Category: Statistics

Curr Eye Res. 2025 May 21:1-8. doi: 10.1080/02713683.2025.2504569. Online ahead of print.

ABSTRACT

PURPOSE: To assess the usability of a smartphone-based augmented reality tool for capsulorhexis training.

METHODS: This is a single-center, prospective, clinical study conducted at the Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany. Surgery-naïve residents were included and divided into three subgroups: (1) augmented reality supported by the Custom Surgical MicroREC system during their capsulorhexis procedures; (2) Expert support supported by an experienced cataract surgeon; (3) No support without support. Capsulorhexis quality was graded by circularity, centration, and radius.

RESULTS: Twenty-one (n_total = 21) participants were enrolled. The augmented reality group was statistically significantly better in terms of circularity than the Expert support (Mann-Whitney’s U-test: p = .00175) and the No support group (Mann-Whitney’s U-test: p = .00268). The procedure duration decreased statistically significantly for all three groups when try 1 and 10 were compared (augmented reality: p < .0001; Expert support: p = .0099; No support: p < .0001). The other parameters did not differ statistically significantly. The questionnaires handed to the augmented reality and No support group before and after the wet lab revealed a high importance of wet lab trainings to all polled participants. The provided wet lab setup was considered adequate by both groups.

CONCLUSION: Augmented reality can assist in cataract training. The Custom Surgical MicroREC system can have a positive influence on capsulorhexis quality in a training environment. Automated quality metrics measured by the augmented reality software provide an objective quality score of the performed surgical procedure. As the tested augmented reality system can be used in training as well as in a real-world setting, this will be a useful tool for trainees and expert surgeons alike.

PMID:40396333 | DOI:10.1080/02713683.2025.2504569

Curr Alzheimer Res. 2025 May 19. doi: 10.2174/0115672050388220250511174043. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVE: Given the role of inflammation in the development of both Alzheimer’s disease (AD) and periodontal disease, it is plausible that periodontal disease may influence the progression of AD. Complete blood count (CBC) parameters may also serve as predictive indicators for this condition. This study investigated the predictive value of CBC parameters on the progression of AD in patients with periodontal disease.

METHODS: Data from a prospective cohort study (n=90) with 6-month follow-up was analyzed. AD was assessed based on the Clinical Dementia Rating Scale. Records of C-reactive Protein (CRP) levels and CBC parameters measured within the 6 months preceding the participation date were evaluated. Cognitive assessments at the initial and 6th-month follow-up were performed using the Standardized Mini-Mental Test (SMMT). All patients underwent clinical periodontal examination.

RESULTS: The difference in SMMT score change (ΔSMMT) and platelet distribution width (PDW) value between groups with and without periodontitis was statistically notable (p<0.05). The presence of periodontitis was found to be significantly associated with age, ΔSMMT, and PDW values using the multivariate logistic regression model (p<0.05). Furthermore, having Stage II and Stage III AD, periodontitis, age factor, and mean platelet volume (MPV) value had a notable impact on ΔSMMT (p<0.05).

CONCLUSION: PDW and MPV levels may have a predictive significance in clarifying the association between periodontitis and AD progression.

PMID:40396318 | DOI:10.2174/0115672050388220250511174043

J Bronchology Interv Pulmonol. 2025 May 21;32(3):e01015. doi: 10.1097/LBR.0000000000001015. eCollection 2025 Jul 1.

ABSTRACT

BACKGROUND: The convex-probe endobronchial ultrasound (CP-EBUS) bronchoscope is widely used in clinical practice. Despite improvements, the existing CP-EBUS remains limited in accessing areas beyond the mediastinum due to its large distal end diameter, long rigid tip segment, and oblique viewing angle. To address this limitation, Olympus Medical Systems Corporation developed the thin CP-EBUS (TCP-EBUS). This study aimed to compare the accessibility and puncturing ability of TCP-EBUS with existing CP-EBUS in cadaveric models.

