Category: Statistics

Cureus. 2025 Nov 9;17(11):e96461. doi: 10.7759/cureus.96461. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: The cervical spine comprises vertebrae and intervertebral discs that facilitate neck mobility and protect neurovascular structures. Intervertebral foramina serve as conduits for spinal nerves and vessels and may undergo morphological changes with aging and degeneration, potentially leading to neurological symptoms. The objectives of this study included performing a CT analysis of the morphometry of intervertebral foramina and the height of the intervertebral disc across different levels of the cervical spine, with comparisons based on age, vertebral level, gender, and laterality.

METHODS: This observational study analyzed CT scans of the cervical spine from 104 patients. Vertical height, anteroposterior depth, and cross-sectional area of intervertebral foramina were measured bilaterally at levels C2C3 to C6C7. Intervertebral disc height was also assessed. Participants were categorized into four age groups and by sex. Statistical analyses included one-way ANOVA, paired samples t-test, Pearson correlation coefficient, and one-sample t-test.

RESULTS: Foraminal dimensions, especially vertical height and cross-sectional area, showed a statistically significant decline with increasing age, most prominently at lower cervical levels (C5C6 and C6C7). Intervertebral disc height also decreased significantly with age, particularly at C5C6. Males demonstrated consistently larger foraminal dimensions and disc heights compared to females. Except for C4C5, foraminal dimensions were largely symmetrical between right and left sides. Age-related degenerative changes in the cervical spine predominantly affect the lower cervical levels, leading to a reduction in foraminal size and disc height.

CONCLUSION: The observed morphometric variations, alongside gender differences, underscore the importance of individualized anatomical assessment in the diagnosis and management of cervical spine pathologies.

PMID:41384205 | PMC:PMC12690273 | DOI:10.7759/cureus.96461

J Health Popul Nutr. 2025 Dec 11. doi: 10.1186/s41043-025-01176-8. Online ahead of print.

ABSTRACT

BACKGROUND: Age-, sex-, and country-specific reference values for lipoprotein levels are essential for identifying lipoprotein disorders, such as familial hypercholesterolemia (FH). However, the Thai-specific data are limited. This study aimed to establish age-and sex-specific reference percentiles for lipid and lipoprotein levels in Thai adults.

METHODS: This study analyzed plasma lipid and lipoprotein levels from the 6th National Health Examination Survey (NHES-VI) conducted in Thailand. Data from Thai adults without cardiovascular disease or lipid-lowering medication were examined to determine age- and sex-specific percentiles. Participants were grouped into 5-year age intervals for both sexes to assess trends across the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of lipid measurements. The weighting was applied to account for the complex survey design and ensure representativeness of the national population. The Kruskal-Wallis test was used to examine statistically significant differences in lipid levels between age groups within sex. A P-value < 0.05 was considered significant.

RESULTS: 17,018 participants (7,244 men and 9,774 women) aged ≥ 20 years were included. Both total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels increased with age in both sexes. The highest median LDL-C levels were found in men aged 45-49 (129 mg/dL) and women aged 55-59 (137 mg/dL). The median and 95th percentile values of LDL-C across different age groups were 126 and 194 mg/dL in men, and 131 and 198 mg/dL in women, respectively. High-density lipoprotein cholesterol (HDL-C) levels were higher in women than in men across all age categories, whereas triglyceride levels were higher in men than in women in all age categories below 70 years old. These findings highlight important age-and sex-related differences that may inform clinical cut-offs for lipoprotein disorders in Thailand.

CONCLUSIONS: This study establishes the first comprehensive, population-based reference values for lipids in the Thai adult population. Our data reveal notably high LDL-C levels compared with other populations, suggesting that the current universal diagnostic thresholds for lipid disorders may need re-evaluation in the Thai context. These findings provide a crucial evidence base for updating national clinical guidelines and public health strategies.

PMID:41382310 | DOI:10.1186/s41043-025-01176-8

BMC Psychol. 2025 Dec 11. doi: 10.1186/s40359-025-03697-7. Online ahead of print.

