Category: Statistics

JCO Clin Cancer Inform. 2025 Jan;9:e2400042. doi: 10.1200/CCI.24.00042. Epub 2025 Jan 22.

ABSTRACT

PURPOSE: Undifferentiated pleomorphic sarcomas (UPSs) demonstrate therapy-induced hemosiderin deposition, granulation tissue formation, fibrosis, and calcification. We aimed to determine the treatment-assessment value of morphologic tumoral hemorrhage patterns and first- and high-order radiomic features extracted from contrast-enhanced susceptibility-weighted imaging (CE-SWI).

MATERIALS AND METHODS: This retrospective institutional review board-authorized study included 33 patients with extremity UPS with magnetic resonance imaging and resection performed from February 2021 to May 2023. Volumetric tumor segmentation was obtained at baseline, postsystemic chemotherapy (PC), and postradiation therapy (PRT). The pathology-assessed treatment effect (PATE) in surgical specimens separated patients into responders (R; ≥90%, n = 16), partial responders (PR; 89%-31%, n = 10), and nonresponders (NR; ≤30%, n = 7). RECIST, WHO, and volume were assessed for all time points. CE-SWI T2* morphologic patterns and 107 radiomic features were analyzed.

RESULTS: A Complete-Ring (CR) pattern was observed in PRT in 71.4% of R (P = 7.71 × 10^-6), an Incomplete-Ring pattern in 33.3% of PR (P = .2751), and a Globular pattern in 50% of NR (P = .1562). The first-order radiomic analysis from the CE-SWI intensity histogram outlined the values of the 10th and 90th percentiles and their skewness. R showed a 280% increase in 10th percentile voxels (P = .061) and a 241% increase in skewness (P = .0449) at PC. PR/NR showed a 690% increase in the 90th percentile voxels (P = .03) at PC. Multiple high-order radiomic texture features observed at PRT discriminated better R versus PR/NR than the first-order features.

CONCLUSION: CE-SWI morphologic patterns strongly correlate with PATE. The CR morphology pattern was the most frequent in R and had the highest statistical association predicting response at PRT, easily recognized by a radiologist not requiring postprocessing software. It can potentially outperform size-based metrics, such as RECIST. The first- and high-order radiomic analysis found several features separating R versus PR/NR.

PMID:39841956 | DOI:10.1200/CCI.24.00042

J Clin Oncol. 2025 Jan 22:JCO2401829. doi: 10.1200/JCO-24-01829. Online ahead of print.

ABSTRACT

PURPOSE: Radiotherapy (RT)/cetuximab (C) demonstrated superiority over RT alone for locally advanced squamous head and neck cancer. We tested this in completely resected, intermediate-risk cancer.

METHODS: Patients had squamous cell carcinoma of the head and neck (SCCHN) of the oral cavity, oropharynx, or larynx, with one or more risk factors warranting postoperative RT. Patients were randomly assigned 1:1 to intensity-modulated RT (60-66 Gy) with once-per-week C or RT alone. The primary hypothesis was that RT + C would improve overall survival (OS) in randomly assigned/eligible patients, with a prespecified secondary plan to test this in the human papillomavirus (HPV)-negative subpopulation. Disease-free survival (DFS) and toxicity were secondary end points. OS and DFS were tested via stratified log-rank test; toxicity was compared via Fisher’s exact test.

RESULTS: We enrolled 702 patients from November 2009 to March 2018; 577 were randomly assigned/eligible. Most (63.6%) had oral cavity cancer and most (84.6%) had high epidermal growth factor receptor expression. There were fewer deaths (184) than expected. OS (median follow up, 7.2 years) was not significantly improved (hazard ratio [HR], 0.81; one-sided P = .0747; 5-year OS 76.5% v 68.7%), but DFS was (HR, 0.75; one-sided P = .0168; 5-year DFS 71.7% v 63.6%). Benefit of RT + C was only seen in the HPV-negative subpopulation (80.2% of patients in the trial). Grade 3-4 acute toxicity rates were 70.3% (RT + C) versus 39.7% (RT; two-sided P < .0001), mostly skin and/or mucosal effects. Late grade ≥3 toxicity rate was 33.2% (RT + C) versus 29.0% (RT; two-sided P = .3101). There were no grade 5 toxicities in either arm.