METHODS: Ten bronchoscopists conducted this study using 2 cadaveric models. The accessibility of TCP-EBUS was evaluated based on the number of bronchial generations that could be reached. To assess the puncturing ability of TCP-EBUS, needle punctures were performed on previously created simulated lesions in the segmental or subsegmental bronchial area, and puncture success rates were calculated.

RESULTS: TCP-EBUS demonstrated greater accessibility than CP-EBUS in all segmental bronchi, with statistically significant differences observed in several bronchi (P<0.05). Puncture success rates for simulated lesions using TCP-EBUS were also significantly higher than those using CP-EBUS in both the segmental (85.0% vs. 60.0%, P<0.001) and subsegmental bronchial areas (84.4% vs. 38.9%, P<0.001). In a questionnaire survey, TCP-EBUS was perceived as significantly superior in terms of usability (P<0.05).

CONCLUSION: TCP-EBUS has significantly improved both accessibility and puncture performance, providing an advantage over CP-EBUS in segmental and subsegmental bronchial areas. TCP-EBUS has the potential to expand the indications for endobronchial ultrasound-guided transbronchial needle aspiration.

PMID:40396305 | DOI:10.1097/LBR.0000000000001015

J Bronchology Interv Pulmonol. 2025 May 21;32(3):e01013. doi: 10.1097/LBR.0000000000001013. eCollection 2025 Jul 1.

ABSTRACT

BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by abnormal alveolar surfactant accumulation. In recent years, transbronchial cryo-biopsy (TBCB) has gradually been applied as it can obtain larger and better-quality specimens. This study aims to assess the diagnostic yield and safety of TBCB in PAP.

METHODS: This study included 78 PAP patients who underwent lung biopsy. Thirty-six of them underwent transbronchial lung biopsy (TBLB) with forceps and the other 42 underwent TBCB. Clinical data, biopsy specimen number and size, the pathologic lesion proportion of biopsied specimens, complications, and pathologic diagnosis of patients from both groups were recorded.

RESULTS: Our data show that the diagnostic yield of TBCB is significantly superior to that of TBLB (78.6% vs. 50%, P<0.05). The TBCB group exhibited a greater number and size of biopsy specimens than the TBLB group (P<0.05). As for pathologic diagnosis, the specimen size in the PAP-positive group was notably larger than in the PAP-negative group (P<0.05). According to the receiver operating characteristic curve, the specimen size of at least 2 mm2 was identified as the cut-off with a higher positive predictive value (area under the curve = 0.676, P=0.007). For complications of TBLB and TBCB, there was no statistically significant difference in the incidence of pneumothorax and bleeding.

CONCLUSION: TBCB emerges as a minimally invasive, effective, and safe technique with a higher diagnostic yield than TBLB in PAP. Augmenting the specimen size can effectively improve the diagnostic yield.

PMID:40396301 | DOI:10.1097/LBR.0000000000001013

Curr HIV Res. 2025 May 20. doi: 10.2174/011570162X366300250509112302. Online ahead of print.

ABSTRACT

INTRODUCTION: Some HIV patients stay in an immune unresponsive state after antiretroviral therapy (ART), with a notably higher risk of AIDS-related and non-AIDS-related complications. Double-negative T cells (DNT) can compensate for immunity and prevent immune overactivation in HIV patients. Also, immune non-responders (INRs) have fewer DNT cells than immune responders (IRs). HIV infection and ART can change the dynamic function of cell mitochondria, which are crucial in ferroptosis. Ferroptosis is a form of cell death marked by the accumulation of reactive oxygen species (ROS) and iron-dependent lipid peroxidation. Yet, the changes in DNT cell function in INRs and the impact of ferroptosis on immune reconstitution remain unclear.

AIMS: Our study focused on the expression level of DNT cells in HIV immune non-responders. Then, we detected markers of ferroptosis, cell activation, proliferation, killing function, and inflammatory states of DNT cells in INRs.

