Antibiotics for the uncomplicated acute sore throat to prevent invasive group A Streptococcus - a critical analysis of current evidence.

Lattice poses risks to patients with prior detachments. This study evaluates such patients' likelihood of rhegmatogenous retinal detachments (RRD) and retinal breaks (RB) and assesses the efficacy of prophylactic laser retinopexy and cryopexy. Retrospective cohort study using the TriNetX registry. Patients either with or without prior contralateral RRD/RB and also with fellow eye lattice were included. Logistic regression calculated the likelihood of RRD/RB in the fellow eye. The number needed to treat (NNT) was calculated for prophylactic laser retinopexy and cryopexy. Patients with prior unilateral RRD/RB had a higher likelihood of fellow eye RRD/RB than those without prior unilateral RRD/RB (OR: 4.47, 99% CI: 3.47-5.76). Myopia increased this likelihood (OR: 5.67, 99% CI: 3.80-8.48). The NNT to prevent one RRD was lower for patients with prior unilateral RRD (NNT: 4.63; 99% CI: 4.07-5.37) than those without (NNT: 43.29; 99% CI: 38.72-49.08). The NNT to prevent one RB was lower for patients with prior unilateral RB (NNT: 3.83; 99% CI: 3.37-4.44) than those without (NNT: 45.70; 99% CI: 39.99-53.30). Prior contralateral RRD/RB increases the likelihood of RRD/RB in fellow eyes with lattice. Prophylactic laser retinopexy and cryopexy reduce the number of fellow eye RRD/RB.

Break-even cost analysis. This study uses a break-even cost-effectiveness model to assess whether enoxaparin is cost-effective for venous thromboembolism (VTE) prophylaxis in patients undergoing posterior lumbar fusion (PLF). A 7-day course of enoxaparin 40mg daily was evaluated using average retail drug costs and literature-based treatment costs for symptomatic VTE. VTE rates after PLF at 2, 3-6, and 7-12 vertebral segments were identified in the TriNetX Diamond database (2018-2023) for patients without prophylaxis. A break-even model calculated the absolute risk reduction and number needed to treat (NNT) for cost-effectiveness. The 7-day enoxaparin course cost $411.34, and treating a symptomatic VTE cost $20,461.32. The overall VTE rate was 0.49%; rates were 0.38% (2-segment), 0.65% (3-6 segments), and 2.7% (7-12 segments). Enoxaparin was cost-effective only for 7-12 segment fusions (NNT=50). Sensitivity analyses demonstrated cost-effectiveness for all PLF and 3-6 segment fusions if drug cost is ≤$100.00, or for 2-segment fusions if ≤$50.00. Alternatively, it is cost-effective if VTE treatment costs ≥$100,000 (all PLF, 2-segment) or ≥$75,000 (3-6 segments). Enoxaparin is cost-effective for PLF of 7-12 segments but not for PLF of fewer than 7 segments. Lower drug costs or higher treatment costs could make prophylaxis cost-effective for PLF of fewer segments.

Attaining LDL-cholesterol target post major coronary event: Care gap, associated factors and clinical outcomes.

Aripiprazole once-monthly for patients diagnosed with bipolar I disorder: Number needed to treat, number needed to harm, and likelihood to be helped or harmed.

