Category: Statistics

Ulus Travma Acil Cerrahi Derg. 2025 Mar;31(3):233-241. doi: 10.14744/tjtes.2024.40088.

ABSTRACT

BACKGROUND: Explosions are not exclusive to battlefields; they also represent a global security concern that affects all societies worldwide. This study aims to elucidate the effects of injuries caused by explosions with multiple mechanisms, which clinicians may encounter at any time, particularly in the context of military personnel. Furthermore, the clinical characteristics of these injuries were examined.

METHODS: A total of 7,865 patient files evaluated between 2008 and 2017 by the Forensic Medicine Department of Gülhane Medical Faculty, Health Sciences University, were subjected to retrospective review. The study encompassed a total of 906 cases presenting with blast injuries. Medical records and health reports of these cases were reviewed and analyzed in terms of age- and gender-specific incidence, military ranks, type of explosion, origin of explosion, wound types, affected body areas, and sequelae.

RESULTS: The findings of this study indicate that blast injuries predominantly affect young males, particularly those in the military. The most common etiological factor identified was terrorism. Blast injuries were found to occur most frequently in non-vehicular pedestrians and were primarily caused by improvised explosive devices and landmines. Blast injuries most commonly resulted in multiplesite injuries with a shrapnel effect and frequently required surgical intervention. Despite all treatments, 53.4% of explosion-related injuries resulted in long-term sequelae.

CONCLUSION: The results of this study demonstrate that explosion-related injuries present a significant and complex problem. Blasts affect multiple body systems and cause severe injuries. Understanding the impact of explosions on the human body can help develop strategies to minimize or possibly eliminate serious injuries, particularly in explosion incidents encountered by security forces.

PMID:40052314 | DOI:10.14744/tjtes.2024.40088

Ulus Travma Acil Cerrahi Derg. 2025 Mar;31(3):249-258. doi: 10.14744/tjtes.2024.36114.

ABSTRACT

BACKGROUND: The increase in liver cholestasis enzyme and bilirubin levels, especially due to pancreatitis, mimics choledocholithiasis. This study aimed to examine the relationship between demographic and laboratory cut-off values and the presence of choledocholithiasis in patients with acute biliary pancreatitis (ABP).

METHODS: Patients diagnosed with ABP in the Department of General Surgery at Istanbul Faculty of Medicine between January 2010 and December 2022 were retrospectively analyzed. The presence of stones in the common bile duct was determined based on the results of magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Demographic and laboratory values of patients with and without bile duct stones were compared. Cut-off values were determined using receiver operating characteristic (ROC) curve analysis, and logistic regression analysis and modeling was performed for each variable.

RESULTS: A total of 1,026 ABP patients were evaluated. Patients whose enzyme levels were not elevated and those who did not undergo MRCP were excluded. A total of 584 patients were included in the study, and choledocholithiasis was detected in 188 (32.2%) patients. In multivariate analysis, age, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and direct bilirubin (DB) were found to be statistically associated with choledocholithiasis. The cut-off values were determined as 65 years for age, 394 U/L for GGT, 173 U/L for ALP, and 1.42 mg/dL for direct bilirubin. In the group where all four parameters were below these cut-off values, suggesting a clean common bile duct, it was observed that the negative predictive value was 97%.

CONCLUSION: Based on the demographic and laboratory data of patients with ABP, we were able to predict with more than 97% accuracy that the common bile duct was clean. Considering that our study only included patients who underwent MRCP due to elevated enzyme levels and suspicion of choledocholithiasis, the negative predictive value would be even higher if patients with acute biliary pancreatitis with normal enzyme levels were included. Additionally, no complications were observed in any of the patients during follow-up. This finding suggests that patients whose common bile duct is predicted to be clean can initially be monitored and supported with additional imaging methods if necessary. As a result, unnecessary imaging can be avoided, reducing costs and preventing the mortality and morbidity associated with unnecessary procedures.

PMID:40052312 | DOI:10.14744/tjtes.2024.36114

Ulus Travma Acil Cerrahi Derg. 2025 Mar;31(3):214-220. doi: 10.14744/tjtes.2024.23583.

ABSTRACT

BACKGROUND: This study aimed to evaluate the efficacy of thrombopoietin (TPO), a growth factor and acute-phase reactant, as an early prognostic marker for predicting disease severity in patients with acute biliary pancreatitis.

