Tag: statistics

Orthop Nurs. 2026 Mar-Apr 01;45(2):115-122. doi: 10.1097/NOR.0000000000001198. Epub 2026 Mar 13.

ABSTRACT

The applicability of the phase angle in assessing nutritional status among older women remains unexamined. This study aimed to evaluate the usefulness of the phase angle for nutritional assessment in older women with hip fractures and determine the cutoff value for malnutrition and the minimal detectable change (MDC). In this study, a combined cross-sectional and longitudinal design was employed. A total of 138 older female inpatients with hip fractures admitted to one of three rehabilitation units were included. At admission, nutritional status was assessed using the Geriatric Nutritional Risk Index, and the phase angle was calculated by bioelectrical impedance analysis. At one of the rehabilitation units, the phase angle was also measured 1 month after admission. Data from 90 participants (mean age: 83.11 ± 6.79 years) were analyzed. The cutoff phase angle for identifying malnutrition was 3.975° (sensitivity: 0.882 and specificity: 0.740). The MDC was 0.768°. The phase angle may be useful as a screening tool for nutritional assessment in older women with hip fractures.

PMID:41849773 | DOI:10.1097/NOR.0000000000001198

Orthop Nurs. 2026 Mar-Apr 01;45(2):107-114. doi: 10.1097/NOR.0000000000001197. Epub 2026 Mar 13.

ABSTRACT

BACKGROUND: Upholding a sterile environment in orthopedic surgery is vital to minimize surgical site infections (SSIs). Among personal protective equipment, beard covers for surgical staff with facial hair have been recommended as a measure to prevent contamination. However, their effectiveness in reducing SSIs remains uncertain, especially in orthopedic procedures that often involve high-risk implants and extended exposure of surgical fields. This systematic review assesses the current evidence on the role of beard covers in infection prevention during surgery.

METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for studies investigating facial hair, beard covers, and infection risk. Eligible studies included comparative studies, laboratory experiments, and consensus statements. Quality was assessed using MINORS and CASP tools, while certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations criteria.

RESULTS: A total of 538 studies were extracted from databases, of which 8 met inclusion criteria. Clinical studies did not demonstrate a statistically significant difference in SSI rates between uncovered bearded surgeons, uncovered clean-shaven surgeons, or with the use of beard covers. Laboratory studies provided mixed results on bacterial shedding associated with facial hair. A consensus statement highlighted insufficient evidence to recommend beard covers as standard practice.

CONCLUSIONS: The current evidence is equivocal when determining the role for beard covers for SSI reduction in orthopedic surgery. Given the lack of evidence-based data, further high-quality research is needed to justify the routine use of beard covers in infection prevention and operating room protocols.

PMID:41849772 | DOI:10.1097/NOR.0000000000001197

Am J Dermatopathol. 2026 Apr 1;48(4):257-266. doi: 10.1097/DAD.0000000000003165. Epub 2025 Nov 13.

ABSTRACT

Secondary syphilis, caused by Treponema pallidum and known as the “the great imitator,” presents with varied manifestations that may mimic other skin conditions. Histopathology is critical when clinical or serologic findings are atypical, and this study analyzed its key features to improve recognition and reduce diagnostic errors. A systematic search was conducted in PubMed, Embase, and Cochrane. Statistical analyses were performed using R, version 4.3.2. A random-effects model was used to determine the proportion with 95% confidence interval (CI). Heterogeneity was assessed using Cochrane Q test and I2 statistics. Eight studies encompassing 384 patients and 460 lesions were included. The mean age was 38.1 years, and approximately 24% of the patients were female. The most common histological features were endothelial swelling, reported by five studies, with a prevalence of 85% (95% CI 0.75-0.96; I2 = 82.6%), and moderate to dense plasma cell infiltration, as reported by six studies, with a prevalence of 83% (95% CI 0.74-0.92; I2 = 90.7%). Acanthosis was observed in six studies, with a prevalence of 66% (95% CI 0.47-0.86; I2 = 96.0%), followed by perivascular inflammatory infiltrate, reported in five studies, with a prevalence of 64% (95% CI 0.37-0.90; I2 = 96.9%). Histopathology reveals consistent features, particularly endothelial swelling and plasma cell-rich infiltrates, in secondary syphilis, reinforcing its diagnostic value when clinical or serologic findings are inconclusive.

PMID:41849752 | DOI:10.1097/DAD.0000000000003165

N Engl J Med. 2026 Mar 18. doi: 10.1056/NEJMoa2513310. Online ahead of print.

