Category: Statistics

BMC Health Serv Res. 2025 Dec 11. doi: 10.1186/s12913-025-13820-4. Online ahead of print.

ABSTRACT

BACKGROUND: Pakistan’s healthcare system faces critical challenges, including limited infrastructure and disparities in access between urban and rural regions. Telehealth has emerged as a promising solution to improve accessibility, but patient-centered evidence on its effectiveness and cost-efficiency remains limited.

METHODS: This cross-sectional survey included patients (n = 532) who completed telehealth consultations with EZShifa between May and December 2023. A structured questionnaire assessed socio-demographics, comfort, trust, perceived quality of care, and patient-reported costs. Descriptive statistics summarised characteristics. Ordinal regression identified predictors of telehealth acceptance. Patient-reported telehealth and in-person care costs were compared, and incremental cost-effectiveness ratios (ICERs) were estimated using acceptance and comfort scores as effectiveness measures.

RESULTS: Most participants were aged 26-50 and from Punjab or Sindh. High satisfaction was reported for provider professionalism and consultation quality, though some concerns about connectivity and privacy remained. Ordinal regression showed that higher comfort (OR 4.15-20.3, p = 0.008) and perceived quality of care (OR 2.59, p = 0.004) significantly predicted acceptance, while sociodemographic factors were non-significant. The mean reported telehealth cost (PKR 2,000) was substantially lower than in-person visits (PKR 4,800). ICER analysis indicated telehealth was dominant, offering cost savings and greater patient-reported effectiveness.

CONCLUSIONS: Telehealth demonstrates strong acceptance, satisfaction, and economic benefits in Pakistan’s primary healthcare system. Despite self-reported costs and cross-sectional design limitations, findings highlight telehealth’s potential for scaling chronic disease management and reducing healthcare disparities.

PMID:41382260 | DOI:10.1186/s12913-025-13820-4

Hum Genomics. 2025 Dec 11. doi: 10.1186/s40246-025-00876-w. Online ahead of print.

NO ABSTRACT

PMID:41382250 | DOI:10.1186/s40246-025-00876-w

Eur J Med Res. 2025 Dec 11. doi: 10.1186/s40001-025-03610-3. Online ahead of print.

ABSTRACT

PURPOSE: Keratorefractive lenticule extraction (KLEx) is widely used for myopia correction. This study aims to investigate the relationships among the designed lenticular area (DLA), lenticule stretched preparation (LSP), and the achieved functional optical zone (AFOZ) to identify factors influencing these discrepancies.

SETTING: The study was conducted at the Eye & ENT Hospital of Fudan University, Shanghai.

DESIGN: The study was a non-randomized, prospective analysis of patients’ surgical parameters.

METHODS: 29 young adults who underwent KLEx for myopia correction were included. Preoperative data, including spherical equivalent and axial length, were recorded. The removed lenticule was stained, flattened, and measured using ImageJ software to calculate the LSP area. Postoperative AFOZ was assessed using Pentacam topography. Statistical analysis compared LSP, DLA, and AFOZ and correlated differences with clinical parameters.

RESULTS: The mean age of the patients was 23.07 ± 4.76 years, with a median spherical equivalent of – 4.3755.375, (- 5.375, – 3.188) D. The AFOZ was smaller than the DLA (35.26 (35.260, 35.260) mm² vs. 36.32 (35.790, 36.320) mm²), likely due to corneal remodeling. Axial length significantly correlated with the LSP-DLA discrepancy (P = 0.005), with longer axial lengths associated with smaller differences, suggesting that increased axial length reduces corneal elasticity. Spherical equivalent also correlated significantly with the AFOZ-DLA discrepancy (P = 0.047).

CONCLUSIONS: Anatomical factors such as axial length and myopia severity affect the AFOZ in KLEx. Future research should incorporate additional biomechanical and imaging parameters to enhance the accuracy of outcome predictions.

PMID:41382247 | DOI:10.1186/s40001-025-03610-3

Acta Neuropathol Commun. 2025 Dec 11. doi: 10.1186/s40478-025-02202-w. Online ahead of print.

