Category: Statistics

Osteoporos Int. 2025 Dec 1. doi: 10.1007/s00198-025-07785-7. Online ahead of print.

ABSTRACT

Osteoporosis patient education has not been evaluated across Danish municipalities. In this observational study, we compared patients who had participated in osteoporosis patient education with patients who had not. We found differences both in favor of patient education and no patient education, and therefore, conclusions regarding effectiveness cannot be drawn based on this study design.

INTRODUCTION: Osteoporosis patients may benefit from patient education, including knowledge dissemination and physical exercises. We examined two primary outcomes: fractures and quality of life as well as eight secondary outcomes (self-efficacy, physical activity, balance, falls, adherence, pain management, psychological wellbeing, and daily functional capacity).

METHODS: We retrieved data from 15 Danish municipalities on citizens who had participated in osteoporosis patient education between 2016 and 2020. These were matched with citizens who had not participated (1:1) on gender, age, time of osteoporosis diagnosis, and type of previous osteoporotic fractures. A questionnaire was sent out and register data was retrieved, on average 3.7 years after participation in patient education. Participants were compared to controls using logistic or linear regression.

RESULTS: We included a total of 3132 individuals; 1660 answered the questionnaire. We found that participants had a lower score on the physical component of quality of life (difference -1.28; 95% CI -2.29, -0.28) and were more worried about falling compared to controls (OR 1.61; 95% CI 1.31, 1.99). Participants had more active spare time (OR 0.59; 95% CI 0.44, 0.81), performed more bone-specific physical activities (difference 0.50; 95% CI 0.01, 0.99), and were more adherent to medication (OR 1.74; 95% CI 1.49, 2.03). All other outcomes showed no statistically significant differences.

CONCLUSION: Our findings show that citizens who participated in patient education were more adherent to medication. Results related to quality of life, physical activity, and fear of falling were inconclusive, and therefore, we cannot draw conclusions regarding the overall effectiveness of osteoporosis patient education. Further studies should include baseline measurements and preferably conduct randomized controlled trials.

PMID:41320715 | DOI:10.1007/s00198-025-07785-7

Lasers Med Sci. 2025 Dec 1;40(1):504. doi: 10.1007/s10103-025-04764-6.

ABSTRACT

To evaluate and compare clinical outcomes, radiographic healing and regenerative biomarkers in laser-irradiated and non-irradiated groups undergoing regenerative endodontics in immature permanent teeth over a 12-month follow-up period. Twenty-eight patients with necrotic immature roots were assigned to one of two groups: a control group (n = 14) receiving standard regenerative endodontic procedure (REP) with a mock laser application, or an experimental group (n = 14) receiving standard REP with adjunctive low-level laser therapy (LLLT). Both groups underwent initial medication with double antibiotic paste. In the experimental group, a diode dental laser (810 nm, 4.5 J/cm², 0.3 W, 9 s) was applied to the apical third every 48 h for 14 days. After 21 days, intracanal bleeding was induced, and blood samples were collected for regenerative marker analysis using ELISA. Mineral trioxide aggregate was placed, followed by coronal restoration. Clinical symptoms and radiographic healing were monitored over 12 months, with statistical analysis performed using the independent t-test at a 95% confidence level. Clinically, both groups demonstrated high success rates (85.7% in the laser group vs. 78.6% in the control group; p = 0.83). No statistically significant differences were observed when pain and radiographic parameters were compared over time between the groups. Considering the biomarkers, only DSPP expression was significantly higher in the laser group (p = 0.03). For the other biomarkers (VEGF, TGF-β, MMP-8, PDGF-BB), the laser group showed numerically higher mean values, but these differences did not reach statistical significance (all p > 0.05). This study demonstrates that adjunctive low-level laser therapy (LLLT) during regenerative endodontic procedures produced comparable clinical and radiographic outcomes to standard treatment, with a significant increase in DSPP expression suggesting early molecular activation. While these findings indicate potential regenerative benefits, larger multicenter studies with extended follow-up are required to validate LLLT as an adjunct in clinical protocols. Trial registration: This trial was registered in the Clinical Trials Registry India (CTRI) under registration number CTRI/2024/01/062114 dated 31/01/2024.

