Category: Statistics

BMC Geriatr. 2025 Jun 9;25(1):420. doi: 10.1186/s12877-025-06094-2.

ABSTRACT

BACKGROUND: Frailty is associated with adverse outcomes in older adults across healthcare settings. Frailty screening tools can serve to identify older adults living with frailty and direct resources to high-risk older adults. This systematic review and meta-analysis examined the diagnostic and predictive accuracy of the Program of Research to Integrate the Services for the Maintenance of Autonomy 7 (PRISMA-7) frailty screening tool.

METHODS: A systematic literature search was conducted in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library. Prospective or retrospective cohort and cross-sectional studies that explored the diagnostic and/or predictive accuracy of the PRISMA-7 tool in older adults were included across all healthcare settings. Study quality was assessed using the QUADAS-2 tool. Statistical analysis was completed using Stata version 12 (StataCorp, TX, USA). A bivariate random effects model was used to generate pooled estimates of sensitivity and specificity. RevMan5 was used to pool data comparing older adults living with frailty versus those without frailty.

RESULTS: Thirty-six studies were included in the review. The overall quality of the studies included was moderate. Meta-analysis of diagnostic accuracy (regardless of reference standard used) showed a pooled sensitivity and specificity of 72% (95% CI 54-84%) and 87% (95% CI 76-93%), respectively. Sub-analysis of the six studies that used Frailty Phenotype as a reference standard demonstrated pooled sensitivity and specificity of 82% (95% CI 73.8-88.2) and 79% (95% CI 72-85.6%), respectively. Meta-analysis of the predictive accuracy of the PRISMA-7 showed that older adults living with frailty spent significantly more time in the emergency department (FEM MD 2.66 h, 95% CI 2.15-3.16 h, I² = 25%) and stayed longer in hospital, (REM MD 1.89 days, 95% CI 0.18-3.6 days, I² = 86%), respectively.

CONCLUSION: The PRISMA-7 has a moderate sensitivity and high specificity for frailty identification. It has good predictive accuracy for multiple adverse outcomes among older adults, supporting its potential utilization across healthcare settings.

PMID:40490744 | DOI:10.1186/s12877-025-06094-2

BMC Pulm Med. 2025 Jun 9;25(1):286. doi: 10.1186/s12890-025-03750-6.

ABSTRACT

BACKGROUND: Stroke-associated pneumonia (SAP) is a common and severe complication following stroke, significantly impacting recovery and outcomes. Early identification of biomarkers and development of predictive models are essential for SAP diagnosis and prevention. This study systematically evaluated the diagnostic value of procalcitonin (PCT) and other biomarkers for SAP and explored their integration into predictive models.

METHODS: A systematic review and meta-analysis were conducted by searching PubMed, Web of Science, and CNKI databases for studies published up to March 2023. Inclusion criteria focused on studies reporting biomarkers for SAP diagnosis and predictive models. Statistical analyses included pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) using RevMan 5.4 and R software.

RESULTS: This meta-analysis included 11 studies with 1,478 patients and found that PCT levels were significantly elevated in SAP patients, particularly those with ischemic stroke (standardized mean difference [SMD] = 2.89, 95% confidence interval [CI] = 1.74-4.04). PCT demonstrated high diagnostic accuracy, with a pooled sensitivity of 0.84, specificity of 0.89, DOR of 48.78, and AUC of 0.91, outperforming other biomarkers like CRP and IL-6. Predictive models incorporating biomarkers improved risk stratification, though heterogeneity among studies underscores the need for standardization.

CONCLUSIONS: PCT is a reliable biomarker for SAP diagnosis, offering high sensitivity and specificity. Combining PCT with predictive models can enhance risk assessment and early detection of SAP. Further research is necessary to refine prediction models and validate the clinical application of biomarkers across diverse populations. This study underscores the importance of biomarkers in guiding SAP prevention and management strategies.

PMID:40490740 | DOI:10.1186/s12890-025-03750-6

Environ Health. 2025 Jun 10;24(1):36. doi: 10.1186/s12940-025-01187-2.

ABSTRACT

BACKGROUND: Glyphosate-based herbicides (GBHs) are the world’s most widely used weed control agents. Public health concerns have increased since the International Agency for Research on Cancer (IARC) classified glyphosate as a probable human carcinogen in 2015. To further investigate the health effects of glyphosate and GBHs, the Ramazzini Institute launched the Global Glyphosate Study (GGS), which is designed to test a wide range of toxicological outcomes. Reported here are the results of the carcinogenicity arm of the GGS.

