Category: Statistics

Cureus. 2025 Feb 24;17(2):e79594. doi: 10.7759/cureus.79594. eCollection 2025 Feb.

ABSTRACT

Background Chronic obstructive pulmonary disease (COPD) is a condition in which airflow limitation becomes irreversible over time, often resulting from long-term exposure to environmental pollutants, harmful particles, smoke, and biomass fuel. Beyond FEV1, identifying a more specific biomarker to predict COPD progression remains a challenge. Soluble urokinase-type plasminogen activator receptor (suPAR) expression increases in the respiratory epithelial cells of COPD patients. This study aimed to evaluate serum suPAR levels across different grades of stable COPD patients. Methods Two hundred stable COPD patients (148 males and 52 females) were recruited after obtaining informed consent. Blood samples were collected, and serum suPAR levels were measured in all participants. Results Serum suPAR levels were elevated in COPD patients at Global Initiative for Obstructive Lung Disease (GOLD) stages IV and III (6.38 ± 0.05 ng/ml and 5.82 ± 0.18 ng/ml, respectively) compared to those at GOLD stages II and I (5.15 ± 0.25 ng/ml and 4.17 ± 0.29 ng/ml). A one-way ANOVA confirmed that the differences between groups were statistically significant (F = 428.83, p < 0.001). Conclusions This study suggests that serum suPAR levels can serve as a diagnostic marker for COPD. As low-grade pulmonary inflammation increases with disease severity, suPAR levels also rise. Additionally, this marker may be useful for monitoring the prognosis of stable COPD and assessing treatment response.

PMID:40151757 | PMC:PMC11947502 | DOI:10.7759/cureus.79594

Global Spine J. 2025 Mar 27:21925682251331462. doi: 10.1177/21925682251331462. Online ahead of print.

ABSTRACT

Study DesignRetrospective study.ObjectiveTo investigate the clinical and radiological outcomes of patients with lumbar degenerative disc disease (DDD) treated with one-level Direct lateral interbody fusion (DLIF) in combination with minimally invasive percutaneous pedicle screw fixation (PPSF) and percutaneous facet joint fixation (PFJF).MethodsThis retrospective single-center study included 98 patients (67 men, 31 women) aged 28 to 59 years with one level lumbar DDD with foraminal and central stenosis, were divided into groups after DLIF: PPSF (n = 50) and PFJF (n = 48). Intraoperative parameters, perioperative clinical data and radiological assessment with X-ray, MRI and CT were used before operation and mean 45-month follow-up. Workload intensity criteria were used to analyze return to work rate.ResultsThe DLIF-PFJF group had significantly shorter surgery time (P = .04), duration of anesthesia (P = .02), X-ray time (P = .02), less back pain (P = .03), better functional status according to ODI (P = .04) and SF-36 PCS (P = .04), less atrophic changes in the multifidus muscle compared with DLIF-PPSF. There were no statistically significant differences in the volume of blood loss, duration of inpatient treatment, VAS leg pain, SF-36 MCS, Macnab results, mean disc height, intervertebral foramen height, sagittal disc angle, global lumbar lordosis, fusion rate, and the number of complications. In heavy/very heavy workload patients, the DLIF-PFJF had a statistically significantly higher rate of return to work compared to the DLIF-PPSF group.ConclusionsDLIF-PFJF appears to be superior to DLIF-PPSF, minimizing invasiveness, which significantly reduces the damage to the paraspinal muscles and also has significant long-term clinical advantages and return to work rates. Both minimally invasive techniques have comparable radiographic parameters, including the height of the intervertebral foramen and disc, fusion rates, global and segmental sagittal correction after surgery.

PMID:40148253 | DOI:10.1177/21925682251331462

J Diabetes. 2025 Apr;17(4):e70080. doi: 10.1111/1753-0407.70080.