ABSTRACT

AIM: Given the demanding nature of teacher education, understanding how resilience relates to academic success and social adaptation is crucial. The aim of this study was to examine the relationship between resilience and academic achievement and to determine whether this relationship varies based on the personality/mental health profile of future teachers.

METHOD: A total of 793 university students enrolled in teacher training programs participated in this study. Data were collected via validated questionnaires measuring resilience (CD-RISC-25) with 5-factor solution including (1) Positive acceptance of change and secure relationships, (2) Trust in one’s instincts, tolerance of negative affect, and strengthening effects of stress, (3) Personal competence, high standards, and tenacity, (4) Control, and (5) Spiritual influences (entered as explanatory or predictor variables in regression models); academic achievement (AAQ) with (1) Study performance, (2) Coping with study demands and (3) Social adaptation domains (treated as dependent variables); personality traits (TIPI) covering Big Five traits (as input for cluster analysis); and mental health indicators (PHQ-4) including depression and anxiety (as input for cluster analysis). Analyses were associative and exploratory; terms such as ‘predictor’ denote statistical prediction, not causation. First, correlation and regression analyses were conducted to determine the overall association between resilience and academic achievement. Next, these associations were tested in groups with different personality/mental health profiles (based on cluster analysis).

RESULTS: The findings of the whole sample analysis revealed that resilience was significantly associated with coping with study demands and social adaptation, accounting for ~ 21% and 30% of the variance in those outcomes, respectively. In particular, Personal Competence, High Standards, and Tenacity (PCHST) and Positive Acceptance of Change and Secure Relationships (PACSR) were found to show the strongest association. In contrast, resilience did not manifest direct association with academic performance. Subsequent subgroup analysis showed that relationship between resilience and academic achievement remained consistent across different personality or mental health profiles, suggesting relevance across personality/mental-health profiles.

CONCLUSION: The cross-sectional findings indicate that resilience is significantly related to the academic achievement of future teachers, and this relationship is independent of their personality structure and mental health issues. These findings underscore the potential importance of resilience in enhancing coping mechanisms and social integration among future teachers. Teacher training programs may consider incorporating resilience-building strategies to support students in managing academic stress and fostering professional preparedness.

PMID:41382303 | DOI:10.1186/s40359-025-03697-7

BMC Ophthalmol. 2025 Dec 11. doi: 10.1186/s12886-025-04458-1. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the changes in macular vascular density (VD), ganglion cell complex GCC thickness, and Fovea Avascular Zone (FAZ) Area at one and six months after Sub-Scleral Trabeculectomy SST with mitomycin C (MMC) in patients with Primary Open Angle Glaucoma POAG and correlate those changes with reduction of IOP using optical coherence tomography angiography (OCTA).

METHODS: Thirty eyes of 30 patients with POAG who underwent SST with MMC were prospectively evaluated. OCTA (AngioVue, Optovue) was used before surgery and at one and six months after surgery to quantify the vascular density of superficial capillary plexus (SCP-VD), deep capillary plexus (DCP-VD), whole image (WI-VD), fovea (F-VD), Parafovea (PAF-VD), Perifovea (PER-VD), in addition to the GCC thickness, FAZ area (FAZ-A), FAZ perimeter (FAZ-P), and foveal density (FD).

