Category: Statistics

Spine Deform. 2026 May 18. doi: 10.1007/s43390-026-01414-x. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study is to examine the factors that contribute to the occurrence of hidden blood loss (HBL) in individuals with ankylosing spondylitis (AS) who undergo posterior correction surgery.

METHODS: From October 2019 to September 2023, 186 patients with AS who were scheduled to have a posterior orthopedic correction surgery were included in our study. The patient’s demographics, bone mineral density (BMD), operative time, hospital stay, intraoperative blood loss, blood transfusion volume, type of corrective osteotomies, the number of pedicle screws and fusion segments, drainage volume, correction angle of kyphosis and laboratory examinations, including preoperative hematocrit (HCT) and platelets (PLT_pre), and preoperative fibrinogen (Fib_pre), were collected retrospectively. The total blood loss (TBL) and HBL were calculated using the Gross equation. The statistical analysis was conducted utilizing SPSS 22.0. Pearson or Spearman correlation analyses were utilized to assess the potential risk factors associated with HBL. To identify the factors that affect HBL, multiple linear regression was utilized.

RESULTS: We reviewed 186 consecutive patients in our study. Potential risk factors of HBL included BMI (P = 0.050), BMD (P = 0.013), operative time (P = 0.002), the number of fusion segments (P = 0.001), the number of pedicle screws (P = 0.033), type of osteotomy (P < 0.001), correction angle (P = 0.005), and PLT_pre (P = 0.079). Multiple linear regression analysis showed that BMD (P = 0.032), type of osteotomy (P = 0.019), and PLT_pre (P = 0.034) were identified as risk factors for HBL.

CONCLUSION: HBL constitutes a significant proportion of perioperative blood loss in individuals with AS who received posterior correction surgery. BMD, type of osteotomy, and PLT_pre are the most important risk factors which determine HBL. Therefore, surgeons should take into account these factors when considering surgical strategies for AS patients.

LEVEL OF EVIDENCE: Level III.

PMID:42151655 | DOI:10.1007/s43390-026-01414-x

J Robot Surg. 2026 May 19;20(1):511. doi: 10.1007/s11701-026-03479-2.

ABSTRACT

Robotic low anterior resection (R-LAR) has been proposed to overcome technical limitations of laparoscopy in rectal surgery. However, previous meta-analyses have evaluated mixed-age populations, and no meta-analysis has specifically investigated younger patients (aged < 65 years) undergoing low anterior resection. This study aimed to compare operative, short-term postoperative, and oncological outcomes between robotic and laparoscopic low anterior resection in this cohort. A systematic review and meta-analysis were conducted according to PRISMA 2020 and the Cochrane Handbook, with prospective registration in Prospero. PubMed, Scopus, and the Cochrane Library were searched up to January 2026. Comparative studies evaluating R-LAR versus L-LAR in younger rectal cancer cohorts, defined as studies with mean patient age ≤ 65 years, were included. Random-effects models were used to calculate pooled mean differences (MD), odds ratios (OR), and hazard ratios (HR) with 95% confidence intervals (CI). Risk of bias was assessed using ROBINS-I and RoB2, and certainty of evidence using GRADE. A total of 16 studies were included. Compared with laparoscopy, R-LAR was associated with longer operative duration (MD 24.59 min, 95% CI 3.85-45.33, p = 0.02, I² = 96%), lower conversion to open surgery (OR 0.38, 95% CI 0.27-0.53, p < 0.0001, I² = 38%), lower overall complications (OR 0.84, 95% CI 0.73-0.97, p = 0.02, I² = 0%), lower 30-day mortality (OR 0.59, 95% CI 0.45-0.77, p = 0.006, I² = 0%), lower 30-day reoperation (OR 0.77, 95% CI 0.61-0.98, p = 0.04, I² = 0%), higher complete TME rates (OR 3.30, 95% CI 2.14-5.10, p = 0.003, I² = 0%) and shorter hospital stay (MD -0.82, 95% CI -1.50 to -0.13, p = 0.02, I²=97%). Estimated blood loss (p = 0.05) and major complications (p = 0.05) were borderline significant in favor of R-LAR. Anastomotic leakage (p = 0.17), postoperative ileus (p = 0.49), time to first flatus (p = 0.12), time to diet initiation (p = 0.10), CRM positivity (p = 0.56), lymph node yield (p = 0.09), local recurrence (p = 0.67), loop ileostomy (p = 0.56), disease-free survival (p = 0.53), and overall survival (p = 0.73) were comparable. The certainty of evidence ranged from very low to moderate. Functional outcomes were insufficient for pooling. Robotic low anterior resection in younger rectal cancer cohorts may improve several perioperative and technical outcomes without compromising oncological adequacy. Further high-quality studies are required to confirm these findings.

