Category: Statistics

Cancer Med. 2025 Nov;14(21):e71341. doi: 10.1002/cam4.71341.

ABSTRACT

BACKGROUND: The low participation rate in colorectal cancer (CRC) screening may be partly attributed to the lack of consideration for the preferences of both Recipients and Providers. This study aims to explore these preferences to inform the optimization of screening design and the improvement of implementation strategies.

METHODS: A discrete choice experiment (DCE) was conducted in Shandong Province to examine CRC screening preferences of Recipients and Providers. The attributes and levels of the DCE were determined using a systematic literature review and explored qualitatively. Questionnaires were generated through a partial factor design, and used a mixed logit model to analyze the data. Relative importance scores (RIS) and marginal willingness to pay were used to quantify preferences, and probability density functions were employed to predict changes in participation rates under varying attribute levels.

RESULTS: Preference data from 570 Recipients and 532 Providers were analyzed. The DCE included five attributes: screening cost (four levels), screening interval (four levels), bowel preparation (two levels), screening accuracy (three levels), and reduction in CRC-related mortality risk (three levels). All attributes significantly influenced preferences. The RIS indicated that Recipients prioritized screening cost (42.8%), followed by interval (24.3%), mortality risk reduction (16.2%), accuracy (10.7%), and bowel preparation (6.0%), whereas Providers emphasized bowel preparation (35.4%), interval (31.7%), cost (25.1%), mortality risk reduction (6.4%), and accuracy (1.3%). Both groups showed strong support for biennial screening. Shortening the interval from 10 to 2 years increased Recipients’ willingness to pay by CNY 1052.95 and Providers’ expected charge by CNY 1370.84, which was also associated with higher predicted participation rates.

CONCLUSION: Recipients and Providers differed in the degree of preference for the five CRC screening attributes, but the directions of their preferences were consistent. Therefore, screening strategies should aim to balance the perspectives of both groups. Where feasible, a biennial screening program that includes bowel preparation, minimizes costs and mortality risk, and maximizes accuracy is recommended.

PMID:41176721 | DOI:10.1002/cam4.71341

ACS Chem Biol. 2025 Nov 2. doi: 10.1021/acschembio.5c00751. Online ahead of print.

ABSTRACT

Immunomodulatory imide drugs (IMiDs), including thalidomide, lenalidomide, and pomalidomide, can be used to induce degradation of a protein of interest that is fused to a short degron motif, which often comprises a zinc finger (ZF). These IMiDs, however, also induce the degradation of endogenous ZF-containing neosubstrates, including IKZF1, IKZF3, and SALL4. To improve degradation selectivity, we took a bump-and-hole approach to design and screen bumped IMiD analogues against 8380 ZF mutants. This yielded a bumped IMiD analogue that induces efficient degradation of a mutant ZF degron, while not affecting other cellular proteins, including IKZF1, IKZF3, and SALL4. In proof-of-concept studies, this system was applied to induce degradation of the optimum degron fused to CDK9, HPRT1, NanoLuc, or TRIM28. We anticipate that this system will be a valuable addition to the current arsenal of degron systems for use in target validation.

PMID:41176706 | DOI:10.1021/acschembio.5c00751

Ann Med. 2025 Dec;57(1):2580783. doi: 10.1080/07853890.2025.2580783. Epub 2025 Nov 2.

ABSTRACT

BACKGROUND: Although some prediction models have been developed to evaluate postpartum haemorrhage in caesarean delivery with complications, limited attention has focused on unplanned return to the operating room (UPROR), especially in twin pregnancies. On this note, this study seeks to investigate the risk factors for UPROR and Postpartum Haemorrhage (PPH) in twin pregnancies after caesarean section (CS) and develop a nomogram for predicting PPH.

OBJECTIVE: This study aimed to investigate the risk factors for UPROR and PPH in twin pregnancies after CS in China and develop a nomogram for PPH prediction.

METHODS: A multicentre retrospective cohort study was conducted. There were a total of 1198 twin pregnant women who underwent a CS at the Women’s Hospital, School of Medicine, Zhejiang University in Hangzhou, Ninghai Maternal and Child Health Hospital, Fuyang Women and Children’s Hospital in China from January 2017 to December 2021. All 1198 pregnant women were randomly divided into two groups (D for development and V for validation), one for training and one for validation by ratio 7:3. A nomogram was developed to predict PPH (blood loss ≥1000 ml) and UPROR based on the model generated by logistic regression analysis. The training cohort and the validation cohort were evaluated in PPH, and a decision curve analysis was developed.

