Category: Statistics

Med Phys. 2025 Apr 28. doi: 10.1002/mp.17845. Online ahead of print.

ABSTRACT

BACKGROUND: The main task of deep learning (DL) based brain tumor segmentation is to get accurate projection from learned image features to their corresponding semantic labels (i.e., brain tumor sub-regions). To achieve this goal, segmentation networks are required to learn image features with high intra-class consistency. However, brain tumor are known to be heterogeneous, and it often causes high diversity in image gray values which further influences the learned image features. Therefore, projecting such diverse image features (i.e., low intra-class consistency) to the same semantic label is often difficult and inefficient.

PURPOSE: The purpose of this study is to address the issue of low intra-class consistency of image features learned from heterogeneous brain tumor regions and ease the projection of image features to their corresponding semantic labels. In this way, accurate segmentation of brain tumor can be achieved.

METHODS: We propose a new DL-based method for brain tumor segmentation, where a semantic feature module (SFM) is introduced to consolidate image features with meaningful semantic information and enhance their intra-class consistency. Specifically, in the SFM, deep semantic vectors are derived and used as prototypes to re-encode image features learned in the segmentation network. Since the relatively consistent deep semantic vectors, diversity of the resulting image features can be reduced; moreover, semantic information in the resulting image features can also be enriched, both facilitating accurate projection to the final semantic labels.

RESULTS: In the experiment, a public brain tumor dataset, BraTS2022 containing, multi-sequence MR images of 1251 patients is used to evaluate our method in the task of brain tumor sub-region segmentation, and the experimental results demonstrate that, benefiting from the SFM, our method outperforms the state-of-the-art methods with statistical significance ( p < 0.05 $p<0.05$ using the Wilcoxon signed rank test). Further ablation study shows that the proposed SFM can yield an improvement in segmentation accuracy (Dice index) of up to 11% comparing with that without the SFM.

CONCLUSIONS: In DL-based segmentation, low intra-class consistency of learned image features degrades segmentation performance. The proposed SFM can effectively enhance the intra-class consistency with high-level semantic information, making the projection of image features to their corresponding semantic labels more accurate.

PMID:40296197 | DOI:10.1002/mp.17845

J Health Popul Nutr. 2025 Apr 28;44(1):139. doi: 10.1186/s41043-025-00857-8.

ABSTRACT

BACKGROUND: Several studies in sub-Saharan Africa and elsewhere have affirmed the importance of community-level factors in influencing maternal health seeking behaviour. However, literature shows no uniform pattern in terms of how contextual-level factors influence delay in seeking antenatal care service in different parts of the region. The association of contextual factors and timing of antenatal care is not well documented at regional level. Thus, this study was conducted to examine how community-level characteristics influence decision not to initiate antenatal care in the first trimester. Regional-level analyses of antenatal care utilisation in sub-Saharan Africa are important because they help identify geographic disparities in access and utilisation of the service. Thus, allowing for targeted interventions to improve maternal health outcomes.

METHODS: Data from the most recent Demographic and Health Surveys conducted between January 2010 and December 2021 were used in this study. A sample of 222,436 women aged 15-49 who gave birth in the last five years preceding each of the 33 country surveys in the region was used in the analysis. The association between individual and contextual-level factors and timing of antenatal care was assessed using multilevel binary logistic regression models. Stata software version 17 was used to perform statistical analysis taking into account the complex survey design. Multivariable results were presented using adjusted odds ratios at 95% confidence interval.

RESULTS: The prevalence of delay in utilisation of first antenatal care service in sub-Saharan Africa was 61.1% [95% CI, 60.6, 61.5]. Mozambique had the highest prevalence of 85.5% [95% CI, [84.2, 86.7] while Liberia had the lowest prevalence at 27.8% [95% CI, [25.6, 30.1]. Women in the age groups 25-34 [aOR = 0.79, 95%CI = 0.76-0.82] or 35-49 [aOR = 0.66, 95%CI = 0.63-0.69], those with secondary or tertiary education [aOR = 0.97, 95%CI = 0.93-1.01] and [aOR = 0.71, 95%CI = 0.66-0.77], belonging to rich households [aOR = 0.91, 95%CI = 0.88-0.95], and those who experienced a pregnancy loss [aOR = 0.84, 95%CI = 0.81-0.87] were less likely to delay first ANC utilisation. Conversely, women living in rural areas [aOR = 1.18, 95%CI = 1.13-1.23], communities with a high proportion of women who experienced unwanted births [aOR = 1.08, 95%CI = 1.02-1.14] were more likely to delay first antenatal care visit.