Venous thromboembolism (VTE) is a potentially life-threatening complication following orthopaedic surgery. While prophylaxis is well-established in joint arthroplasty, its role after Achilles tendon repair remains controversial. Despite being a soft-tissue procedure, prolonged postoperative immobilization increases VTE risk, with some studies reporting symptomatic rates as high as 7%. However, no prior studies have assessed whether pharmacologic VTE prophylaxis breaks-even in this population. A literature review and the TriNetX Research Network were used to identify symptomatic VTE rates within 30 days of primary Achilles tendon repair without pharmacologic prophylaxis. The cost of treating a symptomatic VTE was estimated from published data and adjusted to 2025 US dollars. Retail drug pricing was obtained from an online pharmacy database. A break-even analysis was conducted to determine the absolute risk reduction (ARR) and number needed to treat (NNT) required for aspirin (81 mg and 325 mg), warfarin (5 mg), enoxaparin (40 mg), and rivaroxaban (20 mg) to be cost-effective. A sub-analysis compared postoperative bleeding and transfusion rates in patients who received chemoprophylaxis versus those who did not. Among 8935 patients undergoing Achilles tendon repair without chemoprophylaxis, 47 developed a symptomatic VTE (0.526%). Aspirin and warfarin broke-even across all VTE rates, with NNTs ranging from 9217 to 10 547. Warfarin still broke-even when including international normalized ratio (INR) monitoring costs. Enoxaparin and rivaroxaban only broke-even at the highest VTE rate (7.2%), with NNTs of 131 and 390, respectively, and required higher VTE treatment costs to be justified. In this study, we found that aspirin 81 mg, aspirin 325 mg, and warfarin break-even for VTE chemoprophylaxis following Achilles tendon repair. Enoxaparin and rivaroxaban failed to break-even. Chemoprophylaxis decisions should be individualized, weighing patient risk and economic considerations.

Cardiovascular disease remains the leading cause of global mortality (19.8 million deaths in 2022; 32% of all deaths worldwide). Drug repurposing-extending approved agents beyond their original indications-has emerged as a high-impact strategy in cardiovascular prevention, offering reduced development timelines, established safety profiles, and faster implementation than de novo molecular development. Which repurposed cardiovascular agents demonstrate the most favorable pharmacoeconomic profiles, and how does the convergence of clinical benefit, patient risk stratification, and economic sustainability define the optimal hierarchy for cardiovascular prevention? Narrative review synthesizing evidence from 19 pivotal cardiovascular outcomes trials and European and American guidelines. No formal meta-analysis was applied. For 13 agents across 8 therapeutic classes, efficacy was quantified as relative and absolute risk reductions, and as the number needed to treat or to harm. Pharmacoeconomic value was assessed via incremental cost-effectiveness ratio in US dollars per quality-adjusted life year, integrating mortality in years of life lost and morbidity in years lived with disability. Primary outcomes included all-cause mortality, cardiovascular mortality, major adverse cardiovascular events, and heart failure hospitalizations. Three Incremental Cost-Effectiveness Ratio (ICER) tiers were identified: Low-cost (< $20,000/ Quality-Adjusted Life Year (QALY)): ramipril (Number Needed to Treat (NNT) 28), carvedilol (NNT 29), metformin ( NNT 9-15, highest Relative Risk Reduction (RRR) 38-42%), and generic statins - robust mortality benefits at negligible cost; Moderate-cost ($3,000-$50,000/QALY): empagliflozin (↓38% cardiovascular mortality, NNT 61), dapagliflozin (NNT 20 in Heart Failure with Reduced Ejection Fraction), liraglutide (NNT 51), semaglutide (NNT 43), colchicine (NNT 36, morbidity benefit only), and branded statins; High-cost ($80,000-$300,000/QALY): Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors (evolocumab NNT 63; alirocumab NNT 64) - proven benefit compromised by unaffordable biologic pricing. Pharmacoeconomic stratification of repurposed cardiovascular agents identifies 3 distinct tiers. Generic agents-ramipril, carvedilol, metformin, and statins-demonstrate the most favorable cost-effectiveness profiles and should form the basis of any prevention protocol. SGLT2 inhibitors and GLP-1 receptor agonists offer clinically meaningful benefits in secondary prevention when applied to populations meeting pivotal trial eligibility criteria. PCSK9 inhibitors remain cost-effective only in patients with very high cardiovascular risk and inadequate LDL control on maximally tolerated statin therapy.

