Tag: pubmed

Head Neck. 2025 Nov 21. doi: 10.1002/hed.70102. Online ahead of print.

ABSTRACT

BACKGROUND: Tracheostomy is frequently performed during flap-based reconstruction for head and neck cancer, but predictive factors and complications are not well established.

METHODS: A systematic review and meta-analysis was conducted per PRISMA guidelines. Studies of adult patients undergoing free or pedicled flap reconstruction were included. Pooled tracheostomy rates, predictors, and complications were analyzed using random-effects models. Heterogeneity was assessed with the I² statistic.

RESULTS: Twenty-six studies (27 029 patients) were included. The pooled tracheostomy rate was 54.6%, decreasing to 42.4% when routine tracheostomy studies were excluded. Advanced tumor stage, oropharyngeal site, bilateral neck dissection, prior radiotherapy, and smoking predicted tracheostomy. Flap type was not significantly associated. The overall complication rate was 16.3%, including airway issues (2.6%). No significant change in tracheostomy rates was observed over 30 years.

CONCLUSIONS: Tracheostomy use is influenced by tumor, surgical, and patient factors. Selective tracheostomy and validated risk tools may improve outcomes. Further prospective studies are needed.

PMID:41273066 | DOI:10.1002/hed.70102

Multivariate Behav Res. 2025 Nov 21:1-15. doi: 10.1080/00273171.2025.2570250. Online ahead of print.

ABSTRACT

Bayesian statistics have gained significant traction across various fields over the past few decades. Bayesian statistics textbooks often provide both code and the analytical forms of parameters for simple models. However, they often omit the process of deriving posterior distributions or limit it to basic univariate examples focused on the mean and variance. Additionally, these resources frequently assume a strong background in linear algebra and probability theory, which can present barriers for researchers without extensive mathematical training. This tutorial aims to fill that gap by offering a step-by-step guide to deriving posterior distributions. We aim to make concepts typically reserved for advanced statistics courses more accessible and practical. This tutorial will cover two models: the univariate normal model and the multilevel model. The concepts and properties demonstrated in the two examples can be generalized to other models and distributions.

PMID:41273045 | DOI:10.1080/00273171.2025.2570250

Womens Health (Lond). 2025 Jan-Dec;21:17455057251399891. doi: 10.1177/17455057251399891. Epub 2025 Nov 21.

ABSTRACT

BACKGROUND: Uterine rupture is a rare but serious complication in obstetrics, associated with maternal and fetal risks. This study evaluates its prevalence and outcomes in a Portuguese hospital.

OBJECTIVES: To assess the prevalence of uterine rupture in pregnancy, as well as the associated maternal and neonatal morbidity and mortality, in a hospital setting in Portugal.

DESIGN: A retrospective descriptive study was conducted.

METHODS: Retrospective review of complete uterine rupture cases (2019-2024) at the Local Health Unit of Tâmega e Sousa. Data included maternal characteristics, obstetric history and outcomes.

RESULTS: Among 10,447 deliveries, 13 cases of uterine rupture occurred (12.44/10,000), primarily in women with prior caesarean sections (84.6%). Abnormal cardiotocography (76.9%) and abdominal pain (23.1%) were common signs. Fetal extrusion occurred in 69.2%. No maternal deaths were recorded, but perinatal mortality was 7.7%. Post-partum haemorrhage affected 61.5%, with five transfusions required.

CONCLUSION: The prevalence of uterine rupture aligns with rates in developed countries. Caution is advised when using oxytocin in women with prior caesareans. Prompt detection and intervention are crucial to minimize complications.

PMID:41273021 | DOI:10.1177/17455057251399891

Brain Behav. 2025 Nov;15(11):e71042. doi: 10.1002/brb3.71042.

ABSTRACT

BACKGROUND: Mitochondrial D-loop methylation leads to abnormal cerebral angiogenesis. This study examines its role in vascular phenotypes of moyamoya disease (MMD).

