Tag: statistics

J Craniofac Surg. 2025 Jun 19. doi: 10.1097/SCS.0000000000011565. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to analyze the changes in trabecular bone architecture in the condylar neck and angulus regions of the mandible in patients who were treated with surgically assisted maxillary extension (SARME) using fractal analysis (FA) techniques.

METHODS: The study included 37 patients who underwent SARME operation for maxillary transversal deficiency in the Department of Oral, Maxillofacial and Maxillofacial Surgery. Fractal values (FV) were measured from the right and left condyle neck and angulus on panoramic radiographs before and 6 months after the operation.

RESULTS: As a result of the analysis, statistically significant changes were found in the bilateral condyle neck in pre and postoperative FV scores (P<0.05), whereas the changes in the angulus region were not statistically significant (P>0.05).

CONCLUSIONS: This study concludes that changing occlusion and masticatory forces after SARME surgery change the bone structure in the condyle region of the mandible, increase trabeculation and therefore FV.

PMID:40536787 | DOI:10.1097/SCS.0000000000011565

NEJM Evid. 2025 Jun 19:EVIDoa2500115. doi: 10.1056/EVIDoa2500115. Online ahead of print.

ABSTRACT

BACKGROUND: A predictive model for early-stage classic Hodgkin’s lymphoma (cHL) does not exist. Leveraging patient-level data from large clinical trials and registries, we developed and validated a model that we term the Early-Stage cHL International Prognostication Index (E-HIPI) to predict 2-year progression-free survival (PFS).

METHODS: We developed the model using the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) guidelines in 3000 adults with newly diagnosed early-stage cHL from four international phase III clinical trials conducted from 1994 to 2011. External validation was performed in two cohorts, totaling 2360 treated patients from five international cHL registries (1996 to 2019). Two-year PFS was estimated using a Cox model with pretreatment variables selected using backward elimination. Internal validation corrected for overfitting. External validation assessed discrimination and calibration. The final model was also compared against European Organisation for Research and Treatment of Cancer (EORTC) favorable or unfavorable status.

RESULTS: The median age in the development cohort was 31.2 years; 77.4% had stage II disease. The estimated 2-year PFS was 93.7%. Final variables retained in the model were sex and continuous values of maximum tumor diameter (MTD), and levels of hemoglobin and albumin. The optimism-corrected C statistic in the development cohort was 0.63 (95% confidence interval, 0.60 to 0.69). Two-year PFS was lower in the validation cohorts 1 (90.3%) and 2 (91.6%). In validation cohort 1, the C statistic was 0.63 and the calibration slope was near 1, but overall calibration indicated underprediction, which improved on updating the intercept. The performance was similar in validation cohort 2. In addition, higher-risk E-HIPI scores were associated with worse outcomes in both the EORTC unfavorable and favorable subgroups. When included altogether in one Cox model, the E-HIPI was associated with PFS, whereas EORTC favorable or unfavorable status was not. Online risk calculators were developed (https://rtools.mayo.edu/holistic_ehipi/).

CONCLUSIONS: Utilizing objective, continuous, and readily available variables, we developed and validated a new prediction model for early-stage cHL. Male sex, lower hemoglobin or albumin levels, and higher MTDs were associated with worse PFS. (Funded by the National Cancer Institute; grant number, NCI R01 CA 262265-04.).

PMID:40536772 | DOI:10.1056/EVIDoa2500115

Ir J Med Sci. 2025 Jun 19. doi: 10.1007/s11845-025-03991-8. Online ahead of print.

ABSTRACT

BACKGROUND: Average screen time has increased drastically after the COVID-19 pandemic. It has raised concerns about the adverse effects, including the effect on BMI.

AIM: The present study is conducted to study the relationship between screen time and BMI among medical students at a medical institute in Lahore, Pakistan.

METHODS: For this cross-sectional study, a sample of 370 medical students and residents was obtained from a medical institute in Pakistan. An online survey to gather data about screen time activities, device usage, and BMI. Screen time was categorized into low (1-2 h/day), moderate (3-4 h/day), and high (5-6 h/day), while BMI score was calculated and categorized into under-weight, normal, overweight, and obese groups. Descriptive and inferential statistics including Spearman correlation analysis were applied using IBM SPSS 25.0.