ABSTRACT

BACKGROUND: Catheter-based closure of the left atrial appendage is an alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation. The effectiveness of this strategy, as compared with physician-directed best medical care, in patients at high risk for stroke and bleeding is unknown.

METHODS: In this multicenter randomized trial conducted in Germany, we assigned patients with atrial fibrillation and a high risk of stroke and bleeding to undergo left atrial appendage closure or to receive physician-directed best medical care (including direct oral anticoagulants, if eligible). The primary end point, tested for noninferiority, was a composite of stroke (ischemic or hemorrhagic), systemic embolism, major bleeding, or cardiovascular or unexplained death, assessed in a time-to-event analysis. The noninferiority margin was a hazard ratio of 1.3.

RESULTS: A total of 912 adult patients underwent randomization. The primary end-point analysis included 446 patients who were assigned to undergo left atrial appendage closure (device group) and 442 who were assigned to physician-directed best medical care (medical-therapy group). The mean (±SD) age was 77.9±7.1 years; 38.6% of the patients were women, the mean CHA₂DS₂-VASc score was 5.2±1.5 (range, 0 to 9, with higher scores indicating a greater risk of stroke), and the mean HAS-BLED score was 3.0±0.9 (range, 0 to 9, with higher scores indicating higher risk of bleeding). After a median follow-up of 3 years (interquartile range, 1.7 to 4.7), a first primary end-point event had occurred in 155 patients (incidence per 100 patient-years, 16.8) in the device group and in 127 patients (incidence per 100 patient-years, 13.3) in the medical-therapy group (difference in restricted mean survival time, -0.36 years; 95% confidence interval, -0.70 to -0.01; P = 0.44 for noninferiority). Serious adverse events occurred in 368 patients (82.5%) in the device group and 342 (77.4%) in the medical-therapy group.

CONCLUSIONS: Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to physician-directed best medical care with regard to a composite end point of stroke, systemic embolism, major bleeding, or cardiovascular or unexplained death. (Funded by the German Center for Cardiovascular Research; CLOSURE-AF ClinicalTrials.gov number, NCT03463317.).

PMID:41849741 | DOI:10.1056/NEJMoa2513310

JCO Clin Cancer Inform. 2026 Mar;10:e2500276. doi: 10.1200/CCI-25-00276. Epub 2026 Mar 18.

ABSTRACT

PURPOSE: This study assessed the feasibility of developing the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC)-Medicare-linked database infrastructure by integrating tumor registry, electronic health records (EHRs), and Medicare administrative claims data. The database was designed to support research identifying determinants of differences in cancer outcomes among patient populations commonly under-represented in clinical trials (based on the US population with the disease) including older adults.

METHODS: Patients 65 years and older who were diagnosed and/or received their first course of treatment for a primary tumor at UMGCCC from 2018 to 2021 were included in the database. A two-stage data linkage process was used to merge cancer center tumor registry data with EHR and Medicare claims data. We performed data quality and linkage quality checks. Summary statistics were calculated for patient and tumor characteristics.

RESULTS: Of the 3,322 patients identified from the tumor registry, 3,119 patients (94%) were included in the UMGCCC-Medicare database (mean age 73.1 years, 56% male, 31% Black). Lung cancers were the most common (15%) followed by oral cancers (12%) and non-Hodgkin lymphoma (6%).

CONCLUSION: The development of the UMGCCC-Medicare database serves as proof of concept for linking real-world data from different sources. The database is a valuable resource for research requiring detailed patient-level data and follow-up that may generate real-world evidence for older adults living in the United States and treated in routine oncology practice.

PMID:41849726 | DOI:10.1200/CCI-25-00276

J Craniofac Surg. 2026 Mar 18. doi: 10.1097/SCS.0000000000012617. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate how Clove Oil interacts with epithelial cells in human nasal tissue.

METHODS: Tissue samples taken during surgery were immediately submerged in sterile PBS containing antibiotics and transferred to the lab under cold-chain conditions. After several washes to remove residual blood or debris, the samples were centrifuged at 300 g. Before enzymatic digestion with 0.25% trypsin-EDTA at 37 °C, the tissue was deliberately broken down. Complete DMEM/F-12 medium neutralized the enzyme activity. To ensure cell adhesion and viability testing before treatment, 96-well culture plates were used. Clove oil was added to cells at doses of 1, 5, 15, 25, 50, 75, and 100 µL over 24 hours. To assess cell metabolic activity, the MTT colorimetric assay was used.