The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained increasing adoption in recent years; however, it has been associated with a higher risk of wound-related complications compared with other surgical approaches. Silver-impregnated occlusive dressings have demonstrated antimicrobial potential, though their role in DAA THA remains underexplored. We conducted a retrospective cohort study with a historical control group, reviewing 321 consecutive primary DAA THAs performed by a single surgeon (September 2020-December 2025). Standard sterile gauze was used before August 2021 (n = 76) and a silver-impregnated occlusive dressing (AQUACEL® Ag SURGICAL; ConvaTec, Deeside, UK) thereafter (n = 245). Despite the chronological difference between cohorts, baseline demographic and clinical characteristics did not differ significantly between groups (Table1). The primary endpoint was acute surgical site infection(SSI) within 30 days (CDC criteria); all patients had ≥ 3 months follow-up to capture early wound-related reoperations as secondary outcomes. Four acute SSI events occurred (1.25%). SSI incidence was 3.94% (3/76) with gauze versus 0.41% (1/245) with the silver-impregnated dressing (Fisher's exact p = 0.043). This corresponds to an absolute risk reduction (ARR) of 3.54% (95% CI, 0.34-10.57) and a number needed to treat (NNT) of 29 (95% CI, 10-293). No deep PJI occurred. Given sparse events, adjusted analyses were considered exploratory; in a penalized (Firth) logistic model, silver dressing remained associated with lower odds of SSI, while higher BMI and diabetes were associated with higher odds. In this retrospective historical-control cohort, silver-impregnated occlusive dressing use was associated with a lower 30-day SSI rate after DAA THA. Given the low event rate and potential temporal confounding, these findings should be interpreted cautiously and warrant confirmation in larger studies.

To evaluate the cardiovascular efficacy and absolute benefit of glucagon-like peptide-1 receptor agonists (GLP-1RAs) by baseline estimated glomerular filtration rate (eGFR). PubMed and EMBASE were searched to 29 April 2026 for randomized placebo-controlled trials of GLP-1RAs in adults with type 2 diabetes or overweight/obesity that reported eGFR-stratified major adverse cardiovascular events (MACE). Hazard ratios (HRs) were extracted for eGFR < 60 and ≥ 60 mL/min/1.73 m2. Random-effects meta-analyses estimated pooled HRs within each eGFR stratum and the pooled ratio of HRs (RHR) comparing eGFR < 60 versus ≥ 60 mL/min/1.73 m2. Exploratory absolute risk reduction (ARR) and number needed to treat (NNT) were derived from placebo-group MACE risk and the corresponding pooled HR. Nine publications from eight trials were included, comprising 70 822 participants; 70 534 had eGFR-stratified MACE data. GLP-1RAs similarly reduced MACE risk among participants with eGFR ≥ 60 and < 60 mL/min/1.73 m2, with pooled HRs of 0.83 (95% CI 0.77-0.90; p < 0.001; I2 = 35.6%) and 0.83 (95% CI 0.74-0.93; p < 0.001; I2 = 40.9%), respectively. The pooled RHR showed no evidence of effect modification (1.02, 95% CI 0.85-1.21; p = 0.84). ARR was larger with eGFR < 60 than ≥ 60 mL/min/1.73 m2 (2.6% vs. 1.6%), corresponding to NNTs of 39 (95% CI 26-91) versus 62 (95% CI 46-101). GLP-1RAs reduced MACE risk similarly across eGFR strata, while lower eGFR was associated with a larger estimated absolute cardiovascular benefit. These findings support GLP-1RA therapy in individuals with reduced kidney function.