RESULTS: 16.77% (201/1198) women experienced PPH, 142 of which (142/840, 16.90%) in the training cohort and 59 (59/358, 16.48%) in the validation cohort. Seven optimal variates were obtained as predictors of PPH in twin pregnancies, including assisted reproductive technology (ART), advanced gestational weeks, placenta previa, emergency operation, total birth weight, and the use of uterotonic and anticoagulants. The AUC for the nomogram was 0.75 (95% CI, 0.71-0.79) for the training cohort, while that was 0.83 (95% CI, 0.79-0.88) for the validation dataset. 3.67% (44/1198) of women experienced UPROR for tamponade after the CS; PPH was the cause in all cases, none of whom had a hysterectomy. Six optimal variates were obtained as predictors of UPROR in twin pregnancies, including advanced maternal age, ART, parity ≥ 1, placenta previa, total amount of amniotic fluid (ml) ≥ 1500, and twin growth discordance. The AUC for the nomogram was 0.74 (95% CI, 0.66-0.82).

CONCLUSION: The novel nomogram prediction model for UPROR in twin pregnancies via cesarean section has clinical potentials, including the prevention of PPH in twin pregnancies.

PMID:41176700 | DOI:10.1080/07853890.2025.2580783

Ann Med. 2025 Dec;57(1):2577880. doi: 10.1080/07853890.2025.2577880. Epub 2025 Nov 2.

ABSTRACT

OBJECTIVE: Phlegmasia cerulea dolens (PCD) is the most severe form of deep vein thrombosis in the lower extremities. Clinical guidelines have not systematically outlined its risk factors, diagnostic methods, or treatment strategies. In this study, the literature published over the past 30 years is reviewed to summarize the clinical features of, diagnostic approaches to, prognostic factors of, and evolving management strategies for PCD.

METHODS: A retrospective analysis was conducted on 144 PCD patients from 1990 to 2024. Demographic data, clinical features, comorbidities, diagnostic methods, treatments, and prognostic outcomes were extracted. Descriptive statistical analysis was performed, and univariate and multivariate logistic regression were used to evaluate the impact of clinical factors on prognosis.

RESULTS: The majority of PCD cases involved the left lower limb, with 93.00% of patients having thrombosis extending into the iliocaval vein. Key risk factors included venous structural abnormalities, malignant tumors, and prior venous thromboembolism, with reproductive system cancers being the most common malignancy. Endovenous debulking techniques emerged as the preferred treatment method, reducing the risk of amputation and death by 70% compared with anticoagulation or thrombectomy. Patients with bilateral limb involvement, stage III PCD, or who underwent fasciotomy had significantly greater risks of amputation and death. The overall mortality rate was 18.75%, which was due primarily to metabolic acidosis and multiple organ failure.

CONCLUSION: Multimodal imaging should be recommended for the systematic evaluation of PCD to identify underlying malignancies and venous structural abnormalities. Endovenous debulking has demonstrated advantages in improving prognosis and should be recommended as a first-line treatment for PCD.

PMID:41176699 | DOI:10.1080/07853890.2025.2577880

Recenti Prog Med. 2025 Nov;116(11):661-669. doi: 10.1701/4588.45981.

ABSTRACT

INTRODUCTION: The prognostic potential of history of allergy and atopy in glioblastoma (GBM) patients has been poorly evaluated until now. In the present work, we studied the association between history of allergy/atopy and survival length in a cohort of GBM patients. We also evaluated the association between already suggested demographic, anamnestic, clinicopathologic and molecular prognostic variables for GBM and survival.

METHODS: The study was conducted retrospectively on a cohort of 145 patients diagnosed with GBM between 2015 and 2021. Data were retrieved from clinical charts. Information on history of allergy and atopy was self-reported.

RESULTS: Median overall survival was 9.1 months (IQR 4.3-17). Patients with positive history of allergic/atopic diseases were 33 (22.8%). From univariable analysis, patients with allergies had a longer survival time than those with no allergies; however, this result was not statistically significant (HR:0.72; 95%CI 0.49-1.07). Instead, from multivariable analysis, patients aged ≥65 years resulted to have a shorter survival than the others; (HR:2.10; 95%CI 1.35-2.84), while an increased survival length is observed for patient who underwent tumor surgical resection (HR:0.46; 95%CI 0.30-0.72) and receiving adjuvant therapy (HR:0.25; 95%CI 0.17-0.38).

CONCLUSION: Although the result was not statistically significant, we found a trend of protective effect of allergies/atopies in GBM patients. In addition, the study confirmed positive effects on GBM survival of some well-known variables, such as surgical resection, adjuvant therapy, and age.

PMID:41176669 | DOI:10.1701/4588.45981

Neurol Res. 2025 Nov 2:1-8. doi: 10.1080/01616412.2025.2583441. Online ahead of print.