RESULTS: Most participants fell into the normal BMI category (79%), with a smaller proportion classified as overweight (16%) or obese (5%). Most participants preferred using smartphones (92.1%). About 41% of participants had high screen time. There was a strong positive correlation between low screen time and normal BMI (r = 0.999). However, only 2.9% of the participants had low screen time. The link between higher screen time and obesity is observed especially in males, while females maintain a more stable normal weight, suggesting gender-based lifestyle or metabolic differences.

CONCLUSION: Screen time is significantly associated with BMI with a strong positive correlation as well. There is need to design educational programs to raise awareness about the safe use of devices and the amount of screen time.

PMID:40536737 | DOI:10.1007/s11845-025-03991-8

Ir J Med Sci. 2025 Jun 19. doi: 10.1007/s11845-025-03980-x. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by focal demyelinating lesions, axonal dysfunction/degeneration, and gliosis, which can lead to various clinical disabilities. Visual evoked potentials (VEP) is sensitive and repeatable techniques capable of monitoring significant short-term changes in neuroaxonal integrity and alterations in nerve conduction triggered by acute optic neuritis.

AIM: This study aims to evaluate whether VEP latency and amplitude could serve as subclinical predictors of clinical outcomes in MS patients over short-term follow-ups.

METHODS: This study was planned to include MS patients diagnosed according to the McDonald Criteria 18 who did not have any psychiatric, neurological, or ocular disorders that could interfere with the main purpose. The VEP test was performed for routine evaluation of demyelination or axonal damage.

RESULTS: A total of 83 patients were included in the study, with a mean age of 33.6 ± 9.3 years. Of all the patients, 54 were female (65.1%) and 29 were male (34.9%). Right pattern reversal visual evoked potential (PVEP) P100 (OR for PVEP1: 0.802, p = 0.001; OR for PVEP2: 0.879, p = 0.002) was statistically significant in showing right VEP abnormality at both baseline and at 6 months. Left VEP abnormalities were associated with left PVEP P100 at PVEP1 (OR: 0.852, p = 0.003) and left PVEP N75 at PVEP2 (OR: 0.935, p = 0.029).

CONCLUSION: VEPs have the potential to predict short-term subclinical stability or progression, making them valuable candidates for early treatment adjustments and evaluating future pharmacotherapy-supported remyelination.

PMID:40536736 | DOI:10.1007/s11845-025-03980-x

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11752-5. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to show that spectral computed tomography (CT) can identify different patterns of airway wall thickening and contrast enhancement in lung-healthy controls, coronavirus disease 2019 (COVID-19), and non-COVID-19 pneumonia patients, reflecting airway inflammation in both pneumonia subtypes and airway neovascularization in COVID-19.

MATERIALS AND METHODS: 331 subjects (age 58.9 ± 17.2 years) with 218 arterial and 113 venous phase spectral CT acquisitions were retrospectively recruited: 119 lung-healthy controls, 45 with COVID-19 and 167 with non-COVID-19 pneumonia. Scientific software was used for segmenting the airway tree. Wall thickness (WT_5-10) and the difference in median maximum airway wall attenuation (slope of the spectral attenuation curve) between 40 keV and 100 keV display energy were calculated and aggregated for subsegmental airway generations 5-10 (λHU_5-10). Descriptive statistics, correlations, t-tests, and ANOVA analyses were performed.

RESULTS: Arterial phase WT_5-10 was similarly increased in COVID-19 (1.70 ± 0.44 mm) and non-COVID-19 (1.64 ± 0.53 mm) pneumonia compared to controls (1.18 ± 0.34 mm, p < 0.001). Arterial phase λHU_5-10 was significantly higher in patients with COVID-19 pneumonia (3.09 ± 2.27 HU/keV) than in non-COVID-19 pneumonia (2.18 ± 1.54 HU/keV, p < 0.01) and lung-healthy controls (2.06 ± 1.11 HU/keV, p < 0.01).