METHODS: Glyphosate and two GBHs, Roundup Bioflow used in the European Union (EU) and RangerPro used in the U.S., were administered to male and female Sprague-Dawley (SD) rats, beginning at gestational day 6 (via maternal exposure) through 104 weeks of age. Glyphosate was administered through drinking water at three doses: the EU acceptable daily intake (ADI) of 0.5 mg/kg body weight/day, 5 mg/kg body weight/day and the EU no-observed adverse effect level (NOAEL) of 50 mg/kg body weight/day. The two GBH formulations were administered at the same glyphosate-equivalent doses.

RESULTS: In all 3 treatment groups, statistically significant dose-related increased trends or increased incidences of benign and malignant tumors at multiple anatomic sites were observed compared to historical and concurrent controls. These tumors arose in haemolymphoreticular tissues (leukemia), skin, liver, thyroid, nervous system, ovary, mammary gland, adrenal glands, kidney, urinary bladder, bone, endocrine pancreas, uterus and spleen (hemangiosarcoma). Increased incidences occurred in both sexes. Most of these involved tumors that are rare in SD rats (background incidence < 1%) with 40% of leukemias deaths in the treated groups occurring before 52 weeks of age and increased early deaths were also observed for other solid tumors.

CONCLUSIONS: Glyphosate and GBHs at exposure levels corresponding to the EU ADI and the EU NOAEL caused dose-related increases in incidence of multiple benign and malignant tumors in SD rats of both sexes. Early-life onset and mortality were observed for multiple tumors. These results provide robust evidence supporting IARC’s conclusion that there is “sufficient evidence of carcinogenicity [of glyphosate] in experimental animals”. Furthermore, our data are consistent with epidemiological evidence on the carcinogenicity of glyphosate and GBHs.

PMID:40490737 | DOI:10.1186/s12940-025-01187-2

BMC Complement Med Ther. 2025 Jun 9;25(1):210. doi: 10.1186/s12906-025-04935-6.

ABSTRACT

Although modern contraceptive practices are actively advocated, many individuals continue to rely on traditional medicines for contraception due to their perceived safety. The open-ended questionnaire used in this study sought to gain insights into contraceptive practices from traditional providers’ perspectives. Herb sellers and herbal practitioners from four yoruba-speaking states in Nigeria-Kwara, Lagos, Oyo, and Osun-were interviewed. Data from questionnaires were analyzed via descriptive and inferential statistics. Quantitative analysis was done using the informant consensus factor (ICF) and relative frequency of citation (RFC) indices. A total of 31 species were recorded across the study areas. Kwara had the highest diversity, with 20 plant species, followed by Lagos (16), Oyo (10) and Osun (4). The ICF value recorded across the study areas was 0.7, with the most frequently cited species for female and male contraception varying by location. Carica papaya had RFC values of 0.58 in Oyo and 0.44 in Osun, while Mucuna pruriens recorded 0.30 in Lagos and Jatropha gossypiifolia had 0.27 in Kwara. The plant species were mostly prepared in combination forms, with seeds and leaves being the most used parts. These were administered as herbal contraceptive decoctions, powders, or worn as contraceptive rings or waist beads. A statistically significant difference existed between the plant form, the education level of participants, and having patients seeking contraception. In conclusion, this survey underscores the diverse range of medicinal plant species used for contraception. Further research is essential to validate their efficacy and understand the mechanisms of herbal contraceptives.

PMID:40490736 | DOI:10.1186/s12906-025-04935-6

Clin Spine Surg. 2025 Jun 9. doi: 10.1097/BSD.0000000000001847. Online ahead of print.

ABSTRACT

STUDY DESIGN: The reconstruction of the anterior vertebral body using 3D-printed artificial vertebrae after total en bloc spondylectomy for spinal tumors restores spinal stability.

OBJECTIVE: To investigate the feasibility of using 3D-printed artificial vertebrae for spinal reconstruction after tumor resection.

SUMMARY OF BACKGROUND DATA: Total en bloc spondylectomy is an effective surgical method for treating spinal tumors. However, reconstructing the vertebral body after tumor resection is challenging. 3D-printed artificial vertebrae offer a novel solution to this issue.

METHODS: From December 2016 to September 2023, 43 patients with malignant spinal tumors underwent vertebrectomy followed by reconstruction using 3D-printed artificial vertebrae. The cohort included 30 males and 13 females, aged 15-76 years, with a mean age of 58.0 years. Tumor types included 12 primary malignant tumors and 36 metastatic tumors. Clinical outcomes were assessed using preoperative and postoperative VAS scores at 24 hours and 3 months, Frankel grades, and radiologic evaluation of local tumor control and prosthesis subsidence.

RESULTS: Follow-up ranged from 3 to 31 months, with a mean of 10.9 months. There was a statistically significant improvement in VAS scores at 24 hours and 3 months postoperatively compared with preoperative scores (P<0.01). Of the 43 patients, 42 (97.7%) showed at least one grade improvement in Frankel grade at the last follow-up. During the follow-up period, there were no cases of prosthesis subsidence among the patients who underwent reconstruction with 3D-printed artificial vertebrae.