METHODS: A total of 72 patients with acute pancreatitis admitted to the Ankara Numune Training and Research Hospital, General Surgery Department, were included in the study. The severity of acute pancreatitis was classified using the 2012 Revised Atlanta Classification, and blood samples were collected from each patient within the first six hours of hospitalization to measure TPO levels. TPO levels were then compared to C-reactive protein (CRP) levels and other prognostic scoring systems.

RESULTS: According to the Atlanta Classification, TPO levels were found to be statistically significant in distinguishing severe pancreatitis from moderate and mild cases. When evaluating the sensitivity and specificity ratios of serum TPO levels in predicting the severity of acute pancreatitis, a value of 81.61 pg/dL was identified, with a 86.6% sensitivity and 69% specificity. In our study, the accuracy of TPO levels in detecting severe pancreatitis was compared with other scoring systems. The Balthazar scoring system had the highest precision (area under the curve [AUC]: 0.905) in receiver operating characteristic (ROC) curve analysis for severe pancreatitis (95% confidence interval). Serum TPO levels were identified as the second strongest predictors of severe acute pancreatitis (AUC: 0.831).

CONCLUSION: These findings suggest that TPO is a valuable early marker and prognostic indicator for predicting disease severity in patients with acute biliary pancreatitis. However, further randomized studies with larger patient cohorts are still required.

PMID:40052310 | DOI:10.14744/tjtes.2024.23583

Stroke. 2025 Mar 7. doi: 10.1161/STROKEAHA.124.049140. Online ahead of print.

ABSTRACT

BACKGROUND: Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is recommended for secondary prevention in patients with a minor stroke or transient ischemic attack. However, the effectiveness of DAPT can be significantly influenced by genetic variations. This study aimed to estimate the impact of multiple single-nucleotide polymorphisms across various genes on DAPT efficacy using polygenic risk score (PRS).

METHODS: In this post hoc analysis, we included 2905 patients from the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events), which enrolled a total of 5170 patients in China between October 2009 and July 2012. The primary outcome was new stroke within 90 days. Sixteen single-nucleotide polymorphisms across 7 genes involved in clopidogrel metabolism were selected for PRS development. PRS were calculated by summing single-nucleotide polymorphisms from each individual. The Cox proportional-hazards regression model was utilized to estimate the hazard ratio (HR) and 95% CIs of PRS. The predictive value of PRS was estimated by C statistic and compared with a previously validated model.

RESULTS: The elevated PRSs were associated with an increased risk of new stroke within 90 days (P_trend=0.01). The efficacy of DAPT versus aspirin alone in preventing 1-year composite vascular events was significantly different between patients with low (adjusted HR, 0.47 [95% CI, 0.31-0.71]) and high PRSs (adjusted HR, 0.84 [95% CI, 0.60-1.18]; P_interaction=0.03). In patients receiving DAPT, higher PRSs were associated with increased risk of new stroke and composite vascular events at 90 days (adjusted HR per SD increase was 1.51 [95% CI, 1.15-1.99]) and at 1 year (adjusted HR per SD increase was 1.34 [95% CI, 1.08-1.67]). The C statistic for predicting 90-day new stroke using the PRS developed in this study was 0.57 (95% CI, 0.52-0.62), compared with 0.52 (95% CI, 0.48-0.55) for the ABCD-GENE score.

CONCLUSIONS: Using PRS integrating multiple genes may enhance the precision of secondary prevention strategies for patients with minor stroke or transient ischemic attack in the short and long term.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00979589.

PMID:40052280 | DOI:10.1161/STROKEAHA.124.049140

Cancer Rep (Hoboken). 2025 Mar;8(3):e70174. doi: 10.1002/cnr2.70174.

ABSTRACT

BACKGROUND: Robotic surgery has been associated with superior short-term outcomes in patients undergoing total mesorectal excision (TME) for organ-confined rectal cancer. However, whether this approach offers an additional benefit over laparoscopy when performing lateral pelvic lymph node dissection (LPLND) with TME or extended TME (e-TME) in locally advanced rectal cancer (LARC) is not known.

AIMS: This study was conducted to evaluate the outcomes of robotic and laparoscopic LPLND in patients with lateral pelvic node-positive LARC with reference to intraoperative safety, postoperative morbidity, pathological indices including nodal yield and node positivity rates, lateral pelvic recurrence rates, and short term event-free and overall survival.