ABSTRACT

BACKGROUND: Intracranial hemorrhage (ICH) prevalence is increasing, yet its genetic risk factors and micronutrient associations remain unclear.

METHODS: We performed univariable and multivariable Mendelian randomization (MR) analyses using 15 micronutrients derived from genome-wide association study (GWAS) data to assess their relationship with ICH risk.

RESULTS: Univariable MR analysis suggested that genetically predicted vitamin B6 [odds ratio (OR) = 0.6 (95% CI, 0.38 to 0.96), p = 0.033] and vitamin E [OR = 0.49 (95% CI, 0.33 to 0.73), p < 0.001] were potentially associated with the risk of ICH. Other micronutrients did not exhibit statistically significant associations with ICH in this analysis. Furthermore, multivariable MR analysis revealed significant causal relationship between vitamin E and ICH [OR = 0.514 (95% CI, 0.312 to 0.845), p = 0.009].

CONCLUSION: Vitamin E levels are significantly associated with reduced ICH risk, indicating its potential as a preventative agent. Further research is needed to explore this relationship fully.

PMID:41176655 | DOI:10.1080/01616412.2025.2583441

Cancer. 2025 Nov 1;131(21):e70163. doi: 10.1002/cncr.70163.

ABSTRACT

BACKGROUND: Management of metastatic prostate cancer often requires combining androgen deprivation therapy (ADT) with novel androgen receptor signaling inhibitors (ARSIs). Although these agents improve survival, older patients may face acute care utilization from medication burden, reflected in polypharmacy and nonadherence.

METHODS: Using SEER-Medicare data, the authors identified patients ≥66 years old with de novo metastatic prostate cancer prescribed abiraterone, enzalutamide, or apalutamide (2010-2017). Polypharmacy was defined by the Youden index (≥8 medications). ARSI adherence was measured by medication possession ratio (≥0.8) from initiation to discontinuation, assessed over 6 months. Acute care use was defined as any inpatient hospitalization or emergency visit within 6 months. Demographic characteristics were compared by t-tests/χ². Negative binomial regression estimated incidence rate ratios (IRRs) for acute care use.

RESULTS: Among 2697 patients (mean age, 75 years), most were White (80.3%), married (63.1%), and received prior ADT (85.3%). Polypharmacy was present in 50.6% of patients before ARSI initiation, whereas ARSI nonadherence in the 6 months post-initiation was 34.0%. Polypharmacy and adherence were not significantly associated. In adjusted analyses controlling for demographic, clinical, and treatment factors, both polypharmacy (IRR, 1.59; 95% confidence interval [CI], 1.28-1.98) and ARSI nonadherence (IRR 2.50; 95% CI, 2.00-3.03) independently prognosticated higher acute care use.

CONCLUSIONS: Medication burden, as characterized by suboptimal adherence and polypharmacy, is an independent risk factor for acute care use among older adults initiating ARSI treatment for metastatic prostate cancer. These findings highlight an opportunity for potential interventions to reduce downstream acute care use.

PMID:41176642 | DOI:10.1002/cncr.70163

J Eval Clin Pract. 2025 Dec;31(8):e70300. doi: 10.1111/jep.70300.

ABSTRACT

RATIONALE: Skin cancer is a significant public health problem; it is one of the most commonly occurring cancers worldwide and imposes a high economic burden on society.

AIMS AND OBJECTIVES: This study aimed to elucidate the key factors affecting the cost of skin cancer in patients residing in southern Iran.

METHODS: A comprehensive list of cost-affecting factors for skin cancer was developed through a scoping review of relevant literature from multiple databases (PubMed, ProQuest, Scopus, ISI Web of Science, SID, and Magiran), supplemented by expert input from skin cancer specialists. Subsequently, the data about 216 skin cancer patients selected randomly were collected between March 2020 and March 2022. The factors affecting the costs of skin cancer were determined using SPSS 13.0 software through statistical tests and multiple regression analysis.

RESULTS: Multiple linear regression analysis identified mortality (p < 0.001), inpatient days (p < 0.001), and skin cancer type (p = 0.056) as key cost drivers. Mortality had the strongest impact, increasing costs by $78,249 per case (95% CI: ±$12,433), followed by each additional inpatient day ($4884 ± $845). Melanoma cases incurred $3727 higher costs than non-melanoma cases.

CONCLUSIONS: In conclusion, mortality, cancer type, and inpatient days were key cost drivers in skin cancer management. To mitigate these, we recommend nationwide high-risk screening, hospitalization reduction strategies, and prevention programs. Targeted mortality reduction requires early detection initiatives and public education on warning signs.