CONCLUSION: Spectral CT shows significant differences in segmental wall thickness and airway contrast enhancement between COVID-19 and non-COVID-19 pneumonia and lung-healthy controls. Airway contrast enhancement may be a feasible measure to detect airway inflammation in pneumonia and neovascularization in COVID-19 pneumonia.

KEY POINTS: Question Is spectral CT airway contrast enhancement a feasible quantitative method to detect airway inflammation or neovascularisation? Findings Spectral CT shows significant differences in segmental wall thickness and airway contrast enhancement between COVID-19 and non-COVID-19 pneumonia, and lung-healthy controls. Clinical relevance Spectral CT can be used to assess inflammatory airway diseases such as cystic fibrosis, COPD, asthma and bronchiectasis.

PMID:40536704 | DOI:10.1007/s00330-025-11752-5

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11776-x. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and validate the chronic pancreatitis CT severity model (CATS), an artificial intelligence (AI)-based tool leveraging automated 3D segmentation and radiomics analysis of non-enhanced CT scans for objective severity stratification in chronic pancreatitis (CP).

MATERIALS AND METHODS: This retrospective study encompassed patients with recurrent acute pancreatitis (RAP) and CP from June 2016 to May 2020. A 3D convolutional neural network segmented non-enhanced CT scans, extracting 1843 radiomic features to calculate the radiomics score (Rad-score). The CATS was formulated using multivariable logistic regression and validated in a subsequent cohort from June 2020 to April 2023.

RESULTS: Overall, 2054 patients with RAP and CP were included in the training (n = 927), validation set (n = 616), and external test (n = 511) sets. CP grade I and II patients accounted for 300 (14.61%) and 1754 (85.39%), respectively. The Rad-score significantly correlated with the acinus-to-stroma ratio (p = 0.023; OR, -2.44). The CATS model demonstrated high discriminatory performance in differentiating CP severity grades, achieving an area under the curve (AUC) of 0.96 (95% CI: 0.94-0.98) and 0.88 (95% CI: 0.81-0.90) in the validation and test cohorts. CATS-predicted grades correlated with exocrine insufficiency (all p < 0.05) and showed significant prognostic differences (all p < 0.05). CATS outperformed radiologists in detecting calcifications, identifying all minute calcifications missed by radiologists.

CONCLUSION: The CATS, developed using non-enhanced CT and AI, accurately predicts CP severity, reflects disease morphology, and forecasts short- to medium-term prognosis, offering a significant advancement in CP management.

KEY POINTS: Question Existing CP severity assessments rely on semi-quantitative CT evaluations and multi-modality imaging, leading to inconsistency and inaccuracy in early diagnosis and prognosis prediction. Findings The AI-driven CATS model, using non-enhanced CT, achieved high accuracy in grading CP severity, and correlated with histopathological fibrosis markers. Clinical relevance CATS provides a cost-effective, widely accessible tool for precise CP severity stratification, enabling early intervention, personalized management, and improved outcomes without contrast agents or invasive biopsies.

PMID:40536703 | DOI:10.1007/s00330-025-11776-x

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11746-3. Online ahead of print.

ABSTRACT

OBJECTIVES: Body composition analysis (BCA) is a recognized indicator of patient frailty. Apart from the established bioelectrical impedance analysis (BIA), computed tomography (CT)-derived BCA is being increasingly explored. The aim of this prospective study was to directly compare BCA obtained from BIA and CT.

MATERIALS AND METHODS: A total of 210 consecutive patients scheduled for CT, including a high proportion of cancer patients, were prospectively enrolled. Immediately prior to the CT scan, all patients underwent BIA. CT-based BCA was performed using a single-slice AI tool for automated detection and segmentation at the level of the third lumbar vertebra (L3). BIA-based parameters, body fat mass (BFM_BIA) and skeletal muscle mass (SMM_BIA), CT-based parameters, subcutaneous and visceral adipose tissue area (SATA_CT and VATA_CT) and total abdominal muscle area (TAMA_CT) were determined. Indices were calculated by normalizing the BIA and CT parameters to patient’s weight (body fat percentage (BFP_BIA) and body fat index (BFI_CT)) or height (skeletal muscle index (SMI_BIA) and lumbar skeletal muscle index (LSMI_CT)).