METHOD: Blood samples from 96 intracranial artery stenosis/occlusion (ICASO) patients (35 MMD, 61 non-MMD) and healthy controls underwent methylation analysis. D-loop methylation levels were analyzed using chi-square, T-test, and Wilcoxon tests. Propensity score matching (PSM) adjusted for age and gender disparities. Combine clinical information with methylation data to build a diagnostic model. Further studies included the methylation levels in MMD patients carrying the RNF213 p.R4810K mutation and the methylation levels and possible mechanisms of human brain microvascular endothelial cells (hCMEC/D3) with RNF213 knockdown.

RESULTS: Healthy controls showed higher D-loop methylation than MMD (p < 0.05). Post-PSM, non-MMD ICASO patients showed higher D-loop methylation than MMD (p < 0.05). The AUC of the prediction model was 0.891 (95% CI, 0.821-0.961) after combining clinical information with methylation data. MMD patients with the RNF213 mutation exhibited reduced methylation at most sites, though not statistically significant (p > 0.05). RNF213 knockout in hCMEC/D3 enhanced proliferation, migration, and tube formation, while reducing apoptosis and DNMT1 expression, leading to decreased D-loop methylation and ROS level, increased ATP production and mitochondrial membrane potential.

CONCLUSION: There are differences in the methylation levels in the mitochondrial D-loop region between MMD and non-MMD ICASO. The methylation-metabolism-angiogenesis axis may represent a promising research direction for elucidating MMD pathogenesis.

PMID:41273014 | DOI:10.1002/brb3.71042

Brain Behav. 2025 Nov;15(11):e70851. doi: 10.1002/brb3.70851.

ABSTRACT

INTRODUCTION AND AIM: While chemotherapy contributes to the survival of cancer patients, it also leads to various psychological and physiological problems, increasing the need for supportive care. This study aimed to determine the relationship between psychological resilience, chemotherapy symptoms, and supportive care needs in patients undergoing chemotherapy.

METHOD: This is a descriptive and correlational study. Data were collected using the Descriptive Characteristics Form, the Psychological Resilience Scale (PRS), the Nightingale Symptom Assessment Scale (N-SAS), and the Supportive Care Needs Scale-Short Form (SCNS-SF). Data collection was conducted face-to-face in the chemotherapy unit of a university hospital. Analyses were performed using the Statistical Package for Social Sciences (SPSS) 29.0 and Hayes Process Macro V3.4.

RESULTS: A total of 113 patients participated in the study. The mean age of the participants was 56.91 years (SD = 10.917), the mean PRS score was 106.59 (SD = 5.194), the mean N-SAS score was 2.14 (SD = 0.423), and the mean SCNS-SF score was 72.58 (SD = 9.250). The effect of PRS on N-SAS was primarily direct and statistically significant (β = -0.019; p = 0.011). However, the effect of PDÖ on SCNS-SF was not statistically significant (β = 0.017; p = 0.752). Participants generally demonstrated high levels of psychological resilience, a low impact of symptoms on quality of life, and moderate levels of supportive care needs.

CONCLUSION: The psychological resilience levels of the patients were generally high. The impact of symptoms on patients’ quality of life was low. While an increase in symptoms negatively affected psychological resilience, the effect of psychological resilience on supportive care needs was limited and indirect.

PMID:41273000 | DOI:10.1002/brb3.70851

J Pediatr Orthop. 2025 Nov 6. doi: 10.1097/BPO.0000000000003153. Online ahead of print.

ABSTRACT

BACKGROUND: Although the Ponseti method is a gold-standard, noninvasive treatment for clubfoot, the bracing phase is often associated with complications, such as skin reddening, pressure sores, callus, pain, etc, leading to noncompliance and risk of recurrence. Despite its clinical relevance, very few studies have incidentally reported these. This study aims to assess the prevalence, progression, and resolution of brace-related complications to optimize brace design, improve compliance, and reduce recurrence rates.