Oral cavity squamous cell carcinoma (OCSCC) driven by areca nut consumption-a Group 1 carcinogen affecting 600 million people globally-represents a significant unmet need in precision prevention. Despite the known role of COX-2-mediated inflammation in this etiologic niche, pharmacological strategies remain under-evaluated. We emulated a target trial using a nationwide matched cohort of 50,606 areca nut chewers from the Taiwan National Health Insurance Research Database (2008 to 2021). To minimize selection and immortal time biases, we utilized time-dependent exposure modeling and Fine-Gray subdistribution hazard models to account for competing mortality. Aspirin initiation was associated with a significantly lower risk of incident OCSCC (adjusted sHR, 0.75; 95% CI, 0.65-0.87; P<.001). We identified a robust dose-response relationship, with a 43% risk reduction observed in the high-cumulative-exposure group (≥ median cDDD; sHR, 0.57; 95% CI, 0.47-0.69). The exploratory estimated 5-year number needed to treat (NNT) was 249 for the high-dose group. Sensitivity analyses, including E-value assessment (2.89) and landmark tracking, confirmed the stability of this association against unmeasured confounding and reverse causality. Our findings provide large-scale human evidence that sustained aspirin use significantly alters the trajectory of oral field cancerization in areca nut chewers. This study identifies aspirin as a high-priority candidate for risk-stratified chemoprevention in global populations with high areca nut exposure.

The Smokerface poster campaign for adolescent smoking prevention in schools: A cluster-randomized controlled trial.

Systemic thrombolysis is recommended for high-risk PE and select intermediate-risk patients. We assessed the robustness of RCT evidence comparing systemic thrombolytic therapy with standard anticoagulation. We systematically reviewed RCTs of intravenously administered alteplase or tenecteplase versus heparin. The primary endpoint was all-cause mortality; secondary endpoints included recurrent PE, clinical deterioration in intermediate-risk patients, and major bleeding. Fragility index (FI) or reverse FI (RFI) and fragility quotient (FQ) or reverse FQ (RFQ) were calculated to assess outcome stability. Absolute and relative risk reductions, number needed to treat (NNT), and number needed to harm (NNH) were also derived. Nine RCTs enrolling 1,682 patients met inclusion criteria. Overall, systemic thrombolysis was associated with a nonsignificant reduction in mortality (1.7% vs. 3.8%; RR 0.73; 95% CI 0.39-1.38; p = 0.33) with moderate robustness (RFI = 8; RFQ = 0.004; NNT 91; RRR 27%; ARR 2.1%). Mortality was highly fragile in high-risk PE (RFI = 0) and fragile in intermediate-risk patients (RFI = 4). Systemic thrombolysis moderately reduced recurrent PE (RR 0.42; 95% CI 0.18-0.97; FI = 5; RFQ = 0.002) and prevented clinical deterioration in intermediate-risk patients (RR 0.31; 95% CI 0.15-0.65; FI = 8; RFQ = 0.006; NNT 29; RRR 71%; ARR 3.5%). Major bleeding was robustly increased (FI = 30; RFQ = 0.001; NNH 17), mainly driven by tenecteplase (FI = 9; RFQ = 0.007; NNH 11), whereas alteplase showed no significant increase (RFI = 3). Mortality benefit of systemic thrombolysis is fragile, while major bleeding risk is robust, underscoring the limitations of current guidelines and the need for adequately powered RCTs to inform individualized treatment in high- and intermediate-risk PE.