CONCLUSION: Both individual and community-level factors influenced women’s delay in seeking antenatal care service in sub-Saharan Africa. Integrating community level factors when designing maternal health promotion interventions would be key to improve early utilisation of antenatal care services. There is need to strengthen maternal health promotion initiatives such as Community Health Worker Outreach, Mobile Messaging Campaigns, Male Involvement Initiatives and, School and Youth Friendly Health Programmes targeting women in marginalised communities such as rural settings.

PMID:40296180 | DOI:10.1186/s41043-025-00857-8

Microbiome. 2025 Apr 28;13(1):106. doi: 10.1186/s40168-025-02105-x.

ABSTRACT

BACKGROUND: Microbial taxonomic diversity declines with increased environmental stress. Yet, few studies have explored whether phylogenetic and functional diversities track taxonomic diversity along the stress gradient. Here, we investigated microbial communities within an aquifer in Oak Ridge, Tennessee, USA, which is characterized by a broad spectrum of stressors, including extremely high levels of nitrate, heavy metals like cadmium and chromium, radionuclides such as uranium, and extremely low pH (< 3).

RESULTS: Both taxonomic and phylogenetic α-diversities were reduced in the most impacted wells, while the decline in functional α-diversity was modest and statistically insignificant, indicating a more robust buffering capacity to environmental stress. Differences in functional gene composition (i.e., functional β-diversity) were pronounced in highly contaminated wells, while convergent functional gene composition was observed in uncontaminated wells. The relative abundances of most carbon degradation genes were decreased in contaminated wells, but genes associated with denitrification, adenylylsulfate reduction, and sulfite reduction were increased. Compared to taxonomic and phylogenetic compositions, environmental variables played a more significant role in shaping functional gene composition, suggesting that niche selection could be more closely related to microbial functionality than taxonomy.

CONCLUSIONS: Overall, we demonstrated that despite a reduced taxonomic α-diversity, microbial communities under stress maintained functionality underpinned by environmental selection. Video Abstract.

PMID:40296156 | DOI:10.1186/s40168-025-02105-x

BMC Sports Sci Med Rehabil. 2025 Apr 28;17(1):103. doi: 10.1186/s13102-025-01114-5.

ABSTRACT

PURPOSE: By introducing the grey correlation theory to evaluate the implementation effect of various techniques and tactics of athletes, to conduct a substantial verification of the constructed “New Four-phase Index Statistical Method”, to explore the scientific nature of the division of each Phase index, and to provide theoretical support for subsequent systematic research and improvement of the theoretical research system of table tennis techniques and tactics.

METHODS: By employing research methods such as video analysis, mathematical statistics, and grey correlation, a model of the “New Four-phase Index Statistical Method” was constructed. According to the contribution rate and total contribution rate indicators of the set tactics in the attack-after-serve phase (serve and 3rd stroke), attack-after-receive phase (receive and 4th stroke), transition phase (5th and 6th stroke) and rally phase (I and II) within the statistical model, the quality characteristics of the eight technical and tactical contributions of player T when playing against the main and reserve players of China were evaluated and analyzed.

RESULTS: the contribution rate of the first four strokes is closely related to the total contribution rate, which is the main scoring method for T to win the match. T’s 5th and 6th strokes play an important role in the game of attack and defense transition, which is a key turning point of his attack-after-serve phase and attack-after-receive phase into the rally phase. The correlation between the contribution rate during T’s rally phase and the overall contribution rate is not very close; similarly, the correlation between T’s contribution rate and the total contribution rate is not very close either. With the multi-strokes confrontation, the advantage shown in the match began to decrease slowly.

CONCLUSION: By introducing grey relational analysis (GRA), the various technical and tactical effectiveness of the constructed “New Four-Phase Index” can be objectively, reasonably and accurately evaluated, which has certain practicality and feasibility.

PMID:40296145 | DOI:10.1186/s13102-025-01114-5

Head Face Med. 2025 Apr 28;21(1):34. doi: 10.1186/s13005-025-00512-x.

