Category: Statistics

Eur Radiol. 2025 Nov 1. doi: 10.1007/s00330-025-12092-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the diagnostic performance of ¹⁸F-fluoro-L-ascorbic acid ([¹⁸F]FAA) positron emission tomography-computed tomography (PET/CT) in detecting metastatic differentiated thyroid cancer (DTC) and compare it with ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG) PET/CT.

MATERIALS AND METHODS: Data were retrospectively collected from patients who were clinically suspected or diagnosed with postoperative metastatic DTC between September 2023 and May 2024. Quantification was performed using the maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). Histopathological outcomes and clinical follow-up served as the reference standard for final diagnosis. Diagnostic accuracy was compared using McNemar’s test, and tracer uptake was analyzed via the Wilcoxon signed-rank test.

RESULTS: A total of 85 participants (median age, 51 years; IQR, 38-61 years; 45 women) were evaluated. For cervical lymph nodes (LNs), [¹⁸F]FAA showed superior sensitivity (88% vs. 67%), accuracy (82% vs. 69%), and negative predictive value (78% vs. 57%) (all p < 0.001), with comparable specificity (72% vs. 74%, p = 0.64) and positive predictive value (84% vs. 81%; p = 0.44) than [¹⁸F]FDG. For distant metastases, [¹⁸F]FAA PET/CT demonstrated higher sensitivity than [¹⁸F]FDG for pulmonary metastases (53% vs. 27%), and bone metastases (72% vs. 21%) (all p < 0.001). Semiquantitatively, [¹⁸F]FAA had higher SUVmax in the cervical LN metastasis (10.3 vs. 5.4), pulmonary metastasis (4.7 vs. 2.8), and bone metastasis (16.1 vs. 3.0), as well as higher TBR in cervical LN (18.1 vs. 6.8) and bone metastasis (6.9 vs. 1.9) (all p < 0.01).

CONCLUSION: [¹⁸F]FAA PET/CT outperforms [¹⁸F]FDG PET/CT in the depiction of metastatic thyroid cancer, particularly in neck LNs, pulmonary, and bone metastases.

KEY POINTS: Question Is 6-Deoxy-6-[¹⁸F]fluoro-L-ascorbic acid PET/CT ([¹⁸F]FAA) PET/CT an imaging method that can identify metastatic lesions after thyroid cancer surgery, and is it superior to [¹⁸F]FDG PET/CT? Findings [¹⁸F]FAA exhibited higher sensitivity and elevated SUVmax values compared to [¹⁸F]FDG in the detection of lymph node, lung, and bone metastases of metastatic thyroid cancer. Clinical relevance [¹⁸F]FAA is a reliable diagnostic tool that can accurately locate metastatic sites after thyroid cancer surgery. This helps tailor treatment plans and predict prognosis based on different metastatic scenarios.

PMID:41176553 | DOI:10.1007/s00330-025-12092-0

Eur Radiol. 2025 Nov 1. doi: 10.1007/s00330-025-12115-w. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess treatment response in osteosarcoma, two automated convolutional neural networks (CNNs) were developed to quantify tumour volumes and predict response to induction chemotherapy using histopathology as the reference standard.

MATERIALS AND METHODS: This retrospective, multicentre study included magnetic resonance imaging (MRI) scans from osteosarcoma patients acquired between January 2006 and July 2024. A 3D U-Net CNN segmented tumours and calculated volumes at baseline and post-chemotherapy. A second CNN predicted treatment response based on MRI-derived tumour volume changes using histopathologic necrosis (≥ 90%) as the reference standard. Both models were trained on 162 scans from 81 patients (Centre A) and validated on 40 scans from 20 patients (10 per centre) with Centre B as the external test set. Human readers measured 3D tumour diameters and volumes, compared with CNN-derived volumes using Spearman’s correlation, Bland-Altman plots, and Dice coefficients. Prediction performance was assessed using accuracy, sensitivity, and specificity, with significance determined by agreement metrics.

