Category: Statistics

Cureus. 2025 Jun 23;17(6):e86617. doi: 10.7759/cureus.86617. eCollection 2025 Jun.

ABSTRACT

Coronary artery disease (CAD) is a major global cause of morbidity and mortality, driving ongoing improvements in percutaneous coronary intervention (PCI). Drug-eluting stents (DES) have largely replaced bare-metal stents (BMS) due to superior performance in reducing restenosis and the need for repeat revascularization. This systematic review compares the efficacy and long-term safety of DES versus BMS in patients undergoing PCI. A total of 13 studies, including randomized controlled trials and observational studies, were included, covering diverse populations and follow-up periods ranging from 1 to 14 years. Primary outcomes assessed were all-cause mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), and target lesion revascularization (TLR). DES, particularly second-generation devices, were consistently associated with lower rates of MACE, MI, and TLR compared to BMS. Everolimus-eluting stents (EES) showed the most favorable safety profile regarding stent thrombosis. Secondary outcomes included in-stent restenosis (ISR) and bleeding risks. Notably, the benefits of DES were more pronounced in patients with diabetes and complex coronary anatomy. Some studies suggested gender-based differences favoring DES in women, though subgroup findings were exploratory and not always powered for statistical comparison. A few long-term studies observed a narrowing of the efficacy gap between DES and BMS beyond 10 years, though the clinical relevance of this remains limited. Overall, the findings support the continued use of DES as the preferred option in most PCI settings, with individualized decisions based on lesion complexity, comorbidities, and patient adherence to dual antiplatelet therapy. Continued innovation in stent design and long-term patient monitoring remains essential to optimizing CAD outcomes.

PMID:40704276 | PMC:PMC12286641 | DOI:10.7759/cureus.86617

Cureus. 2025 Jun 22;17(6):e86560. doi: 10.7759/cureus.86560. eCollection 2025 Jun.

ABSTRACT

Objective The purpose of this study was to better understand the impact of a preexisting diagnosis of rheumatoid arthritis (RA) on patient hospital outcomes in acute coronary syndrome (ACS) in comparison to traditional ACS risk factors. Methods This retrospective study protocol included 673 patients hospitalized with ACS in the HCA Healthcare West Florida Division from January 1, 2016, to December 31, 2023. Analysis via logistic regression and negative binomial regression compared associations between patients with ACS as primary diagnostic codes during their hospital admissions who also had RA, considering demographics like age, sex, and race. Patient encounters and diagnoses were identified using ICD-10 codes. Regression models were used for our analysis due to the straightforward computation, increased reproducibility, ability to use both categorical and continuous variables, and capability to convert diagnostic codes into binary variables. Traditional risk factors for ACS were also included in multivariate analyses. These included current tobacco use, former tobacco use, alcohol use disorder, elevated BMI, hyperlipidemia (HLD), and diabetes mellitus (DM). Pregnant patients, patients below 18 years of age, patients missing demographic information, and patients with other autoimmune conditions were excluded from the study. Results For RA, the odds of in-hospital mortality were not significantly 0.779 times as likely (p-value 0.2252, 95% CI (0.520, 1.167)), and 30-day readmission odds were not significantly 0.948 times as likely (p-value 0.5671, 95% CI (0.789, 1.139)). RA resulted in a 1.034-factor statistically insignificant increase in length of stay (LOS) (p-value 0.3369, 95% CI (0.965, 1.108)). For the traditional risk factors, odds of in-hospital mortality were 1.071 times as likely for every one-year increase in age (p-value <0.0001, 95% CI (1.065, 1.077)), 1.285 times as likely for current smokers (p-value 0.0020, 95% CI (1.096, 1.507)), 0.970 times as likely for every one-point increase in BMI (p-value <0.0001, 95% CI (0.961, 0.980)), 0.647 times as likely for patients with HLD (p-value <0.0001, 95% CI (0.576, 0.726)), and 1.349 times as likely for patients with DM (p-value <0.0001, 95% CI (1.212, 1.502)). Age, DM, and alcohol use disorder resulted in statistically significant increased 30-day readmission. Age, male sex, Black race, other non-Caucasian races, former tobacco use, current tobacco use, DM, and alcohol use disorder resulted in statistically significant increased LOS. Conclusions RA was surprisingly associated with decreased in-hospital mortality and 30-day readmission in the setting of ACS despite an associated increased LOS, which needs to be investigated further. In terms of statistical significance, there was no difference in these outcomes in patients with RA versus patients without RA. HLD was unexpectedly associated with a significant decrease in in-hospital mortality, which requires further investigation. Meanwhile, the traditional risk factors, except BMI and HLD, continued to show worse outcomes with statistical significance in the same patient population. Longitudinal follow-up and further clinical investigation of these patient encounters will likely shed more light on these associations. This knowledge may prevent over-utilization of time, equipment, and resources when addressing hospitalized patients with RA presenting with ACS, particularly in acute care settings.

