Tag: statistics

Gynecol Oncol Rep. 2025 Sep 3;61:101944. doi: 10.1016/j.gore.2025.101944. eCollection 2025 Oct.

ABSTRACT

OBJECTIVES: Management of epithelial ovarian cancer presenting with moderate to large pleural effusion at first diagnosis is a clinical challenge. Several options are utilized with limited evidence including initial thoracoscopic evaluation, neoadjuvant chemotherapy (NACT) or some combination. We sought to evaluate the disease course and patterns of recurrence after triage to NACT.

METHODS: We included all clinical Stage IVA patients having moderate to large pleural effusions without radiologic evidence of a Stage IVB metastasis presenting to our institution between 2016 and 2021. Clinical outcomes and patterns of recurrence were evaluated using descriptive statistics and Kaplan-Meier curves.

RESULTS: There were 31 patients (7.5 % of new ovarian cancer cases) who met inclusion criteria with median age 68.0 years. Most had high grade serous histology (29; 93.5 %) and 3/27 (11.1 %) were BRCA positive. Factors influencing triage to NACT were effusion alone in 3 (9.7 %) patients whereas 14/31 (45.2 %) had ≥2 factors. Resolution of the effusion occurred after NACT alone in 23 (74.2 %). Eight patients never proceeded to surgery. Complete gross resection (CGR) of abdominal disease at interval debulking surgery (IDS) was achieved in 14/23 (60.9 %), residual disease (RD) ≤1 cm in 8/23 (34.8 %) and >1 cm in 1/23 (4.3 %). Chemotherapy response scores were available for 19/23 cases and did not correlate with survival. After IDS, all patients received adjuvant platinum-based chemotherapy for a median of 3 cycles and 4 patients received maintenance therapy (PARP inhibitor in 4, bevacizumab in 1). Median OS for the whole cohort was 30.5 months: 3-year OS was 0 % if no surgery (8 patients), 27.8 % if any visible disease after IDS (9 patients), and 71.4 % if CGR (5-year OS 64.3 %). Recurrence or progression occurred in 30/31 distributed as follows: abdomen alone (16/30, 53.3 %) versus abdomen and thorax (13/30, 41.9 %). Only 1 patient recurred in the thorax alone.

CONCLUSIONS: Limited evidence directs the best management for patients presenting with clinical Stage IVA disease. Our data represent a particularly high-risk subgroup which may be characteristic of patients with large pleural effusions and adds important information showing that approximately half of these patients have ≥2 indications to favor NACT, signifying their high-risk status. Despite this, when CGR in the abdomen was achieved at IDS, median OS was greater than 5 years.

PMID:40989964 | PMC:PMC12451284 | DOI:10.1016/j.gore.2025.101944

Plast Reconstr Surg Glob Open. 2025 Sep 22;13(9):e7110. doi: 10.1097/GOX.0000000000007110. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: In this study, we aimed to perform noninvasive acoustic quantification of digital arterial Doppler sounds and to determine the possibility of evaluating digital arterial circulation using the results of acoustic assessment.

METHODS: In this prospective study, we recorded the Doppler sounds of the radial and ulnar digital arteries of all digits of 25 volunteers (male, n = 10; female, n = 15) included in the study, converted these recordings into digital files, and analyzed them using a fast Fourier transform analyzer. We recorded the Doppler sound of each digital artery by means of (1) contralateral digital artery compression, (2) ipsilateral digital artery compression, and (3) no compression as a control. The analyzed parameters comprised the equivalent sound level (Leq), sound pressure difference between the maximum and minimum sound pressures (delta sound pressure), and frequency. In addition, the Doppler sounds of the contralateral and compression groups were acoustically compared with those of the control group by 2 examiners.

RESULTS: The contralateral compression group demonstrated a statistically lower Leq and greater delta sound pressure. In particular, the delta sound pressure had a higher sensitivity and specificity. The ipsilateral compression group had a significantly lower Leq and frequency. The Doppler sounds of the contralateral compression group resembled a staccato rhythm. The agreement rate of the kappa coefficients was high.

