Category: Statistics

J Orthop Sports Phys Ther. 2025 Dec;55(12):1-9. doi: 10.2519/jospt.2025.13558.

ABSTRACT

OBJECTIVES: To (a) estimate the association between socioeconomic position (SEP) and the use and frequency of physical therapy visits in the year preceding hip arthroscopic surgery for femoroacetabular impingement (FAI) syndrome in Denmark and (b) compare these associations before and after 2019, following international recommendations. STUDY DESIGN: Retrospective cohort study. METHODS: A cohort of 5739 patients with FAI syndrome and hip arthroscopy (2012-2024) was identified from the Danish Hip Arthroscopy Registry. Physical therapy use (yes/no) and visit frequency in the year preceding surgery were identified from national registries. SEP was categorized as low, medium, or high based on a composite score of educational attainment, income, and labor market affiliation. Binomial and negative binomial regressions were used to estimate relative risk ratios (RRs) and incidence rate ratios (IRRs). RESULTS: Overall, 35.1% of patients used physical therapy before hip arthroscopy, with lower use among those in the low-SEP group (29.3%) compared to the high-SEP group (36.0%) (directed acyclic graph [DAG]-adjusted RR = 0.83 [95% CI: 0.70, 0.98]) and no significant difference in visit frequency (DAG-adjusted IRR = 0.79 [95% CI: 0.59, 1.07]). Use declined from 38.9% before 2019 to 30.1% after (DAG-adjusted RR = 0.77 [95% CI: 0.72, 0.83]), with visits decreasing from 3.95 to 2.59 (DAG-adjusted IRR = 0.64 [95% CI: 0.56, 0.74]). CONCLUSION: One third of patients used physical therapy in the year before hip arthroscopy in Denmark, with one fifth having 6 or more visits. Patients in the lowest SEP group were less likely to use physical therapy, while differences in visit frequency were not statistically significant. Use of physical therapy declined from 39% before 2019 to 30% after. J Orthop Sports Phys Ther 2025;55(12):1-9. Epub 30 October 2025. doi:10.2519/jospt.2025.13558.

PMID:41288047 | DOI:10.2519/jospt.2025.13558

J Genet Couns. 2025 Dec;34(6):e70129. doi: 10.1002/jgc4.70129.

ABSTRACT

Current reproductive guidelines call for offering expanded carrier screening (ECS) for genetic conditions. Currently available panels can include screening for carrier status of tens to hundreds of autosomal recessive and/or X-linked conditions. Clinical utility is based on alterations to reproductive decision-making, but study cohorts supporting the utility of ECS largely consist of individuals of European ancestry who are highly educated, of high income, and who often receive preconception counseling. There is a lack of research on the views of patients from diverse backgrounds. Therefore, we aimed to assess and compare perceptions of the utility of ECS and targeted carrier screening (TCS) in an ethnically, economically, and educationally diverse population. We administered a survey to obstetrics and gynecology patients in Houston, Texas in the fall of 2022. Questions regarding genetic testing, reproductive management, and demographics were asked. Of the respondents who wanted children in the future, expressed interest in knowing reproductive genetic risks, and would consider using this information to change reproductive plans (114/186, 61%), 100 indicated their test preference, with 70 (70%) preferring ECS and 30 (30%) preferring TCS. There was no statistical difference in test preference by race and ethnicity, education, income, or insurance. Eighty-one of the 114 participants provided feedback on the utility of CS, and 74/81 (91%) of them found it useful. Only 30/81 (37%) of them, however, stated that they would change their reproductive plans if identified as at-risk. Participants were more likely to change their reproductive plans if they were not pregnant (OR = 3.63; 95 CI = 1.26-10.47), had not had prior genetic testing (OR = 3.03; 95 CI = 1.02-8.95), or had higher income (OR = 1.25; 95 CI = 1.00-1.55). This heterogeneous cohort expands upon data from previous homogeneous cohorts assessing CS utility. While attitudes toward CS were favorable, its perceived utility was lower. Information on reproductive management options should be provided to patients in the preconception period, and access to reproductive services must be improved for those with lower incomes. Further insight on the perspectives of diverse populations is imperative to defining the utility of carrier screening most accurately and equitably.

PMID:41288026 | DOI:10.1002/jgc4.70129

Int J Surg. 2025 Nov 24. doi: 10.1097/JS9.0000000000003920. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior cruciate ligament (ACL) tears are common injuries, that often lead to long-term knee instability and complications. Anterior cruciate ligament reconstruction can be performed using either single-bundle (SB) or double-bundle (DB) techniques. This study aimed to systematically compare clinical, functional, and complication outcomes between the two techniques through an umbrella review and meta-meta-analysis.