The European Association of Urology 2024-2025 guidelines recommend conservative management as first-line therapy for pediatric phimosis before considering surgical intervention. Balloon catheter dilation treatment (BCDT) has emerged as a promising foreskin-preserving approach, yet high-quality comparative evidence against conventional circumcision (CC) remains limited. This study aimed to compare the clinical efficacy, safety outcomes, and family-centered measures between BCDT and CC in a pediatric cohort. This retrospective cohort study enrolled 200 boys (aged 2-12 years) with Kikiros grade ≥ 2 phimosis treated between January and December 2024 at a tertiary pediatric surgery center. Patients were allocated to BCDT (n = 100) or CC (n = 100) groups based on treatment received. Primary outcomes included cure rates (Kikiros grade 0-1) at 6 months. Secondary outcomes encompassed procedure-related parameters, complication rates, pain assessment using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, healing time, parent-reported satisfaction, and health literacy-associated compliance measures. Propensity score analysis confirmed baseline comparability. Number needed to treat (NNT) and effect sizes (Cohen's d) were calculated to quantify clinical significance. Both treatments achieved high 6-month cure rates (BCDT: 98.0% vs. CC: 100.0%; P = 0.497; absolute risk difference: 2.0%, 95% CI: -0.7% to 4.7%). BCDT demonstrated substantial advantages in procedure efficiency (mean operative time: 5.03 ± 0.62 vs. 29.38 ± 6.69min; P < 0.001; Cohen's d=-5.13) and recovery parameters (healing time: 6.74 ± 2.13 vs. 15.90 ± 3.06 days; P < 0.001; Cohen's d=-3.47). Pain-related outcomes significantly favored BCDT: lower incidence (65.0% vs. 99.0%; P < 0.001; NNT = 3), shorter duration (21.2 ± 14.0 vs. 93.2 ± 55.6h; P < 0.001), and reduced FLACC scores at 24h (2.59 ± 1.44 vs. 5.22 ± 2.07; P < 0.001; Cohen's d=-1.48). Edema occurrence was substantially lower in the BCDT group (60.0% vs. 100.0%; P < 0.001; NNT = 2.5). Parent satisfaction rates (score 5, very satisfied) were 96.0% and 88.0% for BCDT and CC, respectively (P = 0.068). Parent health literacy (Newest Vital Sign score) positively correlated with home care compliance (r = 0.42; P < 0.001), with adequate literacy (NVS ≥ 4) associated with significantly better adherence (3.21 ± 0.58 vs. 2.74 ± 0.71; P < 0.001). In this retrospective cohort, BCDT achieved short-term (6-month) cure rates non-inferior to CC while offering clinically meaningful advantages in procedural simplicity (6-fold reduction in operative time), pain mitigation (34% absolute reduction in incidence), accelerated healing (2.4-fold faster), and enhanced parent satisfaction. As a foreskin-preserving, minimally invasive option requiring only topical anaesthesia, BCDT may be considered for carefully selected symptomatic children with pathological phimosis, within a stepwise conservative management strategy that includes watchful waiting and topical corticosteroids as first-line therapy. Routine intervention for asymptomatic physiological phimosis is not supported by these data, and durable cure, long-term recurrence prevention, and broad first-line adoption require confirmation in prospectively designed studies with follow-up extending beyond puberty. Outcomes are optimised when supported by adequate parent health literacy for post-procedure home-care adherence.

In the SELECT trial, semaglutide reduced major adverse cardiovascular outcomes (MACE) in individuals with overweight or obesity and established cardiovascular disease (CVD) but without diabetes. However, real-world cardiovascular event rates in comparable populations remain uncharacterised. We therefore aimed to (1) assess real-world cardiovascular outcomes in a SELECT-like cohort with obesity, (2) compare them to the general population and a broader population of individuals with obesity and (3) evaluate the cardiovascular preventive potential of semaglutide in this SELECT-like cohort with obesity. We used healthcare registries and electronic health records from three Swedish regions (2013-2023), covering ~40% of the national population, to identify individuals aged ≥ 45 years with obesity (body mass index [BMI] ≥ 30 kg/m2) and established CVD but without diabetes, in alignment with the SELECT trial criteria. Cardiovascular outcomes in this SELECT-like obesity cohort were compared with matched individuals from the general population as well as with a broader population of individuals with obesity, irrespective of CVD status or other comorbid conditions. To estimate the number needed to treat (NNT), the relative treatment effect of semaglutide observed in the SELECT trial was applied to the absolute risks identified in the SELECT-like obesity cohort. The SELECT-like obesity cohort (n = 9652) had a mean (SD) age of 68.4 (11.3) years, a mean BMI of 33.1 kg/m2 (SD 3.5) and 57.9% were men. Most had a history of myocardial infarction (48.1%) or stroke (41.7%). Over a mean (SD) follow-up of 5.4 (3.2) years, MACE occurred in 21.7%. Compared with the SELECT trial, this real-world population had a higher mean age, had a higher proportion of females, and more often had a prior stroke. Applying the estimated effect of semaglutide from the SELECT trial, the NNT to prevent one MACE was 35 (95% CI, 24-66). Compared with the General population cohort (n = 48 260), the SELECT-like obesity cohort had a higher burden of cardiovascular and obesity-related comorbidities and an increased risk of adverse cardiovascular outcomes, including MACE (HR 2.3 [2.2-2.4]) and heart failure (HR 2.7 [2.5-2.9]). In a real-world setting, despite the use of extensive preventive medications, individuals with obesity and CVD had a higher risk of adverse cardiovascular outcomes and mortality compared with the SELECT trial as well as the general population. These findings highlight the substantial disease burden and the need for improved secondary CVD prevention strategies.