RESULTS: The inhibitory nature of the dose-response relationship was demonstrated by nonlinear regression analysis. The logIC50 value was 1.616, corresponding to an IC50 of 41.29 µL. There was a strong association between product dose and cytotoxic response, as evidenced by a consistent, reproducible effect and a high coefficient of determination (R2=0.9172).Clove oil treatment resulted in a concentration-dependent reduction in cellular metabolic activity, as assessed by the MTT assay. The treated cells showed a clear decrease in cell viability as the product volume increased, whereas the negative control group maintained 100% cell viability. In addition, statistical analysis showed that all clove oil concentrations significantly reduced cell viability compared with untreated controls. Further evidence of a dose-response relationship was that statistical significance increased with the addition of clove oil.

CONCLUSION: Despite clove oil’s promise in otolaryngology, it is essential to establish a safe therapy window. For conditions in which the function of the mucosal barrier and the health of the epithelial cells are critical, such as allergic rhinitis, rhinosinusitis, or upper respiratory tract infections, it can be administered topically by inhalation, nasal spray, or other nasal drug delivery systems. Further study, including in vivo tests, mucociliary function evaluations, and long-term exposure trials, is needed to establish its safety profile and guide its appropriate use in otorhinolaryngology.

PMID:41849713 | DOI:10.1097/SCS.0000000000012617

J Craniofac Surg. 2026 Mar 18. doi: 10.1097/SCS.0000000000012583. Online ahead of print.

ABSTRACT

OBJECTIVES: In the present study, we investigated the efficacy of nasal tip grafts for nasal tip shaping and for evaluating rhinoplasty outcome evaluation (ROE).

METHODS: Patients who underwent open rhinoplasty and received various grafts to improve tip support, including alar batten graft, alar rim graft, caudal septal extension graft, columellar strut, shield graft, tongue-in-groove, and tip-onlay graft, were included in this study (n=510). All follow-up items were recorded during the preoperative, early postoperative, and late postoperative periods. Rhinoplasty outcome evaluation scores, nasofrontal angle, and nasolabial angle were evaluated.

RESULTS: A statistically significant difference was observed between the mean preoperative and postoperative questionnaire scores in the graft groups (P<0.001). Shield graft, tongue-in-groove, and tip-onlay graft groups showed better results than many others. A statistically significant difference was observed between the preoperative and postoperative mean nasolabial angle values in the tongue-in-groove, shield graft, caudal septal extension graft, and columellar strut groups (P<0.001). In addition, a statistically significant difference was found between the preoperative and postoperative mean nasofrontal angle values across the graft groups (P<0.001), with significant changes observed in the tongue-in-groove, shield, caudal septal extension, and columellar strut groups. However, these changes in the nasofrontal angle are considered not directly related to the type of graft used but rather to the dorsal hump reduction performed in these patients.

CONCLUSION: These considerations underscore the limitation of attributing patient satisfaction solely to graft selection. They also highlight the importance of comprehensive preoperative counseling and multifactorial outcome assessment. Future studies using more controlled surgical variables or stratified analyses may help clarify the independent contribution of specific grafting techniques to both objective nasal angles and patient-perceived aesthetic success.

PMID:41849710 | DOI:10.1097/SCS.0000000000012583

J Craniofac Surg. 2026 Mar 18. doi: 10.1097/SCS.0000000000012580. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this paper is to investigate the feasibility and advantages of the gasket-seal technique using an autologous bone flap combined with artificial dura mater, following endoscopic transnasal resection of pituitary tumors.

METHODS: The clinical data of 144 patients who underwent endoscopic transnasal pituitary tumor resection surgery were collected from January 2020 to April 2024 at the Affiliated Hospital of Xuzhou Medical University. Thirty patients who underwent reconstruction with autologous bone flap combined with artificial dura mater using the Gasket-Seal technique were selected as experimental group A. The control group was divided into 2 subgroups, B and C: group B consisted of 47 patients with autologous bone flap combined with pedicled nasal septum mucosal flap, and group C consisted of 67 patients with autologous soft tissue (fat, fascia lata) combined with pedicled nasal septum mucosal flap. The operation time, intraoperative Kelly grading scale, incidence of postoperative complications, and postoperative nasal function scores of the 3 groups were compared. The Sinonasal Outcome Test-22 (SNOT-22) was used to evaluate the postoperative nasal function among the 3 groups.