PMID:40704253 | PMC:PMC12284236 | DOI:10.7759/cureus.86560

Cureus. 2025 Jun 23;17(6):e86596. doi: 10.7759/cureus.86596. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Surgical site infections (SSIs) are a major contributor to postoperative morbidity, particularly in low- and middle-income countries, where infection control practices may be less stringent. This study evaluated the incidence and predictors of SSIs in patients undergoing open surgeries at a tertiary hospital in Chennai, India.

METHODS: A prospective cohort study was conducted over a two-year period, including 250 patients who underwent open surgeries. Patients were monitored for SSIs from surgery until discharge. Data on patient demographics, comorbidities, lifestyle factors, and surgical variables were collected. Statistical analysis included chi-square tests and multivariate logistic regression to identify independent predictors of SSIs.

RESULTS: The overall incidence of SSIs was 22 (8.8%). Risk factors significantly associated with SSIs were diabetes mellitus 12/73 (16.4%), smoking 5/23 (21.7%), alcohol consumption 6/24 (25.0%), emergency surgery 10/53 (18.9%), and contaminated wounds 9/20 (45.0%). Multivariate logistic regression analysis identified several independent predictors of SSIs. Diabetes mellitus was significantly associated with a higher risk of SSIs (odds ratio, OR: 3.21, 95% CI: 1.41-7.30, p = 0.005), as was undergoing emergency surgery (OR: 2.93, 95% CI: 1.19-7.23, p = 0.020). The presence of contaminated wounds was found to be the strongest predictor, with an OR of 5.82 (95% CI: 2.01-16.87, p = 0.001). Smoking also showed a significant association with increased SSI risk (OR: 2.52, 95% CI: 1.01-6.29, p = 0.048). Additionally, a longer duration of surgery was independently associated with SSIs (OR: 1.86, 95% CI: 1.07-3.21, p = 0.027).

CONCLUSION: SSIs were associated with diabetes, emergency surgeries, contaminated wounds, smoking, and prolonged surgical duration. These findings may help guide targeted preventive strategies.

PMID:40704248 | PMC:PMC12285689 | DOI:10.7759/cureus.86596

Cureus. 2025 Jun 22;17(6):e86564. doi: 10.7759/cureus.86564. eCollection 2025 Jun.

ABSTRACT

BACKGROUND AND AIM: Shock is a life-threatening state characterized by inadequate tissue perfusion to meet metabolic demand, leading to organ failure and death. Serum lactate, a byproduct of anaerobic metabolism, has been identified as a significant biomarker for assessing shock severity and predicting outcomes. This study aimed to evaluate the correlation between serial serum lactate levels and hospital outcomes in patients with shock admitted to the ICU at Manik Hospital.

METHODS: A prospective observational study was conducted, including 124 adult patients diagnosed with shock and admitted to the ICU between April 2023 and December 2023. Serum lactate levels were measured at admission and 24 hours later. Outcomes assessed included mortality, mechanical ventilation, ICU stay duration, and shock index. Data were analyzed using descriptive and inferential statistics, including Pearson correlation and receiver operating characteristic (ROC) curves.

RESULTS: The study participants had a mean age of 50.7 years, with hypovolemic shock being the most common condition, affecting 61.3% (n=76). A moderate positive correlation was found between serum lactate levels and the shock index at both admission (r=0.273) and 24 hours (r=0.293) (p<0.001). Elevated lactate levels at both time points were significantly associated with increased mortality and the need for mechanical ventilation (p<0.001). At admission, lactate predicted mortality with an area under the curve (AUC) of 0.765, which increased to 0.848 at 24 hours. Lactate also showed good predictive power for the need for mechanical ventilation, with AUC values of 0.737 at admission and 0.664 at 24 hours.

CONCLUSIONS: Elevated serum lactate levels, both at admission and 24 hours, were identified as strong predictors of mortality, mechanical ventilation, and prolonged ICU stay in shock patients. Serial lactate measurements were found to provide valuable prognostic information, aiding in early risk stratification and personalized patient management. Further research was recommended to validate these findings across multiple centers and explore the role of lactate clearance in predicting recovery.