PMID:41176632 | DOI:10.1111/jep.70300

Coron Artery Dis. 2025 Oct 30. doi: 10.1097/MCA.0000000000001584. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults undergoing percutaneous coronary intervention (PCI) face unique challenges due to complex anatomy and comorbidities. Intravascular imaging [including intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] has been shown to improve PCI outcomes, but its benefits in older adults are less well established. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare intravascular imaging with angiography alone to guide PCI in older adults.

METHODS: Cochrane, PubMed, and Scopus were searched for RCTs comparing intravascular imaging (IVUS or OCT) vs. angiography alone in adults aged ≥65 years. The outcome of interest was major adverse cardiovascular events (MACE) at the longest follow-up, as defined by each trial. Subgroup analyses were performed based on intravascular imaging modality, age group, and lesion complexity. Data were pooled using random-effects models, and heterogeneity was assessed using Higgins’ I² statistic.

RESULTS: Nine RCTs (n = 7164, intravascular imaging = 3703, angiography alone = 3461) met the inclusion criteria. Intravascular imaging significantly reduced MACE compared with angiography alone [relative risk (RR) 0.66, 95% confidence interval (CI) 0.56-0.77; P < 0.001; I² = 0%]. IVUS demonstrated superiority over angiography alone (RR 0.55, 95% CI 0.43-0.72; P < 0.001; I² = 0%), while OCT demonstrated only a trend toward MACE reduction (RR 0.80, 95% CI 0.62-1.02). Subgroup analyses indicated consistent benefits with intravascular imaging for adults aged ≥65 and ≥70 years, respectively, and among those with complex coronary lesions (RR 0.65, 95% CI 0.53-0.79; P < 0.001).

CONCLUSION: Intravascular imaging guidance, especially IVUS, reduces MACE in older adults undergoing PCI compared with angiography alone.

PMID:41176629 | DOI:10.1097/MCA.0000000000001584

BMC Anesthesiol. 2025 Nov 1;25(1):541. doi: 10.1186/s12871-025-03418-y.

ABSTRACT

BACKGROUND: Robotic-assisted minimally invasive esophagectomy (RAMIE) has become an increasingly adopted approach for the treatment of esophageal cancer. However, the impact of intraoperative fluid therapy on postoperative outcomes remains poorly defined. Whereas fluid overload has been linked to pulmonary and anastomotic complications, restrictive strategies may impair tissue perfusion and organ function. This study investigates the association between intraoperative fluid balance and postoperative morbidity in patients undergoing RAMIE.

METHODS: We conducted a retrospective single-center cohort study including 254 consecutive patients who underwent elective RAMIE between 2019 and 2024. Intraoperative fluid balance was calculated in mL/kg/h and analyzed as a continuous variable. Primary endpoints included pulmonary complications, anastomotic leakage, postoperative atrial fibrillation (POAF), and acute kidney injury (AKI). Secondary endpoints comprised ICU length of stay (LOS), postoperative delirium, delayed gastric emptying (DGE), and complication severity according to the Clavien-Dindo classification. Multivariable regression models were adjusted for age, sex, BMI, and ASA status.

RESULTS: Pulmonary complications (23.2%) were significantly associated with higher intraoperative fluid volumes (mean: 5.2 vs. 4.4 ml/kg/h; p = 0.027; OR: 1.24, 95% CI: 1.05-1.46). Anastomotic leakage (18.5%) exhibited an inverted U-shaped relationship, with the highest risk at fluid levels of 4.7-8.1 ml/kg/h). POAF (16.1%) and AKI (5.5%) were not significantly associated with fluid volume in multivariable analysis. POAF showed no significant association with intraoperative fluid volume in adjusted models. Predicted probabilities illustrated a fivefold increase in pulmonary risk across the 0 to 10 ml/kg/h range, whereas POAF declined steadily over this interval. Postoperative delirium showed a trend toward association with fluid volume (OR: 1.34; p = 0.056), while DGE, ICU-LOS, and major complications demonstrated no significant associations. Subgroup analyses suggested stronger associations between fluid volume and pulmonary complications in elderly patients, and a more pronounced POAF risk in males, indicating potential effect modification by age and sex.

CONCLUSION: Intraoperative fluid volume during RAMIE is variably associatiated with postoperative outcomes. While higher volumes are linked to increased pulmonary morbidity, lower volumes may predispose patients to arrhythmias. Anastomotic complications appear to peak at moderate fluid levels. These findings challenge binary fluid strategies and support a more individualized, risk-adapted approach to intraoperative fluid management in esophageal surgery.

PMID:41176601 | DOI:10.1186/s12871-025-03418-y