MATERIALS AND METHODS: Our study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included meta-analyses published in PubMed, Embase, Cochrane, and Web of Science up to January 2025. Data on knee stability, functional scores, complications (graft failure, osteoarthritis incidence, knee extension/flexion deficits), and clinical outcomes were extracted, and quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 and Grading of Recommendations Assessment, Development, and Evaluation systems. Continuous outcomes were synthesized using the Mean Difference (MD) and Standardized Mean Difference (SMD).

RESULTS: A total of 22 meta-analyses were analyzed. The results of our meta-meta-analysis showed no statistically significant differences in objective knee joint stability between DB and SB reconstruction on the pivot shift test, KT 1000/2000 arthrometer, and Lachman test. Clinical outcomes favored the DB technique, which showed statistically superior Lysholm scores (MD = 0.82, P = 0.02) and better subjective IKDC scores (MD = 1.42, P = 0.007); however, these differences did not reach the minimum clinically important difference. There were also no significant differences in complication rates, including graft failure, incidence of osteoarthritis, and knee extension/flexion deficits.

CONCLUSION: This meta-meta-analysis indicates no definitive superiority for either DB or SB anterior cruciate ligament reconstruction. We found no significant differences in knee joint stability or complication rates. While minor statistical differences in clinical outcomes were observed-favoring DB for both Lysholm and subjective IKDC scores-these were not clinically meaningful.

PMID:41287961 | DOI:10.1097/JS9.0000000000003920

Int Endod J. 2025 Nov 25. doi: 10.1111/iej.70072. Online ahead of print.

ABSTRACT

BACKGROUND: There is a strong association between root canal curvatures and iatrogenic complications during root canal treatment.

INTRODUCTION: This study compared the curvature of mesiobuccal (MB) and mesiolingual (ML) canals in mandibular first molars between sagittal and coronal planes using cone-beam computed tomography.

METHODS: Two hundred mesial roots (400) canals from a Brazilian subpopulation were analysed. Curvature angles were measured in sagittal and coronal planes using Schneider’s and Weine’s methods, while curvature radii were calculated geometrically. The prevalence of S-shaped canals was also recorded. Curvature severity was classified according to the American Association of Endodontists Case Difficulty Assessment form, EndoApp, and modified versions incorporating curvature and radius. The influence of the angle measurement method and radius on case complexity was evaluated. Statistical analyses were performed using t-tests and chi-squared tests, with significance set at p ≤ 0.05.

RESULTS: Sagittal planes showed significantly greater angles and smaller radii than coronal planes. Weine’s method yielded consistently higher angles and smaller radii than Schneider’s. Severe single curvatures (≥ 30°) were more frequent in sagittal planes, whereas S-shaped canals were more prevalent in coronal planes. MB was more often classified as higher difficulty than ML canals. Incorporating radius into the classification systems generally shifted cases towards greater severity.

CONCLUSIONS: Sagittal planes revealed more severe single curvatures, whereas coronal planes showed a higher prevalence of S-shaped canals. Weine’s method resulted in greater curvature severity than Schneider’s. Inclusion of radius increased case severity grading. These findings highlight the importance of considering both measurement method and projection plane in endodontic treatment planning and research.

PMID:41287941 | DOI:10.1111/iej.70072

Cardiol J. 2025 Nov 25. doi: 10.5603/cj.99990. Online ahead of print.

ABSTRACT

BACKGROUND: The global mortality rates due to cardiovascular diseases (CVD) are still alarmingly high, highlighting the need for accurate assessment of the risk of severe cardiovascular (CV) events. To address this, the Pol-SCORE and SCORE2 scales have been developed.

METHODS: We conducted an observational and retrospective analysis of 450 patients with LDL ≥ 100 mg/dL admitted to the Clinical Hospital of the Medical University of Warsaw between 2019 and 2020. The objective of our study was to assess the treatment in patients with high levels of LDL cholesterol, without pre-existing CVD, by estimating their CV risk using the Pol-SCORE and SCORE2 scales.

RESULT: We enrolled a total of 150 patients in the study: 86 women (57.3%) and 64 men (42.7%), with an average age of 55.1 years. The high-risk category in the SCORE2 scale included patients with low, moderate, high, and very high risk estimated in the Pol-SCORE scale. It was statistically significant (p < 0.0001) in the distribution of risk assessment results between groups of CV risk.

CONCLUSIONS: According to research, the Pol-SCORE scale has been found to potentially underestimate the likelihood of CV events occurring when compared to the SCORE2 scale, which has a more cautious and restrictive approach. Patients with high and very high risk of fatal and non-fatal CVD are not receiving appropriate treatment. To identify and implement proper recommendations and treatments for patients with elevated risk, the SCORE2 scale should be utilized to estimate CV risk events.

PMID:41287937 | DOI:10.5603/cj.99990

Dis Model Mech. 2025 Nov 25:dmm.052460. doi: 10.1242/dmm.052460. Online ahead of print.