RESULTS: All patients showed a significant reduction in mean IOP at each follow-up from (31.31 ± 4.52) preoperatively to 14.19 ± 2.10 and 13.75 ± 1.27 mmHg at one month and six months postoperative, respectively (p < 0.001). There was a significant improvement in macular deep capillary plexus DCP-VD in all parameter’s values (p < 0.001). The mean whole-image DCP-VD increased from 48.19 ± 2.20% preoperatively to 49.50 ± 2.30% at one month and 53.38 ± 1.78% at six months postoperatively. Similar significant increases were observed in the foveal, parafoveal and perifoveal regions. The FAZ area decreased significantly from 0.398 ± 0.062 mm² preoperatively to 0.357 ± 0.060 mm² at one month and 0.372 ± 0.058 mm² at six months (p = 0.010). The FAZ perimeter also showed a significant reduction from 2.238 ± 0.385 mm preoperatively to 1.889 ± 0.350 mm at one month and 2.075 ± 0.293 mm at six months (p = 0.001). Foveal density increased significantly from 46.88 ± 1.81% preoperatively to 48.52 ± 2.00% at one month and 49.71 ± 2.56% at six months (p < 0.001). Postoperative increases in macular SCP-VD and GCC thickness were minimal and not statistically significant (p > 0.05). A significant negative correlation was found between IOP reduction and DCP-VD at six months (p < 0.05), whereas IOP reduction correlated positively with decreases in FAZ area and perimeter at one month (p = 0.011, p = 0.027) and six months (p = 0.010, p = 0.029).

CONCLUSION: OCTA revealed significant postoperative improvement in deep macular vessel density and FAZ metrics following SST with MMC. These findings highlight the vascular benefits of surgical IOP reduction in restoring macular microcirculation among patients with POAG.

PMID:41382301 | DOI:10.1186/s12886-025-04458-1

BMC Complement Med Ther. 2025 Dec 11. doi: 10.1186/s12906-025-05192-3. Online ahead of print.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) remains a global health burden characterized by insulin resistance, persistent hyperglycaemia, and chronic inflammation. Although single-target therapies effectively reduce glucose levels, they seldom address oxidative stress or adipocyte dysfunction. Polyherbal formulations (PHFs) harness synergistic phytochemicals for multimodal intervention; however, many lack mechanistic transparency owing to excessive inclusion of diverse botanical bioactives, suffer from non-standardized composition, and underexplore volatile antidiabetic constituents. Confronting these challenges, we developed Gluco Balance V (GB5), a cold-percolated ethanolic extract comprising equal proportions of bio-effective parts of Asparagus racemosus, Cyperus rotundus, Tinospora cordifolia, Terminalia arjuna, and Mimosa pudica. These botanicals were selected for complementary antidiabetic, antioxidant, and adiporegulatory activities documented in preclinical and clinical settings, indicating balanced, synergistic, and safe bioactivity.

METHODS: GB5’s phytochemical composition was standardized using gas chromatography-mass spectrometry (GC-MS) fingerprinting. In vitro assays assessed 2,2-diphenyl-1-picrylhydrazyl (DPPH) and nitric oxide (NO) scavenging capacity, inhibition of carbohydrate-digesting enzymes (α-amylase, α-glucosidase), enzyme kinetics, and effects on glucose uptake (GU) and lipid accumulation (LA) in yeast and 3T3-L1 adipocytes. Computational network pharmacology, molecular docking, and pharmacokinetic analyses elucidated molecular targets and bioavailability. Statistical analyses employed robust dose-response modelling, analysis of variance with Dunnett’s T3 test, and t-tests with false discovery rate correction.

RESULTS: GC-MS identified 21 bioactive compounds, including phytol, fatty acids, and sterols, driving GB5’s therapeutic synergy. GB5 showed robust antioxidant activity (DPPH and NO; half-maximal inhibitory concentration (IC₅₀) 88.6 and 74.8 µg/mL) and mixed-type inhibition of α-amylase and α-glucosidase (IC₅₀ 71.6 and 174 µg/mL). At sub-inhibitory doses, it outperformed ascorbic acid (ASA) and acarbose. In 3T3-L1 adipocytes, GB5 increased GU by 32.3% at 2.0 mg/mL, comparable to rosiglitazone, and reduced lipid accumulation by 18.6% (90% effective concentration (EC₉₀) 0.742 mg/mL). Network pharmacology and molecular docking implicated peroxisome proliferator-activated receptor gamma (PPARγ), protein tyrosine phosphatase 1B (PTP1B), cyclooxygenase-2 (COX-2), and advanced glycation end-products-receptor for advanced glycation end-products (AGE-RAGE) pathways with 9,12-octadecadienoic acid and cholestan-3-ol, 2-methylene-, (3β,5α)- as key associates.