RESULTS: Patients from Centre A had a mean age of 15 ± 5 years (52 males), and from Centre B a mean age of 13 ± 0 years (8 males). CNN- and human-derived tumour volumes showed strong correlation (Centre A: r = 0.98, Centre B: r = 0.95; p < 0.001). Dice coefficients were 0.86 (Centre A) and 0.81 (Centre B), with median Hausdorff distances of 15.0 mm and 14.2 mm. The response prediction model classified 16/20 cases (80% accuracy) with 90% sensitivity and 70% specificity.

CONCLUSION: CNN-derived tumour volume measurements were comparable to human assessments. CNN-based volume changes predicted histopathologic response to chemotherapy in paediatric osteosarcoma.

KEY POINTS: Question Accurate, noninvasive assessment of treatment response in paediatric osteosarcoma is limited by its reliance on manual tumour measurements and post-surgical histopathology. Findings Automated deep learning accurately measured tumour volumes on MRI and predicted chemotherapy response with 80% accuracy, 90% sensitivity, and 70% specificity. Clinical relevance Automated deep learning enables accurate tumour volume assessment and prediction of chemotherapy response in paediatric osteosarcoma, offering a noninvasive tool to support and refine patient management.

PMID:41176552 | DOI:10.1007/s00330-025-12115-w

Pain Ther. 2025 Nov 2. doi: 10.1007/s40122-025-00787-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic pelvic pain syndrome (CPPS) in women is a debilitating condition with a high prevalence (5-25%), yet its etiology remains unclear. This prospective observational study aimed to identify clinical and medical history covariates associated with CPPS to elucidate potential pathophysiological mechanisms.

METHODS: A total of 225 women were evaluated in a gynecological pain clinic in Germany, including 41 patients with CPPS (≥ 6 months of lower abdominal pain) and 184 control patients undergoing routine gynecological screening. Exclusion criteria included pregnancy, pelvic malignancy, acute pelvic inflammation, and abnormal uterine bleeding. Covariates were assessed through structured clinical history and physical examination.

RESULTS: Significant associations with CPPS were observed for prior pelvic surgery (72% vs. 45%, p = 0.003), bowel constipation (37% vs. 11%, p = 0.002), history of endometriosis (33% vs. 10%, p = 0.043), and prior trauma (27% vs. 11%, p = 0.013). In contrast, there were no significant differences in rates of depression (p = 0.376), use of psychopharmaceuticals (p = 0.757), pelvic floor abnormalities (p = 0.503), uterine retroversion (p = 0.330), or pelvic congestion (p = 0.455). Dysmenorrhea (59% vs. 42%) and vulvar pain (31% vs. 8%) were more frequent in the CPPS group, though not statistically significant. No differences were found in delivery mode, use of intrauterine devices, analgesics, hormonal replacement therapy, and other medications, or comorbidities such as diabetes, thyroid disease, hypertension, other pain diseases, or musculoskeletal disorders.

CONCLUSIONS: CPPS was not associated with several commonly suspected cofactors, including psychosomatic factors, pelvic congestion, or pelvic floor dysfunction. The findings suggest the existence of two subgroups of CPPS, the endometriosis-associated type and the neurovegetative type, associated with prior pelvic surgery, constipation, and trauma. This concept allows for the development of new targeted therapeutic strategies to successfully treat CPPS.

PMID:41176550 | DOI:10.1007/s40122-025-00787-7

Med Health Care Philos. 2025 Nov 1. doi: 10.1007/s11019-025-10306-2. Online ahead of print.

ABSTRACT

Recent and ongoing advances in medical AI promise to revolutionise medicine by improving the accuracy, speed, and efficiency of clinical care. These promises are responses to the continuous quest of modern medicine to eliminate uncertainty and find answers to crucial questions of diagnosis, prognosis and treatment, while the impressive reported results of medical AI have raised the question of whether medical AI can be perceived as an epistemic authority that challenges the authority of doctors. In this paper, we examine this question by approaching it from the standpoint of what epistemic goods medical AI can offer, or else, what medical AI can claim to “know”. Using Popowicz’ account of epistemic authority in medical practice, which he locates in the scientific method that underpins the practice, we argue that medical AI uses a different scientific method to the one that has given rise and forms the epistemic foundations of traditional western medicine, and this presents a problem. As long as we are seeking not only statistically accurate correlations, but empirically grounded causations in medicine, AI cannot be treated as an epistemic authority in this field. We conclude that until medical practice finds ways to successfully incorporate such epistemological differences, medical AI should submit to the epistemic authority of medical practice and take its place on the long list of important and useful epistemic tools doctors can use to improve the health of patients.