CONCLUSION: RT + C significantly improved DFS, but not OS, with no increase in long-term toxicity, compared with RT alone for resected, intermediate-risk SCCHN. RT + C is an appropriate option for carefully selected patients with HPV-negative disease.

PMID:39841939 | DOI:10.1200/JCO-24-01829

Psychiatry. 2025 Jan 22:1-16. doi: 10.1080/00332747.2024.2447219. Online ahead of print.

ABSTRACT

Objective: The armed conflict in Ukraine and its impact on Europe’s economy have led to an war and economic crisis, potentially affecting the mental health of women during the perinatal period. This study aimed to assess the severity of depressive symptoms and labor anxiety among Polish women in perinatal period during this crisis.

Methods: From June 2, 2022, to April 11, 2023, 152 women completed three sets of online surveys-two during pregnancy (before 33 weeks and/or between 33 and 37 weeks) and one postpartum (4 weeks after childbirth). The questionnaires used to evaluate the anxiety and depressive symptoms included Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI-2), Labor Anxiety Questionnaire (LAQ), and team-developed questionnaires evaluating war-related anxiety (WAQ) and global situation anxiety (GSAQ) Statistical analyses included U-Mann Whitney, Kruskal-Wallis, Wilcoxon signed-rank, Friedman tests and Spearman’s correlations, with a significance level set at p < .05.

Results: Among Polish pregnant women aged 23-43, 31.6% of participants experienced depressive symptoms, while 70.4% reported increased labor-related anxiety. Additionally, 24.3% experienced significant anxiety due to the war, and 25% suffered from severe anxiety related to the global situation. Positive correlations were noted between EPDS and GSAQ scores (R = 0.34, p < .001) and LAQ and WAQ scores (R = 0.21, p = .008).

Conclusions: The prevalence of perinatal depression is high during war and economic crisis, underscoring the urgent need to improve screening for perinatal depression in Poland. Further, the manuscript did not discuss symptom patterns across the three time points.

PMID:39841920 | DOI:10.1080/00332747.2024.2447219

J Cardiovasc Med (Hagerstown). 2025 Feb 1;26(2):81-87. doi: 10.2459/JCM.0000000000001690. Epub 2024 Dec 26.

ABSTRACT

INTRODUCTION: Cardiac amyloidosis typically causes restrictive cardiomyopathy, in which the impairment of diastolic function is dominant. Echocardiography provides prognostic information through some important parameters: left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, LVEF often remains preserved despite disease progression, and GLS is not routinely performed as it is limited by suboptimal image quality. The stroke volume index (SVi) has already been shown to correlate with mortality in heart failure patients; still, its prognostic role in transthyretin cardiac amyloidosis (TTR-CA) is poorly studied.

PURPOSE: This prospective study aimed to evaluate the role of SVi in predicting mortality and heart failure hospitalizations in patients with cardiac amyloidosis, comparing it to other parameters of left ventricular performance.

METHODS: Baseline clinical transthoracic echocardiogram and laboratory data were collected prospectively in 115 patients with diagnosed TTR-CA. The outcome was the occurrence of the composite of heart failure hospitalization and death and its association with SVi, LVEF, GLS and MCF was tested by Cox proportional hazard modelling.

RESULTS: Over a mean follow-up of 16.1 months (interquartile range 7.4-24.9 months), 29 patients died, and 19 were hospitalized for heart failure. SVi was associated with the composite outcome of death and heart failure hospitalization [hazard ratio 0.96; 95% confidence interval (CI) 0.93-0.99] and remained an independent predictor of outcome after adjustment for NAC stage, mitral regurgitation degree, age and the use of disease-modifying treatment. The best cut-off of SVi to predict outcome was 35 ml/m2 (hazard ratio 2.30; 95% CI 1.03-5.17).