ABSTRACT

Collagen VI Related Dystrophies (COL6-RD) are congenital muscle diseases, typically inherited as an autosomal dominant trait. A frequent type of mutation involves glycine substitutions in the triple helical domain of collagen VI alpha chains, exerting a dominant-negative effect on the unaltered protein. Despite this, no prior animal model captured this mutation type. Using CRISPR/Cas9, we generated transgenic mice with the equivalent of the human COL6A1 c.877 G>A; p. Gly293Arg mutation. We characterized their skeletal muscle phenotype over time, utilizing computer-aided tools applied to standardized parameters of muscle pathology and function. Knock-in mice exhibited early-onset reduced muscle weight, myopathic histology, increased fibrosis, reduced collagen VI expression, muscle weakness, and impaired respiratory function. These features provide adequate outcome measures to assess therapeutic interventions. The different automated image analysis methods deployed here analyze thousands of features simultaneously, enhancing accuracy in describing muscle disease models. Overall, the Col6a1 Ki Gly292Arg mouse model offers a robust platform to deepen our understanding of COL6-RD and advance its therapeutic landscape.

PMID:41287928 | DOI:10.1242/dmm.052460

J Esthet Restor Dent. 2025 Nov 25. doi: 10.1111/jerd.70064. Online ahead of print.

ABSTRACT

OBJECTIVE: Multimodal large language models (LLMs) have the potential to transform dental learning and decision-making by addressing multimodal dental inquiries that integrate text, images, and analytical data. The purpose of this study was to evaluate the performance of various multimodal LLMs in responding to multimodal dental queries and to identify factors influencing their performance.

MATERIALS AND METHODS: Four multimodal LLMs (ChatGPT-4V, Claude 3 Sonnet, Microsoft 365 Copilot 2024, and Google Gemini 1.5 Pro) were evaluated based on their correct answers and passing margin for the Integrated National Board Dental Examination (INBDE) and the Advanced Dental Admission Test (ADAT). Descriptive statistics, χ² tests, Cohen’s κ, Kruskal-Wallis tests, and Mann-Whitney U tests were used to analyze the performance across different question types, independent inputs, and picture types (α = 0.05).

RESULTS: Claude 3 Sonnet outperformed the other models in both INBDE and ADAT exams, achieving the highest accuracy, followed by ChatGPT-4V, Microsoft 365 Copilot 2024, and Google Gemini 1.5 Pro. χ² tests revealed significant differences between chatbots in the ADAT exam, but not in the INBDE. Cohen’s κ showed weak to moderate model agreement for INBDE and stronger agreement for ADAT, with the highest agreement between Claude 3 Sonnet and ChatGPT-4V (κ = 0.757) and the lowest between Google Gemini 1.5 Pro and Microsoft 365 Copilot 2024 (κ = 0.059). Model performance was influenced by question type (theoretical and clinical), with common errors including misinterpreting clinical scenarios, visual data difficulties, and dental terminology ambiguities.

CONCLUSION: Multimodal LLMs show potential in answering multimodal dental inquiries, though performance varies across models, with challenges in interpreting clinical scenarios, visual data, and terminology ambiguity.

CLINICAL SIGNIFICANCE: Large language models canbe applied not only to memorization-type but also interpretation andproblem-solving cognitive questions in dentistry. Tomaximize the utility of these artificial intelligence models, users need bothan understanding of their differences and the ability to manage complexclinical data.

PMID:41287924 | DOI:10.1111/jerd.70064

Psychol Med. 2025 Nov 25;55:e358. doi: 10.1017/S003329172510264X.

ABSTRACT

BACKGROUND: Ecological momentary assessment (EMA) is increasingly recognized as a vital tool for tracking the fluctuating nature of mental states and symptoms in psychiatric research. However, determining the optimal sampling rate – that is, deciding how often participants should be queried to report their symptoms – remains a significant challenge. To address this issue, our study utilizes the Nyquist-Shannon theorem from signal processing, which establishes that any sampling rate more than twice the highest frequency component of a signal is adequate.

METHODS: We applied the Nyquist-Shannon theorem to analyze two EMA datasets on depressive symptoms, encompassing a combined total of 35,452 data points collected over periods ranging from 30 to 90 days per individual.

RESULTS: Our analysis of both datasets suggests that the most effective sampling strategy involves measurements at least every other week. We find that measurements at higher frequencies provide valuable and consistent information across both datasets, with significant peaks at weekly and daily intervals.

CONCLUSIONS: Ideal frequency for measurements remains largely consistent, regardless of the specific symptoms used to estimate depression severity. For conditions in which abrupt or transient symptom dynamics are expected, such as during treatment, more frequent data collection is recommended. However, for regular monitoring, weekly assessments of depressive symptoms may be sufficient. We discuss the implications of our findings for EMA study optimization, address our study’s limitations, and outline directions for future research.

