Category: Statistics

Am J Hypertens. 2025 May 6:hpaf078. doi: 10.1093/ajh/hpaf078. Online ahead of print.

ABSTRACT

BACKGROUND: High dietary sodium intake is associated with cardiovascular disease. We investigated the influence of sodium intake on the plasma proteome.

METHODS: Prospectively recruited normotensive participants underwent 2 controlled dietary sodium interventions to evaluate hormonal and proteomic (1,512 proteins) changes: sodium-restriction resembling ancestral hunter-gatherer intake (~10 mEq/day, ~230mg/day) and sodium-loading resembling modern industrialized intake (~200 mEq/day, ~4600mg/day). 24h urine collections were obtained after each diet. Plasma proteomic changes were assessed with correction for false-discovery.

RESULTS: Participants achieved a 24h urinary sodium excretion of 16 mEq/L when sodium-restricted and 249 mEq/L when sodium-loaded. 38 proteins displayed statistically significant changes with 15 additional proteins exhibiting notable trends that did not reach statistical significance. The most apparent changes were increases in proteins related to fibrosis and the extracellular matrix (ECM) when sodium loaded, whereas sodium restriction increased proteins related to immune/inflammatory pathways and the renin-angiotensin system (RAS)-kallikrein-kinin system (KKS)-complement pathway. NT-proBNP, FUMH (fumarate hydratase), LKHA4 (leukotriene A(4) hydrolase), COFA1 (collagen alpha-1(V) chain), COF2 (cofilin-2), BMP-4, and TGF-β RIII had the greatest increases when sodium-loaded, whereas renin, thrombin, apo A-1 (apolipoprotein A-1), FABPA (fatty-acid binding protein), and LEAP-1 (hepcidin) had the greatest increases when sodium-restricted.

CONCLUSION: When compared to a sodium-restricted diet resembling ancestral intake, the modern industrialized dietary sodium intake increased proteins related to fibrosis and the ECM, and decreased proteins related to the RAS, KKS, immunity and inflammation. These findings in normotensive people provide an atlas of proteomic changes, and biological pathways, that may contribute to hypertension and other sodium-related disorders.

PMID:40327765 | DOI:10.1093/ajh/hpaf078

J Nurs Res. 2025 May 6. doi: 10.1097/jnr.0000000000000675. Online ahead of print.

ABSTRACT

BACKGROUND: Vincristine-induced peripheral neuropathy (VIPN), a common side effect of chemotherapy in survivors of non-Hodgkin’s lymphoma (NHL), experience symptoms that may significantly impact quality of life (QoL). The age-related effects on NHL survivors with/without VIPN remain unclear.

PURPOSE: This study was designed to determine the variation in and severity of symptom manifestations in patients in two age groups as well as the effect of age on functional status and QoL.

METHODS: This cross-sectional study was conducted on 98 NHL survivors in two age groups: the younger group (< 65 years, n = 55) and the older group (≥ 65 years, n = 43). The two assessment tools used were the clinical total neuropathy score and the European Organization for Research and Treatment of Cancer Quality of Life-Core 30. Data analyses were conducted on SPSS (Version 22.0), with the chi-square test used on descriptive statistics and the Fisher’s exact test used on categorical variables. The Kruskal-Wallis test was used to compare differences attributable to age, VIPN status, functional status, and QoL.

RESULTS: In the older group, VIPN had a higher severity score compared to the younger group (p = .022), particularly in terms of muscle strength (30.2% vs. 9.1%, p = .009) and deep tendon reflex (60.5% vs. 25.5%, p = .005). In the younger group, NHL patients with VIPN showed poorer physical function, while those in the older group reported poorer QoL. Furthermore, those with VIPN showed poorer cognitive function compared to those without VIPN.

CONCLUSIONS/IMPLICATION FOR PRACTICE: In terms of older survivors with VIPN, essential measures include early fall prevention education and low-intensity exercise programs to maintain muscle strength and limb coordination and preserve overall QoL. Younger survivors with VIPN require comprehensive support for both physical and emotional challenges, with early understanding and intervention critical. Also, cognitive function impairment should not be neglected in NHL survivors with VIPN symptoms, highlighting the significance of assessing and addressing cognitive health in long-term follow-up plans.

PMID:40327764 | DOI:10.1097/jnr.0000000000000675

Sci Signal. 2025 May 6;18(885):eadt8686. doi: 10.1126/scisignal.adt8686. Epub 2025 May 6.