CONCLUSION: SVi is superior to LVEF, MCF, and GLS for prognostication in patients with TTR amyloidosis.

PMID:39841913 | DOI:10.2459/JCM.0000000000001690

Ann Plast Surg. 2025 Feb 1;94(2):212-216. doi: 10.1097/SAP.0000000000004220.

ABSTRACT

International medical graduates (IMGs) represent a significant portion of the US physician workforce, comprising 25% across all specialties with a strong presence in internal medicine and primary care. However, their representation in plastic surgery remains limited at only 10%. Matching into a US plastic surgery residency is highly competitive for both US medical graduates and IMGs. This study aimed to quantify and identify trends in academic contributions from IMGs applicants in a plastic surgery residency program over the past 13 years, hypothesizing that IMG applicants have increasingly contributed to collaborative research projects.Data from National Resident Matching Program annual reports were analyzed, focusing on publications, research experience, and match status. An analysis of variance revealed significant differences between US MDs and IMGs in terms of publications and research experience. IMGs had a higher number of publications and work experience compared to matched US MDs, while US MDs had more research experiences than IMGs.The findings underscore the importance of research for IMGs, who often engage in additional research experiences to enhance their competitiveness for residency positions. The study showed that IMGs have a greater research output, contributing significantly to academic publications within the plastic surgery field. This productivity benefits the IMGs in securing residency positions and enriches the academic research environment of the residency programs.IMGs bring unique perspectives and innovative approaches to research, often collaborating internationally, which enhances the scope and quality of research projects. Their contributions are vital to the advancement of plastic surgery and the broader medical field. As the demand for physicians in the US grows, integrating IMGs into the healthcare system through strategic inclusion in research and clinical training is essential. This study highlights the critical role of IMGs in driving medical research and underscores the need for supportive policies to facilitate their integration into the US healthcare workforce.

PMID:39841900 | DOI:10.1097/SAP.0000000000004220

Ann Plast Surg. 2025 Feb 1;94(2):204-211. doi: 10.1097/SAP.0000000000004228.

ABSTRACT

BACKGROUND: Plastic surgery training continues to evolve with integrated residents spending more time in plastic versus general surgery. Herein, we provide an updated description of interprogram differences in core general, core plastic, and plastic surgery-adjacent training curricula.

METHODS: We obtained rotation schedules from US plastic surgery residency websites or program coordinators for AY2021-2022. Rotation months were recorded and categorized into Core General Surgery, Core Plastic Surgery, and Plastic Surgery-Adjacent. Rotations were compared to American Board of Plastic Surgery (ABPS) and Accreditation Council for Graduate Medical Education (ACGME) standards. Data were analyzed using descriptive statistics (SPSS, IBM Corp., v27.0, Armonk, NY).

RESULTS: Of 84 programs, we obtained schedules for 63 (75%). Most offered 2 years of Core General Surgery followed by 4 years of Core Plastic Surgery training (n = 32, 50.8%). From postgraduate years 1-6, programs offered median 52 months [interquartile range (IQR): 47.5, 55] of Core Plastic Surgery, 12 months (IQR: 9, 14) of Core General Surgery, and 8 months (IQR: 6, 10) of Plastic Surgery-Adjacent rotations. Six (9.5%) programs’ schedules included rotations specifically addressing all ABPS competency requirements; 1 (1.6%) included rotations addressing all ACGME Core General Surgery competency requirements. Departmental status was not associated with differences in training time.

CONCLUSIONS: Our results demonstrate that in AY2021-2022, integrated plastic surgery training programs offered 6 months less Core General Surgery, 3 months less Plastic Surgery-Adjacent, and 9 months more Core Plastic Surgery Rotations than in 2012. Very few program schedules include named rotations that specifically addressed all ABPS or ACGME competency requirements.

