative outcomes.

METHODS: This retrospective cohort study used the 2012 to 2023 ACS NSQIP-Pediatric database to identify patients aged 2 and under who underwent cranial vault remodeling for craniosynostosis using CPT and ICD codes. The authors examined demographic, comorbidity, preoperative laboratory, intraoperative, and postoperative data. Perioperative blood transfusion was predicted using various supervised machine learning algorithms: logistic regression, naive Bayes, K-nearest neighbors, decision trees, random forests, and extreme gradient boosting. Model performance was assessed in training and testing phases for discrimination, calibration, and clinical utility.

RESULTS: A total of 10,732 patients were identified, of which 5781 (53.9%) received a perioperative blood transfusion. The mean age of the blood transfusion group was 8.53 months compared with 5.71 months for the no transfusion group (P<0.001). Multivariable logistic regression revealed that longer anesthesia duration (aOR: 2.07, 95% CI: 1.76-2.44) was significantly associated with increased odds of transfusion. Conversely, factors associated with lower odds of transfusion included higher preoperative hematocrit (aOR: 0.94, 95% CI: 0.89-0.99), along with minimally invasive surgery (aOR: 0.34, 95% CI: 0.13-0.87) and combination approaches (aOR: 0.34, 95% CI: 0.16-0.70) compared with open procedures. The logistic regression model demonstrated the highest discriminative performance (AUC=0.787), with comparable results observed for the random forest model (AUC=0.777). Key predictors identified included anesthesia duration, age, weight, preoperative albumin, platelet count, serum creatinine, hematocrit, and white blood cell count.

CONCLUSION: Patients undergoing craniosynostosis repair are at increased risk for transfusion based on age, comorbidities, surgical approach, and ethnicity. These findings highlight the need for early intervention and strategies to reduce transfusion risk in vulnerable populations.

PMID:41396426 | DOI:10.1097/SCS.0000000000011828

J Craniofac Surg. 2025 Nov-Dec 01;36(8):e1238-e1242. doi: 10.1097/SCS.0000000000012012. Epub 2025 Oct 28.

ABSTRACT

OBJECTIVE: This study aims to assess the effectiveness of combining cognitive behavioral therapy (CBT) and acupoint application for sleep disorders in patients with benign paroxysmal positional vertigo (BPPV), and to contribute evidence for multimodal strategies in managing sleep-vestibular comorbidities within an integrative medicine model.

METHODS: A total of 120 patients with BPPV and comorbid sleep disorders were randomly assigned, using a random number table, to 1 of 3 groups (n=40 per group): (1) control group, which received canalith repositioning maneuvers alone, (2) acupoint application group, which received canalith repositioning combined with acupoint therapy, and (3) the combined treatment group, which received acupoint therapy along with CBT. Primary outcomes included the Pittsburgh Sleep Quality Index (PSQI), dizziness handicap inventory (DHI), and total traditional Chinese medicine (TCM) syndrome score. Assessments were conducted at baseline, 1 week, 2 weeks, and 1 month post-intervention.

RESULTS: The combined treatment group demonstrated significantly greater overall clinical efficacy compared with both the acupoint application and the control group (P<0.05). No statistically significant differences were observed among the groups in baseline PSQI, DHI, and TCM syndrome scores (P>0.05). Post-treatment evaluations revealed significant reductions in PSQI, DHI, and TCM syndrome scores in the combined treatment group compared with the other 2 groups (P<0.05).

CONCLUSIONS: The integration of CBT with acupoint application significantly improved sleep quality, vestibular function, and overall quality of life of patients with BPPV, highlighting the synergistic benefits of this multimodal therapeutic approach.

PMID:41396422 | DOI:10.1097/SCS.0000000000012012

Ophthalmol Ther. 2025 Dec 15. doi: 10.1007/s40123-025-01290-0. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to analyze the influence of refractive status, residential climate, and exposure to adverse environmental factors in contact lens (CL) dropout.

METHODS: This cross-sectional study involved a face-to-face survey conducted by trained optometrists among former and current CL wearers (CLWs) at General Óptica centers throughout Spain. The survey included questions related to demographic characteristics, refractive status, residential climate, and adverse environmental factors. The chi-square test and a forward stepwise binary logistic regression analysis were performed.

