Category: Statistics

Histopathology. 2025 Sep 18. doi: 10.1111/his.15561. Online ahead of print.

ABSTRACT

AIMS: Vulvar squamous cell carcinoma (VSCC) is classified into human papillomavirus (HPV)-associated and HPV-independent types, primarily using p16 immunohistochemistry, with p53 staining playing a complementary role since a subset of HPV-independent VSCC is driven by TP53 mutations. We aimed to assess the robustness of the six-pattern p53 classification by evaluating interobserver agreement and mapping pattern distribution in relation to p16 status.

METHODS: We performed p53 immunohistochemistry on 1293 VSCC cases, comprising 832 p16-negative and 461 p16-positive cases. Eight pathologists independently evaluated p53, with each case assessed by two pathologists. Expression was classified as wild-type (scattered or mid-epithelial) or mutated (basal overexpression, parabasal/diffuse overexpression, absent or cytoplasmic). Interobserver agreement was measured using kappa statistics.

RESULTS: Overall concordance across the six p53 patterns was 66.7%, increasing to 86.9% when dichotomized as wild-type versus mutated. In the p16-negative cases, concordance was 68.8% across all six patterns and 82.6% when dichotomized. Corresponding rates in the p16-positive cases were 62.9% and 94.6%. Kappa values for pairwise assessments ranged from 0.44 to 0.73 (six-pattern) and from 0.60 to 0.88 (dichotomized). After resolving discordant cases, 79.9% of p16-negative cases showed a mutated pattern, and 20.1% were wild type (scattered). Among the p16-positive cases, 93.1% exhibited a wild-type pattern.

CONCLUSIONS: Findings support the clinical robustness of the six-pattern p53 framework, as interobserver agreement was high and most discrepancies were unlikely to impact tumour classification. While p16 proved helpful in p53 interpretation, certain cases remained challenging due to p53 heterogeneity or ambiguous p16/p53 combinations indicating a need for additional molecular testing in such instances.

PMID:40964778 | DOI:10.1111/his.15561

Histopathology. 2025 Sep 18. doi: 10.1111/his.15554. Online ahead of print.

ABSTRACT

AIMS: Endoscopic mucosal resection (EMR) is widely used for treating Barrett’s-related oesophageal dysplasia and low-stage carcinoma. Disease can recur after this procedure. We analysed a large cohort of EMR specimens to assess clinical and histopathologic factors and their relationship to recurrence.

METHODS AND RESULTS: We conducted a retrospective study of 129 patients who had in total 290 oesophageal EMRs for glandular neoplasia. Patient age, patient sex, specimen fragmentation, intestinal metaplasia, highest-grade lesion, margin status and clearance, cancer invasion depth, lymphovascular invasion, tumour budding (using published guidelines for colorectal carcinoma), post-procedure cryoablation/radiofrequency ablation and disease recurrence were recorded. Statistical analyses were performed on 227 eligible cases to determine the significance of these factors in local disease recurrence. Adenocarcinoma was the highest-grade lesion in 42% of the 290 specimens, high-grade dysplasia in 36% and low-grade dysplasia in 22%. Mean age at first EMR was 66 years. Among the 227 statistically analysed cases, post-procedure ablation was performed for 111 (49%) and recurrence of same or worse disease was documented in 104 (46%). Tumour depth and budding did not affect recurrence risk. On multivariate analysis, lack of post-procedure ablation was associated with increased recurrence risk for high-grade dysplasia and carcinoma. Additionally, poor differentiation and margin status were associated with increased recurrence risk for specimens with carcinoma. These relationships mostly held true for recurrence of same/worse neoplasia or recurrence of any neoplasia.

CONCLUSIONS: Differentiation, margin status and post-EMR ablation influence the risk of local disease recurrence for Barrett’s-related adenocarcinoma, while other factors such as tumour budding and lesional depth do not.

PMID:40964766 | DOI:10.1111/his.15554

Indian J Public Health. 2025 Sep 17. doi: 10.4103/ijph.ijph_240_24. Online ahead of print.

ABSTRACT

INTRODUCTION: The first case of measles outbreak in Pune was reported on November 14, 2022; since then, there were a total of 266 cases from Pune Municipal Corporation (PMC).

OBJECTIVE: The objective is to find out risk factors associated with measles during an outbreak in Pune city.

METHODS: This was a 1:1 unmatched case-control study conducted from February 2023 to September 2023 in PMC. Cases were immunoglobulin M-positive laboratory-confirmed measles cases and a control was any child who did not have any rash in the study period and not living in the same household with a case. Face-to-face interview of cases and controls were carried out by visiting houses to obtain information on sociodemographic characteristics and immunization history, including Vitamin A supplementation. The sample size was 200.