PMID:42151640 | DOI:10.1007/s11701-026-03479-2

J Neurooncol. 2026 May 19;178(1):6. doi: 10.1007/s11060-026-05632-1.

ABSTRACT

BACKGROUND: Despite multimodal therapy, glioblastomas invariably recur. In focal recurrent glioblastoma IDH-wildtype (rGBM), local therapy options include laser interstitial thermal therapy (LITT) and stereotactic radiosurgery (SRS), but their relative utilities are unknown. The goal of this study is to compare the efficacy of these two treatment modalities in a homogeneous rGBM population.

METHODS: We conducted a retrospective study of patients undergoing surgical procedures for rGBM between 2010 and 2025. All patients underwent either LITT or SRS at first recurrence. Survival outcomes were assessed with univariable log-rank tests and multivariate Cox regression models. A propensity-score matching (PSM) was performed to address confounders.

RESULTS: 57 patients were identified; of these, 10 underwent LITT, and 47 underwent SRS. There was no difference in post-recurrence survival (PRS) between groups (11.5 months vs. 13.4 months, p = 0.824). There were no surgical complications in the LITT cohort. In the SRS cohort, there were two symptomatic radiation necrosis cases (0% vs. 4.3%, p = 1.000). Contrast-enhancing tumor volume at recurrence was larger in the LITT cohort (8.49 cm³ vs. 1.91 cm³, p = 0.007). To address this difference, we performed a PSM of two cohorts with 7 patients each. This PSM analysis also revealed no significant difference in survival outcomes.

CONCLUSION: Within the limitations of a relatively small sample size, no statistically significant differences in outcomes were observed between LITT and SRS for the treatment of small, focal rGBM. Both modalities remain viable salvage options for small focal rGBM. Larger, multi-institutional studies are warranted.

PMID:42151639 | DOI:10.1007/s11060-026-05632-1

Int J Legal Med. 2026 May 19. doi: 10.1007/s00414-026-03831-z. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: A Likelihood ratio (LR) is a numerical measure of evidential value. Our objective was to use LRs to express the patient-specific evidential values of medical findings that best differentiate abusive versus non-abusive head trauma (AHT). We hypothesized that the evidential values of patients’ AHT-related medical findings would be highly variable.

METHODS: We analyzed existing, uniform, prospective, de-identified data regarding 973 acutely head-injured children < 3 years hospitalized for intensive care across 18 sites between 2011 and 2021; applied two different proxies for AHT and non-AHT ground truth; trained and validated statistical models that differentiate AHT versus non-AHT; and analyzed patient-specific LRs in a log₁₀ (LLR) format that facilitated assessment of evidential values (where LLR values > 0 and < 0 supported hypotheses of AHT and non-AHT, respectively).

RESULTS: The two best performing statistical models revealed evidential (LLR) values for patient-specific, AHT-related medical findings that varied from modest (-1 to + 1) to relatively large (-2.5 to -1 and + 1 to + 3.5), and values that were misleading (AHT patients with LLR values indicative of non-AHT, and vice versa). A few non-AHT patients presented with misleading evidence that was moderately strong, with LLRs approaching + 3.

CONCLUSIONS: Reasonable medical certainty of AHT and non-AHT can be enhanced or limited by the highly variable evidential values of patients’ most discriminating medical findings. Physicians can use available LRs to inform their AHT-related diagnostic reasoning, opinions, and testimony.

PMID:42151630 | DOI:10.1007/s00414-026-03831-z

Aesthetic Plast Surg. 2026 May 18. doi: 10.1007/s00266-026-05871-7. Online ahead of print.

ABSTRACT

BACKGROUND: Atrophic acne scarring presents a significant therapeutic challenge with a profound psychosocial impact, and conventional treatments often yield suboptimal results. Autologous biologics, specifically stromal vascular fraction (SVF) and platelet-rich plasma (PRP), have emerged as promising regenerative strategies to address this issue.

METHODS: This single-center, pilot, randomized, assessor-blinded controlled trial included 60 patients with severe atrophic acne scars. Patients were randomized into four groups: subcision plus SVF (Group 1), subcision plus combined SVF and PRP (Group 2), subcision plus PRP (Group 3), and subcision alone (Group 4, control). Primary endpoints included clinical improvement documented by digital imaging and changes in qualitative grading scales from baseline to 12 months post-procedure. Additionally, flow cytometry was performed to evaluate the cellular composition and mesenchymal stem cell (MSC) marker expression of the SVF preparations.