ABSTRACT

BACKGROUND: Maturity-onset diabetes of the young resulting from mutations of the NEUROD1 gene (NEUROD1-MODY) is a rare form of diabetes and has not been well studied. We aimed to estimate its prevalence in Chinese patients with early-onset type 2 diabetes mellitus (EOD) and summarize its clinical and genetic characteristics.

METHODS: We performed next-generation sequencing in 679 patients with EOD to screen rare variants in NEUROD1 exons and evaluated the effects of variants using in vitro experiments. All the reported NEUROD1-MODY cases were reviewed. Patients carrying pathogenic or likely pathogenic variants were diagnosed with NEUROD1-MODY according to the American College of Medical Genetics and Genomics guidelines.

RESULTS: Four rare variants were identified in 679 patients with EOD, but only P197H decreased the transcriptional activity in in vitro functional assays to an extent comparable to the well-known mutation causing NEUROD1-MODY. Its frequency was pretty higher in the European population (0.024) than that in the East Asian population (0.00034) according to the gnomAD database. Twenty-eight previously reported patients could be confirmed as diagnosed. The patients in Asia had a lower body mass index and a higher rate of ketosis compared with Caucasians, and the mutations present in Asia often occurred in the transactivation domain. Neurological abnormalities were observed in 10.7% of the patients with NEUROD1-MODY.

CONCLUSIONS: NEUROD1-MODY in Chinese patients with EOD is not common (≤ 0.15%). The P197H might account for MODY in Chinese with a higher penetrance than Caucasian and needs further exploration. The possible differences of phenotypes exist between the two ethnic populations.

PMID:40148250 | DOI:10.1111/1753-0407.70080

Palliat Support Care. 2025 Mar 28;23:e34. doi: 10.1017/S1478951524002050.

ABSTRACT

OBJECTIVES: Palliative care (PC) professionals confront the suffering and mortality of their patients, adding to the conventional stressors related to work dynamics or personal life. However, the specific stressors inherent in end-of-life (EOL) care and their relation with the mental health of these professionals, remain inadequately explored. This study seeks to examine the respective roles of various stressors encountered by PC professionals and their associations with mental health. Additionally, it aims to elucidate the relationships between specific psychosocial factors (psychological resources or work environment perceptions) and mental health within the context of stress associated with PC.

METHOD: An online questionnaire was developed and distributed to PC professionals in France (e.g., doctors, nurses, care assistants, psychologists). The questionnaire contained measures of stress experienced in the last 6 months (personal, professional, or EOL); measures of mental health; and measures of psychosocial factors (perceptions of work environment and psychological resources).

RESULTS: Three hundred and seventy-nine participants completed the entire questionnaire in November 2022. Among the various stress factors assessed, the accumulation of EOL care emerged as a robustly linked stressor to poorer mental health. In this specific context of EOL care stress, self-compassion and psychological flexibility are significantly related to well-being and mental health, even when other psychosocial factors related to the work environment are statistically controlled.

SIGNIFICANCE OF RESULTS: This study is the first to highlight the main stressor affecting the well-being of PC professionals – the accumulation of EOL care – along with the key resources – psychological flexibility and self-compassion – that are associated with their well-being.

PMID:40148246 | DOI:10.1017/S1478951524002050

Rev Med Virol. 2025 May;35(3):e70022. doi: 10.1002/rmv.70022.