Abstract Background Recent meta-analyses show that beta-blockers benefit patients with mildly reduced left ventricular ejection fraction (LVEF) after myocardial infarction (MI), but not those with preserved LVEF. Whether simple clinical risk factors can identify patients who derive greater absolute benefit remains unknown. Purpose To assess whether the clinical effect of long-term beta-blocker therapy after MI differs across baseline risk strata defined by a modified Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) Methods This was a substudy of the BETAMI-DANBLOCK trial, which randomized patients with recent MI and LVEF &amp;gt;40% to long-term beta-blocker or no beta-blocker therapy. A modified TRS-2P score (0–8 points) was constructed by excluding current smoking and incorporating mildly reduced LVEF (41–49%). Patients were categorized as low- (0 points), intermediate- (1–2 points), or high-risk (≥3 points). The primary endpoint was a composite of all-cause mortality, MI, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmia. The secondary endpoint was recurrent MI. Within each TRS-2P strata the effect of beta-blocker was estimated using Cox proportional hazard model and Fine-Gray subdistribution hazard model. Three-year absolute risk reduction (ARR) and number needed to treat (NNT) were estimated for each TRS-2P stratum using the total trial hazard ratio (HR) applied to stratum-specific cumulative incidences derived from Kaplan–Meier estimates Results Among the 5,558 patients included in the analysis, 38.4% were low-, 52.8% intermediate-, and 8.8% high-risk. Event rates increased stepwise across risk strata (2.96, 4.58, and 11.05 per 100 person-years, respectively). Relative treatment effects were consistent in low-risk (HR 0.88, 95% CI 0.67-1.13), intermediate-risk (HR 0.81, 95% CI 0.67-0.97), and high-risk patients (HR 0.88, 95% CI 0.63-1.20). Absolute benefit increased with risk strata: 3-year ARR was 1.4% (NNT 72) in low-risk-, 2.1% (NNT 47) in intermediate-risk-, and 3.6% (NNT 28) in high-risk patients. Recurrent MI demonstrated the same pattern, with greater absolute benefit in the higher-risk strata. Conclusions The modified TRS-2P score showed clear prognostic ability, and the absolute benefit of beta-blockers increased with baseline risk despite similar relative effects. These findings support the use of simple clinical risk stratification to guide long-term beta-blocker therapy after MI.Treatment effect of beta-blockersFor image description, please refer to the figure legend and surrounding text. Cumulative incidence of primary endpointFor image description, please refer to the figure legend and surrounding text.

Bezafibrate for Primary Biliary Cholangitis: a Number Needed to Treat Analysis.