CONCLUSIONS: The patency of the digital artery is presumably high if the Doppler sound changes to a staccato rhythm upon compression of the contralateral digital artery.

PMID:40989945 | PMC:PMC12453366 | DOI:10.1097/GOX.0000000000007110

J Exp Orthop. 2025 Sep 22;12(3):e70431. doi: 10.1002/jeo2.70431. eCollection 2025 Jul.

ABSTRACT

PURPOSE: Medial meniscus posterior root tears (MMPRTs) are biomechanically comparable to total meniscectomy, leading to meniscal extrusion, increased tibiofemoral contact pressure and accelerated osteoarthritis (OA) in varus-aligned knees. While high tibial osteotomy (HTO) is effective in unloading the medial compartment, the added value of repairing the MMPRT during HTO remains debated. This systematic review and meta-analysis aimed to evaluate whether combined MMPRT repair and HTO provide superior short-term clinical and radiological outcomes compared to HTO alone.

METHODS: A systematic search of PubMed, Cochrane and Scopus was performed in March 2025. Comparative studies evaluating HTO with or without concurrent MMPR repair in patients with varus knee and medial OA were included. Primary outcomes were clinical scores (International Knee Documentation Committee [IKDC], Lysholm, Knee Society Score [KSS] and Hospital for Special Surgery [HSS]), radiographic parameters (joint line convergence angle [JLCA], hip-knee-ankle [HKA] angle and joint space width), meniscal extrusion and second-look arthroscopic findings. Statistical analysis was conducted using a random-effects model with Review Manager 5.4.

RESULTS: Eight retrospective comparative studies (n = 630 patients) met the inclusion criteria. MMPRT repair plus HTO demonstrated statistically higher IKDC scores (MD = 3.56; p = 0.001) compared to HTO alone; however, there were no significant differences between groups in terms of Lysholm, KSS function and HSS scores. Radiographically, minimal improvements were noted in JLCA (MD = -0.25; p = 0.006), without clear clinical implications. Meniscal extrusion did not differ significantly between groups (MD = 0.30; p = 0.72). Second-look arthroscopy revealed complete root healing in 22% of cases. The risk of bias was moderate to high.

CONCLUSION: Short-term follow-up shows that combining MMPRT repair with HTO yields statistically better IKDC clinical scores. Furthermore, the actual benefit of combining MMPRT repair with HTO in routine clinical practice is questionable. Prospective studies with longer follow-up are required to clarify the long-term clinical impact of MM.

LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis.

PMID:40989938 | PMC:PMC12451467 | DOI:10.1002/jeo2.70431

J Exp Orthop. 2025 Sep 22;12(3):e70417. doi: 10.1002/jeo2.70417. eCollection 2025 Jul.

ABSTRACT

PURPOSE: Early diagnosis of femoroacetabular impingement syndrome (FAIS) is essential. This systematic review aimed to identify biomarkers useful for diagnosing FAIS and predicting its progression to hip osteoarthritis. Our hypothesis was that there are biomarkers that are useful for the diagnosis and/or prognosis of FAIS. Our research questions were: (1) which biomarkers support diagnosis or screening of FAIS? and (2) which biomarkers predict disease progression?

METHODS: A systematic review using the PRISMA guidelines was conducted to investigate the relationship between biomarkers and FAIS. The diagnosis of FAIS was based on the criteria used in each original study, typically involving clinical symptoms and radiographic evidence of CAM or pincer morphology. The protocol for the review has been published in PROSPERO. Literature search was performed using three databases: Embase, MEDLINE and Cochrane Library. The initial search yielded 683 articles of which 16 articles were included for final analysis. Data from a total of 2134 participants were analysed. Sixty-eight unique biomarkers associated with FAIS were identified and measured.

RESULTS: Diagnostically, 19 biomarkers were identified, of which 12 could significantly detect a difference between patients with FAIS and healthy controls. Forty-two biomarkers predicting the association of FAIS with hip osteoarthritis or late FAIS were identified, of which 16 biomarkers were statistically significant. Only 4-aminobutyrate aminotransferase promoter (ABAT) and peroxisome proliferator-activated receptor gamma (PPARγ) were associated with both diagnosis and prognosis.