METHODS AND RESULTS: In this retrospective single-center study, consecutive patients with non-metastatic histologically proven LARC and clinically significant lateral pelvic lymphadenopathy who had undergone laparoscopic or robotic LPLND with TME or e-TME between 2014 and 2023 were included, all procedures having been performed by minimal-access colorectal surgeons who were beyond the learning curve for either surgical approach. Of the 115 patients evaluated, 98.3% received neoadjuvant chemoradiotherapy, following which 27 (23.5%) underwent robotic and 88 (76.5%) laparoscopic LPLND with TME or e-TME. The baseline clinicodemographic features, treatment-related characteristics, and proportion of patients undergoing extended resections for persistent circumferential resection margin-positive rectal cancer (22.7% vs. 18.5%, respectively) were statistically similar in both groups. When comparing robotic with laparoscopic resections, no significant difference was observed in intraoperative parameters including procedure-associated blood loss (median 250 mL vs. 400 mL) and on-table adverse events or conversion rates (none in either group), postoperative outcomes comprising clinically significant early (14.8% vs. 9.1%), intermediate (5.3% vs. 1.9%) and late (5.3% vs. 2.0%) surgical morbidity, re-exploration rates (7.4% vs. 3.4%) and duration of hospital stay (median 6 days in both groups), or the pathological quality indices of margin involvement (7.4% vs. 2.3%), nodal yield (median 4 vs. 7 nodes) and lateral node positivity (22.2% vs. 26.1%), respectively. At a median 11 months follow-up, oncological outcomes in terms of lateral pelvic recurrence rates (3.7% vs. 4.5%), 2-year event-free survival (78.7% vs. 79.3%) and 2-year overall survival (83.1% vs. 93.8%) were also comparable.

CONCLUSION: Surgical competence in laparoscopy may offset the potential benefits extended by robotic platforms. In a high-volume setup with experienced minimal-access surgeons, the clinical, pathological, and short-term oncological outcomes associated with both approaches may be considered equivalent.

PMID:40052270 | DOI:10.1002/cnr2.70174

Stroke. 2025 Mar 7. doi: 10.1161/STROKEAHA.124.047747. Online ahead of print.

ABSTRACT

BACKGROUND: Various measures of abnormal left atrial (LA) structure or function (LA myopathy) are associated with a higher risk of ischemic stroke and dementia, independent of atrial fibrillation. However, limited data exist on their prognostic usefulness. Therefore, we aimed to assess the ability of markers of LA myopathy to improve the prediction of ischemic stroke and dementia.

METHODS: The ARIC study (Atherosclerosis Risk in Communities) is a prospective community-based cohort study. For this analysis, we included participants who attended visit 5 (2011-2013) without a history of stroke or atrial fibrillation and had a 12-lead ECG and a transthoracic echocardiogram. Markers of LA myopathy included P wave abnormalities from 12-lead ECG, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and LA volume and strain parameters from the echocardiogram. The primary composite outcome comprised ischemic stroke and dementia, which were ascertained through hospital surveillance, cohort follow-up, and death registries. To determine improvement in risk prediction of the composite outcome, each marker was individually added to a model that included CHA₂DS₂-VASc variables, and Akaike information criterion, C statistic, and its change were computed. Cox proportional hazards models were used to assess the independent association of LA myopathy markers with the outcome.

RESULTS: Among 4712 participants (59% female; mean age, 74 years), 193 ischemic strokes and 769 dementia cases were ascertained over a median follow-up of 8.3 years. Of LA myopathy markers, only LA reservoir strain and NT-proBNP significantly improved C statistic when added to the CHA₂DS₂-VASc model (base C statistic, 0.677) for the prediction of the composite outcome. Adding the LA reservoir yielded the highest increase in C statistic (0.010 [95% CI, 0.003-0.017]), and the model including the LA reservoir showed the lowest Akaike information criterion. In multivariable regression models, LA volume index, NT-proBNP, and LA strain parameters were significantly associated with the composite outcome.

CONCLUSIONS: Of various LA myopathy markers, LA reservoir yields the greatest improvement in the prediction of ischemic stroke and dementia, supporting its use to identify people at high risk of cerebrovascular events and dementia.