PMID:41320703 | DOI:10.1007/s10103-025-04764-6

Bull Environ Contam Toxicol. 2025 Nov 30;115(6):73. doi: 10.1007/s00128-025-04142-6.

ABSTRACT

This study investigated the bioaccumulation of Zn, Pb, and Cd in the sternal feathers of house sparrows (Passer domesticus) collected from five sites in Meknes, Morocco, representing urban, industrial, and rural environments. Metal concentrations were quantified using inductively coupled plasma optical emission spectrometry (ICP-OES). The analysis revealed significant spatial differences for Pb and Cd, whereas Zn showed no marked variation among sites. Post-hoc comparisons confirmed that urban and industrial stations had considerably higher Pb and Cd levels compared to the rural reference site. No significant sex-related differences were found. Principal Component Analysis (PCA) was used as a descriptive tool to visualize correlations among metals and sampling sites, confirming spatial clustering linked to anthropogenic influence. These findings highlight P. domesticus as a reliable and non-invasive bioindicator of urban and industrial metal pollution, particularly for Pb and Cd, emphasizing its ecological relevance in monitoring environmental contamination.

PMID:41320699 | DOI:10.1007/s00128-025-04142-6

Bull Environ Contam Toxicol. 2025 Nov 30;115(6):77. doi: 10.1007/s00128-025-04152-4.

ABSTRACT

China faces escalating ozone pollution challenges, with O₃ becoming the primary pollutant in summer since 2013 and exhibiting deteriorating compliance rates (Grade I attainment plummeted from 6.9 to 0.3% during 2015-2023). Critical hotspots include the Beijing-Tianjin-Hebei region (exceeding standards by 20 µg/m³), driven by inadequate coordinated control of VOC and NO_x. Analysis of the ABaCAS-EI v2.0 dataset (2005-2021) reveals divergent precursor trends: VOC emissions shifted from residential to industrial dominance, with industrial solvents (PRSO) surging 389% during 2005-2013 and comprising 61% of national totals by 2021. Spatially, eastern provinces (e.g., Guangdong) showed transport-industrial emission profiles (TRON: 28%; PRSO: 32%), while northern regions achieved significant NO_x reductions through industrial restructuring, with Hebei’s emissions falling 46% from peak levels. Conversely, NO_x emissions peaked earlier (2011), but transportation’s share grew to 42% by 2021 (TRON: 31%). Regional disparities persist-coastal areas leveraged advanced controls, whereas western provinces struggled with expanding pollution bases. These findings underscore the imperative for spatially-explicit strategies addressing sector-region heterogeneities to mitigate ozone’s health/ecological impacts.

PMID:41320696 | DOI:10.1007/s00128-025-04152-4

Am J Biol Anthropol. 2025 Dec;188(4):e70153. doi: 10.1002/ajpa.70153.

ABSTRACT

OBJECTIVES: Energetic deficits through lack of access to resources and/or increased exposure to stressors are associated with the disadvantaged biocultural environments often afforded to individuals with lower socioeconomic status (SES). We use anthropometric and demographic data collected from 224 adult (aged 20-50 years) individuals whose computed tomography (CT) scans are housed in the New Mexico Decedent Image Database to explore how various limb proportions differ between childhood SES levels.

MATERIALS AND METHODS: Relationships between childhood SES and body proportions, calculated from standard anthropometrics measured on CT scans, were tested using ANOVA and ANCOVA.

RESULTS: Higher-SES individuals have larger dimensions for a given trunk length than lower-SES individuals across all measurements. The largest differences in individual segments are found in the lower limb segments (tibia and thigh); though total upper limb shows greater between-group differences than total lower limb. Foot length (autopod) differences do not reach statistical significance.