PMID:39841899 | DOI:10.1097/SAP.0000000000004228

Ann Plast Surg. 2025 Feb 1;94(2):145-151. doi: 10.1097/SAP.0000000000004183.

ABSTRACT

BACKGROUND: The medial epicanthal fold is a common ethnic trait in East Asian faces, and there is a significant demand for its correction for cosmetic reasons. Numerous epicanthoplasty techniques have been proposed; however, visible scarring and unnatural canthal shapes have been challenges. This study aimed to introduce a simpler approach for medial epicanthoplasty to address these issues and evaluate its outcomes.

METHODS: From January 2020 to October 2023, 199 patients who were followed up for more than 6 months and had no history of prior medial epicanthoplasty were included in the study. The intercanthal distance (ICD) was measured from preoperative and recent medical photographs, and the ratio of the ICD to the corneal diameter was calculated for magnification correction. Postoperative complications and patient-reported aesthetic outcomes were evaluated.

RESULTS: The medial epicanthoplasty techniques used were the elliptical excision method in 94 patients and the mini-redraping method in 105 patients. The average follow-up period was 10.8 months. The ICD measurements demonstrated a statistically significant reduction after surgery in both groups. In the elliptical excision group, 14 patients (14.9%) reported dissatisfaction with their surgical outcomes. Two patients had prominent medial vertical scars, and 12 patients reported undercorrection. In the mini-redraping group, only 4 patients reported dissatisfaction with the surgical outcome (3.8%), all owing to undercorrection. No significant postoperative complications were observed in either group.

CONCLUSIONS: With the mini-redraping method, the medial epicanthal fold can be effectively addressed with minimal complications while achieving the natural shape and symmetry of both canthi in a straightforward manner.

PMID:39841896 | DOI:10.1097/SAP.0000000000004183

JAMA Netw Open. 2025 Jan 2;8(1):e2455471. doi: 10.1001/jamanetworkopen.2024.55471.

NO ABSTRACT

PMID:39841479 | DOI:10.1001/jamanetworkopen.2024.55471

JAMA Netw Open. 2025 Jan 2;8(1):e2455461. doi: 10.1001/jamanetworkopen.2024.55461.

ABSTRACT

IMPORTANCE: More than 4 million Medicare beneficiaries have enrolled in dual-eligible Special Needs Plans (D-SNPs), and coordination-only D-SNPs are common. Little is known about the impact of coordination-only D-SNPs on Medicaid-covered services and spending, including long-term services and supports, which are financed primarily by Medicaid.

OBJECTIVE: To evaluate changes in Medicaid fee-for-service (FFS) spending before and after new enrollment in coordination-only D-SNPs vs new enrollment in non-D-SNP Medicare Advantage (MA) plans among community-living beneficiaries enrolled in both Medicare and North Carolina Medicaid.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study applied a new user, active comparator design to control for selection into MA and inverse probability of treatment weighting to improve the comparability between groups. The cohort included community-living dual-eligible Medicare and Medicaid beneficiaries in North Carolina with 365 days of Medicare FFS enrollment prior to new enrollment in D-SNP (treatment) or other MA plan (active comparator). Linked 100% Medicare and North Carolina Medicaid claims data (2014-2017) provided payments across both payers prior to MA enrollment; after MA enrollment, payments for Medicaid-funded services and supplemental Medicaid payments for Medicare-funded services were observed. Data were analyzed from August 2023 to November 2024.

EXPOSURE: New D-SNP enrollment.

MAIN OUTCOMES AND MEASURES: Outcomes included annualized 1-year Medicaid FFS spending overall and by claim type, including inpatient, outpatient, carrier, home health, personal care services, and behavioral health services.