CONCLUSIONS: Biomarkers may support the diagnosis and monitoring disease progression in patients with FAIS. Twelve biomarkers may detect early changes, and 16 may predict progression to osteoarthritis. Further refinement is required to identify those most useful in clinical practice. ABAT and PPARγ may be linked to both diagnosis and progression. While primarily preclinical, these findings may improve diagnostic accuracy, reduce overtreatment and aid decisions regarding joint preservation strategies.

LEVEL OF EVIDENCE: Level III.

PMID:40989937 | PMC:PMC12451476 | DOI:10.1002/jeo2.70417

Arthroplasty. 2025 Sep 23;7(1):46. doi: 10.1186/s42836-025-00330-1.

ABSTRACT

BACKGROUND: Periprosthetic joint infection (PJI) is a serious complication that necessitates a complex treatment strategy. Single-stage exchange arthroplasty, combined with intravenous and intra-articular antibiotic infusions, has shown high efficacy in treating complex PJIs. However, the impact of this approach on hematologic parameters remains underexplored. This study aims to evaluate the postoperative trends in blood platelet count, white blood cell (WBC) count, and neutrophil count in patients undergoing single-stage exchange arthroplasty.

METHODS: A retrospective analysis was conducted on 313 patients who underwent single-stage revision for PJI between June 2010 and October 2022. Hematologic parameters were monitored for the first seven postoperative days. The delta between preoperative and lowest postoperative values for platelet, WBC, and neutrophil counts was calculated. Statistical analyses compared these changes between revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) groups.

RESULTS: Platelet count significantly decreased postoperatively, reaching its nadir on day 2.5 for rTHA and day 2.8 for rTKA. The delta in platelet count was higher in rTHA patients (73.5 × 10⁹/L) compared to rTKA patients (46.0 × 10⁹/L). The incidence of thrombocytopenia was higher in the rTHA group (28.7%) compared to the rTKA group (12.3%). Multivariate regression analysis identified rTHA and preoperative platelet levels as independent risk factors for greater postoperative platelet decreases. WBC and neutrophil counts initially increased postoperatively, peaking on day 1, and then gradually declined, with nadirs around day 4-5.

CONCLUSION: Single-stage revision for PJI is associated with significant postoperative decreases in platelet count, particularly in patients undergoing rTHA. However, this hematologic change did not result in bleeding complications and may not represent a major clinical concern in most patients. Routine monitoring remains advisable to guide perioperative management.

PMID:40988075 | DOI:10.1186/s42836-025-00330-1

BMC Chem. 2025 Sep 23;19(1):261. doi: 10.1186/s13065-025-01624-w.

ABSTRACT

The widespread clinical utilization of amlodipine-aspirin combinations, despite potential pharmacodynamic interactions and the high prevalence of drug-drug interactions in cardiovascular patients, necessitates robust analytical methods for pharmaceutical quality control and therapeutic drug monitoring. Current analytical approaches face limitations including lengthy analysis times, substantial solvent consumption, and high operational costs. This study presents a novel spectrofluorimetric method coupled with genetic algorithm-enhanced partial least squares (GA-PLS) regression for simultaneous quantification of amlodipine and aspirin in pharmaceutical formulations and biological plasma samples. Synchronous fluorescence spectroscopy at Δλ = 100 nm in 1% sodium dodecyl sulfate-ethanolic medium enhanced spectral characteristics, while chemometric approaches were essential to address remaining spectral overlap for accurate quantification. The GA-PLS approach demonstrated superior performance over conventional partial least squares regression, achieving relative root mean square errors of prediction (RRMSEP) of 0.93 and 1.24 for amlodipine and aspirin respectively, with limits of detection of 22.05 and 15.15 ng/mL. Genetic algorithm optimization reduced spectral variables to approximately 10% of the original dataset while maintaining optimal model performance with only two latent variables. Method validation according to ICH Q2(R2) guidelines demonstrated excellent accuracy (98.62-101.90% recovery) and precision (RSD < 2%) across the analytical range of 200-800 ng/mL. Statistical comparison with established HPLC reference methods showed no significant differences, while application in human plasma achieved recoveries of 95.58-104.51% with coefficient of variation below 5%. Multi-dimensional sustainability assessment using the MA Tool and RGB12 whiteness evaluation achieved an overall score of 91.2%, demonstrating clear superiority over conventional HPLC-UV (83.0%) and LC-MS/MS (69.2%) methods across environmental, analytical, and practical dimensions. The developed method provides a sustainable, cost-effective alternative for routine pharmaceutical analysis, demonstrating enhanced performance through intelligent variable selection and improved operational efficiency.