PMID:41176529 | DOI:10.1007/s11019-025-10306-2

J Optom. 2025 Oct 31:100583. doi: 10.1016/j.optom.2025.100583. Online ahead of print.

ABSTRACT

PURPOSE: To assess the feasibility of a novel method for simulating a Rigid Gas Permeable Contact Lenses (RGP-CL) fitting using 3-D printed sclero-corneal surfaces (SCSs).

METHODS: The experiment involved the fabrication of two resin SCSs with biconic corneal geometry and the participation of 22 optician-optometrists as observers. Participants compared the fluorescein patterns of three RGP-CL fitted on each SCS with theoretical patterns generated through computer simulation. To standardize visualization, comparisons were conducted through a multiple-choice questionnaire composed of 6 questions. Each question presented one main fluorescein pattern (either theoretical or experimental) and four additional patterns obtained using the other technique. Optometrists were required to select the fluorescein pattern more similar to the main pattern. A statistical analysis was performed to evaluate the accuracy of the comparison between the two methods.

RESULTS: The surface quality of the printed SCSs was sufficient to produce consistent and interpretable fluorescein patterns. In all questions, at least 70 % of optometrists selected the correct pattern. In four questions, more than 90 % identified the correct pattern, and in one question accuracy reached 100 %. The correct option was always the most frequently chosen, with a significantly higher rate than the second most selected option (p = 0.05).

CONCLUSIONS: The ability of most optometrists to correctly identify patterns suggests that, even without polishing, 3-D printed SCSs can simulate fluorescein patterns closely resembling theoretical ones. This approach shows promise as a supportive tool for training in RGP-CL fitting.

PMID:41176486 | DOI:10.1016/j.optom.2025.100583

Radiography (Lond). 2025 Oct 31:103215. doi: 10.1016/j.radi.2025.103215. Online ahead of print.

ABSTRACT

INTRODUCTION: Women with dense breast tissue are at increased risk for breast cancer, and standard mammography often fails to detect cancer in this population. Supplementary screening modalities offer improved detection, yet practices across Europe remain inconsistent. This study explores the requirements for implementing supplementary breast cancer screening across Europe by surveying current guidance and practices, examining workforce awareness and perceptions of existing protocols, identifying barriers to practice change, and evaluating staff willingness to adopt these screenings.

METHODS: A mixed-methods cross-sectional survey was distributed online to radiographers and radiologists in breast cancer screening units across Europe. Descriptive and inferential statistics, including the Friedman and Chi-Square tests, were used to analyse quantitative data. Qualitative data from open-ended questions were analysed using content analysis.

RESULTS: Eighty-three respondents from 39 countries responded over a six-month period. The majority (95.2 %) of respondents worked in breast screening programs. Hand-held ultrasound (45.8 %), Digital Breast Tomosynthesis (32.5 %), and Magnetic Resonance Imaging (22.9 %) were the most used supplementary modalities. Main barriers included waiting lists (mean = 3.99), cost (mean = 3.98), and workload (mean = 3.95). Only 34.9 % of the respondents recorded breast density. Awareness of guidelines varied significantly by profession (p = 0.009). Themes from open-ended responses highlighted technological needs, staffing gaps, training needs, and cost barriers.

CONCLUSION: Despite high awareness, implementation of supplementary screening remains limited due to systemic barriers. Standardized guidelines, resource investment, and targeted education are needed to ensure equitable breast cancer screening across Europe.

IMPLICATIONS FOR PRACTICE: Addressing disparities in training, resources, and guideline implementation is essential to support healthcare professionals in delivering effective supplementary screening for women with dense breasts. These findings can inform the development of standardized protocols and targeted professional education across Europe.

PMID:41176479 | DOI:10.1016/j.radi.2025.103215

Int Psychogeriatr. 2025 Oct 31:100159. doi: 10.1016/j.inpsyc.2025.100159. Online ahead of print.