RESULTS: There was a statistically significant difference among the mean age of cases (53.18 ± 18.08) and controls (30.08 ± 18.08). Father’s and mother’s education, immunization, and Vitamin A supplementation were also significant. Those who had not received any dose of measles-rubella (MR) vaccine had a higher chance of having infection with an odds ratio of 3.093 (95% confidence interval [CI]: 2.37-4.037) and those who were partially immunized with 1 dose of MR showed odds ratio of 2.027 (95% CI: 1.328-3.096) for having measles infection. COVID-19 lockdown was the reason given by majority (29.3%) for unimmunized of the measles vaccine.

CONCLUSIONS: In this study, the main cause of this measles outbreak was under immunization. It is important to maintain high levels of under 5 immunization even during emergencies to prevent future measles outbreaks.

PMID:40964759 | DOI:10.4103/ijph.ijph_240_24

Indian J Public Health. 2025 Sep 17. doi: 10.4103/ijph.ijph_508_24. Online ahead of print.

ABSTRACT

BACKGROUND: Noise-induced nonauditory effects and hearing loss are increasingly recognized as significant occupational health risks.

OBJECTIVES: The study investigates the nonauditory and auditory effects of daily noise exposure on traffic policemen in Chandigarh, focusing on their knowledge, perceptions, and attitudes toward noise pollution.

METHODS: A cross-sectional design was employed, comparing 100 traffic policemen exposed to noise pollution with a control group of policemen working in quieter office settings.

RESULTS: The Chi-square test showed a statistically significant association between stress and irritation among traffic policemen compared to their office-based counterparts (P < 0.05). However, no significant differences were found in responses regarding disturbance, headache, loss of sleep, or hypertension (P > 0.05). Self-assessment of auditory effects revealed that 56% of traffic policemen experienced symptoms of tinnitus, compared to 29% of general policemen. Diurnal noise levels at various traffic junctions in Chandigarh showed the highest (Leq) near the airport light point junction (79.9-78.8 dB) and the lowest at the Sukhna Lake entry point (72.0-69.89 dB). Average noise levels across all locations ranged from 76.04 to 75.30 dB, both during peak and nonpeak hours, well above the World Health Organization’s recommended limit of 65 dB for traffic areas. Most traffic policemen were unaware of the harmful effects of noise pollution and did not consider it an occupational hazard.

CONCLUSION: This study highlights the need for stricter enforcement of noise control policies and increased awareness of noise pollution to reduce its impact on public health, particularly regarding noncommunicable diseases.

PMID:40964735 | DOI:10.4103/ijph.ijph_508_24

Hand (N Y). 2025 Sep 18:15589447251369031. doi: 10.1177/15589447251369031. Online ahead of print.

ABSTRACT

BACKGROUND: Carpal tunnel syndrome (CTS) may occur after surgical fixation of a distal radius fracture (DRF) and can result in muscle atrophy and permanent nerve damage if untreated. Despite increased surgical treatments for DRFs, the frequency and risk factors for secondary carpal tunnel release (CTR) after DRF fixation remain unclear. This study aims to identify the frequency of secondary CTR after DRF fixation and factors associated with secondary release.

METHODS: Adult patients who underwent either a secondary CTR within 1 year after surgical fixation of the DRF (secondary release case group) or a concomitant CTR (concomitant release control group) between 2001 and 2023 were identified. Secondary release cases were matched 1:4 to concomitant release controls. Patient, diagnosis, and treatment characteristics were collected and analyzed. Multivariable logistic regression using backward selection was performed to identify risk factors for secondary CTR.

RESULTS: Of 6612 surgically treated DRFs, 77 patients (1.2%) underwent secondary release within the first year, and 948 patients (14.3%) underwent concomitant release. Nerve compression symptoms before initial surgical fixation of the DRF were observed in 26 patients (33.8%). Multivariable logistic regression revealed that hypothyroidism and osteoporosis were statistically significant predictors for secondary CTR after surgical fixation of the DRF. The scores of Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Reported Outcomes Measurement Information System (PROMIS)-Upper Extremity were clinically similar for both groups of patients.

CONCLUSION: Of all patients undergoing CTR within 1 year of DRF fixation, 92.5% underwent concomitant release, and 7.5% underwent secondary release. Patients diagnosed with hypothyroidism or osteoporosis were significantly more likely to undergo a secondary surgery for CTR.

PMID:40964734 | DOI:10.1177/15589447251369031

Hum Vaccin Immunother. 2025 Dec;21(1):2555698. doi: 10.1080/21645515.2025.2555698. Epub 2025 Sep 18.