ABSTRACT

Spinal hemangioblastomas (sHB) are rare vascular tumors, with distinct clinical courses between von Hippel-Lindau (VHL)-associated and sporadic cases. The MIB-1 labeling index has been proposed as a surrogate marker for tumor proliferation, but its prognostic value remains unclear in this context. In this subgroup analysis from a multicenter retrospective study, we analyzed 116 primary sHB patients with available MIB-1 indices. Patients were stratified by VHL status. Statistical comparisons included ROC analyses for local progression-free survival (PFS) prediction and Kaplan-Meier survival curves for local PFS, stratified by a MIB-1 index cut-off derived from Youden’s index. The MIB-1 index was significantly lower in VHL-associated tumors compared to sporadic ones (mean 2.17% vs. 3.02%, p = 0.008). In VHL-associated sHB, a higher MIB-1 index (≥ 2%) correlated with an increased risk of local tumor progression (AUC 0.74, 95% CI 0.49-0.98), whereas this was not observed in sporadic cases (AUC 0.56, 95% CI 0.23-0.88). Kaplan-Meier analysis showed that VHL patients with MIB-1 ≥ 2% had significantly shorter PFS (p = 0.05), while no significant association was found in sporadic tumors (p = 0.87). Our findings suggest that while VHL-associated sHB exhibit lower proliferative indices overall, elevated MIB-1 labeling indices might serve as a prognostic marker of shorter local PFS in this subgroup. In contrast, MIB-1 index appears to have limited prognostic relevance in sporadic sHB. These results highlight the importance of further molecular stratification and proliferation assessment in sHB to better inform clinical decision-making.

PMID:41382243 | DOI:10.1186/s40478-025-02202-w

Popul Health Metr. 2025 Dec 11. doi: 10.1186/s12963-025-00440-7. Online ahead of print.

ABSTRACT

The aim of the study was to analyze changes and demographic inequalities in the mortality of the Lithuanian population in 2020 and 2021 compared to the period of 2015-2019, assess the major causes of death that contributed to the changes, and identify the groups of the society that suffered most.

METHODS: Mortality rates for 2015-2021 from all causes, cardiovascular diseases, malignant neoplasms, external causes, diseases of the digestive system, diseases of the respiratory system, and COVID-19 in Lithuania by sex and age were calculated per 100,000 population. Mortality changes compared with the previous year and between the average of 2015-2019 years were calculated. The average annual percentage change was calculated to determine the aggregated 2015-2019 change in mortality from the leading causes of death. Coefficients of linear regression multiplied by 100 were presented as average annual changes, which were statistically significant at p < 0.05. Mortality rate differences between 2020 and 2021 years and the average of 2015-2019 years were calculated.

RESULTS: Lithuania has recorded 9.4% higher overall mortality among males in 2020 and 18% higher mortality in 2021 compared with a period unaffected by the COVID-19 pandemic (p < 0.05). Among females – 10.7% higher mortality in 2020 and 22.6% in 2021 (p < 0.05). Male and female mortality from COVID-19 in all age groups in 2021 was higher than that in 2020, and mortality rates increased with an increase in age. Negative changes in mortality from 2015 to 2019 to 2020 among males and females of all age groups were mainly determined by COVID-19. The most significant impact of COVID-19 in 2021 on the overall mortality changes was estimated in the 55-64 and 65-74 male age groups, while female overall mortality was in the 45-54 and 65-74 age groups.

CONCLUSIONS: Negative changes in mortality from 2015 to 2019 to 2020 among males and females of all age groups were mainly determined by COVID-19. The most significant impact of COVID-19 in 2021 on the overall mortality changes was estimated in the 55-74 male age group, while on female overall mortality in the 45-54 and 65-74 age groups.

PMID:41382237 | DOI:10.1186/s12963-025-00440-7

J Ovarian Res. 2025 Dec 11. doi: 10.1186/s13048-025-01884-z. Online ahead of print.

ABSTRACT

PURPOSE: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder, with dysregulated lipid metabolism and immune dysfunction. However, it remains unclear whether immune phenotypes mediate the relationship between lipidomes and PCOS.

METHODS: A two-step Mendelian Randomization analysis was employed to explore the causal relationship between plasma lipidomes and PCOS and to investigate the mediating role of immune cells. A total of 179 plasma lipidomes and 731 immune phenotypes were analyzed. We used single nucleotide polymorphisms (SNPs) associated with plasma lipidome levels as instrumental variables and applied statistical methods, including the inverse-variance weighted approach, to assess potential causal relationships.The function of immune phenotypes in regulating the relationship between lipids and PCOS was evaluated through mediation analysis.

RESULTS: Ten lipid-immune pathways mediating the association between plasma lipidomes and PCOS were identified. Elevated levels of phosphatidylcholines and triacylglycerols increased the risk of PCOS by modulating immune markers such as HLA DR on B cells and CD28 on regulatory T cells. Conversely, phosphatidylinositol (18:1_18:2) demonstrated a protective effect against PCOS through CD33 on myeloid-derived suppressor cells. Six specific plasma lipidomes were causally linked to PCOS risk, including phosphatidylcholine (18:1_20:4) and triacylglycerol (50:4), which increased risk, and phosphatidylinositol (18:1_18:2), which lowered risk. Additionally, 31 immune phenotypes were identified as causally associated with PCOS, with 27 increasing risk and 4 offering protective effects.

