Category: Statistics

Front Pediatr. 2025 May 20;13:1477711. doi: 10.3389/fped.2025.1477711. eCollection 2025.

ABSTRACT

PURPOSE: The aim of this study was to assess the performance of utilizing the coaxial technique in conjunction with gelatin sponge slurry plugging for ultrasound-guided liver biopsy in children.

METHODS: We conducted a retrospective study of children undergoing ultrasound-guided coaxial liver biopsy at our institution between March 2020 and March 2025. Participants were stratified into two intervention groups: those receiving gelatin sponge tract embolization vs. batroxobin administered through needle tract. Through comprehensive electronic medical record review, we systematically extracted and compared the following outcome measures: (a) overall complication rates, (b) hemorrhage rates.

RESULTS: This study included 48 children, with 30 allocated to the gelatin sponge group and 18 to the batroxobin group. The gelatin sponge group demonstrated 9 complications (30.0%, 9/30), consisting of 5 pain events and 4 febrile episodes, while the batroxobin group experienced 6 complications (33.3%, 6/18), including 2 hemorrhage cases, 3 pain events, and 1 febrile episode. The overall complication rates showed no statistically significant difference between groups (30.0% vs. 33.3%, P = 0.809). However, a significant divergence was observed in hemorrhage incidence, with the gelatin sponge group demonstrating superior safety (0% vs. 11.1%, P = 0.044).

CONCLUSION: Compared to batroxobin tract injection, coaxial technique in conjunction with gelatin sponge slurry plugging significantly reduced hemorrhagic complications in liver biopsies for children, demonstrating superior safety. The finding supported its adoption as the preferred hemostatic method in children undergoing percutaneous liver biopsy.

PMID:40464048 | PMC:PMC12129982 | DOI:10.3389/fped.2025.1477711

Front Pediatr. 2025 May 20;13:1559405. doi: 10.3389/fped.2025.1559405. eCollection 2025.

ABSTRACT

BACKGROUND: The intensive care of critically ill children is challenging due to diverse etiologies and rapid disease progression. Early identification of high-risk patients is crucial for improving outcomes. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential biomarker reflecting the balance between innate and adaptive immune responses, with studies in adults showing its correlation with mortality and survival in intensive care settings. However, its application in pediatric intensive care units (PICU) is less explored.

OBJECTIVE: To examine the impact and predictive value of NLR on in-hospital mortality and 90-day survival rates in critically ill children using data from the Pediatric Intensive Care (PIC) database at the Children’s Hospital of Zhejiang University School of Medicine.

METHODS: This retrospective cohort study included 3,350 patients from the PIC database, with patients older than 28 days and an ICU stay of at least 48 h. Data on demographic information, ICU admission type, laboratory test results, and clinical outcomes were collected. The normal range of NLR was calculated using the percentile method. Time-weighted NLR was calculated using the trapezoidal rule to estimate the area under the curve of NLR values over time. Statistical analyses included chi-square tests, Mann-Whitney U tests, and multivariable logistic regression to assess the association between NLR and outcomes.

RESULTS: Higher time-weighted NLR levels were significantly associated with increased in-hospital mortality (OR = 1.15, 95% CI: 1.08-1.22, p < 0.001) and shorter ICU length of stay. The Kaplan-Meier survival analysis showed significantly different 90-day survival rates among NLR groups (p = 0.034). Subgroup analysis revealed the highest predictive value of time-weighted NLR in patients under 1 year old with an initial NLR less than 0.48 (AUC = 0.832).

CONCLUSION: The study confirms NLR, particularly in its time-weighted form, as a robust prognostic indicator for critically ill children. Elevated time-weighted NLR levels are associated with increased in-hospital mortality and shorter ICU stays, highlighting its potential for risk stratification and guiding clinical decisions in PICU. The dynamic nature of the time-weighted NLR provides a more accurate reflection of the patient’s inflammatory burden over time. However, the retrospective and single-center design of the study limits the generalizability of the results. Future research should address these limitations and explore the integration of NLR with other clinical and laboratory parameters to enhance prognostic accuracy in pediatric critical care settings.

PMID:40464042 | PMC:PMC12130025 | DOI:10.3389/fped.2025.1559405

Front Pediatr. 2025 May 20;13:1543755. doi: 10.3389/fped.2025.1543755. eCollection 2025.

ABSTRACT

CONTEXT: The most common congenital condition, congenital heart disease (CHD), is often left untreated or doesn’t get timely attention for various reasons. Nowadays, many pediatric cardiac centers in India offer surgical management, even in semi-urban or rural areas. Our center is one of them.

AIMS: This study aims to generate regional data from the Western part of India, primarily to determine the outcome of patients who had surgical intervention at our pediatric cardiac center.