METHODS: This prospective study was conducted at the MiracleFeet-supported Clubfoot Clinic in Khyber Teaching Hospital, Pakistan. Ninety-one clubfoot patients under age 2 years with postcasting Pirani score “0” were enrolled through convenience sampling. Complications were recorded at 24 hours, day 7, day 14, and day 30 using a standardized, pilot-tested questionnaire. Brace ease-of-use was assessed using an adapted USAID MiracleFeet tool. Descriptive statistics were applied using SPSS v29.

RESULTS: Among the recorded complications, skin reddening (75.8%) and pain (88%) were the most common complications at 24 hours, followed by blisters/sores (42.9%) and distal tibial swelling (26.4%). Both sores and swelling were notably consistent till day 7, affecting 41.8% and 25.3% of the patients, respectively. While most complications declined significantly by day 30, muscle atrophy and weakness peaked at 32% on day 14 and persisted in 24.2% of patients. Callus formation was also reported in 10% of patients. Sweating-related discomfort and abduction bar breakage (9 cases) appeared as late issues. Parental feedback showed generally favorable brace usability, with heel placement being most difficult. Most complications declined over time, although several persisted or appeared later, such as muscle atrophy and swelling; however, brace compliance was high regardless. No relapse occurred during the 6-month study period.

CONCLUSIONS: Given the lack of focused research, these findings underscore the need for improved brace design, more personalized follow-ups, and effective caregiver guidance. In low-resource settings, these will improve treatment protocols and help prevent disease recurrence.

LEVEL OF EVIDENCE: Level IV-Prospective case series on early brace-related complications in Ponseti-treated clubfoot patients.

PMID:41272987 | DOI:10.1097/BPO.0000000000003153

J Appl Clin Med Phys. 2025 Dec;26(12):e70379. doi: 10.1002/acm2.70379.

ABSTRACT

PURPOSE: This study evaluates the dosimetric accuracy of three image-guided radiotherapy (IGRT) imaging modalities, cone-beam computed tomography (CBCT), megavoltage computed tomography (MVCT), and image-guided kilovoltage computed tomography (IG-kVCT), using modality-specific HU-to-density (HU-D) calibrations. Dose calculations from IGRT images were compared to computed tomography simulation (CT-sim) references in phantoms and validated against measurements from head and neck and prostate patient plans to assess the feasibility of each modality for precise dose calculation in adaptive radiotherapy (ART).

METHODS: Two phantoms, the Tomo phantom HE and CIRS Thorax phantom, were used for HU-to-density (HU-D) calibration. IGRT images were acquired using Elekta Synergy XVI (CBCT) and Radixact X9 (MVCT and IG-kVCT), and calibration curves were generated for each modality. Dose distributions calculated from IGRT images were then compared with those from CT-sim in phantom studies. For measurement-based evaluation, 10 patient plans (head and neck and prostate cases) were delivered to a phantom and measured using the ArcCHECK system, and recalculated doses on CT-sim and IGRT images were compared to the measured doses. Gamma analysis was performed to assess dosimetric accuracy.

RESULTS: IG-kVCT showed the closest agreement with CT-sim, achieving gamma passing rates (GPR) of 99.8% ± 0.3% for 3%/3 mm and 98.5% ± 0.7% for 3%/2 mm criteria, with dose differences below 1%. CBCT and MVCT demonstrated slightly lower accuracy, with GPRs of 97.2% ± 1.1% and 96.5% ± 1.3% for 3%/3 mm, respectively, and dose differences up to 2%. Similar trends were observed when compared to measured doses. All IGRT modalities showed clinically acceptable agreement, and no statistically significant differences were found between CT-sim and any IGRT modality.

CONCLUSION: All three IGRT modalities demonstrated clinically acceptable accuracy for adaptive dose calculation with modality-specific HU-D calibration curves.