CONCLUSIONS: While individuals who face resource deficits in early childhood may undergo catch-up growth later in development, our study indicates the material disadvantage offered by lower- and middle-SES in New Mexico prevents catch-up growth from equalizing linear growth outcomes even in less plastic dimensions. Our study demonstrates the importance of limb segments as biomarkers of childhood biocultural environments. We highlight that SES is a socially defined category of resource allocation with clear biological impacts, which may be socially mitigated by policies supporting a more equitable division of resources.

PMID:41320675 | DOI:10.1002/ajpa.70153

Am J Hum Biol. 2025 Dec;37(12):e70173. doi: 10.1002/ajhb.70173.

ABSTRACT

BACKGROUND: Low birth weight is a critical predictor of child mortality and morbidity, contributing to both immediate health complications after birth and long-term health issues later in life. Globally, it remains a major public health challenge, particularly in low- and middle-income countries, where poor maternal nutrition, limited access to quality healthcare, and poverty exacerbate the risk. Regions such as Sub-Saharan Africa and South Asia carry the highest burden, accounting for the majority of low birth weight cases worldwide. Within this context, Pakistan stands out as one of the countries with the highest rates of child mortality and malnutrition, making the issue of low birth weight especially pressing.

METHODOLOGY: Utilizing the Demographic and Health Survey of 2017-18, multiple analytical techniques were used including logistic regression, standard, Wagestaff, Erreygers concentration index analysis and concentration curves.

RESULTS: The study indicates that low birth weight (LBW) is disproportionately concentrated among socio-economically disadvantaged groups. Negative and significant concentration indices for household wealth, maternal education, and paternal education show that children from poorer and less educated families are at higher risk of LBW. Further analysis reveals that the relationship between household wealth, parental education and LBW is nonlinear in the context of rural-urban division. Rural children from middle and higher-income families show a slightly elevated risk as compared with urban. Similarly, mother’s education seems less effective against LBW. However, father’s education might help as LBW is slightly reduced among higher educated fathers. This counterintuitive pattern may be influenced by factors such as multiple births, cesarean deliveries, antenatal care utilization, or other socio-cultural dynamics. For example rural women might have less decision-making autonomy regarding health and meeting other necessities of life.

CONCLUSION: The study finds that low birth weight (LBW) is disproportionately concentrated among socio-economically disadvantaged groups, with household wealth and parental education serving as strong protective factors. However children from middle and higher-income households, in rural areas, may also experience a slightly elevated risk of LBW as compared to urban populations Father’s education might play a more protective role against low birth weight among rural areas.

PMID:41320666 | DOI:10.1002/ajhb.70173

Zhonghua Yi Xue Za Zhi. 2025 Dec 2;105(44):4076-4080. doi: 10.3760/cma.j.cn112137-20250621-01515.

ABSTRACT

Objective: To explore the clinical effect of different coronary artery flow isolation methods in off-pump coronary artery bypass grafting (OPCABG). Methods: A total of 60 patients who accepted OPCABG in the Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University from June 2021 to June 2024 were randomly divided into three groups by computer. The different coronary flow isolation methods were used in three groups. The coronary artery was occluded with tourniquets in the occlusion group (n=20). The coronary artery was shunted with shunt in the shunt group (n=20). The coronary artery was selectively shunted or occluded according to the different blood flow conditions of each target vessel in the combined group (n=20). The anastomosis time and the amount of bleeding were observed and compared. The serum levels of cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-ProBNP) were detected after eight hours of operation. Results: Among the 60 patients with coronary artery disease, 48 patients were male and 12 patients were female. The anastomotic time of each anastomosis in the shunt group was longer than that in the occlusion group and the combined group [(18.4±2.8) min vs (12.3±2.2) min, (14.3±2.9) min, both P<0.017]. There was no statistically significant difference in anastomotic time between the occlusion group and the combined group (P=0.176). Postoperative serum cTnT in the occlusion group was higher than that in the shunt group and the combined group [(0.28±0.07) μg/L vs (0.16±0.03) μg/L, (0.17±0.04) μg/L, both P<0.017]. There was no statistically significant difference in postoperative serum cTnT between the shunt group and the combined group (P=0.152). Postoperative serum NT-ProBNP in the combined group was lower than that in the occlusion group and the shunt group [(254±27) ng/L vs (481±19) ng/L, (373±42) ng/L, both P<0.017]. Postoperative serum NT-ProBNP in the shunt group was lower than that in the occlusion group [(373±42) ng/L vs (481±19) ng/L, P=0.001]. There were no significantly differences in the amount of bleeding among the three groups (P=0.191). Conclusion: The selected method of occlusion or shunting depending on the flow condition of target coronary artery in OPCABG can decrease anastomosis time and myocardial injury.