PMID:41287919 | DOI:10.1017/S003329172510264X

Int J Surg. 2025 Nov 24. doi: 10.1097/JS9.0000000000004104. Online ahead of print.

ABSTRACT

BACKGROUNDAIMS: Current binary definition of early allograft dysfunction (EAD) was not sufficiently accurate for discriminating clinical outcomes after liver transplantation (LT). We investigated the clinical heterogeneity among EAD sub-criteria and explored the necessity of dividing EAD into different stages to grade the severity of graft dysfunction.

METHODS: 1242 LT patients from 5 centers were included. EAD patients were divided as i) EAD-type-A: only AST/ALT criteria; ii) EAD-type-B: bilirubin or INR criteria; iii) EAD-type-C: meeting two or three EAD sub-criteria. Peri-operative clinical complications and survival outcomes were compared.

RESULTS: Three-month early graft failure (EAF) from non-EAD to EAD-type-C were 1.6%, 3.5%, 12.8% and 29.6%. EAD-type-B and EAD-type-C were significantly associated with higher rates of AKI, RRT, in-hospital death, longer hospital stay, ICU stay, ventilator support time, and inferior one-year survival outcomes(P<0.001); However, there were no statistical differences between EAD-type-A and non-EAD (P>0.05). New EAD classification with three stages was proposed to grade EAD severity: a)EAD-stage-I: only ALT/AST≥2000 U/L within POD7; b)EAD-stage-II: only bilirubin 10-30 mg/dL or INR≥1.6 on POD7; c)EAD-stage-III: bilirubin≥30 mg/dL; both bilirubin≥10 mg/dL and INR≥1.6 on POD7. Clinical outcomes and survival rates deteriorated following EAD stages. New EAD classification had an excellent discrimination (AUROC = 0.84, CI 0.81-0.86) in determining EAF, superior to binary EAD definition (AUROC = 0.73, CI 0.70-0.77) and MEAF (AUROC = 0.76, CI 0.73-0.79) (P<0.001), while similar to L-GrAFT-7(AUROC = 0.87, CI = 0.84-0.90 P>0.05). Consistent with findings in derivation cohort, external validation confirmed its excellent discrimination of graft dysfunction and 3-month EAF.

CONCLUSIONS: Different EAD sub-criteria had significantly different clinical outcomes. EAD definition should be further reclassified with different severities. New EAD classification with 3 stages could be serve as an effective tool to accurately grade the severity of EAD and identify patients in high risk of early graft failure.

PMID:41287877 | DOI:10.1097/JS9.0000000000004104

Int J Surg. 2025 Nov 25. doi: 10.1097/JS9.0000000000003891. Online ahead of print.

ABSTRACT

BACKGROUND: While the relationship between adult obesity and dysfunction-associated steatotic liver disease (MASLD) is well-established, the impact of childhood obesity remains unclear. We aimed to comprehensively characterize the causal effect and genetic relationships of child obesity-related exposures at different ages and MASLD.

METHODS: Using summary statistics from large-scale genome-wide association studies (GWAS) of child obesity-related traits and MASLD in European-ancestry populations, we performed LDSC and SUPERGNOVA to quantify overall and local genetic correlations, respectively. Univariable Mendelian randomization (UVMR) analysis infers causal relationships. Genomic structural equation modeling (GenomicSEM) and multivariable Mendelian randomization (MVMR) estimated independent genetic correlations and causal effects of each obesity-related trait on MASLD. A two-step MR analysis investigated the mediating pathway from childhood obesity to MASLD through adult obesity.

RESULT: We observed a positive genetic correlation between BMI at age 5 and MASLD ( = 0.45, P-value = 0.01), and a similar correlation for BMI at age 7 ( = 0.44, P-value = 0.044). A significant negative genetic correlation was identified between birth weight and MASLD ( = – 0.23, P-value = 4.4 × 10-8). UVMR indicated increased MASLD risk was associated with overall obesity (OR ivw = 1.40, 95% CI = 1.22, 1.62) and obesity at age 8 (OR ivw = 1.34, 95% CI = 1.01, 1.78). Birth weight had a protective effect (OR ivw = 0.69, 95% CI = 0.61, 0.78). The birth weight effect estimate attenuated to null after collectively adjusting for lifestyle factors in MVMR (OR = 1.05, 95%CI = 0.98-1.12). Mediation analysis showed that this masking effect was mediated by adult obesity.

CONCLUSION: These findings suggest that the association between childhood obesity at different ages and MASLD may differ, indicating a contribution of childhood obesity to MASLD risk and confirmed that sustained obesity into adulthood is the mediating pathway.

PMID:41287864 | DOI:10.1097/JS9.0000000000003891