PMID:40988073 | DOI:10.1186/s13065-025-01624-w

Orphanet J Rare Dis. 2025 Sep 23;20(1):479. doi: 10.1186/s13023-025-04034-2.

ABSTRACT

BACKGROUND: Dystrophic epidermolysis bullosa (DEB) is a rare inherited skin disorder caused by mutations in the type VII collagen gene, leading to mucocutaneous blistering. Subsequent inflammation contributes to chronic wounds, scarring, and systemic complications. There is controversy over whether and how inflammation should be therapeutically targeted.

OBJECTIVE: This systematic review and meta-analysis aim to question tissue and systemic inflammation in DEB and identify inflammatory patterns and research gaps to improve patient management.

METHODS: A comprehensive search of MEDLINE via PubMed was conducted to identify studies examining “DEB and tissue or systemic inflammation”. Out of 663 studies identified, 37 met the inclusion criteria. Data for synthesis were extracted from studies assessing systemic inflammatory parameter levels in DEB patients. For outcomes with multiple available studies, we performed an exploratory network meta-analysis to compare the standardized mean difference in systemic inflammatory parameters across three patient groups: DEB patients, healthy controls, and patients with other types of epidermolysis bullosa (EB).

RESULTS: The point estimate results for IL-4, IL-6, tumor necrosis factor-alpha, C-reactive protein, immunoglobulin (Ig) A, IgG, and IgM, as well as anti-collagen VII, anti-BP230, anti-BP180 autoantibodies suggested elevated values in DEB patients compared to healthy patients or other EB patients. The estimated standardized mean differences showed lower values of interleukin (IL)-10, hemoglobin and serum albumin in DEB patients compared to controls or other EB patients.

CONCLUSION: Current evidence is limited by small and heterogeneous patient cohorts, variability in study designs and reporting methods, and a predominant reliance on observational and retrospective descriptive studies. Well-designed clinical trials and prospective studies are necessary to further investigate inflammatory pathways and assess the efficacy of (targeted) anti-inflammatory therapies but are difficult to perform and cost-intensive. AI tools for small-data may support research in this field. PROSPERO Registration Number CRD42024535352.

PMID:40988071 | DOI:10.1186/s13023-025-04034-2

BMC Emerg Med. 2025 Sep 23;25(1):184. doi: 10.1186/s12873-025-01361-2.

ABSTRACT

BACKGROUND/OBJECTIVES: Over the past 50 years, the concept of the golden hour of shock was established as one of the central tenets of emergency trauma medicine. A shorter duration of prehospital care correlates with a positive change in outcome in numerous studies. Dispatching by the public safety answering points has hardly been discussed to date. Thanks to improved vehicle safety, additional accident data is now available to the emergency call centers.

METHODS: We investigated the effects of third-party system emergency calls (TPS-eCalls), which have become mandatory in new passenger cars in the EU in 2018, on dispatching in the emergency medical services (EMS). For this purpose, we linked the data of a public-safety answering point (PSAP) and an EMS. All emergency service deployments from 01/01/2023 to 31/12/2023 were evaluated. N = 1546 rescue missions were dispatched after motor vehicle accidents (MVA), 111 after TPS-eCall-alerts, 1435 after conventional alerts.

RESULTS: Dispatching in the PSAP currently took longer after TPS-eCall alerts than conventional alerts (01:39 ± 01:40 min vs. 02:41 ± 02:01 min, p ≤ 0.001). The differences were only significant in the case of accidents involving ≤ 2 passengers.