ABSTRACT

Bacterial serine-threonine kinases (STKs) regulate diverse cellular processes associated with cell growth, virulence, and pathogenicity and are evolutionarily related to the druggable eukaryotic STKs. A deeper understanding of how bacterial STKs differ from their eukaryotic counterparts and how they have evolved to regulate diverse bacterial signaling functions is crucial for advancing the discovery and development of new antibiotic therapies. Here, we classified more than 300,000 bacterial STK sequences from the NCBI RefSeq nonredundant and UniProt protein databases into 35 canonical and seven pseudokinase families on the basis of the patterns of evolutionary constraints in the conserved catalytic domain and flanking regulatory domains. Through statistical comparisons, we identified features distinguishing bacterial STKs from eukaryotic STKs, including an arginine residue in a regulatory helix (C helix) that dynamically couples the ATP- and substrate-binding lobes of the kinase domain. Biochemical and peptide library screens demonstrated that evolutionarily constrained residues contributed to substrate specificity and kinase activation in the Mycobacterium tuberculosis kinase PknB. Together, these findings open previously unidentified avenues for investigating bacterial STK functions in cellular signaling and for developing selective bacterial STK inhibitors.

PMID:40327749 | DOI:10.1126/scisignal.adt8686

J Surg Orthop Adv. 2025 Summer;34(1):46-49.

ABSTRACT

Patellar crepitus and patellar clunk syndrome are potential complications seen in patients undergoing total knee arthroplasty (TKA). The etiology of this phenomenon is incompletely understood. A retrospective chart review was performed to identify a consecutive series of patients who underwent primary TKA with either a traditional posterior-stabilized implant (group 1, 728 TKAs) or a cruciate substituting implant (group 2, 393 TKAs). All surgical procedures were performed by a single surgeon at the same institution using the same surgical technique, including selective patellar resurfacing and release of the posterior cruciate ligament. The incidence of patellar clunk requiring arthroscopic debridement was recorded. Statistical analysis was performed. The incidence of patellar clunk requiring arthroscopic debridement was significantly higher in group 1 versus group 2 (6.6% vs. 0% respectively, p < 0.001) with standardization of surgeon and technique factors, suggesting implant design is a critical variable in the development of this complication. (Journal of Surgical Orthopaedic Advances 34(1):046-049, 2025).

PMID:40327739

J Surg Orthop Adv. 2025 Summer;34(1):41-45.

ABSTRACT

The rates and risk factors of postoperative hyponatremia and acute kidney injury (AKI) were examined in spine surgery patients. A 2-year retrospective review of 348 patients was performed. Patients were instructed to take their routine nonsteroidal anti-inflammatory drugs and antihypertensive medications the morning of surgery. Postoperative hyponatremia and AKI were studied. Statistical analysis included bivariate and multivariable logistic regression analysis with odds ratio and quantile regression model. Thirty-eight percent of patients (133/348) had postoperative hyponatremia (serum sodium < 135 mEq/L). Seven percent (24/348) had AKI (0.3 mg/dL or > 50% increase in baseline serum creatinine). On the multivariable logistic regression model, two factors remained significant for hyponatremia: preoperative sodium level and operative time. Body mass index and use of preoperative angiotensin blocking medications were significant for AKI. Patients with hyponatremia and AKI demonstrated a longer length of hospital stay. In conclusion, postoperative hyponatremia (38%) and AKI (7%) are common following spine surgery. (Journal of Surgical Orthopaedic Advances 34(1):041-045, 2025).

PMID:40327738

JMIR Mhealth Uhealth. 2025 May 6;13:e70228. doi: 10.2196/70228.

ABSTRACT

BACKGROUND: Obesity represents a major public health crisis in the United States, imposing substantial health risks and economic costs. Medical nutrition therapy (MNT) is an evidence-based treatment where a registered dietitian provides personalized nutrition and lifestyle guidance to patients. MNT has been demonstrated to be effective for weight loss and managing chronic diseases in patients with obesity. With the rise of telehealth, MNT has gained popularity as an accessible alternative to traditional in-person care. While a nationwide program integrating MNT with a companion mobile app offers a comprehensive weight management solution, data supporting its clinical effectiveness is limited.

OBJECTIVE: This study aimed to evaluate the effectiveness of an MNT program with a companion mobile app on weight loss among adults with overweight and obesity.

METHODS: This retrospective cohort study included users of Nourish, an MNT program with a companion mobile app, who attended at least 1 appointment between August 2023 and October 2024 and had a baseline BMI≥30 kg/m² or a BMI between 27-30 kg/m² with diabetes or prediabetes. The primary outcome was the proportion of participants who achieved at least 5% weight loss; secondary outcomes included mean weight change, mean percent weight change, and the proportion of participants who achieved at least 3% weight loss. Statistical significance of weight change was determined using 2-tailed t tests. Subgroup analyses were performed by sex, BMI, follow-up time between weights, number of appointments completed, and levels of engagement according to appointment frequency and app usage.

