Immune checkpoint inhibitors (ICIs) have transformed melanoma treatment, yet comparative real-world data characterizing ICI-associated neurologic adverse events against the well-established neurotoxicity profile of conventional chemotherapy remain limited. We sought to contextualize the neurologic risk landscape of ICIs relative to chemotherapy as a historical comparator, to inform treatment-specific supportive care and surveillance strategies. We performed a propensity score–matched analysis using the TriNetX Global Collaborative Network, encompassing 162 healthcare organizations. Adult patients with melanoma receiving chemotherapy (dacarbazine, paclitaxel, carboplatin, or temozolomide; n = 9787) or ICI therapy (pembrolizumab, nivolumab, or ipilimumab; n = 14,627) from January 2014 through November 2025 were identified. After 1:1 nearest-neighbor matching on 52 baseline covariates, 6887 pairs were analyzed over 1–1095 days post-index therapy. Primary outcomes were peripheral neuropathy, encephalopathy, and laboratory-anchored myositis (ICD-10 myositis codes with creatine kinase ≥ 500 U/L). Fractures served as a negative control. A pre-specified conservative sensitivity analysis excluded bidirectional treatment switching, restricted the ICI cohort to anti-PD-1 predominant exposure, tightened outcome definitions, and extended follow-up to 5 years. Among 13,774 matched patients (mean age 67.1 years; 48.5
RATIONALE:Cecal dermoid cysts, mature cystic teratomas, are exceedingly rare. They may present with nonspecific abdominal pain and mimic common surgical conditions. We report a pediatric case of cecal dermoid cyst presenting with acute appendicitis and provide a systematic review of all published cecal dermoid cases. PATIENT CONCERNS:A 14-year-old female presented with 1 day of right lower abdominal pain, nausea, vomiting and anorexia; she had prior vague right-sided pain with an ultrasound 5 years earlier that identified a right iliac fossa cyst, which was not followed up. DIAGNOSES:Contrast-enhanced computed tomography showed an inflamed appendix with peri-appendiceal fat stranding and an appendicolith, and a separate well-defined hypodense lesion (3.5 × 3.2 cm) at the ileocecal junction. Differential diagnoses included duplication cyst, dermoid cyst, or low-grade mucinous neoplasm. INTERVENTIONS:Diagnostic laparoscopy confirmed acute appendicitis and a distinct cecal mass with enlarged ileocolic lymph nodes. Because malignancy could not be excluded intraoperatively, a laparoscopic oncologic right hemicolectomy with ileocolic anastomosis was performed. OUTCOMES:Histopathology demonstrated a benign dermoid cyst and acute suppurative appendicitis with microscopic perforation; 20 reactive lymph nodes were negative. The postoperative course was uneventful and the patient was discharged. LESSONS:Cecal dermoid cysts are rare and can mimic common pathologies such as appendicitis or ovarian masses. Preoperative diagnosis is challenging; definitive diagnosis requires surgical excision and histopathology. Laparoscopy is a useful diagnostic and therapeutic tool, but oncologic resection may be required when malignancy cannot be excluded intraoperatively.
Meta-analysis has become central to evidence-based medicine, yet persistent misconceptions continue to distort how models are selected and interpreted. This paper identifies and clarifies six entrenched misconceptions that have shaped the practice of meta-analysis for decades. It first challenges the belief that the choice of parameter assumption determines whether inference can extend beyond the included studies, emphasizing that conditional or unconditional inference arises from the analyst's scientific objective-not from the model or its assumptions. Second, it corrects the notion that the fixed-effect (FE) model is the only model under the common parameters assumption (aCP), noting that several modern models within this framework can accommodate heterogeneity. Third, it dispels the idea that only random-effects (RE) models can address heterogeneity, showing that this property exists under any parameter assumption. Fourth, it refutes the practice of letting observed heterogeneity dictate model choice, arguing that parameter assumptions and inferential purpose must guide decisions instead. Fifth, it challenges the claim that RE estimators best handle overdispersion, demonstrating persistent error-estimation flaws and inflated type I error rates. Finally, it contests the view that heterogeneity renders aCP-based models unrealistic, highlighting that recent aCP models handle such diversity effectively. By disentangling these misconceptions, the paper proposes a purpose-driven, assumption-aware framework for model selection that prioritizes conceptual clarity, analytical validity, and reproducibility in evidence synthesis.
Body image reflects how individuals perceive, evaluate, and emotionally respond to their physical appearance. Massive weight loss often leads patients to seek body contouring procedures to relieve both physical discomfort and psychological distress from excess skin. While primarily esthetic, such surgeries have shown psychological benefits. This study assessed the association between body contouring and changes in psychometric scores and identified predictors of improved outcomes. Patients undergoing body contouring at Hamad General Hospital between January 2021 and December 2023 were evaluated using the Appearance Anxiety Inventory (AAI), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Scores were categorized into a low-risk group (LRG; ≤ 2) and higher-risk group. Hormone concentrations of active ghrelin (AG), glucagon-like peptide-1 (GLP-1), leptin, spexin, and peptide YY were measured. Logistic regression, adjusted for repeated measures, examined predictors of LRG status. Forty patients completed baseline assessments, with 19 completing Visit 3 (6–10 weeks postoperatively). Postoperative status was statistically divergently associated with LRG membership for PHQ-9 (a nearly fourfold increase in odds 6–10 weeks after surgery), and AAI (a nearly fivefold increase in odds 6–10 weeks after surgery). AG levels demonstrated the strongest and most statistically divergent positive association with LRG membership for GAD-7. Body contouring surgery is associated with short-term psychological improvements, reflected in higher odds of being in a LRG for PHQ-9, GAD-7, and AAI 6–10 weeks after surgery. The strong postoperative association with LRG status underscores the mental health benefits of surgical reshaping, suggesting that such procedures may positively influence psychological well-being although such well-being is also modulated by nutrient-stimulated hormones. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Current discussions in plastic surgery research highlight the need for improved statistical reporting to enhance clarity and accuracy. Although existing literature addresses common reporting issues, this communication emphasizes the critical role of language in statistical interpretation. Terms like "statistical significance" and "confidence intervals" often mislead by implying importance and certainty, respectively. Instead, adopting "statistical divergence" and "uncertainty intervals" would better reflect their true meanings-divergence from a null model and uncertainty in parameter estimates. Moving beyond the rigid 0.05 threshold, a continuous interpretation of P values could reduce binary thinking, mitigate P-hacking, and improve transparency in small-sample studies. Additionally, redefining confidence intervals as uncertainty intervals would correct common misconceptions about their probabilistic nature. To address these issues, we recommend that journals provide clear author guidelines promoting precise terminology and framing statistical results in terms of divergence and uncertainty. Aligning language with statistical reality will reduce misinterpretation and strengthen research quality in plastic surgery.