ABSTRACT

BACKGROUND: Electroconvulsive therapy (ECT) is one of the most effective options for severe psychiatric disorders. However, it is often underutilized due to stigma and fear of cognitive side effects. This is the first systematic review and meta-analysis synthesizing the currently available evidence regarding ECT exposure and dementia risk.

METHODS: We included observational studies assessing the risk of developing dementia after ECT exposure or its incidence among ECT-treated patients to July 2025. Adjusted hazard ratios (HR) were pooled using a random-effects model.

RESULTS: Six observational cohort studies encompassing 286,995 patients, predominantly with affective disorders, were included. 9124 of the patients were exposed to ECT while 277,871 patients were not treated with ECT. Follow-up durations ranged from a median of 4.9-16.9 years, and the weighted mean baseline age was ∼51 years. Meta-analysis revealed no statistically significant association between ECT exposure and the overall risk of dementia (HR = 0.98, 95 %CI [0.79, 1.21], P = 0.83, I² = 67.1 %, very low certainty). Sensitivity analysis showed a marginally lower risk after excluding one study (HR = 0.87, P = 0.045). In older adults (>50 years; 112,842 patients), ECT was associated with a significantly lower risk of dementia (HR = 0.78, 95 %CI [0.69, 0.88], P < 0.001, I²= 0 %, moderate certainty).

CONCLUSION: The study provides preliminary insights on the long-term cognitive safety of ECT. ECT was not associated with increased risk of dementia in patients with affective disorders and was associated with lower risk among older adults. More studies are needed to confirm our results, particularly with proper adjustment for potential confounders.

PMID:41176476 | DOI:10.1016/j.inpsyc.2025.100159

J Voice. 2025 Oct 31:S0892-1997(25)00420-5. doi: 10.1016/j.jvoice.2025.10.004. Online ahead of print.

ABSTRACT

OBJECTIVES: Gender-affirming voice training (GAVT) can reduce voice dysphoria for some transgender/ gender-diverse individuals, but access is often limited by factors such as high cost and a shortage of well-trained providers. Interactive software could increase the accessibility of GAVT, but existing applications are limited in functionality, particularly in the area of resonance. This paper reports the design and usability testing of a web-based software module that provides visual-acoustic biofeedback for vocal tract resonance. This preliminary study focuses on the use of the software for voice feminization.

MATERIALS AND METHODS: The resonance module, part of a larger project to develop free GAVT software called TruVox, represents resonant frequencies of the vocal tract as peaks in a real-time linear predictive coding spectrum. It features built-in resonance targets for English vowel sounds, a routine for practicing resonance modification in utterances of increasing length, and video tutorials explaining how to use the website. This paper reports the results of both online and in-lab usability testing of the software. After an unstructured (online) or structured (in-person) interaction with the software, participants completed the system usability scale (SUS) and provided qualitative feedback. Participants in the in-lab study additionally completed the intrinsic motivation inventory and produced vowel targets in one-syllable words for acoustic measurement at the start and end of the session.

RESULTS: Participants who completed in-lab testing rated the software with an average SUS score of 75.25, indicating acceptable-to-good usability. In their qualitative feedback, users reported that the visual-acoustic biofeedback helped them understand and control their vocal resonance; they also identified a number of areas where usability could be improved. While little acoustic change was expected in light of the short duration of the session, 8/10 participants showed a trend in the expected direction for the vowel that was practiced most extensively.

CONCLUSION: The results of this usability testing suggest that our web-based biofeedback tool has the potential to enhance resonance training in the GAVT context. Future goals to improve the app include refining our automated resonance tracking algorithm for more interpretable feedback, allowing users to set individualized resonance targets based on their own voice at baseline, and adding targets for nonbinary and transmasculine users. Clinical trials to measure acoustic changes after an extended period of interaction with the software are also planned.

PMID:41176464 | DOI:10.1016/j.jvoice.2025.10.004

Midwifery. 2025 Oct 14:104634. doi: 10.1016/j.midw.2025.104634. Online ahead of print.