ABSTRACT

COVID-19 has emerged as a global health crisis with significant consequences, not only for respiratory health but also for the cardiovascular system. This study aimed to investigate potential sex-based disparities in cardiovascular outcomes among individuals diagnosed with COVID-19 A systematic search was performed in PUBMED/MEDLINE, SCOPUS, and EMBASE, up until January 2024 to identify studies measuring the sex-based differences in cardiovascular outcomes associated with COVID-19. The outcomes of interest included (myocardial infarction, venous thromboembolism, ischemic stroke, major bleeding, mortality, heart failure and hospitalization length). The meta-analysis was performed using the ‘Stata’ software, version 18. We identified 11 studies involving 31,044 males and 25,917 females in our review. A slightly lower risk of myocardial infarction in females (RR: 1.24; 95% CI [1.03, 1.49]; p = 0.02) contrasted with a substantially increased risk of venous thromboembolic events (RR: 1.43; 95% CI [1.19, 1.71]; p = 0.00) in males. Additionally, males displayed a slightly higher risk of major bleeding (RR: 1.22; 95% CI [1.06, 1.40]; p = 0.00). This trend continued with significantly higher rates of extracorporeal membrane oxygenation (ECMO) utilization (RR: 2.14; 95% CI [1.11, 4.13]; p = 0.02) in males. Moreover, stroke outcomes and overall mortality were demonstrably worse for males (RR: 1.46; p = 0.05 and RR: 1.21; p = 0.00, respectively). Males with COVID-19 face higher risks of myocardial infarction, venous thromboembolism, ischemic stroke, major bleeding, and mortality. Heart failure and hospitalization length show no gender disparity. These findings highlight the crucial role of gender in COVID-19’s cardiovascular complications.

PMID:40148238 | DOI:10.1002/rmv.70022

Int J Geriatr Psychiatry. 2025 Apr;40(4):e70066. doi: 10.1002/gps.70066.

ABSTRACT

OBJECTIVES: People with dementia often have various unmet care needs across physical, psychological, environmental, and social domains. There’s a need to explore the association between domains of unmet needs and characteristics of people with dementia. The aim of this paper was to describe the domains of unmet and met needs among community-dwelling people living with dementia, focusing on the home environment, physical, psychological, and social areas, and to identify sociodemographic, clinical, and health-related parameters associated with unmet needs.

METHODS: We analyzed the InDePendent trial’s baseline data of N = 417 people with dementia. The Camberwell Assessment of Needs for the Elderly (CANE) was used to identify needs. Descriptive statistics were used to evaluate the distribution of needs and Logistic and Poisson regression models to detect sociodemographic and clinical factors associated with unmet needs in the four need domains.

RESULTS: People with dementia were on average 80.6 years old, mostly female (56%) and mildly to moderately cognitively impaired (85%). 98.6% of the participants had at least one need, of which just over a third (36.5%) were rated as met and just under two-thirds (63.5%) as unmet. Lacking a care grade (access to social care) and low education were found to be risk factors for the occurrence of unmet needs in almost all areas. Factors such as increased medication use (OR = 1.10 [95%CI 1.02 to 1.19]) and loneliness (OR = 2.51 [95%CI 1.44 to 4.36]) were associated with a higher likelihood of unmet environmental needs. Similarly, the absence of a caregiver (OR = 2.81 [95%CI 1.03 to 7.64]), lower social support (OR = 1.71 [95%CI 1.02 to 2.84]), and poor physical health (OR = 8.40 [95%CI 3.39 to 20.81]) correlated with unmet physical needs. Participants living alone demonstrated higher levels of unmet physical needs (β = 0.27 [95%CI 0.01 to 0.53]). Depression (OR = 2.13 [95%CI 1.10 to 4.08]), living alone (OR = 1.73 [95%CI 1.04 to 2.86]) and poor physical health (OR = 2.82 [95%CI 1.15 to 6.93]) significantly increased the risk of unmet psychological needs. Social needs are more likely to be unmet in females (OR = 1.88 [95%CI 1.05 to 3.37]). Sensitivity analyses showed the positive effects of regular General Practitioner (GP) visits on the fulfillment of social needs (β = -0.61 [95%CI -1.01 to -0.22]).

CONCLUSION: Access to comprehensive care, for example, through a care grade, education and regular visits to the GP, is just as important for meeting needs in various areas as psychosocial measures aimed at reducing loneliness, living alone, and social exclusion. Both areas must be given equal consideration to improve the living and care situation of people with dementia sustainably.

TRIAL REGISTRATION: The study is registered as a clinical trial (ClinicalTrials.gov Identifier: NCT04741932). The study protocol is published elsewhere.