PMID:41272933 | DOI:10.1002/acm2.70379

Prostate Cancer Prostatic Dis. 2025 Nov 21. doi: 10.1038/s41391-025-01053-9. Online ahead of print.

ABSTRACT

BACKGROUND: AI is increasingly integrated within prostate cancer diagnosis pathway.

PURPOSE: To provide estimates of diagnostic accuracy of AI assistance for clinically significant prostate cancer (csPCa) via MRI.

MATERIALS AND METHODS: A systematic search of PubMed, Embase, Cochrane, Scopus and Web of Science from January 2017 to October 2024 was performed for studies on the diagnostic utility of AI for prostate MRI. Diagnostic performance metrics were synthesized through hierarchical summary receiver operating characteristic modeling with random-effects assumptions. Specially, to test inferiority and potential superiority of AI, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), cancer detection rate (CDR), and accuracy was pairwisely compared between AI and radiologists in study level using odds ratios (ORs) with Z-statistics.

RESULTS: 7398 patients from 29 studies with AI-vs-human pairwise comparison were included. When acting as an assistant to human readers, AI demonstrated superior performance compared to stand-alone human readers in diagnosing csPCa via MRI, specifically with higher sensitivity (86.5% vs 82.6%, P = 0.001), specificity (57.8% vs 50.0%, P = 0.028), PPV (64.3% vs 58.9%, P = 0.001), and NPV (82.9% vs 76.5%, P = 0.001) while maintaining comparable CDR (40.5% vs 38.6%, P = 0.093). When used as standalone readers, AI exhibited higher specificity (58.7% vs 48.7%, P = 0.026) but at the cost of reduced sensitivity (87.2% vs 90.1%, P = 0.017). Subgroup analysis indicated that readers of varying experience levels could all improve their diagnostic performance with AI assistance.

CONCLUSION: Integrating AI as an assistant in csPCa diagnostic workflows could enhance accuracy, particularly for less experienced readers.

CLINICAL TRIAL REGISTRATION INFORMATION: Trial Name: The efficiency comparison of radiologists with or without assistance of artificial intelligence in prostate cancer diagnosis: a meta-analysis. Registration date: April 17, 2024.

REGISTRATION NUMBER: CRD42024533016. Registration information available at: https://www.crd.york.ac.uk/PROSPERO/ .

PMID:41272268 | DOI:10.1038/s41391-025-01053-9

CNS Drugs. 2025 Nov 21. doi: 10.1007/s40263-025-01240-1. Online ahead of print.

ABSTRACT

BACKGROUND: Long-acting injectable antipsychotic (LAI) treatment is associated with improved adherence and reduced relapse and hospitalization rates, compared with oral antipsychotics, in patients with schizophrenia. TV-46000, an LAI formulation of risperidone, is approved for the treatment of schizophrenia in adults. TV-46000 administered once monthly (q1m) and once every 2 months (q2m) has previously been shown to be effective and safe in patients with schizophrenia in the phase 3 studies, RISE and SHINE. Here, the effect of long-term treatment with TV-46000 on psychopathological symptoms and severity of illness was evaluated.

METHODS: In RISE, patients were stabilized on oral risperidone for 12 weeks before randomization to subcutaneous treatment with TV-46000 q1m, q2m, or placebo (1:1:1) until study endpoint. Patients who successfully completed RISE (placebo and TV-46000 rollover cohorts) and newly recruited patients (de novo cohort) were eligible to enroll in SHINE to receive TV-46000 q1m or q2m for up to 56 weeks. Symptom severity was evaluated with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions-Severity (CGI-S) scale, and the Clinical Global Impressions-Improvement (CGI-I) scale, as prespecified exploratory endpoints from the RISE and SHINE studies.