PMID:41320662 | DOI:10.3760/cma.j.cn112137-20250621-01515

Zhonghua Yi Xue Za Zhi. 2025 Dec 2;105(44):4065-4075. doi: 10.3760/cma.j.cn112137-20250901-02267.

ABSTRACT

Objective: This study aimed to comprehensively investigate the regulatory mechanism and clinical value of secreted phosphoprotein 1 (SPP1) in the three-stage progression of “smoking-chronic obstructive pulmonary disease (COPD)-carcinogenesis” in lung squamous cell carcinoma (LUSC) through integrated bioinformatics analysis and machine learning. Methods: The datasets for the three stages of LUSC were downloaded from the Gene Expression Omnibus (GEO) database, including GSE18385 (containing lung tissue samples from 31 healthy smokers and 21 healthy non-smokers), GSE38974 (containing lung tissue samples from 23 smoking COPD patients and 9 healthy smokers), and GSE12472 (containing lung tissue samples from 18 LUSC patients with COPD and 17 smoking COPD patients). The Cancer Genome Atlas (TCGA)-LUSC dataset (comprising 504 samples, including lung tissue samples from LUSC patients and their matched normal lung tissue samples) was downloaded from TCGA database for further analysis. Samples and follow-up information from 208 non-small cell lung cancer patients who underwent radical resection and mediastinal lymph node dissection at Zhongshan Hospital, Fudan University in 2005 were selected for prognostic analysis and validation. Weighted Gene Co-expression Network Analysis (WGCNA) was applied to screen stage-specific module genes. Differentially expressed genes (DEGs) were identified through differential expression analysis. The CIBERSORT algorithm and Gene Set Enrichment Analysis (GSEA) were used to characterize the immune microenvironment. Eight machine learning algorithms and protein-protein interaction (PPI) network analysis were combined to screen for core regulatory targets. Results: Results from WGCNA and differential analysis of the GEO datasets indicated that SPP1 is consistently highly expressed across the three stages of LUSC. Analysis of the TCGA-LUSC dataset further verified that the relative expression level of SPP1 in lung tissues of LUSC patients was significantly higher than in normal lung tissues (9.13±2.01 vs 4.68±1.64, P<0.001). Furthermore, SPP1 expression was significantly higher in patients with TNM stage Ⅲ than in those with stage Ⅱ (9.59±2.09 vs 8.80±2.15, P=0.045). Male LUSC patients with high smoking exposure exhibited higher SPP1 expression levels than those with low smoking exposure (9.56±2.23 vs 8.60±2.04, P=0.032). Survival prognosis analysis revealed that among male patients, the difference in median overall survival (OS) between the high SPP1 expression group and the low expression group was statistically significant [2.90 (95%CI: 2.11-4.64) years vs 4.69 (95%CI: 2.95-7.34) years, P=0.032). Data validation from Zhongshan Hospital, Fudan University, also showed that the 5-year survival rate of lung cancer patients with high SPP1 expression was lower than that of patients with low SPP1 expression (49.3% vs 62.6%, P=0.042). Results from the CIBERSORT algorithm indicated that high SPP1 expression drives increased infiltration of M2 macrophages (P<0.001). Machine learning combined with PPI network analysis identified NTN1 and CX3CL1 as key regulatory targets of SPP1, which may be associated with the occurrence and development of lung cancer. Conclusion: SPP1 may promote LUSC progression by mediating M2 macrophage polarization through suppressing NTN1 or activating CX3CL1, suggesting its potential as a prognostic biomarker and therapeutic target for high-risk male smokers.