METHODS AND MATERIAL: The present study retrospectively analyzed the data of the operated pediatric patients by reviewing the charts of patients admitted to the pediatric division of the cardiac center between April 2018 and October 2022. All demographic details, anthropometry, preoperative evaluation, operative procedures, postoperative issues, outcomes, etc. were reviewed, and the collected data were entered into Microsoft Excel.

STATISTICAL ANALYSIS: Descriptive statistics were used to present demographic data. Chi-square and Fisher exact tests were applied to find an association, and a p-value of <0.05 was considered statistically significant.

RESULTS: Out of the 422 pediatric admissions during the period studied, 386 underwent cardiac surgeries. The median (Q1, Q3) age of patients in months was 12 (6, 60), and 251 (61.2%) were males. The most prevalent CHD was ventricular septal defect (VSD), accounting for 88 patients (21.6%). Out of the 386 total patients who underwent cardiac surgery, 16 (4.1%) patients experienced mortality. The most common surgeries performed were VSD closure, patent ductus arteriosus ligation, and intracardiac repair for tetralogy of Fallot (TOF).

CONCLUSIONS: Pediatric heart surgery was offered for a varied CHD with comparable mortality and morbidity with other centers.

PMID:40464041 | PMC:PMC12129920 | DOI:10.3389/fped.2025.1543755

Crit Care Res Pract. 2025 May 27;2025:8884182. doi: 10.1155/ccrp/8884182. eCollection 2025.

ABSTRACT

Hospital-acquired anaemia (HAA) is characterised by initially normal haemoglobin levels upon admission that are lowered during the hospital stay. The decreased haemoglobin levels related to the days of intensive care unit (ICU) hospitalisation may explain the effect of other interventions on haemoglobin levels. This study aimed to investigate the association between decreased haemoglobin levels and days of hospitalisation in critically ill patients in the Qassim region by analysing haemoglobin levels within the first 7, 14, and 21 days after ICU admission. A total of 180 patients were admitted during the study period. Patients with gastrointestinal bleeding, transfusion-dependent anaemia, a history of anaemia or bleeding, those with chronic kidney disease or on dialysis, and those who had hematologic or other malignancies were excluded (n = 97). Finally, those who were at least 18 years old, was within the normal range of haemoglobin upon admission to the ICU and had been hospitalized for at least 21 days in the ICU were included (n = 83). The initial average haemoglobin concentration was higher in men (15.24 g/dL) than in women (13.45 g/dL). Both experienced a significant and relatively parallel decline in haemoglobin levels (8.95 g/dL) and (8.66 g/dL), respectively, throughout the 21 day hospitalization period. The p value (< 0.001) suggests that the fixed effects are statistically significant, indicating that time (days) has a significant effect on haemoglobin levels. This study found a consistent decrease in haemoglobin levels over the ICU hospitalisation period, suggesting a progressive condition or treatment effect leading to reduced haemoglobin levels. However, further studies are required to analyse the causes of HAA in ICU.

PMID:40464039 | PMC:PMC12133354 | DOI:10.1155/ccrp/8884182

J Dent Res Dent Clin Dent Prospects. 2025 Mar 31;19(1):29-32. doi: 10.34172/joddd.025.41232. eCollection 2025 Mar.

ABSTRACT

BACKGROUND: Apicoectomy is often required to treat a non-healing endodontic lesion. Materials used during this procedure, such as root-end conditioners and retrograde filling materials, can significantly affect the success. Mineral trioxide aggregate (MTA) has been used as a root-end filling material for a long time; however, success has also been reported with some novel materials such as Biodentine. The present study compared the sealing ability of MTA and Biodentine in root-end cavities following apicoectomy after using EDTA and maleic acid as root-end conditioners.

METHODS: The apical one-third of 60 extracted teeth were resected, followed by root-end preparation of 3 mm. The samples were divided into 4 groups of 15 each. The roots in groups 1 and 2 were conditioned with EDTA and maleic acid in groups 3 and 4. Retrograde cavities in groups 1 and 3 were filled with MTA and in groups 2 and 4 with Biodentine. Microleakage was checked using the dye penetration method. One-way ANOVA and post hoc Tukey tests were used for statistical analyses.

RESULTS: Group 1 showed the highest (2.94±0.112), while group 4 had the least dye penetration (2.55±0.213).

CONCLUSION: It can be concluded that Biodentine showed better sealing ability after using maleic acid than MTA and can be used as an alternative to MTA in root-end surgeries.

PMID:40464030 | PMC:PMC12128211 | DOI:10.34172/joddd.025.41232

J Dent Res Dent Clin Dent Prospects. 2025 Mar 31;19(1):46-56. doi: 10.34172/joddd.025.41487. eCollection 2025 Mar.

ABSTRACT

BACKGROUND: The present study evaluated condylar position changes using cone beam computed tomography (CBCT) in treating Cl II malocclusion with the twin block and clear functional jaw corrector (CFJC) appliances.