CONCLUSION: Porous titanium artificial vertebrae produced by 3D printing technology exhibit good biocompatibility and mechanical stability, making them suitable for reconstruction after vertebrectomy.

PMID:40489897 | DOI:10.1097/BSD.0000000000001847

Clin Spine Surg. 2025 Jun 9. doi: 10.1097/BSD.0000000000001837. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To assess potential risk factors for cage subsidence after transforaminal lumbar interbody fusion (TLIF), specifically comparing polyetheretherketone (PEEK) versus titanium cages.

SUMMARY OF BACKGROUND DATA: PEEK and titanium cages are commonly used for arthrodesis in TLIF. Titanium may demonstrate osseointegration superior to PEEK, but there is little evidence comparing the risk-stratified subsidence rate between the 2 cage types.

METHODS: We identified adult patients who underwent 1-level TLIF over a 5-year period at our institution. We recorded patient demographics, cage subsidence, fusion status, and average Hounsfield unit (HU) measurements of the target endplates. Univariate analysis evaluated cage subsidence and clinical and patient-reported outcomes. Risk stratification was based on subsidence grades. Potential risk factors for subsidence were identified by multivariate analysis.

RESULTS: The 130 TLIF patients received 74 PEEK and 56 titanium cages. Demographics, clinical characteristics, and average HU did not differ between the cage types, and no statistically significant correlation was observed between these measures and subsidence grade. PEEK (86.5%) and titanium (89.3%) groups demonstrated similar fusion rates (P=0.630). The titanium group had a higher subsidence rate than the PEEK group (55.4% vs. 39.2%, P=0.067) and overall more higher-grade (25%-100%) subsidence (51.5% vs. 45.5%, P=0.186). Patients who demonstrated evidence of subsidence within 1 month of surgery were more likely to experience high-grade subsidence at 1-year follow-up (odds ratio=30.178, P<0.001). Although high-grade subsidence was associated with pseudarthrosis, early subsidence did not necessarily lead to pseudarthrosis.

CONCLUSIONS: The rate and severity of cage subsidence may be multifactorial and warrant further high-powered, risk-adjusted studies.

LEVEL OF EVIDENCE: Level III.

PMID:40489896 | DOI:10.1097/BSD.0000000000001837

Medicine (Baltimore). 2025 Jun 6;104(23):e42569. doi: 10.1097/MD.0000000000042569.

ABSTRACT

The maxillofacial region consists of soft and hard tissues that form the face and extend from the frontal bone superiorly to the mandible inferiorly. Because the face is the most exposed part of the body, it is especially vulnerable to trauma. Trauma to the maxillofacial regions is a major public health problem worldwide. Nearly 5% to 10% of trauma patients have facial fractures. Thus, the aim of this study was to assess the etiology and pattern of maxillofacial fractures among patients who visited Jimma Medical Center (JMC) dental clinic, Southwest Ethiopia. Institutional based retrospective cross-sectional study was conducted on 331 patients (279 males and 52 females with a mean age of 26.23 ± 13.51 years) with maxillofacial fractures who visited JMC dental clinic from January 2018 to December 2020. To collect data first charts of the patients were found using their medical record numbers. Then information like socio-demographic characteristics, patterns of fractures, and causes of fractures, was collected using a structured and pretested checklist from the chart. Data was entered into the Epi-data version 3.1 and exported to SPSS version 25 for analysis. Descriptive analysis was done and presented by the use of tables, bar graphs and pie chart. The leading cause of fracture was road traffic accidents (45%), followed by assault (33.2%) and accidental fall (11.8%). Head (51.6%) injuries were the most common associated injuries. Surgical site infection (52.2%) was the most common posttreatment complication. The study’s findings can be used to guide public health activities, healthcare professional training, and resource allocation in Ethiopia in order to enhance maxillofacial fracture prevention, management, and outcomes.

PMID:40489882 | DOI:10.1097/MD.0000000000042569

Medicine (Baltimore). 2025 Jun 6;104(23):e42658. doi: 10.1097/MD.0000000000042658.