PMID:41320661 | DOI:10.3760/cma.j.cn112137-20250901-02267

Zhonghua Yi Xue Za Zhi. 2025 Dec 2;105(44):4056-4064. doi: 10.3760/cma.j.cn112137-20250619-01495.

ABSTRACT

Objective: To construct and validate a prognostic model for patients with advanced lung squamous cell carcinoma (LUSC) receiving chemotherapy combined with immunotherapy based on quantitative CT features. Methods: A total of 96 patients with advanced LUSC who received chemotherapy combined with immunotherapy at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2020 to October 2023 were retrospectively included. They were randomly divided into a training set (n=72) and an internal validation set (n=24) at a ratio of 3∶1 (random sequence was generated by R Studio 4.4.2 software). Additionally, patients with advanced LUSC who visited Yichang Central People’s Hospital from October 2020 to June 2024 were enrolled as the external validation set (n=58) according to the same criteria. Pretreatment chest CT images were obtained from patients, and quantitative CT features were extracted. Based on the training set data, LASSO regression and univariate and multivariate Cox regression models were used to screen the independent variables, and the model was constructed with the progression-free survival (PFS, progress=1, no progression=0) as the dependent variable. Taking the progression at 180 d as the outcome variable and the quantitative CT score as the evaluation index, the receiver operating characteristic (ROC) curve was drawn. The calibration curve and decision curve were used to evaluate the model efficacy. Based on the optimal cut-off value determined by the ROC curve, patients were divided into high-risk and low-risk groups, and the log-rank test was used to compare the survival differences between the two groups. Results: A total of 154 patients with LUSC were included, including 147 males and 7 females, with an age of (64.7±8.1) years; there were no statistically significant differences in demographic characteristics and TNM stage among the training set, internal validation set, and external validation set (all P>0.05). Four quantitative CT features were associated with PFS, including the percentage of low attenuation area with CT value < -910 HU in the whole lung (LAA%-910_lung) (HR=0.013, 95%CI: 0.002-0.313), the area percentage of low attenuation area with CT value < -950 HU in the right lower lung (LAA%-950_right_lower) (HR=0.011, 95%CI: 0.001-0.012), the minimum wall thickness of grade 2 airwall (minThicknessOfAirwall_2) (HR=0.117, 95%CI: 0.029-0.463) and the mean diameter of grade 1 airway (meanDiameterOfAirway_1) (HR=0.767, 95%CI: 0.687-0.857), which were used to construct the quantitative CT (QCT) score: QCTscore=-4.346×(LAA%-910_lung)-4.513×(LAA%-950_right_lower)-2.14×(minThicknessOfAirwall_2)-0.265×(meanDiameterOfAirway_1). The optimal cutoff value for the score was -9.45. The areas under the ROC curve (AUC) for predicting 180 d survival was 0.843 (95%CI: 0.773-0.952) in the training set, 0.778 (95%CI: 0.527-0.999) in the internal test set, and 0.762 (95%CI: 0.615-0.921) in the external test set. The Hosmer-Lemeshow goodness-fit test results showed that the model had a good fitting effect (training set: χ²=8.058, P=0.428; internal validation set: χ²=12.883, P=0.116; internal validation set: χ²=3.141, P=0.925). The decision curve shows that when the risk threshold of the training set is 0 to 79%, that of the internal validation set is 0 to 81%, and that of the independent validation set is 0 to 82%, the prediction model has a clinical net benefit. In the three data sets, the 180 d PFS rate of the high-risk group (QCT score ≥ -9.45) was lower than that of the low-risk group (QCT score < -9.45) (training set: 5.1% vs 66.7%; internal validation set: 180 d progression-free survival rate 12.5% vs 75%; external validation set: 180 d progression-free survival rate 68.6% vs 100.0%, all P<0.05). Conclusion: Based on the QCT image features, a prognostic prediction model for chemotherapy combined with immunotherapy in LUSC was constructed, providing an effective means for predicting the response of chemotherapy combined with immunotherapy in LUSC patients.