RESULTS: Group 2 (subcision + SVF + PRP) demonstrated superior clinical efficacy, with 53.3% of patients achieving “Grade 3” (marked) physician satisfaction compared to 0% in the control group (p ≤ 0.001). This group also showed significantly greater improvement in scar size and color (p ≤ 0.001). Mechanistically, flow cytometry confirmed that Group 2 contained significantly higher expression of mesenchymal stem cell markers (CD73+ and CD105+) compared to the SVF alone (p ≤ 0.001). While patient-reported FACE-Q scores consistently favored Group 2, differences in specific QoL sub-domains did not reach statistical significance (p > 0.05), likely due to the pilot sample size.

CONCLUSION: The combination of SVF and PRP, when used as an adjuvant to subcision, represents a promising regenerative strategy for atrophic acne scars, achieving clinical results superior to monotherapies or subcision alone. This enhanced therapeutic effect appears attributable to the enrichment of the mesenchymal stem cell population within the “biostimulated” SVF.

LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42151612 | DOI:10.1007/s00266-026-05871-7

Aesthetic Plast Surg. 2026 May 18. doi: 10.1007/s00266-026-05901-4. Online ahead of print.

ABSTRACT

BACKGROUND: Prepectoral breast reconstruction with polyurethane (PU)-coated implants has been proposed to enhance implant stability and reduce complications. Evidence regarding their clinical and aesthetic performance remains limited.

METHODS: A retrospective review was performed on 117 patients (186 breasts) who underwent immediate prepectoral reconstruction with PU-coated implants between 2020 and 2025. Complications were analyzed with univariate and multivariable regression. Aesthetic outcomes were evaluated using BCCT.core software.

RESULTS: At a median follow-up of 15 months, 34 patients (29.1%) experienced at least one complication, most commonly rippling or upper-pole visibility (16.2%). Implant loss occurred in 3.4% and capsular contracture in 1.7%. Higher BMI, larger implant size, and skin-reducing mastectomy were associated with increased complication risk, although none remained independently significant. Chemotherapy had no measurable impact, and radiotherapy showed only a mild trend toward poorer aesthetic scores. Overall, 81.2% of patients achieved excellent or good BCCT.core results. Younger age and absence of complications were the strongest predictors of favorable aesthetic outcomes.

CONCLUSIONS: PU-coated implants provided stable outcomes in prepectoral reconstruction, with low implant loss and rare contracture. Most patients achieved favorable cosmetic results without the need for additional reinforcement materials. Higher BMI, larger implants, smoking, and skin-reducing mastectomy increased complication risk primarily in univariate analyses. Prospective multicenter studies with longer follow-up and patient-reported outcomes are required to validate these findings.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42151611 | DOI:10.1007/s00266-026-05901-4

Aesthetic Plast Surg. 2026 May 18. doi: 10.1007/s00266-026-05907-y. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the impact of CO₂ fractional laser intervention at various time points within one month post-surgery on scar formation, thereby guiding clinicians in optimizing the timing of treatment.

METHODS: Six New Zealand white rabbits were used in this study. Six surgical incisions were made on the ventral side of each rabbit’s ear and randomly divided into six groups: Group A (non-laser intervention group), Group B (the day of surgery laser intervention group), Group C (1 week post-surgery laser intervention group), Group D (2 weeks post-surgery laser intervention group), Group E (3 weeks post-surgery laser intervention group), Group F (4 weeks post-surgery laser intervention group). At week 7 post-surgery, Scar Cosmesis Assessment and Rating (SCAR) scores were recorded. Hematoxylin and eosin (HE) staining was employed to measure dermal thickness, while Masson staining was utilized to determine the collagen volume fraction. Additionally, microvascular density was evaluated via CD31 immunohistochemistry. One-way analysis of variance (ANOVA) was conducted to assess overall differences among the groups. Where significant differences were found, the least significant difference (LSD) post hoc test was employed for pairwise comparisons. Statistical significance was determined at a threshold of P< 0.05.

RESULTS: At week 7 post-surgery, macroscopic observation revealed that Group A (non-laser intervention group) exhibited the most pronounced linear scars. In contrast, Groups B to F, which underwent laser intervention, displayed only partial linear scars. The SCAR scores, dermal thickness, collagen volume fraction, and microvascular density in Group A were all significantly higher than those in the laser intervention groups (Groups B-F) (P < 0.05). However, no statistically significant differences were observed among the laser intervention groups (Groups B-F) for any of these parameters (P > 0.05).

CONCLUSIONS: CO₂ fractional laser intervention at five different time points-the day of surgery, and at 1, 2, 3, and 4 weeks post-surgery-significantly reduces scar formation on rabbit ear surgical incisions. However, earlier laser intervention for postoperative scars within one month does not yield superior outcomes.

NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42151609 | DOI:10.1007/s00266-026-05907-y

Aesthetic Plast Surg. 2026 May 18. doi: 10.1007/s00266-026-05909-w. Online ahead of print.