RESULTS: A total of 1094 surveys were included, comprising 509 former CLWs and 585 current CLWs. Age (B = 0.03; OR 1.03, 95% CI 1.02-1.04) and exposure to chemical (B = 3.51; OR 41.67, 95% CI 12.06-143.95) or dusty environments (B = 1.05; OR 2.93, 95% CI 1.16-7.41) were significantly associated with CL dropout. However, residing in a continental climate was associated with a lower CL dropout compared with a Mediterranean climate (B = – 1.39; OR 0.25, 95% CI 0.15-0.42). Spherical refraction, cylindrical refraction, and near addition power did not show statistically significant associations with CL dropout. Furthermore, the model excluded sex, exposure to high-humidity or dry environments, and the interactions between adverse environmental factors and residential climate as predictive factors.

CONCLUSIONS: Older age, residence in the Mediterranean climate, and exposure to chemical or dusty environments increase the risk of contact lens dropout. However, climate-specific conditions do not appear to significantly influence dropout rates, suggesting that other factors may play a more important role.

PMID:41396411 | DOI:10.1007/s40123-025-01290-0

J Artif Organs. 2025 Dec 15;29(1):15. doi: 10.1007/s10047-025-01541-8.

ABSTRACT

BACKGROUND: To evaluate the feasibility and safety of anticoagulation-free peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during lung re-transplantation and to assess its impact on blood transfusion requirements and clinical outcomes.

METHODS: In this single-center retrospective cohort (January 2023-April 2025), we included adults undergoing bilateral re-do lung transplantation on peripheral VA-ECMO with an anticoagulation-avoidance protocol; primary lung transplants were not included. Data on patient demographics, intraoperative transfusion volumes, postoperative complications, and survival were collected. The primary outcomes were intraoperative packed red blood cell transfusion volume and overall survival; secondary outcomes included incidence of primary graft dysfunction, acute kidney injury, and hemorrhagic and thromboembolic events. Continuous variables are reported as medians with interquartile ranges, and survival was estimated using the Kaplan-Meier method.

RESULTS: Seven patients (median age, 42 years; range, 30-56 years) underwent re-transplantation for chronic lung allograft dysfunction. The median intraoperative transfusion requirement was 560 ml (interquartile range 280-1050 ml). One patient developed primary graft dysfunction of grade 3and two developed stage 3 acute kidney injury requiring renal replacement therapy. Two developed deep venous thrombosis nonrelated to ECMO cannulation; no pulmonary embolism occurred. At a median follow-up of 469 days, all patients survived without evidence of recurrence of chronic lung allograft dysfunction.

CONCLUSIONS: Full anticoagulation-free peripheral VA-ECMO during lung re-transplantation is feasible and safe, with acceptable complication rates and potential reduction in transfusion requirements. Larger, multicenter studies are warranted to confirm these findings.

PMID:41396406 | DOI:10.1007/s10047-025-01541-8

Mol Biotechnol. 2025 Dec 15. doi: 10.1007/s12033-025-01520-7. Online ahead of print.

ABSTRACT

Bacterial cellulose (BC) is one of the biodegradable materials that is produced by BC-producing bacteria and is widely used in various industries. In previous studies, we isolated high-yield BC-producing Komagataeibacter diospyri MI 2 and analyzed its genomes. In this study, we aimed to improve the BC production ability of K. diospyri MI 2 by UV light and to investigate BC-regulating genes by comparative genomics. Of the 17 surviving colonies after UV irradiation, most produced significantly more BC higher than the wild type, while K. diospyri mutants B, G, and O had the highest BC yield. The properties of BC were analyzed by SEM and X-ray diffraction. The results showed that the BC produced by the K. diospyri mutants was denser than that of the wild type but did not significantly change crystallinity. The whole-genome sequencing and comparative genomics were performed to explore the genes involved in the improvement of BC in the K. diospyri mutants. The result showed that the descriptive statistics of the assembled genomes of the K. diospyri mutants were similar to that of the wild type. When comparing their genomes, we found that genes, including galE, aes, and bfr, which were likely involved in BC biosynthesis, disappeared in the K. diospyri mutants. In addition, variant analysis was performed, and SNPs and InDels located on the CDS of genes, including the response regulator, efflux transporter outer membrane subunit, chloride channel protein, and ribonuclease E, could be potential biomarkers for higher BC production. Our study provided the K. diospyri mutants by UV mutagenesis and explored the set of genes possibly involved in BC production.