PMID:40148225 | DOI:10.1002/gps.70066

J Voice. 2025 Mar 26:S0892-1997(25)00051-7. doi: 10.1016/j.jvoice.2025.02.007. Online ahead of print.

ABSTRACT

OBJECTIVE: “Nanofat” refers to fat further emulsified into 1-µm sizes. It is commonly used in facial plastic surgery. Nanofat increases the release of adipose-derived stem cells. This study tested whether injection laryngoplasty using nanofat resulted in bulking and vibratory effects comparable to using microfat in treating patients with fold atrophy.

METHODS: This was a randomized, controlled, single-blind, prospective study of 18 patients with vocal atrophy who underwent transoral lipoinjection using microlaryngoscopy. The control group received bilateral microfat injection. The experimental group randomly received microfat in one vocal fold and nanofat in the contralateral vocal fold. The average volume of fat injected was 0.6 mL on each side. The postsurgery evaluation at 3 months included ratings of stroboscopy and acoustic recordings by blinded expert raters. Vibratory behavior, voice ratings, preVoice Handicap Index-10 (VHI-10) and postVHI-10 score, and Cepstral/Spectral Index of Dysphonia (CSID) were compared.

RESULTS: Significant improvement in the VHI at three-month follow-up was noted in all patients (n = 18 total, 12 experimental, six control). In the subgroup analysis, only the nanofat group significantly improved VHI. Improvements in the CSID were observed in both techniques; however, neither group showed statistical significance. Improved glottic closure was comparable in both groups. Expert raters observed an improvement in the voice quality of nanofat individuals but no change in microfat individuals.

CONCLUSION: Lipoinjection laryngoplasty with nanofat may be an alternative to microfat in patients with vocal atrophy.

LEVEL OF EVIDENCE: II.

PMID:40148203 | DOI:10.1016/j.jvoice.2025.02.007

Eur J Surg Oncol. 2025 Mar 13:109971. doi: 10.1016/j.ejso.2025.109971. Online ahead of print.

ABSTRACT

INTRODUCTION: Whilst about 18 % of all cancers in females are gynaecological cancers, more than 50 % of these can be classified as rare tumours (defined as an annual incidence of <6 per 100,000). Such cancers represent an important challenge for small countries like Malta where the small caseload may limit the expertise of clinicians in the diagnosis and treatment of such cancers.

METHODOLOGY: The study uses data from the Maltese population-based cancer registry to examine trends in incidence rate of the rare gynaecological cancers for the 12-year period between 2010 and 2021. It employs the RARECAREnet list to identify the rare gynaecological cancers by major rare gynaecological cancer categories and histological types and analyses the number of cases and incidence rates in Malta to monitor trends and provide an insight of the burden of such cancers.

RESULTS: A total of 709 new cases of rare gynaecological cancers were discovered during the 12-year period. Globally, these rare gynae cancers, constituted 42.6 % of all the gynae cancers that occurred during this period. Most of these rare cancers were ovarian (399 cases, 56.3 %), followed by rare cancers of the vulva and vagina (122 cases, 17.21 %), rare cancers of the corpus uteri (93 cases, 13.12 %) and rare cancers of the cervix uteri (73 cases, 10.3 %). Other rare gynaecological cancers (10 cases, 1.41 %) and cancers of the placenta (2 cases, 0.04 %) were much rarer. The outcomes in terms of 5-year survival was worse for the rare cancers compared with the commoner types of gynae cancers with an overall 5-year survival of 45.10 % and 45.48 % for rare gynae cancers for the 2010-2014 and 2015-2019 cohorts respectively and an overall 5-year survival of 69.94 % and 73.44 % for the common gynae cancers for the 2010-2014 and 2015-2019 cohorts respectively.