CONCLUSIONS: TPS-eCall data will be available increasingly. The future expansion data availability offers the opportunity to include objective accident data (airbag deployment, number of occupants, change of velocity) in the dispatching process. Adequate technical connection can improve dispatching and shorten preclinical treatment, especially for complex events with more than 2 passengers.

PMID:40988067 | DOI:10.1186/s12873-025-01361-2

J Cannabis Res. 2025 Sep 23;7(1):67. doi: 10.1186/s42238-025-00334-3.

ABSTRACT

BACKGROUND: The evidence is mixed regarding how socioeconomic status (SES) it is related to cannabis use among adolescents. This study assessed the association between parental SES, measured as the highest level of completed education, and past 12 month cannabis use in older adolescents.

METHOD: Self-reported survey data from the first and second wave of a nationwide cohort study (Futura01) were used (n = 3328). Register information on parental education was linked to the survey data. Two measures of cannabis use were considered: any use during the past 12 months, and use 10 + times during the past 12 months. Control variables included demographics, family and school variables, conduct and emotional problems, and cannabis use at baseline. Multilevel Poisson regression was used to assess the associations.

RESULTS: Adolescents having parents with low SES had a lower risk for any cannabis use during the past 12 months, ranging from RR = 0.71 (95% CI = 0.49-1.01) in the unadjusted model to RR = 0.61 (95% CI = 0.42-0.87) in the most adjusted model compared to adolescents with parents having high SES. Compared to those with parents with high SES, those with parents with intermediate SES had lower risk for any cannabis use past 12 months, with RRs ranging from 0.79 (95% CI = 0.59-1.07) in the unadjusted model to RR = 0.71 (95% CI = 0.53-0.95) in the fully adjusted model. For use 10 + times, non-significant associations were observed.

CONCLUSION: Adolescents with parents with lower SES had a lower risk of any past 12 months cannabis use. For more frequent use, no statistically significant associations were observed.

PMID:40988061 | DOI:10.1186/s42238-025-00334-3

BMC Anesthesiol. 2025 Sep 23;25(1):450. doi: 10.1186/s12871-025-03374-7.

ABSTRACT

BACKGROUND: Intraoperative hemodynamic monitoring has advanced significantly over the past few decades, enhancing patient safety and improving perioperative outcomes. This survey aimed to examine current practices in intraoperative hemodynamic management in Austria.

METHOD: Between January 2024 and February 2024, members of the Austrian Society of Anesthesiology, Resuscitation, and Intensive Care Medicine (ÖGARI) with a registered email address (n = 1,839) were invited to participate in an anonymous web-based survey.

RESULTS: A total of 201 questionnaires were received, of which 177 were fully completed. When using intermittent oscillometry, 40% (71/177) of respondents measure blood pressure every three minutes during anesthesia induction. Nearly 45% (80/177) routinely insert an arterial catheter before anesthesia induction, using mean arterial pressure (MAP) to Guide blood pressure management. While 36% (61/168) consider a MAP of 60 mmHg critically low, 48% (80/168) set the threshold at 65 mmHg. Intraoperative hypotension is predominantly managed at individual discretion by 79% (140/177), while 12% (21/177) follow institutional standardized protocols. A pulse contour analysis monitor is available in 94% (166/177) of respondents, with 49% (87/177) reporting frequent use. Regarding the limited use of advanced hemodynamic monitoring in high-risk non-cardiac surgery patients, 64% (113/177) perceived its added value as too low, while 57% (100/177) cite a lack of experience in interpreting the parameters as a barrier to implementation.

DISCUSSION: This survey among ÖGARI members provides key insights into intraoperative hemodynamic monitoring in Austrian hospitals. The findings suggest that respondents largely follow international recommendations, particularly concerning general blood pressure thresholds, measurement intervals, and indications for advanced hemodynamic monitoring. However, hemodynamic management appear to be only partially standardized, with decisions primarily left to the discretion of the anesthetist.

TRIAL REGISTRATION: The study was prospectively registered in the German Clinical Trials Register (DRKS; registration number DRKS00033181 on December 6, 2023).

PMID:40988060 | DOI:10.1186/s12871-025-03374-7