CONCLUSIONS: GB5’s multi-targeted efficacy against hyperglycaemia, oxidative stress, and adipocyte dysfunction positions it as a promising complementary therapy for T2DM, meriting further in vivo evaluation.

PMID:41382285 | DOI:10.1186/s12906-025-05192-3

BMC Genomics. 2025 Dec 12. doi: 10.1186/s12864-025-12239-9. Online ahead of print.

NO ABSTRACT

PMID:41382283 | DOI:10.1186/s12864-025-12239-9

BMC Neurol. 2025 Dec 11;25(1):499. doi: 10.1186/s12883-025-04523-8.

ABSTRACT

BACKGROUND: Stroke-associated pneumonia (SAP) significantly impacts mortality and functional outcomes in acute stroke care. While multiple risk prediction scores have been developed internationally, their performance in Japanese healthcare settings-characterized by high nurse-to-patient ratios and systematic multidisciplinary protocols-remains unexplored. This study aimed to determine SAP incidence in Japanese acute stroke care and validate established risk prediction scores.

METHODS: We conducted a retrospective cohort study of consecutive patients with first-ever acute stroke admitted within 7 days of onset to a 199-bed acute care hospital with a dedicated 24-bed stroke care unit (April 2022-March 2023). SAP was diagnosed using modified CDC criteria requiring radiographic evidence. Three validated risk scores (A²DS², Pneumonia score, ISAN) were calculated and compared using receiver operating characteristic analysis. Independent predictors were identified through multivariable logistic regression using directed acyclic graph-based variable selection.

RESULTS: Among 847 patients analyzed (median age 75 years, 54.2% male), SAP developed in 22 patients (2.6%, 95% CI 1.5-3.7). Most cases (77.3%) occurred within 72 h. All three scores demonstrated good discrimination: A²DS² achieved the highest AUROC of 0.825 (95% CI 0.78-0.88), followed by Pneumonia score and ISAN (both AUROC 0.798). No statistically significant differences were observed between scores. An A²DS² cutoff ≥ 6 provided optimal balance (sensitivity 86.4%, specificity 65.8%, NPV 99.5%). Independent predictors included male sex (OR 3.87, 95% CI 1.41-10.61), NIHSS score (OR 1.08 per point, 95% CI 1.03-1.12), dysphagia (OR 5.31, 95% CI 1.16-24.34), and mechanical ventilation (OR 5.33, 95% CI 1.28-22.18).

CONCLUSIONS: SAP incidence in Japanese acute stroke care (2.6%) was substantially lower than international reports, likely reflecting high nursing standards and systematic preventive protocols. Despite low baseline risk, the A²DS² score demonstrated excellent discrimination and high negative predictive value, enabling reliable risk stratification. The predominance of early SAP onset supports intensive monitoring during the critical first 72 h. These findings support implementation of A²DS²-based risk stratification protocols in Japanese stroke care settings.

PMID:41382279 | DOI:10.1186/s12883-025-04523-8

Mol Med. 2025 Dec 11. doi: 10.1186/s10020-025-01409-w. Online ahead of print.

ABSTRACT

BACKGROUND: Immunotherapy is a promising treatment for drug-resistant cancers. However, its effectiveness against head and neck squamous cell carcinoma (HNSCC) is limited. This indicates the need to explore additional factors that can predict tumor response to new therapies and improve or supplement their effects. Therefore, we aimed to investigate whether the post-radiation usage of anti-TIGIT and/or anti-CD96 could enhance the antitumor response in HNSCC.

METHODS: HNSCC tissues, as well as human and mouse cell lines, were examined to evaluate the effects of radiation on immune checkpoint receptors (TIGIT, CD96, and CD226) and tumor ligands (CD155, CD112, CD113, and CD111). Overall and disease-free survival, along with factors related to these immune checkpoint receptors and ligands, were detected. Moreover, we investigated the effects of radiation dose and exposure time on the expression of these receptors and ligands in vitro and in vivo. Tumor growth and survival rates were then evaluated using TIGIT and/or CD96 inhibitors injected intraperitoneally after exposure to radiation. Finally, various proliferative and immunological parameters of the tumor microenvironment were determined using immunohistochemistry and flow cytometry. Statistical analyses were performed using Student’s t-test, one-way analysis of variance, or two-way analysis of variance.