METHODS: The study involved 88 PLHIVs who had received antiretroviral therapy for over 4 years and tested virus-negative. These patients were classified into two groups: 28 INRs (CD4 < 350/μl) and 60 IRs (CD4 ≥350/μl). Additionally, 25 sex- and age-matched HCs were included. Flow cytometry was used to detect ferroptosis markers (JC-1, Lipid ROS, lipid peroxidation), cell proliferation, and cell activation. Transmission electron microscopy (TEM) was applied to observe mitochondrial morphology. Finally, statistical analysis was performed on the detection results.

RESULTS: After long-term antiretroviral therapy, we found that INRs had a lower DNT cell count than IRs. Regarding proliferation and activation, our results showed higher CD38/HLA-DR co-expression and Ki67 expression in INRs’ DNT cells than in IRs’, indicating over-activation of DNT cells in INRs. In terms of killing function, the perforin and granzyme B levels in INRs’ DNT cells were lower than those in IRs’, suggesting impaired killing function of DNT cells in INRs. For ferroptosis, the proportion of DNT cells with decreased MMP in INRs was higher than in IRs and HCs. INRs’ DNT cells also had higher levels of lipid ROS and lipid peroxidation compared to those in IRs and HCs. TEM revealed that the mitochondria of INRs’ DNT cells had typical morphological features. Moreover, INRs’ DNT cells had a greater degree of inflammation.

CONCLUSION: Our study centered on the proliferation, activation, ferroptosis, killing function, and inflammatory status of DNT cells in INRs. We found that DNT cells in INRs had more active proliferation and activation, weakened killing function, mitochondrial function with typical ferroptosis features, and increased TNF-αlevels. Correlation analysis indicated that DNT cell overactivation (Ki-67+, CD38+HLA-DR+), MMP reduction ratio, and TNF-αexpression were negatively related to immune reconstitution in PLHIVs. In contrast, the killing function (perforin+) of DNT cells was positively related to it. These findings provide a theoretical basis for targeting the functional remodeling of DNT cells. In the future, therapeutic strategies can be explored, such as regulating the mitochondrial metabolic pathway or enhancing the immunoregulatory activity of DNT cells. These strategies can thus offer innovative solutions to the dilemma of immune reconstitution in HIV-infected individuals.

PMID:40396294 | DOI:10.2174/011570162X366300250509112302

Eur J Dent Educ. 2025 May 21. doi: 10.1111/eje.13111. Online ahead of print.

ABSTRACT

PURPOSE: Dental surgeons are particularly exposed to musculoskeletal disorders. Ergonomics can help prevent them. Third-party ergonomic assessment is beneficial in the short term. However, self-assessment of one’s working posture is even more valuable, as it fosters lifelong awareness.

METHODS: Fifth year odontology students were randomly assigned to one of two groups (control and training) to evaluate whether a protocol for ergonomic self-assessment by paediatric odontology students, using photography, led to an improvement in their working position. The Modified-Dental Operator Posture Assessment Instrument was used.

RESULTS: The study included 82 fifth-year odontology students who performed paediatric care between September 2022 and June 2023. A statistically significant difference was found between the control and training groups for both self-assessments (p < 0.001) and evaluator analyses (p < 0.001).

CONCLUSIONS: The longitudinal follow-up approach appears to be unique in the field of ergonomics education in dentistry. The results demonstrated a significant reduction in ergonomics scores for the group that received ergonomic advice and visual feedback compared to the control group. This improvement was confirmed both by evaluator-assigned scores and by students’ self-assessments.

PMID:40396283 | DOI:10.1111/eje.13111

Health Expect. 2025 Jun;28(3):e70300. doi: 10.1111/hex.70300.

ABSTRACT

INTRODUCTION: Our ability to address inequities in health outcomes is hampered by the under-representation of underserved groups in research. Research exploring this topic has focused on observational studies in the American context. This is a pivotal concern for maternity research in the UK as perinatal outcome variables vary by ethnicity, socioeconomic and linguistic background. This paper reports the findings of an analysis of the diversity achieved by different recruitment strategies used within a feasibility study and pilot trial of group antenatal care (Pregnancy Circles).