ABSTRACT

BACKGROUND: This study utilized MRI-based texture analysis to quantify structural alterations in the lateral pterygoid muscle (LPM) among MR images with unilateral anterior disc displacement (uADD) of the temporomandibular joint. Retrospective analysis of anonymized MR images from 232 uADD patients and 123 healthy individuals (January 2022- December 2024), approved by the Ethics Committee of Wenzhou Medical University Affiliated School of Stomatology (Ethics Number: WYKQ 2024008) with waived informed consent due to the use of de-identified retrospective data, was conducted to identify diagnostic markers and possible related pathological changes of disc displacement. According to the inclusion and exclusion criteria four groups of MR images were included in this study: the healthy temporomandibular joints (H-TMJ) of individuals with uADD, joints with anterior disc displacement with reduction (ADDwR), joints with anterior disc displacement without reduction (ADDwoR), and MR images from normal volunteers as the healthy group (HG). Four texture parameters were used for analysis: the angular second moment (ASM), Contrast, inverse difference moment (IDM) and Entropy.

RESULTS: Statistically significant differences (P < 0.05) were found between groups for the ASM, Contrast, IDM, and Entropy variables, indicating their potential as diagnostic markers. Additionally, Entropy values differed significantly between the ADDwoR and ADDwR groups (P < 0.05), highlighting its diagnostic potential in distinguishing these two conditions. The severity of ADD disease showed varying degrees of correlation with specific texture parameters, with significant associations observed for ASM, Contrast, IDM, and Entropy (P < 0.05).

CONCLUSIONS: The texture parameters of the LPM exhibit significant changes in MR images with anterior disc displacement(ADD). Notably, the Entropy value of the LPM demonstrates high diagnostic utility in distinguishing ADDwoR from ADDwR, particularly in cases of complex disc displacement involving deformation or remodeling. Furthermore, the severity of ADD disease shows varying degrees of correlation with specific texture parameters. However, further research is required to validate the relationship between numerical texture changes in the LPM and their corresponding pathological alterations.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40296140 | DOI:10.1186/s13005-025-00512-x

Head Face Med. 2025 Apr 28;21(1):33. doi: 10.1186/s13005-025-00485-x.

ABSTRACT

BACKGROUND: Selecting the correct imaging technique for critical anatomical structures is essential in descriptive studies and for supporting clinical applications. Facial canal dehiscence poses a significant risk for iatrogenic facial nerve injuries during middle ear surgeries. Accurate imaging is critical for surgical planning and minimizing complications. Detection of facial canal openings in the clinic is performed using imaging methods such as high-resolution computed tomography (HRCT). Studies have shown that the sensitivity of this method is approximately 66%. A high-resolution, 3D imaging method was used to measure the sensitivity of HRCT in the most accurate way.

AIMS/OBJECTIVES: This study aimed to compare two radiological methods for measuring facial canal dehiscence. Specifically, we compared cone-beam computed tomography (CBCT) with high-resolution micro-computed tomography (micro-CT).

MATERIALS AND METHODS: Thirty-six temporal bone specimens without external defects were used. The specimens were scanned using both CBCT and micro-CT. The presence of facial canal dehiscence in the tympanic segment of the facial nerve (FN) was evaluated. A paired sample t-test was used for statistical analysis, with significance set at p < 0.05.

RESULTS: Facial canal dehiscence was detected in 10 bones on micro-CT images, while 26 bones appeared intact. In contrast, CBCT images showed dehiscence in 25 bones, with 11 bones intact. Additionally, the mean dehiscence width was 3.469 mm (range: 1.577-8.921 mm) in micro-CT images, compared to 1.279 mm (range: 0.670-9.354 mm) in CBCT images. In the 10 bones where dehiscence was identified by both methods, the average width of the dehiscence measured 5.347 mm (range: 1.840-9.354 mm) in the CBCT images. The difference in measurements between CBCT and micro-CT was statistically significant (p < 0.05).

CONCLUSIONS AND SIGNIFICANCE: The low resolution of CBCT was insufficient for visualizing the thin bony tissue lining the facial canal. These findings suggest that the frequency of facial canal dehiscence measured in preoperative CBCT images may be overestimated compared to actual anatomical conditions. These findings provide critical insights for preoperative evaluation and surgical planning in middle ear procedures.