RESULTS: Elevated levels of TIGIT, CD96, CD155, CD112, CD113, and CD111 were observed in both HNSCC tissues and the cell lines. Radiation increased the expression of these inhibitory receptors and ligands. Thus, anti-TIGIT and anti-CD96 were used to target the upregulated expression of the receptors TIGIT and CD96, respectively. This treatment combination inhibited tumor growth by boosting apoptosis, reducing tumor cell proliferation, and restoring the cytotoxic functions of CD4⁺ and CD8⁺ T cells after radiation therapy.

CONCLUSION: Our findings suggest that TIGIT and CD96 could be markers of the clinical stage and treatment response of HNSCC. Therefore, administering anti-TIGIT and anti-CD96 after radiotherapy may provide a novel approach for incorporating immunoradiotherapy into HNSCC treatment.

PMID:41382272 | DOI:10.1186/s10020-025-01409-w

BMC Infect Dis. 2025 Dec 11. doi: 10.1186/s12879-025-12316-0. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 patients frequently present with various comorbidities. Two developed antiviral medications, nirmatrelvir/ritonavir and molnupiravir, have been utilized in COVID-19 patients; but comparisons of the effectiveness between nirmatrelvir/ritonavir and molnupiravir in COVID-19 patients with different comorbidities remain unknown. This study aims to compare the effectiveness, including invasive ventilation and mortality, of nirmatrelvir/ritonavir and molnupiravir in the overall population and populations with various comorbidities in Taiwanese patients during the omicron BA.2 wave.

METHODS: We retrospectively collected electronic medical records from the Taipei Medical University Clinical Research Database between January and December 2022 and conducted an analysis of adult patients diagnosed with SARS-CoV-2 infection. For data management, we performed propensity score matching to minimize the imbalance between two groups; the standardized mean difference > 0.1 or a p value < 0.05 considered statistically significant. Variables, which remained imbalanced after matching, were adjusted by cox regression model. To identify the risk associated with these variables, a Cox proportional hazards model were performed. Kaplan-Meier method was applied to estimate invasive ventilation and mortality, comparing survival curves between nirmatrelvir/ritonavir users and molnupiravir users.

RESULTS: Our cohort was recruited from a database, including patients who receive nirmatrelvir/ritonavir or molnupiravir treatment. Out of a total of 35,617 patients, 968 patients received nirmatrelvir/ritonavir and 1198 patients received molnupiravir after matching. Patients with chronic liver disease or mental disease on nirmatrelvir/ritonavir had lower risks of intubation than those on molnupiravir. Overall, nirmatrelvir/ritonavir reduced mortality risk by 65% (adjusted hazard ratio (aHR): 0.35, 95% confidence interval (CI): 0.14-0.88, p = 0.026). For patients with diabetes mellitus (aHR: 0.29, 95% CI: 0.11-0.78, p = 0.014), with chronic kidney disease (aHR: 0.26, 95% CI: 0.10-0.68, p = 0.007), or aged over 65 years (aHR: 0.30, 95% CI: 0.13-0.70, p = 0.005), nirmatrelvir/ritonavir demonstrated superior efficacy in reducing mortality risk compared to molnupiravir.

CONCLUSIONS: Data revealed that both nirmatrelvir/ritonavir and molnupiravir demonstrated clinical benefits in treating COVID-19 patients in a real-world setting. Moreover, nirmatrelvir/ritonavir was associated with a lower risk of mortality in COVID-19 patients with specific circumstances.

CLINICAL TRIAL: Clinical trial number is not applicable.

PMID:41382264 | DOI:10.1186/s12879-025-12316-0

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