Psychological outcomes after cervical spine surgery remain underexplored, particularly the development of new-onset depression. This study aimed to compare the long-term incidence of new-onset depression following anterior cervical discectomy and fusion (ACDF) versus cervical artificial disc replacement (ADR), hypothesizing that motion preservation with ADR may be associated with a lower risk of postoperative depression. We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including patients who underwent ACDF or ADR between 2005 and 2020. Patients with pre-existing mood disorders or prior antidepressant use were excluded. A 1:1 propensity score matching was performed based on demographics and baseline comorbidities. New-onset depression was identified using ICD-10 diagnoses and/or antidepressant prescriptions. Time-to-event analyses were conducted using Kaplan-Meier curves, and hazard ratios (HRs), absolute risk differences, and numbers needed to treat (NNTs) were calculated. At 5-year follow-up, ADR was associated with a significantly lower incidence of new-onset depression compared with ACDF (HR, 0.79; 95% CI, 0.72-0.87). The absolute risk difference was - 5.2%, corresponding to an NNT of 19. Consistent results were observed across alternative depression definitions. In this large real-world cohort, ADR was associated with a modest but clinically meaningful reduction in the risk of new-onset depression compared with ACDF. These findings are hypothesis-generating and should be interpreted with caution given the observational design and the potential for residual confounding. Further prospective studies incorporating patient-reported outcomes are warranted.

Background: Reliable assessment of cervical lymph node metastases remains a key challenge in the management of oral squamous cell carcinoma (OSCC). While elective ipsilateral neck dissection (ND) is widely accepted, the benefit of contralateral ND and the influence of tumor site on metastatic risk remain incompletely defined. This study aimed to evaluate patterns of lymphatic metastases, the diagnostic accuracy of preoperative staging, and the therapeutic relevance of ipsilateral and contralateral ND. Methods: A retrospective single-center cohort study was conducted including 287 patients with histologically confirmed OSCC treated between 2013 and 2019. Patterns of lymph node metastases were analyzed with respect to tumor localization and clinicopathological factors. Multivariate binary logistic regression was performed to identify predictors of cervical lymph node metastases. The diagnostic accuracy of preoperative staging was evaluated using histopathological findings as the reference standard. Results: Tumor localization and histopathological grading significantly influenced the occurrence of lymph node metastases. OSCC of the maxilla demonstrated a significantly lower observed rate of cervical and occult metastases compared with other tumor sites. Occult metastases were detected in 16.9% of primary tumor cases, with only two contralateral occult metastases observed. The calculated number needed to treat (NNT) was 6 for ipsilateral elective ND and 74 for contralateral elective ND. Preoperative staging showed limited diagnostic accuracy, with a negative predictive value of 0.83 and a positive predictive value of 0.65. Conclusions: Elective ipsilateral ND remains an essential component in the surgical management of OSCC due to the considerable rate of occult metastases and the limited reliability of preoperative staging. In contrast, the benefit of contralateral elective ND appears limited in patients without midline-crossing tumors. Maxillary OSCC and well-differentiated tumors demonstrated a significantly lower metastatic risk, supporting a more individualized risk-adapted approach to neck dissection in selected cases.

Direct oral anticoagulants (DOACs) have demonstrated efficacy in extended-duration secondary prevention in non-cancer patients with venous thromboembolism (VTE), but the robustness of these results has not been fully assessed. We performed a systematic review of phase 3 and 4 randomized placebo-controlled trials evaluating extended-duration DOACs therapy for secondary prevention of VTE. The primary outcome was symptomatic recurrent VTE in non-cancer patients. Secondary outcomes included major and clinically relevant non-major bleeding (CRNMB), number needed to treat (NNT), and number needed to harm (NNH). Fragility indices (FI) and quotients (FQ) were used to evaluate the robustness of trial findings. Four trials enrolling a total of 8,394 patients met the inclusion criteria. Extended-duration anticoagulation with DOACs consistently reduced recurrent VTE compared to placebo, with relative risk reductions of 80-93% and absolute risk reductions of 5-9%, yielding NNTs of 11-19. Extended DOACs therapy consistently showed net clinical benefit, with a pooled NNT of 14.4 versus an NNH of 116.2. Major bleeding was rare, while CRNMBs were slightly more common (although findings were statistically fragile across trials). Extended-duration DOACs therapy reduces recurrent VTE in non-cancer patients with a favourable safety profile compared to placebo in trial populations, supported by robust statistical evidence. These findings support DOACs as a preferred option for extended-duration secondary prevention of VTE.

Plasma signals of lung tumor promotion for molecular cancer prevention.