RESULTS: Overall, 543 adult patients were enrolled in RISE (TV-46000 q1m, n = 183; q2m, n = 179; placebo, n = 181) and 333 in SHINE (TV-46000 q1m, n = 173 and q2m, n = 160; source groups: de novo, n = 106; placebo rollover, n = 55; TV-46000 rollover, n = 172). In RISE, PANSS total scores decreased after randomization to end of treatment (EoT) for TV-46000 (least squares mean [LSM] change [SE], q1m: -3.5 [0.69]; q2m, -4.9 [0.73]), but increased for placebo (1.1 [0.86]; P < 0.0001 for both TV-46000 q1m and q2m versus placebo). Corresponding changes from baseline to last assessment (LA) were -0.9 (0.97) for q1m, -0.2 (0.99) for q2m, and 7.4 (0.99) for placebo; P < 0.0001 for both versus placebo. Similar results were seen for the PANSS positive and general psychopathology subscales (P < 0.001 for both TV-46000 q1m and q2m versus placebo). These symptom improvements were maintained or improved in the TV-46000 q1m and q2m groups in SHINE, with notable improvements observed in patients without prior TV-46000 exposure. Similar results were observed in RISE and SHINE when PANSS scores were categorized by Marder factors of schizophrenia symptoms. CGI-I scores at EoT and LA were significantly better with TV-46000 than with placebo in RISE (LSM at EoT and LA: 3.3 and 3.6 for TV-46000 q1m, 3.2 and 3.6 for q2m; 3.9 and 4.4 for placebo, respectively [P < 0.0001 versus placebo]). These scores were maintained in the TV-46000 groups in SHINE, with larger improvements seen in the de novo cohort than in the placebo rollover and TV-46000 rollover cohorts.

CONCLUSIONS: Treatment with TV-46000 provided sustained overall symptom improvement in the RISE and SHINE studies in patients with schizophrenia who were stabilized on oral risperidone.

CLINICAL TRIALS REGISTRATION: RISE (ClinicalTrials.gov identifier: NCT03503318) and SHINE (ClinicalTrials.gov identifier: NCT03893825).

PMID:41272239 | DOI:10.1007/s40263-025-01240-1

Sci Rep. 2025 Nov 21;15(1):41165. doi: 10.1038/s41598-025-26521-z.

ABSTRACT

Corona discharge has been recognized for centuries, with sailors reporting the bluish glow of St. Elmo’s fire on ship masts during storms. In the early development of high-voltage engineering, researchers such as Townsend and Peek described the physical basis of this phenomenon as the ionization of air around a conductor when the electric field exceeds the strength of the surrounding medium. The result is a partial discharge that produces visible light, hissing sounds, ozone, and other reactive gases, while also creating radio interference and ultraviolet radiation. In modern transmission systems, these effects appear as wasted power, accelerated wear of insulators, shortened equipment lifetime, and environmental concerns. Although corona has been studied for decades, it continues to challenge the reliable and economical operation of high-voltage networks, particularly under changing weather conditions. This study investigates the phenomenon by analyzing its causes, effects, and mitigation strategies through a combination of theoretical modelling, simulation, and statistical analysis. Using MATLAB Simulink and Python, simulations were conducted under varying environmental conditions-including temperature, humidity, and pressure-as well as electrical parameters such as voltage and conductor design, using observed data to ensure practical relevance. Comparable data sources may be used in other national or regional contexts. Key statistical techniques, including linear and multiple regression, analysis of variance (ANOVA), t-tests, and Monte Carlo simulations, were applied to determine the most influential factors affecting corona discharge losses. Results confirmed that higher voltage levels and unfavorable environmental conditions significantly increase corona loss, while increased conductor spacing and the use of corona rings emerged as the most effective mitigation strategies. An economic analysis based on probabilistic modelling estimated potential annual savings of up to 455 million Egyptian pounds (EGP) for the Egyptian grid, serving as a representative case study. The analytical framework is general and can be applied to other national transmission systems with appropriate data. The findings offer data-driven insights for improving transmission efficiency, minimizing power losses, and enhancing the overall reliability and cost-effectiveness of high-voltage power systems.

PMID:41272217 | DOI:10.1038/s41598-025-26521-z