METHOD: A pilot randomised controlled trial involved implementation of Pregnancy Circles across three maternity services in an area of high ethnic, socioeconomic and linguistic diversity. Following findings of high ethnic diversity but low levels of educational and linguistic diversity amongst participants recruited in our prior feasibility study, equity-informed strategies were put into place to attempt to increase recruitment diversity in the pilot trial, addressing organisational barriers (additional language support); attitudinal barriers (staff training to counteract recruitment bias) and practical barriers (extending the recruitment period to reach women accessing care late). Women who declined participation were invited to complete a short anonymous questionnaire covering demographic details and reasons for declining. The demographic characteristics of participants in the feasibility and pilot studies, and the pilot study decliners, were compared using descriptive statistics and free-text reasons for declining were analysed thematically.

RESULTS: The targeted recruitment processes were successful in widening the diversity of participants in this study, in particular for women with limited English proficiency and low educational achievement. Nevertheless, comparison of participants to those who declined showed some barriers persisted. The most common reason to decline was lack of time, most commonly due to caring responsibilities, and this was more likely to be cited by ethnically minoritized women.

CONCLUSION: Recruitment plans focused on widening diversity can be effective but are likely to require additional resources such as funding longer recruitment periods or interpreting services. The gendered nature of maternity research poses particular challenges, and our study suggests that addressing barriers such as those around childcare would enhance the recruitment of socio-economically deprived and minoritized women.

PATIENT OR PUBLIC CONTRIBUTION: Our study team included two service user representatives as co-investigators, feeding into all aspects of the study. The focus of the work reported here was to increase the participation of underserved communities in the pilot trial and to inform the Pregnancy Circles RCT, to enable them to contribute their data and lived experience to the findings and evaluation of this intervention.

TRIAL REGISTRATION: Due to an administrative oversight, trial registration for this pilot trial was applied for during the 6-week recruitment period, rather than before recruitment commencing (ISRCTN66925258. Retrospectively registered 3 April 2017). Registration occurred before programme intervention, outcomes and process data collection and all data analysis.

PMID:40396261 | DOI:10.1111/hex.70300

Ann Surg. 2025 May 21. doi: 10.1097/SLA.0000000000006760. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of hypovolemic phlebotomy (HP) versus conventional management (control group) in achieving low central venous pressure (CVP) to reduce blood loss during open liver resections.

BACKGROUND: Excessive blood loss increases perioperative complications and worsen patient outcomes. HP is used to reduce blood loss and the need for allogenic transfusions. This study compares intraoperative blood loss between HP and conventional techniques in liver resection.

METHODS: This prospective, randomized controlled trial, conducted between 2020 and 2024, evaluated intraoperative blood loss as the primary endpoint, with secondary endpoints of allogenic transfusion and postoperative outcomes.

RESULTS: One hundred participants were randomized to either HP or control groups, with similar baseline characteristics. The HP group had significantly lower blood loss during parenchymal transection (300 (250-500) vs. 500 (300-750) mL, difference = 150, 95% CI [50, 275]; P = 0.02), shorter time to achieve low CVP (50 (30-100) vs. 107.5 (45-150) minutes, difference = -75.0, 95% CI [-95.0, -56.0]; P = 0.01), and a lower surgical bleeding score (2 (1-3) vs. 2 (2-4), difference = -1.0, 95% CI [-1.0, -0.5]; P = 0.01). Transfusion rates and postoperative complications were similar. HP was an independent protective against blood loss > 500 mL (AOR = 0.19, 95% CI [0.04-0.80]; P = 0.02).

CONCLUSIONS: HP significantly reduces intraoperative blood loss and enhances bleeding control by achieving low CVP more quickly. It is an effective technique for minimizing blood loss and improving outcomes in open liver resections.

PMID:40396243 | DOI:10.1097/SLA.0000000000006760

Front Immunol. 2025 May 6;16:1490637. doi: 10.3389/fimmu.2025.1490637. eCollection 2025.