CONCLUSION: This study provides evidence that immune phenotypes mediate the relationship between plasma lipidomes and PCOS. These findings highlight the potential of targeting both lipid metabolic processes and immune pathways as novel therapeutic strategies for managing PCOS.

PMID:41382225 | DOI:10.1186/s13048-025-01884-z

Cell Commun Signal. 2025 Dec 11. doi: 10.1186/s12964-025-02573-6. Online ahead of print.

ABSTRACT

BACKGROUND: Given the role of metabolism in brain health and disease, the investigation of the role of insulin (INS) and insulin-like growth factors (IGFs) as potential therapeutic strategies for neurodegenerative diseases is currently underway. Yet, the signaling pathways associated with INS and IGFs in the brain remain elusive, particularly for the human brain. Unraveling these pathways is critical for harnessing their therapeutic potential in metabolism-associated brain disorders.

METHODS: This study employed phosphoproteomics using a human neuroblastoma cell line, SH-SY5Y, to unravel the signaling networks of INS, IGF-1, and IGF-2. Briefly, cells were stimulated for 10 and 60-minutes with the ligands, followed by protein extraction, trypsin digestion, tandem mass tag (TMT) labelling and phosphopeptide enrichment using an immobilized metal affinity chromatography (IMAC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. The data were processed using R statistical software. Protein annotations were obtained from the UniprotKB database, and pathway enrichment analysis was performed using Ingenuity Pathway Analysis (IPA).

RESULTS: Phosphoproteomics performed at 10 and 60 min identified 34,358 phosphosites, of which 3,284 were significant at 10 min and 2,374 at 60 min (p.adj < 0.05) across all three ligands. Ligand stimulation induced modulation in phosphorylation at both the receptor level and downstream targets at serine (S), threonine (T), and tyrosine (Y) residues. LIMA1-Y229, a regulator of actin-cytoskeletal function, was the most prominent Y phosphosite across all ligands. IPA identified Rho GTPase as the most significantly enriched pathway, with IGF-1 predominantly driving phosphorylation of Rho GTPase effectors such as Rho guanine nucleotide exchange factors (ARHGEFs), Rho GTPase activating proteins (ARHGAPs) and CDC42. Myocardin-related transcription factor A (MRTFA), a transcriptional target of Rho GTPase, was increased in ligand-stimulated cells at 10 min, and inhibition of the Rho/SRF pathway and PI3K by CCG1423 and wortmannin, respectively, prevented nuclear localization of IGF-1-induced MRTFA.

CONCLUSIONS: This study demonstrates that INS, IGF-1, and IGF-2 regulate Rho GTPase and MRTFA activation, thereby contributing to the control of actin cytoskeletal dynamics in neuronal cells. Given the role of INS and IGFs in neuronal survival and neurodegenerative conditions, elucidating these mechanisms is of critical importance, as it offers insights into disease pathogenesis and potential therapeutic targets.

PMID:41382216 | DOI:10.1186/s12964-025-02573-6

Diabetol Metab Syndr. 2025 Dec 11. doi: 10.1186/s13098-025-02052-5. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic syndrome (MS) poses a growing threat to adolescent health, yet its sex-specific patterns remain inadequately characterized. This study aimed to investigate sex differences in MS prevalence, risk factor clustering, and metabolic phenotypes among U.S. adolescents.

METHODS: We analyzed cross-sectional data from 6,989 adolescents aged 12-19 years, representing 30.97 million U.S. adolescents, from the National Health and Nutrition Examination Survey (1999-2020). MS was defined based on abdominal obesity, elevated blood pressure, hyperglycemia, and dyslipidemia, using weighted analyses to account for complex survey design.

RESULTS: The overall MS prevalence was 5.1%, with a significantly higher prevalence in males than in females (6.1% vs. 4.1%, P = 0.017). Critically, no significant temporal trends in MS prevalence were observed over the 20-year period for either sex. Males accumulated more metabolic risk factors than females, showing higher rates of elevated BP (5.9% vs. 0.9%), fasting glucose (22.7% vs. 10.4%), and triglycerides (8.8% vs. 6.4%), whereas, females had higher prevalences of abdominal obesity (25.9% vs. 12.6%) and low HDL-C (22.8% vs. 18.8%). Moreover, metabolically unhealthy obesity was more common in males (13.7% vs. 10.0%). Subgroup analyses showed significant sex disparities persisted among ages 12-15, obese, non-Hispanic White, and high-income subgroups. Sensitivity analyses using alternative definitions, including waist-to-height ratio for abdominal obesity, robustly confirmed the male predominance in MS prevalence.