METHODS: In this RCT, we included 60 patients, with 30 in each treatment group (control group: twin block appliance, case group: CFJC appliance), randomly allocated using a lottery system. A twin block appliance or CFJC was fabricated for each patient following the protocol. Pre- and post-treatment records were collected over twelve months at 0-, 6- and 12-month intervals using cephalograms, CBCT, and questionnaires assessing the patient perception of the appliance.

RESULTS: Both groups showed significant improvements in malocclusion. Cephalometric analysis showed statistically significant differences between the two groups in SNB, ANB, and U1-NA. In comparing the two groups, significant differences were found in Arnett’s soft tissue parameters, including upper lip to E line, lower lip to E line, upper lip protrusion, upper lip length, lower lip length, lower 1/3 of the face, maxillary first incisor exposure, and mandibular height in the CFJC group. The intergroup comparison of projections to TVL (true vertical line) also showed significant differences across all parameters in the CFJC group. Furthermore, significant disparities in CBCT parameters were observed between the groups, specifically in condylar position, condylar height, and anterior joint space. Also, significant differences in patient comfort and perception of the appliance were observed, highlighting better compliance with the CFJC appliance.

CONCLUSION: The CFJC appliance is a top choice for Cl II malocclusion due to its superior effectiveness in skeletal, dental, and soft tissue improvements and significant condylar remodeling. Additionally, patients showed better compliance and acceptance of the CFJC appliance compared to traditional options, enhancing its clinical advantage in orthodontic practice.

PMID:40464026 | PMC:PMC12128203 | DOI:10.34172/joddd.025.41487

BJPsych Open. 2025 Jun 4;11(4):e117. doi: 10.1192/bjo.2025.67.

ABSTRACT

BACKGROUND: Studies have reported conflicting findings on the association between maternal pre- and perinatal depression and autism spectrum disorder (ASD) in offspring.

AIMS: To examine and consolidate the existing evidence on the association between maternal pre- and perinatal depression and the risk of ASD in children and adolescents.

METHOD: In this systematic review and meta-analysis, we searched PubMed, Medline, EMBASE, Scopus, CINAHL and PsycINFO from the database inception to 21 February 2024. A meta-analysis was performed using random-effect models, and summary effect estimates were presented as odds ratios with 95% confidence intervals. Heterogeneity was assessed with Cochran’s Q and the I²-statistic test. Additionally, subgroup analysis was conducted to identify the source of potential heterogeneity within the included studies. A funnel plot and Egger’s regression test were employed to evaluate publication bias.

RESULTS: Twelve studies involving over 1.6 million mother-offspring pairs were included in the final analysis. A random-effects meta-analysis of these studies revealed a 52% increased risk (odds ratio 1.52, 95% CI 1.13-1.90) of ASD in the offspring of mothers experiencing pre-pregnancy depression, a 48% increased risk (odds ratio 1.48, 95% CI 1.32-1.64) in those experiencing antenatal depression and a 70% increased risk (odds ratio 1.70, 95% CI 1.41-1.99) in those with postnatal depression.

CONCLUSIONS: This systematic review and meta-analysis found that offspring born to mothers with depression before, during and after birth have a higher risk of developing ASD. Our findings underscore the need for early screening and targeted intervention programmes for at-risk children.

PMID:40462259 | DOI:10.1192/bjo.2025.67

Musculoskeletal Care. 2025 Jun;23(2):e70136. doi: 10.1002/msc.70136.

ABSTRACT

OBJECTIVE: To determine the relationship between Nail Psoriasis Severity Index (NAPSI) and cardiovascular risk (CVR) assessed by 10 CVR calculators.

METHODS: Cross-sectional, observational, and comparative study of psoriatic arthritis (PsA) patients aged 30-75, classified according to established diagnostic criteria. The NAPSI was assessed, classifying patients into two groups: with (≥ 1) and without (< 1) nail involvement. The CVR was evaluated through: Framingham (FRS) lipids and body mass index (BMI), American College of Cardiology/American Heart Association- Atherosclerotic Cardiovascular Disease 2013 (ACC/AHA ASCVD 2013), Systematic Coronary Risk Evaluation (SCORE), SCORE 2, SCORE-Older Persons (OP), QRISK3, Reynolds Risk Score (RRS), Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) atherosclerotic cardiovascular disease (ASCVD) and PREVENT Heart Failure (HF) calculator. Group distribution was assessed using the Kolmogorov-Smirnov test. Comparisons were conducted accordingly with Chi-Squared, T-Student, U-Mann-Whitney, and Kruskal-Wallis tests. Correlations were performed using Spearman’s rho. Statistical significance was set at p ≤ 0.05.