PMID:40296137 | DOI:10.1186/s13005-025-00485-x

Ann Gen Psychiatry. 2025 Apr 28;24(1):25. doi: 10.1186/s12991-025-00562-0.

ABSTRACT

BACKGROUND: The eyes serve as a portal to the brain and are highly connected neurologically, making them the only externally visible part of the brain. Moreover, the correlation between the physical attributes of the eye and psychiatric disorders has been increasingly established in recent years. Therefore, this study examined the association between iris color density and bipolar I disorder (BD).

METHODS: In a case-control study, 48 subjects diagnosed with BD are compared to an equal number of healthy controls. A semi-structured interview questionnaire is designed to collect sociodemographic, psychiatric, medical history, and clinical data from all participants. The Group with BD is diagnosed based on clinical assessment by the Consultant/specialist by using a semi-structured clinical interview for DSM 5 Clinician Version (SCID-5-CV) to diagnose BD’s current episode and to exclude the other comorbid mental disorders. Additionally, the group with BD is further assessed by The Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) to evaluate the severity of manic and depressive symptoms. The iris color of participants in both groups was evaluated using a standardized photographic system for iris imaging.

RESULTS: It showed a statistically significant increase in the percentage of the colored iris in the patients’ group compared with the control group, and the presence of a colored iris significantly increases the risk of BD by 2.36 folds. There is no statistically significant difference between iris color and either hospitalization, suicide, Electroconvulsive Therapy (ECT), family history, medical history, duration, or frequency of episodes.

CONCLUSION: Our findings revealed a strong association between iris color and bipolar disorder (BD) but no significant association between iris color and clinical factors such as hospitalization, suicide, electroconvulsive therapy (ECT), family history, medical history, or the duration and frequency of episodes. These results suggest that iris color may serve as a trait marker rather than a state marker in BD, potentially offering a simple and non-invasive indicator of bipolarity.

PMID:40296136 | DOI:10.1186/s12991-025-00562-0

Clin Epigenetics. 2025 Apr 28;17(1):65. doi: 10.1186/s13148-025-01869-1.

ABSTRACT

BACKGROUND: To identify nongenetic factors influences on DNA methylation (DNAm) variations associated with blood Alanine Aminotransferase (ALT) concentration, this study conducted an epigenome-wide association study (EWAS) on Chinese monozygotic twins.

METHODS: A total of 61 pairs of Chinese monozygotic twins involved in this study. Whole blood samples were analyzed for DNAm profiling using the Reduced Representation Bisulfite Sequencing (RRBS) technique. We examined the relationship between DNAm levels at each CpG site and serum ALT using a linear mixed-effects model. Enrichment analysis and causal inference analysis was conducted, and differentially methylated regions (DMRs) were further identified. Candidate CpGs were validated in a community sample. Genome-wide significance were calculated by Bonferroni correction (p < 2.14 × 10^-7).

RESULTS: We identified 85 CpGs reaching genome-wide significance (p < 2.14 × 10^-7), located in 16 genes including FLT4, ADARB2, MRPS31P2, and RELB. Causal inference suggested that DNAm at 61 out of 85 significant CpGs within 14 genes influenced ALT level. 52 DMRs and 1765 pathways such as low voltage-gated calcium channel activity and focal adhesion were identified having influences on ALT levels. Further validation using community population found four CpGs mapped to FLT4 and three to RELB showing hypomethylation and hypermethylation in cases with abnormal ALT (ALT > 40 U/L), respectively.

CONCLUSION: This study identified several differentially methylated CpG sites associated with serum ALT in the Chinese population, particularly within FLT4 and RELB. These findings provide new insights into the epigenetic modifications underlying liver function.

PMID:40296130 | DOI:10.1186/s13148-025-01869-1

Diabetol Metab Syndr. 2025 Apr 28;17(1):143. doi: 10.1186/s13098-025-01704-w.

ABSTRACT

BACKGROUND: Metabolic syndrome (MetS) is a conglomerate of metabolic abnormalities including hypertension, obesity, hyperglycemia, hypertriglyceridemia, and low levels of high-density lipoprotein cholesterol (HDL-C). The relationship between MetS and Inflammatory Bowel Disease (IBD) has received a lot of attention lately. Epidemiological investigation has yet to determine if the two illnesses are causally related. To investigate the causal link between IBD and MetS levels, we screened publically available genome-wide association study (GWAS) data using Mendelian randomization (MR) analysis. The study aimed to comprehensively analyze the causal association of each component of MetS, including fasting blood glucose(FBG), HDL-C, triglyceride(TG), waist circumference(WC), and hypertension, on the risk of IBD and its subtypes via univariate, two-way, and multivariate MR (MVMR) methods.