ABSTRACT

PROBLEM: Despite progress in maternal and newborn health, China still lacks a validated and multidimensional tool to monitor care quality and guide improvements.

BACKGROUND: The Quality Maternal and Newborn Care Framework index (QMNCFi) is a novel but comprehensive and globally developed tool for assessing maternity care quality from the service user’s perspective, offering huge potential for assessing care quality in China.

AIM: This study aimed to validate the Chinese version of the QMNCFi and report initial findings from economically diverse settings.

METHODS: An online survey was conducted in five hospitals in five provinces in China among women between 6 weeks to 1 year postpartum. Construct validity was assessed using confirmatory factor analysis. Reliability was evaluated through internal consistency and test-retest reliability. Inferential statistics were used to analyze score differences across sub-groups.

FINDINGS: 547 mothers completed the survey. Confirmatory factor analysis indicated that the construct of the Chinese version aligned with the original version. The Cronbach’s α for the survey’s 13 sections ranged from 0.629 to 0.975, and the Intraclass Correlation Coefficient of test-retest ranged from 0.620 to 0.926. There is a modest correlation between regional economic level and QMNCFi scores at all time periods (p < 0.05). Pregnancy sub-index scores were slightly higher among women in rural areas compared to urban areas (p < 0.05).

CONCLUSION: The Chinese version of the QMNCFi is feasible to obtain service user perceptions of the quality of care at scale in China.

PMID:41176456 | DOI:10.1016/j.midw.2025.104634

J Prosthet Dent. 2025 Oct 31:S0022-3913(25)00841-8. doi: 10.1016/j.prosdent.2025.10.035. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: To ensure long-term stability and performance, removable partial dentures (RPDs) must be fitted precisely. Although 3-dimensional (3D) printing has been widely used, studies comparing various methods of manufacturing and designs for mandibular removable partial denture (RPD) frameworks are lacking.

PURPOSE: The aim of this in vitro study was to compare the trueness of RPD metal frameworks with 2 different major connector design types (lingual bar and lingual plate) fabricated with direct and indirect metal 3D printing with those fabricated with the conventional lost wax technique.

MATERIAL AND METHODS: A Type IV stone cast of a Kennedy classification II modification 1 partially edentulous mandibular arch was prepared as the reference cast. A total of 30 definitive casts were fabricated from the reference cast and scanned into standard tessellation language (STL) files. Ten of these casts were used to fabricate cobalt chromium (Co-Cr) frameworks with the conventional lost wax technique (CLW group), 10 were used to fabricate frameworks by printing into a castable resin pattern followed by conventional casting (RPC group), and 10 were used to print metal frameworks directly using a selective laser melting printer (DSLM group). For each fabrication method, the group was divided into 2 design types: 5 casts for lingual plate frameworks and 5 for lingual bar frameworks (n=5). All metal frameworks were scanned and superimposed with the definitive casts with the Geomagic Control X software program. Gap discrepancies were measured as mean ±standard deviation (trueness), and the data were statistically analyzed with the 2-way ANOVA test (α=.05) to determine the interaction of the fabrication methods and design types on trueness. The Tukey HSD test was used to compare mean trueness among groups (α=.05).

RESULTS: The CLW group demonstrated the highest overall gap discrepancies in the lingual plate frameworks, measuring 0.207 ±0.035 mm, whereas the DSLM group recorded the lowest value at 0.141 ±0.022 mm. No statistically significant difference was found between the DSLM and RPC groups (P>.05). The DSLM group exhibited the lowest mean gap for the lingual bar frameworks, 0.091 ±0.016 mm, with no significant difference between the RPC and CLW groups (P>.05). The 2-way ANOVA indicated that trueness was significantly affected by fabrication methods and design types. The color mapping of the lingual plate and bar in the DSLM frameworks shows minimal deviations relative to other groups.

CONCLUSIONS: The direct and indirect 3D printing of lingual plate RPD frameworks demonstrated better trueness compared with conventional casting methods. Direct 3D metal printing showed better fit and lower discrepancy for lingual bar designs. Both conventional and 3D printing methods demonstrated clinically acceptable adaptation.

PMID:41176439 | DOI:10.1016/j.prosdent.2025.10.035