PMID:40052267 | DOI:10.1161/STROKEAHA.124.047747

Otolaryngol Head Neck Surg. 2025 Mar 7. doi: 10.1002/ohn.1184. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to describe and evaluate clinical and polysomnographic outcomes of the preservation palatopharyngoplasty procedure, which preserves pharyngeal mucosa and muscles, in patients with obstructive sleep apnea with high modified Mallampati scores (3 or 4).

STUDY DESIGN: A retrospective chart review.

SETTING: A tertiary medical center.

METHODS: A total of 23 patients who underwent preservation palatopharyngoplasty between November 2022 and May 2024 were included. Outcomes measured were apnea-hypopnea index (AHI), oxygen desaturation index (ODI), Epworth Sleepiness Scale (ESS) scores, and Nasal Obstruction Symptom Evaluation (NOSE) Scale scores pre- and postsurgery. Data were analyzed using unpaired or paired t-tests, and statistical significance was set at P < .05.

RESULTS: The mean age of included patients was 51.74 years. Postoperative results showed a significant 25.48% (standard deviation [SD] = 32.59) decrease in AHI (P = .0011) and 35.25% (SD = 11.00) mean decrease in ODI (P = .0030). REM sleep percentage increased from 12.96% to 21.35% (P = .0106), and REM AHI decreased from 55.49 to 40.02 events/h (P = .0255). Significant improvements were also seen in ESS (P = .0123) and NOSE scores (P = .0134). Among the included patients, 12 out of 23 patients achieved surgical success per Sher’s criteria.

CONCLUSION: The preservation palatopharyngoplasty significantly improved subjective and objective measures in OSA patients with higher Mallampati scores by enhancing upper airway patency and reducing OSA severity.

PMID:40052264 | DOI:10.1002/ohn.1184

Circ Heart Fail. 2025 Mar 7:e012484. doi: 10.1161/CIRCHEARTFAILURE.124.012484. Online ahead of print.

ABSTRACT

BACKGROUND: Heart rate (HR) affects heart failure outcomes, via uncertain mechanisms that may include left ventricular remodeling. However, in human ventricular myocardium, HR change has not been associated with a particular remodeling molecular phenotype.

METHODS: Patients with nonischemic dilated cardiomyopathy (N=22) in sinus rhythm and refractory to β-blockade for both HR lowering and reverse remodeling were randomized 2:1 double-blind to the HCN4 (hyperpolarization-activated cyclic nucleotide-gated potassium channel 4) channel inhibitor ivabradine or placebo for 24 weeks treatment while maintaining target doses of β-blockers. Reverse remodeling was measured by left ventricular ejection fraction (LVEF), and myocardial gene expression by sequencing RNA extracted from endomyocardial biopsies. The primary statistical analysis was between HR change categories divided at the median, which resulted in Decreased HR (N=90) and Unchanged HR (N=8) groups.

RESULTS: Respective HRs at baseline and 24 weeks were as follows: Decreased HR, 82.9±6.8 and 69.7±8.0 beats per minute (P=0.0005) and Unchanged HR, 80.8±5.7 and 79.2±11.6 beats per minute (P=0.58). All completing Decreased HR subjects were treated with ivabradine, whereas in the Unchanged HR group, 3 received ivabradine and 5 placebo. In Decreased HR, LVEF increased from 29.4±8.8% at baseline to 44.2±9.4% at 24 weeks (P=0.0003), compared with respective values of 26.6±11.4% and 29.2±12.0% (P=0.28) in Unchanged HR. HR and LVEF changes were not different from a previously conducted β-blocker nonischemic dilated cardiomyopathy study subdivided into LVEF responders and nonresponders. However, differentially expressed genes (N=151) in the Decreased versus Unchanged HR groups were >99% nonconcordant and therefore individually unique compared with β-blocker HR/LVEF responders versus nonresponders (2 shared differentially expressed genes). Multiple unique differentially expressed genes in Decreased HR including NRG1 upregulation are considered cardioprotective or involved in cardiac development.

CONCLUSIONS: In patients with nonischemic dilated cardiomyopathy in sinus rhythm, HR lowering per se (1) is associated with substantial left ventricular reverse remodeling; (2) its absence can cause β-blocker reverse remodeling nonresponse; and (3) when from HCN4 channel inhibition, results in a unique molecular phenotype.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02973594.