CONCLUSION: The study shows that globally rare gynaecological cancers in a small state like Malta are in fact not so rare – with a total of 709 rare gynaecological cancers in 12 years for Malta. These cases are however few when considering that they are divided into over 30 different histopathological groups. Numbers are also small when it comes to accumulating statistical power for analysis. The caseload for the individual sub-categories is small and will often be shared amongst the different individual gynaecologists and/or their clinical team. Thus, it might be difficult for these specialists to gather enough technical expertise that is crucial for early diagnosis and the treatment of these rare cancers. This study provides a rationale for international collaboration where there is scope for joint research and sharing of expertise. Establishment of common databases for the various types of rare gynaecological tumours will provide statistical power, enabling analysis of outcomes for these rare cancers and establishment of guidelines.

PMID:40148197 | DOI:10.1016/j.ejso.2025.109971

Br J Oral Maxillofac Surg. 2025 Mar 3:S0266-4356(25)00045-2. doi: 10.1016/j.bjoms.2025.02.008. Online ahead of print.

ABSTRACT

The aim of this cross-sectional study was to correlate the severity of dentofacial deformity and oral health-related quality of life (OHRQoL) in 42 class III patients with cleft lip and palate (CLP). The main outcome measures were clinical evaluations of overjet and overbite. OHRQoL was assessed with the Oral Health Impact Profile-14 questionnaire (OHIP-14). Angular (facial angle, SNA, SNB, ANB) and linear (N-PerpA, N-PerpPog and Wits appraisal) measurements were made using digital lateral teleradiography. No statistical difference was found between clinical variables and OHIP-14 scores (total score and domains, p > 0.05). A moderate positive correlation was found between the SNA angle and the handicap domain (r_s = 0.428; p = 0.005), between the ANB angle and the handicap domain (r_s = 0.319; p = 0.040) and psychological disability (r_s = 0.331; p = 0.032); between N-PerpA and the social disability domain (r_s = 0.345, p = 0.025); and between Wits appraisal and total OHIP-14 score (r_s = 0.331; p = 0.032) and psychological disability (r_s = 0.348; p = 0.024). Some angular and linear measurements of class III patients with CLP correlated with the total OHIP-14 score and the handicap, psychological disability, and social disability domains.

PMID:40148164 | DOI:10.1016/j.bjoms.2025.02.008

Pain Manag Nurs. 2025 Mar 26:S1524-9042(25)00128-6. doi: 10.1016/j.pmn.2025.03.001. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the efficacy of mobile health-based interventions for alleviating symptoms of chronic neck pain in patients.

METHODS: A systematic search was conducted in databases, including the China National Knowledge Infrastructure, VIP, Wanfang, Chinese Biomedical Databases, PubMed, Embase, Web of Science, and Cochrane Library, for randomized controlled trials (RCTs) regarding support provided to patients with chronic neck pain using mobile health interventions from database inception to March 2024. Two researchers independently screened the literature and evaluated the quality using the Cochrane Handbook 5.1 risk of bias assessment tool. Statistical analyses were performed using RevMan 5.2, and the quality of evidence was assessed according to the GRADE criteria.

RESULTS: Ten RCTs comprising 825 participants were included. A meta-analysis indicated that mobile health interventions were more effective than other physical therapies for reducing pain (short-term: SMD = -0.76, [95% CI -1.50, -0.02], p = .04; mid-term: SMD = -0.48, [95% CI -0.78, -0.18], p < .01), although there was no significant difference for improving neck disability status (short-term: MD = -6.74, [95% CI -13.65, 0.17], p = .06; mid-term: SMD = -2.26 [95% CI -6.71, 2.20], p = .32). Compared to minimal intervention, mobile health interventions were more effective in reducing pain (short-term: SMD = -1.16, [95% CI -1.70, -0.63], p < .001) and improving neck disability status (short-term: MD = -7.88, [95% CI -12.27, -3.13], p < .001).

CONCLUSIONS: Mobile health-based interventions positively affected the predictive outcomes for patients with chronic neck pain, reduced pain levels, and improved neck disability. Further research is needed to demonstrate their benefits for reducing fear of pain and improving quality of life.

PMID:40148143 | DOI:10.1016/j.pmn.2025.03.001