PMID:40704246 | PMC:PMC12284338 | DOI:10.7759/cureus.86564

Cureus. 2025 Jun 23;17(6):e86582. doi: 10.7759/cureus.86582. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Lumbar spondylolisthesis often causes pain and disability, requiring surgical intervention. While prior studies explore the impact of body mass index (BMI) on outcomes following lumbar fusion, the effect of different surgical approaches, specifically transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF), across BMI categories remains unclear. This study evaluates patient-reported outcomes (PROs) following TLIF and LLIF in low-grade degenerative and isthmic spondylolisthesis, focusing on BMI stratification.

METHODS: This study retrospectively analyzes patients with low-grade degenerative and isthmic spondylolisthesis who underwent lumbar fusion between 2010 and 2023. Patients were stratified by BMI into the following four groups: non-obese (<30), class I (30-34.9), class II (35-39.9), and class III (≥40). It assesses PROs using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for pain at baseline and 12 months, comparing the achievement of minimal clinically important difference (MCID) between TLIF and LLIF.

RESULTS: This analysis included 72 patients showing significant improvements in ODI (mean change: 17.0; p<0.001) and VAS (mean change: 2.3; p<0.001) scores across all BMI categories at 12 months. TLIF and LLIF achieve similar rates of MCID, with no statistically significant differences between the surgical approaches (p=0.72). Non-obese and class II patients maintain sustained improvements.

CONCLUSION: Lumbar fusion using both open and minimally invasive (MIS) TLIF and LLIF leads to significant disability reduction across BMI categories, indicating that obesity does not contraindicate lumbar fusion. Surgical approach selection should focus on individual patient factors rather than BMI alone. Prospective studies with extended follow-up will further clarify the long-term impact of these approaches.

PMID:40704244 | PMC:PMC12285202 | DOI:10.7759/cureus.86582

Cureus. 2025 Jun 23;17(6):e86604. doi: 10.7759/cureus.86604. eCollection 2025 Jun.

ABSTRACT

STUDY DESIGN AND OBJECTIVE: A prospective observational study aimed to study the use of ultrasonographic location of the catheter tip as an alternative to on-table fluoroscopy in determining the correct placement of long-term vascular access devices (VADs) in children.

METHODS: The study was conducted in a large, tertiary care, teaching hospital in South India. A total of 30 consecutive paediatric haemato-oncology patients were planned for surgical insertion of long-term VADs (Hickman^TM catheter (Bard Access Systems, Salt Lake City, UT, USA) or Port-a-Cath^® (Smiths Medical, St. Paul, MN, USA)), recruited over a period of three months. The primary outcome of the study was to see if the ultrasonographic location of the catheter tip was in agreement with on-table fluoroscopy findings.

PROCEDURE: After surgical insertion of the long-term VAD, an intra-operative trans-thoracic ultrasonography of the heart was done prior to fluoroscopy. A four-chamber view of the heart was obtained using either the sub-xiphoid or apical view. With the heart chambers in view, 2 mL of saline was injected rapidly into the external port, and the corresponding turbulence was visualized in real-time on transthoracic echocardiography (TTE). Depending on the site of appearance of the turbulence, the catheter tip location was inferred (right atrium (RA), above the RA, or in the right ventricle (RV)). The location of the catheter tip was then verified using fluoroscopy. ​​​​Kappa statistics were calculated to obtain the degree of agreement between ultrasound and fluoroscopy.

RESULTS: We found a 92.5% overall agreement between ultrasound and fluoroscopy, which was significant (p-value <0.01). The degree of agreement was 100% for the RV positions, while it was 95.5% for the RA position, and 83.3% for the above RA.

CONCLUSION: Ultrasonographic confirmation of the vascular catheter tip position is a quick, easy-to-perform, cost-effective, and safe alternative to fluoroscopy.

PMID:40704230 | PMC:PMC12285746 | DOI:10.7759/cureus.86604

Ewha Med J. 2025 Jan;48(1):e9. doi: 10.12771/emj.2025.e9. Epub 2025 Jan 31.

ABSTRACT

This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.

PMID:40704207 | PMC:PMC12277885 | DOI:10.12771/emj.2025.e9

Adv Contin Discret Model. 2025;2025(1):114. doi: 10.1186/s13662-025-03972-2. Epub 2025 Jul 21.