PMID:40052260 | DOI:10.1161/CIRCHEARTFAILURE.124.012484

Obesity (Silver Spring). 2025 Mar 6. doi: 10.1002/oby.24243. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to examine associations of computed tomography (CT)-derived musculoskeletal measures with demographics and traditional musculoskeletal characteristics.

METHODS: The Incorporating Nutrition, Vests, Education, and Strength Training (INVEST) in Bone Health trial (NCT04076618) acquired a battery of musculoskeletal measures in 150 older-aged adults living with overweight or obesity. At baseline, CT (i.e., volumetric bone mineral density, cortical thickness, muscle radiomics, and muscle/intermuscular adipose tissue [IMAT] area and density), dual-energy x-ray absorptiometry (DXA; i.e., areal bone mineral density, total body fat mass, appendicular lean mass, and lean body mass), and strength assessments (i.e., grip and knee extensor strength) were collected, along with demographic and clinical characteristics. Analyses employed linear regression and mixed-effects models along with factor analysis for dimensionality reduction of the radiomics data.

RESULTS: Participants were older-aged (mean [SD] age: 66 [5] years), mostly female (75%), and were living with overweight or obesity (mean [SD] BMI: 33.6 [3.3] kg/m²). Age was not significantly associated with most CT-derived bone, IMAT, or muscle measures. BMI was significantly associated with DXA and CT-derived muscle and IMAT measures, which were higher in male than female individuals (all p < 0.01). For the midthigh, muscle size was significantly related to grip and knee extensor strength (both p < 0.01).

CONCLUSIONS: Machine learning-derived CT metrics correlated strongly with DXA and muscle strength, with higher BMI linked to greater IMAT and poorer muscle quality.

PMID:40051020 | DOI:10.1002/oby.24243

J Health Popul Nutr. 2025 Mar 6;44(1):67. doi: 10.1186/s41043-025-00779-5.

ABSTRACT

BACKGROUND: Infectious diseases, including malaria, Hepatitis B surface antigen (HBsAg), and Hepatitis C virus (HCV), remain significant public health concerns in developing regions like Lafia, Nasarawa State, Nigeria. Socio-demographic factors, such as gender, age, income level, and access to healthcare resources, have been shown to influence the prevalence and outcomes of these diseases. Despite their importance, there is limited research exploring the interrelationship between these infections and socio-demographic factors within this region. The study aims to investigate the prevalence of malaria, HBsAg, and HCV among patients in Lafia, Nigeria, and to examine the relationship between these infections and socio-demographic factors. Specifically, it seeks to identify correlations between demographic variables, clinical manifestations, and health behaviors, such as mosquito net usage and vaccination status.

METHOD: A cross-sectional design was employed, involving 264 patients from Lafia, Nasarawa State, Nigeria. Data were collected using structured questionnaires which were pretested in a previous study to gather demographic information, vaccination status, and clinical symptoms. Laboratory assessments confirmed the presence of malaria, HBsAg, and HCV. Statistical analysis, including correlations between socio-demographic factors and disease prevalence were analyzed, and used to identify associations between socio-demographic factors, clinical manifestations, and disease prevalence.

RESULTS: Significant findings include a negative correlation between male sex and malaria infection (Pearson Correlation = -0.139, p = 0.024), a positive correlation between age and HCV prevalence (Pearson Correlation = 0.218, p < 0.001), and a negative correlation between the use of mosquito nets and malaria infection (Pearson Correlation = -0.231, p < 0.001). Additionally, HBsAg-positive individuals exhibited more pronounced clinical symptoms (Pearson Correlation = 0.173, p = 0.005), while higher income levels correlated with reduced mosquito net usage (Pearson Correlation = -0.144, p = 0.020). The study underscores the role of socio-demographic factors in shaping the prevalence of malaria, HBsAg, and HCV.

CONCLUSION: This study highlights the interplay between socio-demographic factors and the prevalence of malaria, HBsAg, and HCV in Lafia, Nigeria. It underscores the importance of comprehensive public health interventions tailored to the specific needs of the population to reduce disease burden and improve health outcomes, including health education, to address socio-economic vulnerabilities and promote preventive measures such as mosquito net usage. Addressing these factors could mitigate the burden of infectious diseases in Lafia and similar regions.

PMID:40051006 | DOI:10.1186/s41043-025-00779-5