ABSTRACT

INTRODUCTION: Changes in oral neutrophil number and function may occur in patients after orthodontic treatment, affecting the oral immune microenvironment. However, the specific mechanisms are unclear. In this study, we describe the changes in the levels of neutrophil extracellular traps (NET) markers and inflammatory factors in the gingival crevicular fluid (GCF) and saliva of patients after orthodontic treatment and further explore the correlation between them.

METHODS: 68 patients underwent fixed orthodontic treatment in the Department of Orthodontics from January 2021 to June 2023 were selected. GCF and saliva samples were collected from the patients 1 day before orthodontic treatment and 2 h, 24 h, and 1 week after orthodontic treatment to evaluate changes in NET marker and inflammatory factors. The differences in and associations between NET markers and inflammatory cytokine levels in the GCF and saliva of patients were evaluated.

RESULTS: After fixed orthodontic treatment, the neutrophil elastase (NE), myeloperoxidase (MPO), citrullinated histone 3 (CitH3), and MPO-DNA in the GCF and saliva of the patients increased gradually, the interleukin (IL)-1β and IL-8 in the GCF increased gradually, and there were significant differences among the different time points (P<0.05). There was a positive correlation between the NE, MPO, CitH3, MPO-DNA, IL-1β and IL-8 in the GCF of patients at 2 hours and 24 hours after orthodontic treatment (P<0.05). There was a significant positive correlation between the GCF and saliva levels of NE, MPO, CitH3, MPO-DNA, IL-1β and IL-8 (P<0.05); however, there was no statistically sex- or age-dependent differences in the NE, MPO, CitH3, MPO-DNA, IL-1β and IL-8 levels in the GCF of orthodontic patients (P>0.05).

CONCLUSION: This study significantly reveals that NET marker levels in the GCF and saliva rapidly change following the initial orthodontic arch wire stress. The inflammation in periodontal tissues induced by orthodontic stress has the potential to trigger oral inflammation via the GCF. These findings are crucial for understanding the oral immune microenvironment changes during orthodontic treatment, providing a theoretical basis for preventing and treating orthodontic – related periodontal complications, thus having important implications for improving orthodontic treatment outcomes.

PMID:40396177 | PMC:PMC12089083 | DOI:10.3389/fimmu.2025.1490637

Front Public Health. 2025 May 6;13:1557538. doi: 10.3389/fpubh.2025.1557538. eCollection 2025.

ABSTRACT

OBJECTIVE: To compare the impact of a package of interventions on surface cleaning and disinfection in two public and private neonatal intensive care units (NICUs).

METHOD: This is a quasi-experimental, quantitative study. The study consisted of three phases: baseline (phase I), implementation of the intervention package without feedback to the team (phase II), and, finally, short-term monitoring with feedback to the team (phase III). A total of 864 evaluations were carried out according to the monitoring methods: adenosine triphosphate, visual inspection, microbial load counting, and detection of Staphylococcus aureus and testing for its methicillin resistance (MRSA) in each unit over 4 months, evaluating six high-frequency touch surfaces, before and after cleaning and disinfection carried out by nursing and sanitizing professionals.

RESULTS: When comparing the effect of the package in the two units (public and private), no significant differences were found in the proportions of MRSA-positive surfaces in all the phases evaluated. The same occurred concerning the ATP method, which showed no significant differences between the hospitals in all study phases. Concerning the microbial count, in phase II of the study, only on one surface (scales) was a significantly lower difference found in the private hospital compared to the public one. Visual inspection indicated that the private NICU had a substantially higher proportion of surfaces with adequate hygiene in phase I: the infusion pump and the armchair; in phase II, the counter and in phase III again the counter surface. Concerning human factors, when comparing the two institutions, there were no statistically significant associations or correlations with job satisfaction. However, the public institution had higher work performance scores than the private one.

CONCLUSION: The study highlights that the rigorous implementation of intervention packages for cleaning in NICUs, even though they are different, still showed similar results in terms of effectiveness for all the methods used, except visual inspection. This study showed that even though the employees had various levels of work performance, there was still a similar effect on the outcome of the intervention package.

PMID:40396167 | PMC:PMC12088969 | DOI:10.3389/fpubh.2025.1557538