ABSTRACT

A stochastic distributed delay epidemic model with Markovian switching and Allee effect is constructed, where the infectious disease transmission rate follows a mean-reverting Ornstein-Uhlenbeck process. Hybrid dynamic effects of Ornstein-Uhlenbeck process and Lévy jumps on infectious disease transmission are discussed. Stochastically, the ultimate boundedness of the positive solution is investigated. The existence of a unique global positive solution is studied. By constructing appropriate stochastic Lyapunov functionals, sufficient conditions for weak persistence of the infected population are investigated. The existence of a unique ergodic stationary distribution is discussed based on Hasminskii’s ergodic theory. Sufficient conditions for the extinction of infectious disease are discussed. Numerical simulations are carried out to show consistency with the theoretical analysis.

PMID:40704180 | PMC:PMC12279583 | DOI:10.1186/s13662-025-03972-2

MethodsX. 2025 Jul 12;15:103504. doi: 10.1016/j.mex.2025.103504. eCollection 2025 Dec.

ABSTRACT

This study proposes novel framework to enhance statistical process control (SPC) of water quality by addressing the pervasive issue of autocorrelation in time-series data. We investigate the characteristics of pH, turbidity, and KMnO₄ in Surabaya city’s water, revealing significant autocorrelation that compromises statistical independence assumption crucial for reliable SPC. To overcome this, Generative Adversarial Network (GAN) model was developed to generate decorrelated residual time-series. The efficacy of GAN model in reducing autocorrelation was quantitatively validated, achieving Mean Squared Error (MSE) of 0.0054, Root Mean Squared Error (RMSE) of 0.0738, and Mean Absolute Error (MAE) of 0.0556. Subsequently, these GAN-derived residuals were integrated into Multivariate Exponentially Weighted Moving Average (MEWMA) control chart for process monitoring. Phase I analysis detected 33 out-of-control signals; after identifying and removing outliers, process was brought under statistical control with no further out-of-control signals detected. However, subsequent Phase II online monitoring detected eight statistically significant out-of-control signals, indicating a potential loss of process stability over time. Our findings underscore the significant utility of GAN-based residual analysis as a robust strategy for mitigating autocorrelation effects in environmental water quality data. This approach leads to improved process monitoring and enables early anomaly detection, crucial for proactive water quality management.

PMID:40704177 | PMC:PMC12284534 | DOI:10.1016/j.mex.2025.103504

N Am Spine Soc J. 2025 Jun 18;23:100752. doi: 10.1016/j.xnsj.2025.100752. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Biportal endoscopic spine surgery offers advantages such as reduced postoperative pain and faster recovery, often enabling same-day discharge. However, the patient-specific factors influencing the need for inpatient admission remain unclear. This study evaluates variables contributing to overnight stays following biportal lumbar endoscopic decompression and proposes a predictive fragility score.

METHODS: A retrospective analysis of prospectively collected data was conducted on 84 consecutive patients undergoing one- or two-level lumbar endoscopic decompression at a single U.S. academic center. Patients with trauma, tumor, infection, or revision procedures were excluded. Cohorts were divided by discharge status: same-day discharge (outpatient) versus one or more night hospital stay (inpatient). A novel fragility score (4-21 points) incorporating age, body mass index (BMI), comorbidities, and procedure type was developed. Sarcopenia was assessed using the psoas muscle index (PMI), defined as the ratio of psoas to vertebral cross-sectional area on preoperative imaging. Cutoff values were analyzed via Youden’s J statistic and receiver operating characteristic analysis.

RESULTS: Same-day discharge patients were significantly younger (55.3 vs. 68.5 years; p=.0003) and had lower American Society of Anesthesiologists (2.0 vs. 2.7; p<.0001) and Charlson Comorbidity Index scores (1.6 vs. 3.5; p<.0001). No significant BMI difference was observed (p=.4341). Outpatients more frequently underwent discectomy; inpatients more commonly received ULBD and two-level decompression (p<.0001, p=.0014). A fragility score ≥11 predicted inpatient stay with an area under the curve (AUC) of 0.810, outperforming Modified 5-Item Frailty Index (AUC 0.640). PMI did not differ between groups (p=.6732), with AUCs of 0.417 overall, and 0.482 (males), 0.487 (females). Fragility score and PMI were weakly correlated (r=-0.130).

CONCLUSIONS: The proposed Outpatient Appropriateness Fragility Score effectively predicts inpatient admission after biportal lumbar decompression. Factors such as age, comorbidities, and surgical extent are more predictive than BMI or sarcopenia. This tool may guide preoperative planning and optimize resource utilization.

PMID:40704166 | PMC:PMC12284479 | DOI:10.1016/j.xnsj.2025.100752