ABSTRACT

Hepatitis B virus (HBV) remains a public health burden, with non-Hispanic Asian/Pacific Islander and non-Hispanic Black persons disproportionately impacted. Social determinants of health influence vaccination rates and healthcare access. This study used HBV vaccination to identify potential drivers of health disparities associated with multidose HBV vaccines, understand how patients and healthcare providers (HCPs) approach HBV vaccine decision-making and selection, and evaluate the patient and HCP preferences for multidose HBV vaccines. Patients (n = 805) and HCPs (n = 300) were recruited through an online survey. Social vulnerability index was used to identify health disparities linked to demographics and socioeconomic status. Results revealed challenges to vaccination, including lengthy appointment durations (40% spending more than 2 hours), high visit costs (27% paying over $100), and appointment cancellations due to affordability concerns (31%). 38% of patients with higher SVI missed an appointment due to cost. Logistic regression analysis for patients’ likelihood for vaccine dose decisions did not show significance, despite reported preference for a two-dose HBV vaccine. A multinomial logistic regression showed that when HCPs were aware of a two-dose HBV vaccine, they had 78.5% lower odds of recommending a three-dose HBV vaccine (OR = 0.215, 95 CI [0.101, 0.458], p < .001). 97% of HCPs agreed that their responsibilities include discussing vaccination with patients, but only 33% did so. There is an opportunity to improve low HBV vaccination rates through HCP influence. This study exposed barriers that patients face in accessing preventive healthcare. The two-dose HBV vaccine may address healthcare disparities and, by reducing appointment burden, could assist socially vulnerable individuals.

PMID:40964698 | DOI:10.1080/21645515.2025.2555698

Int J Endocrinol. 2025 Sep 9;2025:4478977. doi: 10.1155/ije/4478977. eCollection 2025.

ABSTRACT

Background: Socioeconomic status (SES) influences a wide range of health outcomes, including hepatic steatosis and liver fibrosis, which are increasingly concerning. The aim of the study was to investigate the association between SES and hepatic steatosis and liver fibrosis and examine the potential mediating effects of body mass index (BMI) in this association. Methods: We used the National Health and Nutrition Examination Survey (NHANES) 2021-2023 data to conduct a cross-sectional study. Occupation, insurance, family income level, and education level were employed as indicators of SES. Hepatic steatosis and liver fibrosis were quantified by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. Mediation analysis was used to estimate the direct and indirect associations of SES with hepatic steatosis and liver fibrosis through BMI after adjustment for potential confounders. Results: The study included 4455 participants. Compared to individuals with low SES, those with high SES had a lower risk of hepatic steatosis (odds ratios [OR] = 0.80, 95% CI: 0.69-0.94, p < 0.01) and liver fibrosis (OR = 0.77, 95% CI: 0.61-0.97, p=0.03). However, after adjusting for confounding factors, the associations were no longer statistically significant (hepatic steatosis: OR = 0.90, 95% CI: 0.75-1.08, p=0.25; liver fibrosis: OR = 0.87, 95% CI: 0.67-1.15, p=0.32). BMI differed significantly across SES grades (p=0.04). Restricted cubic spline analysis revealed a significant nonlinear positive association between BMI and hepatic steatosis (p < 0.01), and a linear positive association with liver fibrosis (p=0.11). Moreover, BMI accounted for 32.8% of the mediation effect between SES and hepatic steatosis and 18.2% of the mediation effect between SES and liver fibrosis. Conclusion: People with higher SES are less likely to develop hepatic steatosis and liver fibrosis, although the associations were attenuated after adjustment for confounding factors. SES might contribute to hepatic steatosis and liver fibrosis through the involvement of BMI.

PMID:40964692 | PMC:PMC12440650 | DOI:10.1155/ije/4478977

Front Nutr. 2025 Sep 2;12:1645063. doi: 10.3389/fnut.2025.1645063. eCollection 2025.

ABSTRACT

INTRODUCTION: Bakery products formulated with wheat flour as the major constituent are unfit for consumption for people with gluten sensitivity. Hence, there is a need to utilize other substitutes as a major ingredient in food commodities for individuals suffering from gluten sensitivity or celiac disease, without compromising consumer acceptability.

OBJECTIVE: The objective of the current study was to develop gluten-free cookies by partial substitution of the cookie’s rice flour with date fruit pulp and pit powder.

METHODS: Cookies were formulated by adding 100 g rice flour, 13.5 g eggs, 54 g sugar, 49.5 g shortening, and 2-3 drops of vanilla essence. Moreover, the proportion of date fruit pulp/date paste was 20, 40, 60, 80, and 100%, respectively, in groups T₁, T₂, T₃, T_4, and T₅. Similarly, the proportion of date pit powder varied from 5, 10, 15, 20, and 25%, respectively, in groups T₁, T₂, T₃, T_4, and T₅. Nutritional (proximate) composition, physical attributes, and sensory parameters of the prepared cookies were determined. Data were analyzed statistically using ANOVA and compared using Tukey’s Least Significance Difference (LSD).