RESULTS: The operation time of the patients in group A was 3.15 ± 0.68 hours. The operation times of groups B and C were 3.90 ± 0.77 hours and 3.61 ± 0.84 hours, respectively. The operation time was shortest in group A, which was the experimental group (P<0.05). No significant difference was observed in intraoperative Kelly grading among the 3 groups (P>0.05). There was no statistically significant difference in the incidence of postoperative complications among the 3 groups (P>0.05). The SNOT-22 score of patients in group A was 3.50 (range: 0.00-6.50) points. The SNOT-22 scores in groups B and C were 9.00 (range: 5.50-11.00) points and 10.00 (range: 8.00-13.00) points, respectively. The SNOT-22 score of patients in the experimental group was the lowest (P<0.05).

CONCLUSION: The gasket-seal reconstruction technique using an autogenous bone flap and artificial dura achieves close anatomic restoration of the sellar floor. This technique shortens the operation time, reduces nasal trauma, and protects olfactory function. It can be considered a viable option for clinical use.

PMID:41849709 | DOI:10.1097/SCS.0000000000012580

J Craniofac Surg. 2026 Mar 18. doi: 10.1097/SCS.0000000000012605. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative edema, ecchymosis, and delayed social recovery remain major concerns following implant-based rhinoplasty. Tranexamic acid (TXA) has been widely used to mitigate postoperative bleeding; however, the optimal route of administration in implant-based rhinoplasty remains controversial.

OBJECTIVE: This study aimed to compare the effects of different perioperative TXA administration strategies-local injection, topical application, and intravenous administration-on early postoperative recovery following implant-based rhinoplasty.

METHOD: This study included 82 patients undergoing primary implant-based rhinoplasty. Patients were allocated into 4 groups: no TXA (control), local TXA injection, topical TXA application via intraoperative soaked gauze, and intravenous TXA administration. Postoperative outcomes included edema and ecchymosis scores, pain scores, and time to social recovery. Assessments were performed on postoperative day (POD) 1, 3, 7, and 1 month. Group comparisons were performed using appropriate parametric or nonparametric statistical tests.

RESULT: Significant differences in early postoperative recovery were observed among groups. The topical TXA group demonstrated the lowest edema and ecchymosis scores on POD1 and POD3, followed by the local injection and intravenous TXA groups, while the control group consistently showed the poorest outcomes. By POD7, all TXA-treated groups showed improved recovery compared with controls; however, locally administered TXA remained superior to intravenous administration. At 1 month postoperatively, no clinically meaningful differences were observed among the 4 groups. Time to social recovery was shortest in the topical TXA group and longest in the control group.

CONCLUSION: Local administration of TXA, particularly topical intraoperative application, significantly improves early postoperative recovery following implant-based rhinoplasty. These benefits appear to be limited to the early postoperative period, with no impact on long-term outcomes. Topical TXA represents a simple and effective adjunct for enhanced recovery in aesthetic rhinoplasty.

PMID:41849708 | DOI:10.1097/SCS.0000000000012605

Clin Exp Dent Res. 2026 Apr;12(2):e70336. doi: 10.1002/cre2.70336.

ABSTRACT

OBJECTIVES: To evaluate the influence of operator access on surface roughness parameters and material loss following implantoplasty (IP).

MATERIAL AND METHODS: A total of 42 dental implants were utilized in this study, and three different implant designs. Two set-ups were used: a table-top, allowing unrestricted access, and a phantom-head, imposing limitations in access and better replicating the clinical situation. A combination of tungsten carbide burs and silicone polishers was used to perform IP on the implants. The total amount of time required for IP of each implant was measured for comparisons between modalities, and a 2D roughness profile analysis (R_a and R_z) was conducted using a contact stylus profilometer. The weight and the diameter of the implants were also measured before and after IP was performed.

RESULTS: A statistically significant difference was found between the R_a (p = 0.004) and R_z (p = 0.019) values of implants prepared under table-top conditions, being smoother, when compared to the ones prepared in the phantom head. The time required to perform IP was significantly different between the two different settings (p < 0.001) and between some implant types. The set-up in which IP was performed did not have a significant impact on the change in implant mass (p = 0.926) or in implant diameter (p = 0.721).

CONCLUSIONS: Implants treated with IP in the phantom-head set-up exhibited significantly greater surface roughness and required longer procedural time compared to those treated in the table-top model, but did not influence material loss.

PMID:41849691 | DOI:10.1002/cre2.70336