PMID:41396403 | DOI:10.1007/s12033-025-01520-7

Phys Eng Sci Med. 2025 Dec 15. doi: 10.1007/s13246-025-01686-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Deep learning (DL)-based auto-segmentation has rapidly become the state-of-the-art in radiotherapy planning, significantly reducing contouring time while achieving geometric accuracy comparable to expert-derived contours [1-3]. While AI contouring on CTp is now widely established, its application to cone-beam CT (CBCT) is less well explored, despite CBCT’s critical role in daily image guidance for prostate radiotherapy. Current adaptive workflows rely on manual contouring or deformable image registration (DIR), both of which are resource-intensive and subject to limitations in accuracy and consistency. Recent advances in AI-based CBCT segmentation have shown promise in reducing manual workload, improving contour consistency, and supporting adaptive radiotherapy (ART) workflows [4]. To assess the clinical implications of these developments, this study retrospectively analyzed CBCT images from 20 prostate cancer patients, comparing AI- and DIR-generated contours to evaluate systematic differences and their potential impact on dosimetry and ART decision-making.

METHODS: Twenty prostate radiotherapy patients were retrospectively selected, treated with either 42.7 Gy in 7 fractions or 60 Gy in 20 fractions, and imaged on Halcyon linear accelerators using Hypersight CBCT ([Formula: see text]). AI-generated contours were produced with Limbus AI v1.8.0, while deformable image registration (DIR) contours were propagated from planning CTs in Velocity v4.2. Contour accuracy was assessed by two senior medical officers using a four-point Likert scale across 140 CBCTs. Prostate, bladder, and rectum were analyzed using Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), mean surface distance (MSD), center-of-mass (COM) displacement, and volumetric change relative to the planning CT. Dosimetric evaluation included [Formula: see text], [Formula: see text], [Formula: see text], and clinically defined organ-at-risk metrics to assess potential implications for adaptive radiotherapy. Statistical significance was tested using paired Student’s t-tests and Wilcoxon signed-rank tests with a threshold of [Formula: see text].

RESULTS: AI-generated contours achieved acceptable clinical accuracy in >80% of cases, with fewer severe or medium errors compared to DIR-derived contours, which required minimal changes of 49%. Quantitative analysis demonstrated broadly comparable Dice Similarity Coefficients (DSC), Hausdorff Distance (HD), and mean surface distance (MSD) across prostate, bladder, and rectum. Organ variation on CBCT revealed larger mean centre of mass shifts and volume differences for AI, particularly in bladder contours, whereas DIR showed smaller systematic deviations. Dosimetric comparisons highlighted that prostate dose metrics were significantly different between methods, while bladder differences were mostly non-significant except at high-dose volumes, and rectum analysis revealed consistent statistically significant variations. Overall, although both methods captured daily anatomical changes, suggesting complementary strengths depending on adaptive radiotherapy application.

CONCLUSION: AI-generated contours for prostate radiotherapy on CBCT images demonstrate high geometric accuracy and clinical usability, requiring minimal expert correction, while DIR contours, although generally usable, show greater variability, particularly for organs subject to large anatomical changes such as the bladder and rectum. Despite similar geometric comparisons, statistically significant dosimetric differences highlight the importance of careful expert verification, especially for sensitive structures like the rectum. These findings support the integration of AI-based contouring into adaptive radiotherapy workflows to streamline clinical processes, reduce workload, and maintain treatment accuracy, while emphasizing that automated contours, whether AI- or DIR-derived, should always undergo expert review to ensure safe and effective patient care.

PMID:41396387 | DOI:10.1007/s13246-025-01686-z

Ann Ist Super Sanita. 2025 Oct-Dec;61(4):277-284. doi: 10.4415/ANN_25_04_06.

ABSTRACT

BACKGROUND: Accurate estimation of vaccine effectiveness (VE) in real-world settings is essential for guiding immunization strategies, especially in older populations. However, observational studies are prone to bias due to confounding factors, and the choice of statistical method can significantly influence VE estimates.

MATERIALS AND METHODS: We compared the performance of a multivariable Cox proportional hazards model with seven propensity score (PS)-based models to estimate the relative vaccine effectiveness (rVE) of the bivalent Original/Omicron BA.4-5 mRNA vaccine as a second or third booster, compared to a first mRNA booster received ≥120 days earlier. Data from 11,879,461 individuals aged ≥60 in Italy (April-June 2023) were analyzed.