RESULTS: In total, 3951 participants were included in the analysis. The mean age was 38 (SD 10) years, and 78% (3082/3951) of participants were female. Weight loss was reported as a program goal by 70% (2748/3951) of participants, while 31% (1204/3951) and 24% (939/3951) reported diabetes or prediabetes and a cardiovascular condition, respectively. Over a median follow-up of 2.2 months, 17% (689/3951) of participants achieved at least 5% weight loss. The mean weight change was -4.5 (SD 8.9) pounds, corresponding to a mean percent weight change of -2% (SD 3.9; P<.001). Males and participants aged 60 years or older were more likely to experience at least 5% weight loss. Longer follow-up time between weights and a higher number of completed appointments (≥5 appointments) were significantly associated with a significantly higher likelihood of achieving at least 5% weight loss (P<.001 for both). In addition, participants who were most engaged, based on appointment frequency and app usage, were more likely to achieve at least 5% weight loss compared with those who were less engaged (P<.001).

CONCLUSIONS: Engagement with an MNT program and companion mobile app is associated with significant weight loss for adults with overweight and obesity and may serve as an effective, scalable weight management solution.

PMID:40327381 | DOI:10.2196/70228

J Trauma Acute Care Surg. 2025 May 6. doi: 10.1097/TA.0000000000004635. Online ahead of print.

ABSTRACT

BACKGROUND: Leadership is a crucial component to successful team functioning in high-acuity scenarios. However, literature addressing the potential impact of leadership style on team members during trauma resuscitations is scarce. We aim to assess the link between leadership type and team resilience among trainees in the trauma bay through video review and hypothesize that transformational leadership would be predominant and positively linked with team member behaviors.

METHODS: We performed a single-center cross-sectional study of adult patients (14 years or older) presenting at our Level I trauma center. Trainee performance was evaluated with Behavior Anchored Rating Scales through post hoc audiovisual review of captured trauma resuscitations. Statistical analysis was performed to explore possible correlations between leadership style (transformational, transactional, and passive) and three team resilience behaviors (speaking up, knowledge sharing, and cooperation).

RESULTS: A total of 118 Level I and II trauma activations were analyzed. The average age was 34 [26-47] years, with 23% (n = 27) penetrating injuries, and an average Injury Severity Score of 12.5 [5-23.5]. Trauma leads scored highest on passive leadership (M = 2.96, SD = 1.16), followed by transactional (M = 2.67, SD = 1.29) and transformational (M = 2.33, SD = 1.19). Team members scored highest on knowledge sharing (M = 3.67, SD = 0.78) but lower on cooperation (M = 3.10, SD = 0.70) and speaking up (M = 3.10, SD = 1.17). Transformational and transactional leaderships were both positively correlated to the capacity in which team members cooperate (r = 0.53, p < 0.001 and r = 0.53, p < 0.001, respectively), share knowledge (r = 0.47, p < 0.001 and r = 0.47, p < 0.001, respectively), and speak up (r = 0.52, p < 0.001 and r = 0.49, p < 0.001, respectively). Passive leadership was negatively correlated with all three trauma team behaviors (p < 0.001).

CONCLUSION: Both transactional and transformational leaderships were positively associated with team resilience behaviors during trauma resuscitations. Opportunities for improvement among trainees suggest adopting an active rather than passive leadership style to promote team performance.

LEVEL OF EVIDENCE: Single-Center Prospective Observational Study; Level IV.

PMID:40327368 | DOI:10.1097/TA.0000000000004635

JMIR Mhealth Uhealth. 2025 May 6;13:e70473. doi: 10.2196/70473.

ABSTRACT

BACKGROUND: Encouraging physical activity improves mental health and is recommended in workplace mental health guidelines. Although mobile health (mHealth) interventions are promising for physical activity promotion, their impact on mental health outcomes is inconsistent. Furthermore, poor user retention rates of mHealth apps pose a major challenge.

OBJECTIVE: This study aimed to examine the effectiveness and implementation outcomes of the smartphone app ASHARE in Japanese workplace settings, leveraging a deep learning model to monitor depression and anxiety through physical activity.

METHODS: This hybrid effectiveness-implementation trial was a 3-month nonrandomized controlled trial conducted from October 2023 to September 2024. Work units and employees were recruited and allocated to the intervention or active control group based on preference. The intervention group installed the ASHARE app, whereas the control group participated in an existing multicomponent workplace program promoting physical activity. Changes in physical activity and psychological distress levels were compared between the groups. User retention rates, participation rates, acceptability, appropriateness, feasibility, satisfaction, and potential harm were also assessed.

RESULTS: A total of 84 employees from 7 work units participated (67 from 5 units in the intervention group and 17 from 2 units in the control group). In total, 78 employees completed the 3-month follow-up survey (follow-up rate: 93%). Both groups showed increased physical activity, and the intervention group showed reduced psychological distress; however, the differences between groups were not statistically significant (P=.20; P=.36). In a sensitivity analysis of protocol-compliant employees (n=21), psychological distress levels were significantly reduced in the intervention group compared with the control group (coefficient=-3.68, SE 1.65; P=.03). The app’s 3-month user retention rate was 20% (12/61), which was lower than the participation rate in each component of the control programs. Implementation outcomes evaluated by employees were less favorable in the intervention group than in the control group, whereas health promotion managers found them to be similar.