RESULTS: Among 8869 participants in the D-SNP cohort, 4762 (53.7%) were younger than 65 years, 5833 (65.8%), were female, and 975 (11.0%) resided in rural areas. After inverse probability of treatment weighting, characteristics were similar among the comparison MA cohort of 4389 participants (4706 [53.2%] aged <65 years; 5739 [64.9%] female; 971 [11.0%] rural). There were no significant differences in Medicaid FFS spending per person-year (PPY) at baseline or differential change in the year following new enrollment (mean marginal effect, -$387 [95% CI, -$1274 to $501) between groups. There were significant differences between groups in the change in spending on long-term services and supports, with maintained spending on community-based personal care services following new enrollment in D-SNPs compared with reductions for other MA, resulting in a relative increase of $343 (95% CI, $147 to $539).

CONCLUSIONS AND RELEVANCE: This cohort study found that coordination-only D-SNPs was associated with maintained North Carolina Medicaid FFS spending levels for long-term services and supports compared with other MA plans, despite limited integration requirements. However, to reduce or delay nursing home transitions, higher levels of integration may be necessary.

PMID:39841476 | DOI:10.1001/jamanetworkopen.2024.55461

JAMA Netw Open. 2025 Jan 2;8(1):e2455475. doi: 10.1001/jamanetworkopen.2024.55475.

ABSTRACT

IMPORTANCE: The Walter Index is a widely used prognostic tool for assessing 12-month mortality risk among hospitalized older adults. Developed in the US in 2001, its accuracy in contemporary non-US contexts is unclear.

OBJECTIVE: To evaluate the external validity of the Walter Index in predicting posthospitalization mortality risk in Brazilian older adult inpatients.

DESIGN, SETTING, AND PARTICIPANTS: This prognostic study used data from a cohort of adults aged 70 years or older admitted to the geriatric unit of a university hospital in Brazil from January 1, 2009, to February 28, 2020. Participants underwent comprehensive geriatric assessments at admission, were reevaluated at discharge, and were subsequently followed up for 48 months. Data were analyzed from March to July 2024.

MAIN OUTCOMES AND MEASURES: The Walter Index, a score based on 6 risk factors (male sex, dependent activities of daily living at discharge, heart failure, cancer, high creatinine level, and low albumin level), was calculated to assess its predictive accuracy for 12-month mortality as well as 6-, 24-, and 48-month mortality. The study investigated whether incorporating delirium, frailty, or C-reactive protein level enhanced accuracy. Performance was assessed using discrimination, calibration, and clinical utility measures.

RESULTS: In total, 2780 participants (mean [SD] age, 81 [7] years; 1795 [65%] female) were included, with 89 (3%) lost to follow-up. The 12-month posthospitalization mortality rate was 23% (646 participants). Mortality was 7% (47 of 634) in the lowest-risk group (0-1 point), 17% (111 of 668) for 2 to 3 points, 25% (198 of 803) for 4 to 6 points, and 43% (290 of 675) in the highest-risk group (≥7 points). The index demonstrated an area under the receiver operating characteristic curve (AUC) of 0.714 (95% CI, 0.691-0.736) for predicting 12-month posthospitalization mortality (AUCs were 0.75 and 0.80 in the original derivation and validation cohorts, respectively). Comparable results were observed for mortality at 6 months (AUC, 0.726; 95% CI, 0.700-0.752), 24 months (AUC, 0.711; 95% CI, 0.691-0.730), and 48 months (AUC, 0.719; 95% CI, 0.700-0.738). Adding delirium modestly increased the index’s discrimination (AUC, 0.723; 95% CI, 0.702-0.749); additionally including frailty and C-reactive protein level did not improve discrimination further (AUC, 0.723; 95% CI, 0.701-0.744).

CONCLUSIONS AND RELEVANCE: In this prognostic study of hospitalized older adults in Brazil, the Walter Index showed similar discrimination in predicting postdischarge mortality as it did 2 decades ago in the US. These findings highlight the need for continuous validation and potential modification of established prognostic tools to improve their applicability across settings.

PMID:39841475 | DOI:10.1001/jamanetworkopen.2024.55475