RESULTS: The utilization of date paste and pit powder improved the proximate composition of cookies with increasing levels of added paste, whereas physical parameters showed a decrease in values with increasing levels of substitution. Organoleptic characteristics exhibited that biscuit quality was acceptable under various treatments.

CONCLUSION: Rice-based cookies with added date fruit and pit powder could be a practical and acceptable substitute for individuals with gluten sensitivity.

PMID:40964681 | PMC:PMC12436297 | DOI:10.3389/fnut.2025.1645063

J Conserv Dent Endod. 2025 Sep;28(9):899-904. doi: 10.4103/JCDE.JCDE_91_25. Epub 2025 Sep 5.

ABSTRACT

CONTEXT: The removal of intracanal medicament is necessary to promote adequate sealing.

AIMS: This study evaluated three techniques (conventional irrigation, Ultrasonic activation, and XP-endo Finisher) to remove intracanal medication (Ultracal XS and Bio-C Temp) using micro-computed tomography.

MATERIALS AND METHODS: The roots were randomly divided into six groups (n = 10) according to the intracanal medication and the irrigation protocol employed to remove the pastes: Ultracal and Manual (UC/M); Ultracal and XP-endo Finisher (UC/XP); Ultracal and Ultrasonic activation (UC/US); Bio-C Temp and Manual (BIO/M); Bio-C Temp and XP-endo Finisher (BIO/XP) and Bio-C Temp and Ultrasonic activation (BIO/US) The samples were then subjected to microcomputed tomography scan to assess the total volume of filling and remaining medication after removal protocol.

STATISTICAL ANALYSIS USED: The Shapiro-Wilk normality test indicated a normal distribution of the data. Then, to compare the groups, one-way ANOVA and Tukey’s post hoc tests were performed. For all statistical tests used, the significance level established was 5%.

RESULTS: When the samples were evaluated after applying the protocols regarding the root canal thirds, there was a greater remaining volume of Bio C Temp in the cervical third compared to the middle and apical thirds in the Bio C Temp/M and Bio C Temp/XP groups (P < 0.05). Ultrasonic activation removed the volume of Bio C Temp from the cervical third to similar levels of the middle and apical thirds (P > 0.05). In the cervical third, the Bio C Temp/XP, Bio C Temp/M group obtained a greater volume of remaining material than Bio C Temp/US, Ultracal/M, Ultracal/XP, and Ultracal/US (P < 0.05).

CONCLUSION: In the present study, the activation methods of intracanal medications did not differ in the removal capacity between the two types of root canal dressing and none of the removal protocols were able to completely remove dressings from the root canal.

PMID:40964648 | PMC:PMC12440337 | DOI:10.4103/JCDE.JCDE_91_25

J Conserv Dent Endod. 2025 Sep;28(9):892-898. doi: 10.4103/JCDE.JCDE_83_25. Epub 2025 Sep 5.

ABSTRACT

AIM: Despite the advancement in dental care, dental caries remains the most prevalent oral disease, necessitating the need for effective, preventive, and minimally invasive treatment options. The aim of this study was to evaluate the effectiveness of silver diamine fluoride (SDF) in arresting initial approximal carious lesions in adults.

MATERIALS AND METHODS: This study was a randomized, triple-blinded, placebo-controlled clinical trial. Participants were randomly assigned to one of two arms (A or B). One randomly selected lesion received either treatment (SDF solution) or placebo (water). Lesions were followed at 6- and 12-month using bitewing radiographs. Lesion progression was assessed via three evaluation methods: (1) pairwise comparison of bitewing radiographs (visual assessment), (2) assessment of subtraction radiographs (digital subtraction radiography [DSR]), and (3) histogram analysis of subtraction radiographs (HA). All the statistical analyses were performed using R software (the R Foundation, Vienna, Austria) at the 5% significance level.

RESULTS: Over 12-month period, more than 90% of the lesions were arrested in both groups. The SDF group performed significantly better according to the DSR method between baseline and 6 months (P = 0.05). There were no significant differences between the groups at the 12-month follow-up.

CONCLUSION: SDF treatment was superior in arresting initial approximal caries lesions during the first 6 months of use. This is significant for disease control in high-risk individuals who present to the clinic with multiple initial approximal caries lesions. Further studies are needed to confirm its effectiveness.

PMID:40964644 | PMC:PMC12440336 | DOI:10.4103/JCDE.JCDE_83_25