CONCLUSIONS: The ASHARE app did not show superior effectiveness compared with an existing multicomponent workplace program for promoting physical activity. An implementation gap may exist between health promotion managers and employees, possibly contributing to the app’s low user retention rate. Future research should focus on examining the effectiveness of strategies to get engagement from managers and from segments of employees with favorable responses in the workplace at an early stage.

PMID:40327360 | DOI:10.2196/70473

JAMA Netw Open. 2025 May 1;8(5):e258479. doi: 10.1001/jamanetworkopen.2025.8479.

ABSTRACT

IMPORTANCE: Displaced pediatric medial humeral epicondyle fractures are traditionally treated nonoperatively with casting. However, the use of surgical treatment has increased despite limited high-level evidence supporting its benefits.

OBJECTIVE: To determine whether open surgical reduction and internal fixation improve functional outcomes compared with long arm casting in children with displaced medial humeral epicondyle fractures at 12 months post injury.

DESIGN, SETTING, AND PARTICIPANTS: This noninferiority randomized clinical trial was conducted in 4 university hospitals in Finland between August 30, 2019, and August 22, 2023, with a 12-month follow-up completed August 20, 2024. Participants included children (aged 7-16 years) with nonincarcerated medial humeral epicondyle fractures and more than 2 mm of displacement. Data analysis was based on intention to treat.

INTERVENTIONS: Open reduction and fixation, followed by a long arm cast for 4 weeks, or long arm cast without reduction for 4 weeks.

MAIN OUTCOME AND MEASURE: The primary outcome was the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score at 12 months (range, 0-100 points, with 0 denoting no disability and 100 extreme disability; prespecified noninferiority margin was 6.8 points).

RESULTS: Seventy-two patients were randomized (43 [59.7%] female; mean [SD] age, 12.1 [2.1] years; range, 7.9-15.9 years), with 37 (19 [51.4%] female) to the surgery group (mean [SD] age, 12.2 [2.3] years; range, 7.9-15.9 years) and 35 (24 [68.6%] female) to the cast group (mean [SD] age, 11.9 [2.0] years; range 7.9-15.9 years). At 12 months, the mean QDASH score was 1.73 (95% CI, 0.65-2.81) in the surgery group and 2.71 (95% CI, 0.52-4.90) in the cast group, showing noninferiority (mean difference, -0.98 [95% CI, -2.95 to 0.98] points). The cosmetic visual analog scale favored the cast group, with a statistically significant between-group difference of -8.9 points (95% CI, -16.6 to -1.2 points; P < .001). Nonunion occurred in 1 of 37 surgically treated patients (2.7%) and 24 of 35 cast-treated patients (68.6%). No crossovers from casting to surgery occurred.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of displaced medial epicondyle fractures, treatment with casting alone was noninferior at 12 months to surgical reduction and internal fixation followed by casting. Findings support nonoperative care as effective at 1 year; longer-term outcomes remain to be studied.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04531085.

PMID:40327343 | DOI:10.1001/jamanetworkopen.2025.8479

Am J Physiol Renal Physiol. 2025 May 6. doi: 10.1152/ajprenal.00259.2024. Online ahead of print.

ABSTRACT

Chronic kidney disease (CKD) is a progressive disorder marked by a decline in kidney function. Obesity and sedentary behavior contribute to the development of CKD, though mechanisms by which this occurs are poorly understood. This knowledge gap is worsened by the lack of a reliable murine CKD model that does not rely on injury, toxin, or gene deletion to induce a reduction in kidney function. High-fat diet (HFD) feeding alone is insufficient to cause reduced kidney function until later in life. Here, we employed a small mouse cage (SMC), a recently developed mouse model of sedentariness, to study its effect on kidney function. Wildtype C57BL/6J male mice were housed in sham or SMC housing for six months with HFD in room (22°C) or thermoneutral (30°C) conditions. Despite hyperinsulinemia induced by the SMC+HFD intervention, kidneys from these mice displayed normal glomerular filtration rate (GFR). However, the kidneys showed early signs of kidney injury, including increases in Col1a1 and NGAL transcripts, as well as fibrosis by histology, primarily in the inner medullary/papilla region. High-resolution respirometry and fluorometry experiments showed no statistically significant changes in the capacities for respiration, ATP synthesis, or electron leak. These data confirm the technical challenge in modeling human CKD. They further support the notion that obesity and a sedentary lifestyle make the kidneys more vulnerable, but additional insults are likely required for the pathogenesis of CKD.

PMID:40327334 | DOI:10.1152/ajprenal.00259.2024