CONCLUSION: Male U.S. adolescents exhibited a higher MS prevalence and a more unfavorable aggregation of metabolic risk factors than females. The stability of MS prevalence over the two-decade period highlighted the need for sex-specific and developmentally targeted interventions, especially within identified high-disparity subgroups.

PMID:41382204 | DOI:10.1186/s13098-025-02052-5

Indian Dermatol Online J. 2025 Dec 11. doi: 10.4103/idoj.idoj_983_24. Online ahead of print.

ABSTRACT

BACKGROUND: Age-related decline in skin moisture affects many older adults and is exacerbated by factors such as sun exposure and lifestyle habits. Recent research has explored the potential of exercise to improve skin moisture; however, the optimal activity levels remain unclear. This study investigated the link between exercise habits and skin moisture to inform clinical preventive strategies.

PATIENTS AND METHODS: In this cross-sectional study, we investigated the relationship between stratum corneum (SC) hydration and lifestyle habits in older adults using the International Physical Activity Questionnaire (IPAQ) short version and a self-administered questionnaire. Participants were recruited from community spaces and local elderly facilities. Data were collected between September 1 and December 31, 2023. Based on the IPAQ responses, physical activity levels were classified as low, moderate, or high, and SC hydration was measured on the right forearm. Statistical analyses were conducted using t-tests.

RESULTS: A total of 124 participants were included, with a mean age of 84.3 ± 9.2 years. Among them, 69.4% were female. The participants were belonged to low (57) and moderate/high (67) activity-level groups, with significant differences in SC hydration (P = 0.001) between the groups.

LIMITATIONS: Cross-sectional design, restricted sample, and potential unmeasured confounding may limit interpretation.

CONCLUSIONS: The results suggested a significant difference in horny skin water content between the low-and moderate/high-activity groups, indicating that exercise habits may enhance skin moisturization, possibly via increased skin blood flow, stress reduction, improved sleep, and increased collagen production. Exercise regimens may mitigate age-related decline in skin function, potentially offering a preventive strategy for skin dryness and related conditions in older adults.

PMID:41382199 | DOI:10.4103/idoj.idoj_983_24

Eur J Med Res. 2025 Dec 11. doi: 10.1186/s40001-025-03639-4. Online ahead of print.

ABSTRACT

BACKGROUND: Vestibular migraine (VM) is often considered a subtype of migraine, but the pathogenesis of both has not been fully elucidated. The aim of this study is to integrate clinical data systems through transcriptome sequencing to explore the similarities and differences between the two in terms of pathogenesis and clinical manifestations and predict therapeutic drugs.

METHODS: This study included 9 cases of VM, 6 cases of migraine only (MO), and 14 healthy controls (HC). Detailed records were kept of each participants basic information and clinical characteristics related to their onset of illness, with statistical analysis conducted using R. Additionally, peripheral blood mononuclear cells (PBMCs) from each participant were collected for high-throughput RNA sequencing. Next, DEseq2 packages were used to identify differentially expressed genes (DEGs) between MO/HC, VM/HC, and VM/MO. Pearson correlation was used to calculate co-expressed genes between MO/HC and VM/HC, and gene sets were functional annotation and pathway enrichment analysis. Furthermore, hub genes were screened using protein interaction and Cytoscapes Degree algorithm, and further evaluation was conducted using transcriptome data. Finally, common therapeutic drugs were predicted using DGIdb, Drugbank, and ClinicalTricals.

RESULTS: Compared to HC, both VM and MO patients exhibited higher incidences of anxiety, depression, and sleep disorders, with overlapping triggers and symptoms. However, VM patients demonstrated higher headache frequency, longer attack duration, and a higher prevalence of abnormal vestibular function tests. Transcriptomic analysis revealed significant activation of neutrophil activation and cholesterol metabolism pathways in MO, while Interleukin-17 (IL-17) signaling, calcium signaling, and estrogen-related pathways were prominent in VM. Co-expression analysis identified IL-17 signaling as a key pathway, more activated in VM than MO, potentially explaining VM’s higher attack frequency and delayed onset (average 9 years after migraine diagnosis). C-X-C motif chemokine ligand 8 (CXCL8) was validated as a common biomarker for both conditions. Drug prediction identified 55 potential therapeutic agents, including nonsteroidal antiinflammatory drugs (NSAIDs), vitamin A, and verapamil.

CONCLUSION: VM and MO share overlapping clinical and pathogenic features, particularly inflammation and metabolic dysregulation. CXCL8 serves as a shared biomarker, and NSAIDs, vitamin A, and verapamil may offer therapeutic benefits. The heightened inflammatory activation in VM suggests it could represent an advanced stage of MO, emphasizing the importance of early intervention in migraine progression.

PMID:41382196 | DOI:10.1186/s40001-025-03639-4