RESULTS: Parameters representing fat, BFM_BIA and SATA_CT + VATA_CT, and parameters representing muscle tissue, SMM_BIA and TAMA_CT, showed strong correlations in female (fat: r = 0.95; muscle: r = 0.72; p < 0.001) and male (fat: r = 0.91; muscle: r = 0.71; p < 0.001) patients. Linear regression analysis was statistically significant (fat: R² = 0.73 (female) and 0.74 (male); muscle: R² = 0.56 (female) and 0.56 (male); p < 0.001), showing that BFI_CT and LSMI_CT allowed prediction of BFP_BIA and SMI_BIA for both sexes.

CONCLUSION: CT-based BCA strongly correlates with BIA results and yields quantitative results for BFP and SMI comparable to the existing gold standard.

KEY POINTS: Question CT-based body composition analysis (BCA) is moving more and more into clinical focus, but validation against established methods is lacking. Findings Fully automated CT-based BCA correlates very strongly with guideline-accepted bioelectrical impedance analysis (BIA). Clinical relevance BCA is currently moving further into clinical focus to improve assessment of patient frailty and individualize therapies accordingly. Comparability with established BIA strengthens the value of CT-based BCA and supports its translation into clinical routine.

PMID:40536702 | DOI:10.1007/s00330-025-11746-3

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11761-4. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to explore the prognostic value of primary tumor [¹⁸F]fluorodeoxyglucose (FDG) uptake in non-small cell lung cancer (NSCLC) patients treated with curative therapy, particularly when considered alongside the new 9th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system.

MATERIALS AND METHODS: A single-center retrospective study analyzed 3070 NSCLC patients who underwent pretherapeutic FDG PET/CT for initial staging. The survival analyses considered clinical variables, disease stage, and the primary tumor’s maximum standardized uptake value (SUVmax). Univariate and multivariate analyses evaluated the prognostic significance of disease stage and SUVmax in predicting overall and disease-free survival. A new staging system incorporating SUVmax is proposed and compared with the conventional staging.

RESULTS: Two thousand nine hundred seventy-two patients (mean age, 64.5 ± 10.1 years; 1888 men) were evaluated. Primary tumor SUVmax was an independent prognostic factor in the univariate and multivariate analyses for overall and disease-free survival, alongside disease stages. Integrating SUVmax into the staging system improved prognostic stratification, especially in intermediate stages (stage IIA vs IIB, hazard ratio [HR] = 1.06, p = 0.72 for the conventional stage; HR = 1.27, p = 0.04 for the new proposed stage with SUVmax). Survival analyses revealed significant distinctions between reclassified groups based on SUVmax, highlighting its potential for risk assessment refinement.

CONCLUSIONS: The primary tumor SUVmax adds prognostic value to the 9th AJCC/UICC staging system for NSCLC. The proposed staging system incorporating SUVmax demonstrates enhanced prognostic accuracy compared with the conventional system.

KEY POINTS: Question The new NSCLC staging system does not incorporate tumor metabolism, which may enhance prognostic accuracy and improve risk stratification. Findings Primary tumor FDG uptake was an independent prognostic factor for survival in NSCLC. Its integration into staging improved risk stratification. Clinical relevance Primary tumor FDG uptake provides prognostic information in NSCLC. Its incorporation into staging improved risk classification, particularly in intermediate stages, allowing for more precise prognostication based on metabolic activity.

PMID:40536701 | DOI:10.1007/s00330-025-11761-4

Eur J Orthop Surg Traumatol. 2025 Jun 19;35(1):260. doi: 10.1007/s00590-025-04381-7.

ABSTRACT

INTRODUCTION: Graft re-rupture is a devastating complication after revision ACLR surgery. The literature regarding the risk factors of graft re-rupture is sparse and not definitive. Studies have suggested that a smaller graft diameter is associated with poorer outcomes after primary ACLR, however there is a paucity of literature regarding the effects of graft size on revision ACLR outcomes. This study aims to determine the risk factors for graft re-rupture after revision ACLR, and investigate the optimum graft diameter for revision ACLR.