ABSTRACT

INTRODUCTION: Various surgical approaches have been developed to address brow ptosis. The direct brow lift allows a precise correction of brow ptosis by targeting the head, body and/or tail of the brow.

OBJECTIVE: The aim of this study was to evaluate the clinical efficacy, long-term positional stability, aesthetic satisfaction and scar-related outcomes of the direct brow lift procedure.

METHODS: This prospective monocentric study included 41 patients who underwent direct brow lift surgery with the Castanares technique between September 2020 and April 2024. In 35 patients, upper blepharoplasty was performed concurrently. Objective morphometric assessments of brow position were performed at preoperative (T0), 1-month (T1) and 12-month (T12) post-operative evaluating standardized photographic images with ImageJ software. Patient satisfaction was measured through the FACE-Q questionnaire (“Satisfaction with Forehead and Eyebrows”), while scar perception was assessed using the SCAR-Q. Data were analysed using ANOVA for repeated measures.

RESULTS: A statistically significant post-operative increase in the distance from point A (brow’s tail) and point C (brow’s head) to the interpupillary line was observed at one month, with only a slight decrease at 12 months, indicating long-term surgical stability. In contrast, the brow’s body (point B) exhibited minimal variation overall. In terms of patient satisfaction, FACE-Q scores improved at all time points and across all patient groups. The overall SCAR-Q scores reflected improved patient perception of the scar with time.

CONCLUSIONS: The direct brow lift is a reliable and effective technique for achieving stable, long-term correction of brow ptosis. It demonstrates high patient satisfaction and acceptable scar perception over time.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42151608 | DOI:10.1007/s00266-026-05909-w

Hormones (Athens). 2026 May 18. doi: 10.1007/s42000-026-00787-y. Online ahead of print.

ABSTRACT

PURPOSE: The oxidative balance score (OBS) was developed to reflect the overall exposure of the body to antioxidants and pro-oxidants in the individual’s lifestyle and diet. The research aims to explore the relationship between OBS and sex hormones, including total testosterone (TT) and estradiol (E2), as well as indices including sex hormone-binding globulin (SHBG), testosterone deficiency (TD), free testosterone, and the ratio of TT to E2.

METHODS: A total of 2464 male participants were enrolled in the study during the period 2013 to 2016. Multivariable regression analyses were performed to investigate the association between OBS and sex hormones. Stratified analysis was conducted in participants of different age, body mass index (BMI), poverty income ratio, smoking status, alcohol consumption, and diabetes mellitus (DM).

RESULTS: We found that OBS (β = 2.13, 95% CI: 0.17 ~ 4.09, P = 0.030) and lifestyle OBS (β = 21.09, 95% CI: 9.27 ~ 32.90, P = 0.004) were significantly correlated with TT with full adjustment. We also found noteworthy relationships between lifestyle OBS and SHBG (β = 2.55, 95% CI: 0.77 ~ 4.33, P = 0.010), TD (OR = 0.76, 95% CI: 0.58 ~ 1.00, P = 0.045), and ratio of TT to E2 (β = 1.10, 95% CI: 0.71 ~ 1.50, P < 0.001). Stratified analyses by many covariates revealed that the results were basically stable across populations.

CONCLUSION: The results showed that males who lead an antioxidant-rich lifestyle had increased serum TT levels and were less likely to develop TD. This suggests that antioxidant-rich lifestyle choices may additionally help to prevent disorders related to sex hormone imbalance.

PMID:42151602 | DOI:10.1007/s42000-026-00787-y

Braz J Microbiol. 2026 May 19;57(1):148. doi: 10.1007/s42770-026-01962-4.

ABSTRACT

Weeds are a major problem in wheat crop causing low productivity. Nowadays, maximum doses of herbicides are used in wheat crop production, but after some time their negative effects are visible on crop and soil. The presence of ‘sorgoleone’ allelochemical in sorghum extract reduces weed density in early growth stage and increases the quality as well as soil microbial activity. Sequential application of sorghum extract (1:3) + ready-mix of clodinafop + metsulfuron 64 g/ha as post emergence, significantly increased the microbial population in soil, and enhanced quality and production of wheat. Same treatment produced significantly higher grain yield of 4543 kg/ha and magnitude of increments were 34.87% over weedy check and it was found statistically similar with sorghum extract (1:2) + ready-mix of clodinafop + metsulfuron 64 g/ha. However, both the treatments showed significant superiority over all other treatments. Maximum soil bacterial and fungal populations were obtained under lower concentration of sorghum extract (1:3) at 60 DAS and at harvest stages of crop, respectively, which measured in terms of magnitude improvements as compared to the population recorded before spraying.

PMID:42151590 | DOI:10.1007/s42770-026-01962-4