PMID:41320660 | DOI:10.3760/cma.j.cn112137-20250619-01495

Zhonghua Yi Xue Za Zhi. 2025 Dec 2;105(44):4048-4055. doi: 10.3760/cma.j.cn112137-20250924-02479.

ABSTRACT

Objective: To analyze the mutational landscape of primary and acquired mesenchymal to epithelial transition factor (MET) mutations in non-small cell lung cancer (NSCLC) and investigate the impact of co-mutations on the therapeutic efficacy. Methods: A total of 316 pathologically confirmed NSCLC patients with MET gene mutations treated at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, and Shanghai Chest Hospital, Shanghai Jiao Tong University, between January 2012 and May 2023 were retrospectively enrolled. Demographics, clinicopathological characteristics, and treatment outcomes were collected. Patients were classified into primary MET mutation and acquired MET mutation groups according to the timing of mutation occurrence, and intergroup differences were compared. Treatment responses were evaluated according to the Response Evaluation Criteria in Solid Tumors criteria. Follow-up data on efficacy and progression-free survival (PFS) were collected through telephone calls and medical record review. The follow-up continued until January 2024. Kaplan-Meier survival curves were generated, and log-rank tests were used to compare PFS between patients with different co-mutations receiving tyrosine kinase inhibitor (TKI) or immune checkpoint inhibitor (ICI) therapy. Results: Compared to the acquired mutation group, patients with primary MET mutations were significantly older[median (Q₁, Q₃) age: 65 (58, 71) vs 59 (51, 64) years; P<0.001], had a higher proportion of males [62.4% (141/226) vs 48.9% (44/90), P=0.028] and a higher proportion of never-smokers [48.7% (110/226) vs 30% (27/90), P=0.002]. In the primary mutation group, TP53 was the most common co-mutation gene (43%, 51/118), followed by EGFR (32%, 38/118) and KRAS (9%, 11/118). In the acquired mutation group, 89% (69/73) of patients retained the EGFR mutation. Aside from EGFR, the most common co-mutation genes were TP53 (63%, 46/73) and CDK4 (12%, 9/73). Among the 62 patients treated with MET-TKI, those with concurrent EGFR-sensitive mutations had a median PFS of 3.1 (95%CI: 2.4-7.2) months, significantly shorter than that of EGFR wild-type patients [18.2 (95%CI: 9.2-22.1) months, P<0.001]. Patients with TP53 co-mutations had a median PFS of 7.5 (95%CI: 6.4-not reached) months, which was significantly longer than TP53 wild-type patients [3.4 (95%CI: 1.8-4.3) months, P=0.035]. Among the 57 patients treated with ICI, those with EGFR-sensitive mutations had a median PFS of 5.3 (95%CI: 2.0-8.2) months, which was significantly shorter than EGFR wild-type patients [10.4 (95%CI: 5.2-not reached) months, P=0.027]. Patients with TP53 co-mutations had a median PFS of 5.9 (95%CI: 3.8-20.4) months, which was longer than TP53 wild-type patients [3.0 (95%CI: 2.0-4.5) months], although the difference was not statistically significant (P=0.344). Conclusions: Primary and acquired MET mutations in NSCLC exhibit distinct genomic characteristics. Patients harboring concurrent EGFR mutations in NSCLC may derive less benefit from MET-TKI and ICI, whereas those harboring TP53 co-mutations tend to experience more favorable outcomes compared with TP53 wild-type NSCLC patients when treated with MET-TKI.

PMID:41320659 | DOI:10.3760/cma.j.cn112137-20250924-02479