METHODS: The records of all patients who underwent revision ACLR from 2013 to 2021 were reviewed. Data collected included patient demographics, operative variables, and demographic details. To determine the optimal graft diameter, receiver operating characteristic (ROC) analysis was performed. Associations between re-rupture rate and return to pivoting sport, intra-articular knee pathologies, and graft diameter were assessed using contingency tables. Data were examined using univariable logistic regression models to explore the association between graft re-rupture after revision ACLR and prognostic variables. Co-variates with a p value p < 0.100 were included in a multivariable logistic regression model to identify independent associations with graft re-rupture.

RESULTS: In total, 132 revision ACLR were identified with a mean follow-up time of 3.22 ± 3.26 years. The graft re-rupture rate was 16.7% (n = 22). There were 91 (68.9%) males and 41 (31.1%) female with a mean age of 27.4 years (range 17.3-50.8 years) at revision. 87.9% (n = 116) were involved in one or more types of pivoting sports. Kaplan-Meier analysis showed that the mean survival time for revision ACL grafts was 148 months (95% CI 130-166). The mean graft diameter during revision ACLR was 9.26 mm (range 7.0-10.5 mm) and mean graft length was 43.6 mm (range 22.0-60.0 mm). No associated procedure such as anterolateral (ALL) reconstruction were performed. At the time of revision ACLR, MRI detected concomitant knee pathologies: medial meniscus pathology (n = 45; 34.1%), lateral meniscus pathology (n = 41; 31.1%), chondral pathology (n = 26; 19.7%). None were associated with an increased rate of re-rupture. Risk factors determined by the multivariable logistic regression model were graft diameter < 9 mm (OR: 3.873; 95% CI 1.128-13.293; p = 0.031) and return to pivoting sport after revision ACLR surgery (OR: 4.105; 95%CI 1.008-16.721; p = 0.049).

CONCLUSION: A graft diameter < 9 mm and return to pivoting sports after revision ACLR are risk factors for graft re-rupture. Meniscus pathology and chondral lesion were not associated with graft re-rupture. The findings of this study can be used to improve revision ACLR results for patients, but needs to be expanded in multi-centre trials with larger sample sizes.

PMID:40536685 | DOI:10.1007/s00590-025-04381-7

Eur J Orthop Surg Traumatol. 2025 Jun 19;35(1):257. doi: 10.1007/s00590-025-04355-9.

ABSTRACT

PURPOSE: Although surgical stabilization for displaced extra-articular scapular fractures is increasingly utilized, there remains limited evidence on predictors of functional recovery. This study aimed to evaluate long-term functional and radiographic outcomes after stabilization using the Brodsky posterior approach and to determine whether glenopolar angle or lateral border medialization independently predicts postoperative function. We hypothesized that improved radiographic parameters would be associated with better outcomes.

METHODS: This retrospective cohort included 16 patients with displaced extra-articular scapular fractures treated with open reduction and internal fixation via the Brodsky approach. Functional recovery was assessed using the Constant score at 48 months postoperatively. Pre- and postoperative glenopolar angle and lateral border medialization were measured. Paired comparisons and multiple linear regression were used to identify predictors of outcome.

RESULTS: All patients achieved full fracture union without complications or need for reoperation. The median Constant score of the operated shoulder was 94 (IQR 88-95), compared to 96 (IQR 93-96) in the contralateral shoulder (p = 0.002). Despite statistical significance, the 2-point difference did not exceed the minimal clinically important difference for shoulder function. Postoperative improvements in glenopolar angle and medialization were significant. The contralateral Constant score was the only independent predictor of postoperative outcome (β = 1.52, p = 0.001). Radiographic variables were not predictive.

CONCLUSION: The Brodsky approach yields excellent long-term outcomes. Although radiographic correction is achieved, the preoperative function of the contralateral shoulder remains the most reliable indicator of postoperative recovery potential.

PMID:40536675 | DOI:10.1007/s00590-025-04355-9