METHODS: We selected independent genetic variants of MetS and IBD as instrumental variables (IVs) from published data from the IEU OpenGWAS project and IIBDGC (International Inflammatory Bowel Disease Genetic Consortium), used MR to infer potential causal effects between them, and used a variety of methods (random effect inverse variance weighting (IVW), weighted median, MR-Egger regression, etc.) to ensure the robustness of causal effects.

RESULTS: Univariate two-sample MR (TSMR) revealed that WC was significantly linked to the risk of Crohn’s disease (CD) (OR = 1.659; 95% CI: 1.144-2.405; p = 0.008) and IBD (OR = 1.383; 95% CI: 1.050-1.822; p = 0.021). However, MVMR did not support this finding. In MVMR analysis, hypertension was predicted to be positively associated with the risk of IBD (OR = 2.322516, 95% CI: 1.097713-4.91392, p = 0.0275365), whereas FBG was confirmed to reduce the risk of CD in MVMR studies (OR = 0.4346427, 95% CI: 0.2685399-0.7034868, p = 0.0006948939). Other elements of the MetS did not significantly correlate with IBD.

CONCLUSION: Although confounding factors cannot be completely ruled out, certain metabolic components, such as WC, may impact the risk of IBD. In addition to highlighting the need for more research to understand the underlying mechanisms and potential indirect effects between MetS components and IBD, this research offers insight into therapeutic treatment decisions for patients with IBD and MetS.

PMID:40296126 | DOI:10.1186/s13098-025-01704-w

BMC Nurs. 2025 Apr 28;24(1):465. doi: 10.1186/s12912-025-03061-5.

ABSTRACT

BACKGROUND: Burnout and psychological distress are significant concerns among healthcare professionals, particularly pediatric oncology nurses, who face emotional and physical challenges due to their demanding roles. Continuous exposure to life-threatening illnesses, high patient mortality rates, and emotionally taxing interactions contribute to severe occupational stress, potentially affecting both nurse well-being and patient care quality. This study aimed to analyze the relationship between burnout and psychological distress among pediatric oncology nurses at the Children’s Cancer Hospital Foundation (CCHE 57357) in Egypt.

METHODS: A descriptive correlational research design was employed, involving a purposive sample of 188 nurses working in inpatient and intensive care units. Data were collected using three validated tools: (1) a Sociodemographic Data Sheet, (2) the Copenhagen Burnout Inventory (CBI) to assess personal, work-related, and client-related burnout, and (3) the Kessler Psychological Distress Scale (K10) to measure levels of psychological distress. The instruments underwent translation and validation for use in Arabic. Data collection occurred over six months, with statistical analysis conducted using SPSS (version 25). Descriptive statistics, Pearson correlation, and linear regression models examined relationships between burnout and psychological distress.

RESULTS: The findings revealed that 55.8% of nurses had low burnout levels, 31.4% had moderate burnout, and 12.8% exhibited high burnout. In addition, psychological distress levels varied, with 34% experiencing moderate distress, 25% showing very high psychological distress, and 22% reporting high distress. A statistically significant positive correlation (r = 0.59, p = 0.00) was identified between total burnout and psychological distress, indicating that higher burnout levels were associated with increased psychological distress. Regression analysis further confirmed the significant impact of psychological distress on burnout (R² = 0.35, Beta = 0.59, p = 0.00).

CONCLUSION: This study highlights the significant correlation between burnout and psychological distress among pediatric oncology nurses, emphasizing the critical need for specialized interventions to promote mental well-being. The findings stress the importance of implementing stress reduction programs, fostering better work-life balance strategies, and providing comprehensive mental health support to alleviate burnout and distress. Effectively addressing these issues will not only improve nurses’ overall well-being but also contribute to enhancing the quality of care in pediatric oncology settings.

CLINICAL TRIAL REGISTRATION: Not applicable.

PMID:40296125 | DOI:10.1186/s12912-025-03061-5