RESULTS: Seventy-one patients with PsA were included, 31 with nail involvement and 40 without. CVR score was higher in PsA patients with nail involvement using SCORE (2.0 (1.0-3.7) versus 1.0 (0.0-2.0), p = 0.02). Regarding CVR, positive correlations were found between NAPSI and the following calculators: ACC/AHA ASCVD 2013 (Spearman’s rho = 0.202, p = 0.045), FRS BMI (Spearman’s rho = 0.229, p = 0.027), SCORE (Spearman’s rho = 0.344, p = 0.002), PREVENT ASCVD (Spearman’s rho = 0.198, p = 0.049), and PREVENT HF (Spearman’s rho = 0.291, p = 0.007).

CONCLUSIONS: A NAPSI ≥ 1 score is related to higher CVR assessed through SCORE and positively correlates with ACC/AHA, PREVENT TM ASCVD, and PREVENT HF.

PMID:40462257 | DOI:10.1002/msc.70136

Trop Med Health. 2025 Jun 3;53(1):78. doi: 10.1186/s41182-025-00761-1.

ABSTRACT

INTRODUCTION: Diurnal temperature range (DTR), the difference between daily maximum and minimum temperatures, has been increasingly recognized for its potential impact on human health. However, its contribution to mortality remains underexplored, particularly in tropical regions such as Thailand.

OBJECTIVE: To estimate the burden of all-cause mortality attributable to variations in DTR in Thailand utilizing data from 2007 to 2021.

METHODOLOGY: Data on daily all-cause mortality (ICD-10: A00-R99), excluding accidental causes, were obtained from the Strategy and Planning Division under the Office of the Permanent Secretary, Ministry of Public Health between January 2007 and December 2021, while daily meteorological data were sourced from the Thai Meteorological Department during the same period. A two-stage statistical model was utilized to assess the relationship between DTR and mortality. In the first stage, a time-stratified case-crossover design with conditional Poisson regression model was applied to estimate the province-specific associations between DTR and mortality. In the second stage, these province-specific estimates were pooled using a multivariate meta-regression model to obtain the national-level estimate. Finally, the mortality burden attributable to variations in DTR was determined using a backward perspective based on the relative risks obtained from the distributed lag non-linear model (DLNM).

RESULTS: During the study period, a total of 5,574,850 non-accidental cause of deaths was reported. The association between DTR and mortality followed a non-linear with U-shaped pattern, where the effect of DTR on mortality was higher at both low and high DTR levels. The fraction of mortality attributable to DTR at cumulative lag 0-7, 0-14, and 0-21 days was 1.88% (95% empirical confidence interval (eCI): 0.69-3.03), 2.39% (95% eCI: 0.75-3.99), and 4.67% (95% eCI: – 1.14-9.87), respectively.

CONCLUSIONS: The findings indicate that both low and high DTRs were associated with an increased risk of all-cause mortality in Thailand. This underscores the need to consider DTR as a significant climate-related health risk, particularly in tropical regions, to inform public health strategies aimed at reducing the burden of climate-related mortality.

PMID:40462239 | DOI:10.1186/s41182-025-00761-1

Inj Epidemiol. 2025 Jun 3;12(1):30. doi: 10.1186/s40621-025-00585-x.

ABSTRACT

OBJECTIVES: Extreme Risk Protection Orders (ERPOs) are civil court orders that temporarily prohibit firearm purchase and possession by someone (“respondent”) at imminent risk of harming themselves or others. Despite ERPOs being currently available in 21 states, DC, and U.S. V.I., little is known about the circumstances under which they are used across states.

METHODS: Using a standardized protocol, we abstracted ERPO petitions and associated court documents from 6 states to examine characteristics of respondents, documented risks of harm, and court outcomes. Included cases were filed through June 30, 2020, from 2013 (Connecticut) or from when the law went into effect (California: 2016; Colorado: 2020; Florida: 2018; Maryland: 2018; and Washington: 2016).

RESULTS: There were 6,634 ERPO petitions across included states. The median age of respondents was 40.0 years (SD: 16.4), and 10.8% were female. Almost half of petitions noted suicidal threats, plans, or ideation (43.9%) as the precipitating event, half noted interpersonal violence threats (50.8%), and one quarter (24.6%) noted threats to both self and others. Around one third (36.0%) noted unlawful or reckless firearm use. The majority of petitions (84.1%) indicated the respondent had current or recent access to a firearm. Most (77.5%) of the final orders (post-hearing) were granted. ERPO implementation varied across states, particularly with regard to how frequently they were used, for what type of threat, and by what type of petitioner.

CONCLUSIONS: This study examined ERPO law implementation in 6 states, highlighting differences and similarities. This comparison allows for a more nuanced understanding of variation in ERPO use, which can inform ERPO implementation and future studies of ERPOs’ effectiveness.

PMID:40462226 | DOI:10.1186/s40621-025-00585-x