RESULTS: All models produced consistent rVE estimates, with values ranging from 16.4% to 22.1%. Over time, booster effectiveness declined, with the reference model showing a drop in rVE from 45.6% (15-60 days) to 14.3% (181-265 days). PS-based methods improved covariate balance but did not outperform the Cox model in terms of precision or interpretability.

CONCLUSIONS: In large, relatively balanced datasets, traditional multivariable models remain a robust and reliable choice for estimating VE. While PS-based methods offer theoretical advantages, their practical benefit may be limited when confounding is well controlled.

PMID:41392961 | DOI:10.4415/ANN_25_04_06

Folia Parasitol. 2025 Nov 28;72:2025.031. doi: 10.14411/fp.2025.031.

ABSTRACT

The pathogenicity of haemogregarines and their effects on the health status of ectothermic hosts remain largely unexplored. In this study, we examined the impact of Hemolivia mauritanica (Sergent et Sergent, 1904) infection on the differential leukocyte count (DLC) as a measurable indicator of health in tortoise hosts. A total of 206 blood smears were analysed, including 181 from spur-thighed tortoises (Testudo graeca Linnaeus) and 25 from marginated tortoises (Testudo marginata Schoepff). Light microscopy was used to identify infected individuals, determine DLC, and quantify parasitaemia levels. Overall, H. mauritanica was detected in 125 of 181 (69%) T. graeca samples and 21 of 25 (84%) T. marginata samples. To assess whether infection influenced DLC, we statistically compared leukocyte profiles between infected and uninfected individuals. Additionally, we evaluated the effects of other factors, including host species, parasitaemia intensity, sex, age, and the month and year of blood collection. Wilcoxon rank-sum tests revealed that parasitaemia and age had a statistically significant effect on DLC in T. graeca. Further analysis using linear models showed a significant association between parasitaemia and DLC, specifically affecting azurophils in T. graeca and basophils in T. marginata. Nine T. graeca tortoises positive for H. mauritanica were co-infected with haemosporidian parasites of the genus Haemocystidium Castellani et Willey, 1904, specifically three with Haemocystidium anatolicum (Orkun et Güven, 2013) and six with Haemocystidium caucasicum (Krasilnikov, 1965). Although co-infection itself was not statistically significant, a separate analysis of Haemocystidium parasitaemia revealed a significant effect on lymphocyte DLC. Furthermore, the frequent presence of mitotic and polychromatophilous erythrocytes in H. mauritanica-infected tortoises suggests a potential increase in erythrocyte regeneration.

PMID:41392952 | DOI:10.14411/fp.2025.031

Drug Alcohol Rev. 2026 Jan;45(1):e70091. doi: 10.1111/dar.70091.

ABSTRACT

ISSUES: This review aimed to estimate the prevalence of non-medical anabolic-androgenic steroid (AAS) use among same-sex attracted men (SSM).

APPROACH: We conducted a systematic review of peer-reviewed articles in English, focusing on AAS use among SSM. We excluded grey literature and studies that measure AAS use through some form of analysis (e.g., hair or urine). Ten databases were searched. Titles and abstracts for all articles were screened, followed by full-text assessment and data extraction by multiple authors. The pooled overall and subgroup (gym/community-recruited SSM) lifetime and past 12-month prevalence of AAS use among SSM was obtained using a generalised linear random effects model, which was reported when heterogeneity of estimates was not high. Risk of bias was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool.

KEY FINDINGS: Nine studies met inclusion criteria. All studies were conducted in high-income countries. Overall, the pooled lifetime and past 12-month prevalences of AAS use were 13.9% (95% CI 9.2%-20.5%, 6 studies) and 8.1% (95% CI 3.9%-16.2%, 3 studies), respectively. Among the gym subgroup, the pooled lifetime and past 12-month prevalences were 15.2% (95% CI 11.6%-19.6%, I² = 72.8%, 3 studies) in the gym subgroup and 13.3% (95% CI 9.9%-17.7%, I² = 73.1%, 2 studies). The difference in lifetime prevalence between gym and community-recruited SSM was not statistically significant (p = 0.676).

CONCLUSIONS: The non-medical use of AAS among SSM is higher than general global estimates, with some evidence that use may be higher among gym users.

PMID:41392947 | DOI:10.1111/dar.70091