ABSTRACT

The genetic prediction of the causal relationship between enlarged perivascular spaces (PVS) and intracerebral hemorrhage (ICH). We performed a 2-sample Mendelian randomization (MR) study that used published data from genome-wide association studies on ICH and PVS. We primarily utilized the inverse variance weighted (IVW), MR-Egger, weighted median and weighted mode method. Sensitivity analyses included Cochran Q test, MR-Egger regression, MR-PRESSO global test and leave-one-out analysis. IVW analysis showed no statistical association between genetically predicted enlargement of hippocampal PVS (OR = 0.74, 95% CI = 0.23-2.35, P = .605), basal ganglia PVS (OR = 1.59, 95% CI = 0.64-3.95, P = .318), or white matter PVS (OR = 1.59, 95% CI = 0.64-3.95, P = .318) with the risk of ICH. The results of MR-Egger regression, Weighted Median, and Weighted Mode methods were consistent with those of the IVW method. The sensitivity analyses did not reveal any pleiotropy or heterogeneity. The leave-one-out plots did not found any single mutation that might influence the results. Our findings indicate that there is no causal relationship between PVS enlargement and the development of ICH at the genetic level. Using PVS as a diagnostic marker might lack specificity, needed for the planning of timely diagnostic procedures in the risk populations.

PMID:40489879 | DOI:10.1097/MD.0000000000042658

Medicine (Baltimore). 2025 Jun 6;104(23):e42591. doi: 10.1097/MD.0000000000042591.

ABSTRACT

Obesity is a recognized risk factor for VTE in both children and adults. However, the causal relationship between childhood obesity and the risk of VTE in adulthood remains unclear. This study conducted a bidirectional 2-sample Mendelian randomization (MR) analysis using genome-wide association study data to explore this association. The inverse-variance weighting (IVW) method, along with weighted median and MR-Egger approaches, was employed to assess causality, while linkage disequilibrium score regression (LDSC) evaluated genetic correlations. Sensitivity analyses, including Cochran Q statistics, the MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis, ensured the robustness of the findings. In the forward MR analysis, the IVW analysis identified a significant causal association between childhood body mass index (BMI) and UBK_VTE (OR: 1.005, 95% CI: 1.000-1.008, P = .002), FinnGen_VTE (OR: 1.303, 95% CI: 1.175-1.446, P < .001), FinnGen_pulmonary embolism (PE) (OR: 1.265, 95% CI: 1.079-1.484, P = .004) and FinnGen_deep vein thrombosis (DVT) (OR: 1.345, 95% CI: 1.145-1.58, P < .001). The results remained consistent across different MR methods, with no evidence of pleiotropy or heterogeneity. Reverse MR analysis showed that VTE, including PE and DVT, had no causal effect on childhood obesity. LDSC analysis further confirmed significant genetic correlations between childhood BMI and VTE outcomes (FinnGen_VTE [rg = 0.28, P = 2.21 × 10-7], FinnGen_PE [rg = 0.24, P = 8.62 × 10-5], and FinnGen_DVT [rg = 0.27, P = 1.79 × 10-5]). In conclusion, these findings provide genetic evidence that childhood obesity increases the risk of developing VTE in adulthood, emphasizing the need for early prevention and weight management strategies. Further studies are required to explore underlying biological mechanisms and assess the impact of obesity interventions on VTE risk reduction.

PMID:40489873 | DOI:10.1097/MD.0000000000042591

Medicine (Baltimore). 2025 Jun 6;104(23):e42641. doi: 10.1097/MD.0000000000042641.

ABSTRACT

Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional procedure that is often performed under sedation anesthesia and that is used in the diagnosis and treatment of hepatopancreaticobiliary diseases. The objective of this study was to compare the efficacy of hypnosis in conjunction with sedoanalgesia and sedoanalgesia alone in the context of outpatient anesthesia prior to ERCP. Patients undergoing ERCP in the endoscopy unit between March and May 2021 were randomly assigned to 1 of 2 groups: group 1 received hypnosis and sedoanalgesia, and group 2 received sedoanalgesia alone. Both groups were administered 0.5 to 0.6 mg/kg intravenous pethidine hydrochloride (HCl), 1 to 3 mg intravenous midazolam, and 1 to 2 mg/kg intravenous propofol. The first group also received hypnotic induction before the procedure and anesthetic agents. In the event of patients exhibiting movement during the procedure, an anesthesiologist was unaware of the patient’s allocation and administered additional propofol and/or pethidine HCl. A statistical comparison was conducted between the 2 groups regarding demographic data, vital parameters, medication requirements, and satisfaction scales. Thirty patients were included in both groups. Following the procedure, the administration of propofol and pethidine HCl was reduced in group 1 (P = .031 and P = .009, respectively). The 5-minute heart rate, baseline peripheral oxygen saturation at 3 and 10 minutes were lower in group 2 (P = .008, P = .011, P = .017, and P = .031, respectively). Although the dose of anesthetic drugs were lower, no significant difference was observed neither in the patient satisfaction scores, nor in patient movements. The use of hypnosis during ERCP enhances the efficacy of sedoanalgesia. Hypnotic anesthesia may be employed as an alternative method in cases where high-dose administration of these agents is contraindicated.

PMID:40489869 | DOI:10.1097/MD.0000000000042641