Category: Statistics

BMC Public Health. 2025 Oct 3;25(1):3335. doi: 10.1186/s12889-025-24746-1.

ABSTRACT

OBJECTIVES: Although previous research has established a strong link between sarcopenia and fall risk in middle-aged and older adults, the effects of sarcopenic obesity and possible sarcopenic obesity on fall risk remain underexplored in large-scale studies. This longitudinal analysis aimed to examine these associations using nationally representative cohort data.

METHODS: We analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), including 9,996 participants aged 45 and older with available body composition measurements. Participants were categorized into four groups based on Asian Working Group for Sarcopenia (AWGS) criteria and median waist circumference (WC): (1) normal WC without sarcopenia (control group), (2) normal WC with sarcopenia, (3) obesity without sarcopenia, and (4) obesity with sarcopenia. Cox proportional hazards model was used to estimate adjusted hazard ratios (HRs), 95% confidence intervals (CIs), and P-values, with the control group as the reference. The model was sequentially adjusted for demographic (age, sex, residence), socioeconomic (education), and behavioral (smoking, alcohol) variables.

RESULTS: Compared to participants with normal WC and no sarcopenia (reference group), those with sarcopenic obesity had a significantly higher risk of falls (HR = 1.25; 95% CI: 1.00-1.56; P = 0.048), even after adjusting for demographic, socioeconomic, and behavioral factors. Similarly, possible sarcopenic obesity was linked to a modest but statistically significant increase in fall risk (HR = 1.12; 95% CI: 1.02-1.24; P = 0.021). Subgroup analyses revealed that the fourth quartile showed a trend toward higher fall risk across all subgroups, especially among individuals aged ≥ 60 years and males. However, in most Subgroups, the 95% CIs cross 1, suggesting limited statistical significance in some strata.

CONCLUSIONS: Both sarcopenic obesity and possible sarcopenic obesity are associated with an elevated risk of falls. Middle-aged and older adults should adopt preventive strategies, such as maintaining regular physical activity, to preserve muscle mass and reduce the risk of falls.

PMID:41044525 | DOI:10.1186/s12889-025-24746-1

BMC Pulm Med. 2025 Oct 3;25(1):448. doi: 10.1186/s12890-025-03756-0.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Sarcoidosis (SAR) and lymph-node tuberculosis (LNTB) are granulomatous diseases that present diagnostic challenges, especially in TB-endemic regions. We hypothesized that serum-metabolic profiles would help in differentiating SARs from LNTBs.

OBJECTIVE: This study aimed to identify serum metabolic biomarkers to distinguish SAR from LNTB using NMR-based metabolomics analysis.

METHODS: Serum samples were collected from 26 SAR and 22 LNTB patients. The serum metabolic profiles were measured using 800 MHz NMR spectroscopy and quantified using the commercial software CHENOMX. The serum metabolic profiles were compared using multivariate partial least squares discriminant analysis (PLS-DA), and potential discriminatory metabolites were identified using variable importance in projection (VIP) scores and subsequently evaluated for statistical significance using a volcano plot. The diagnostic potential of the discriminatory metabolites was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS: PLS-DA demonstrated significant metabolic disparity between the SAR and LNTB groups. The key metabolic features identified included elevated levels of glutamate, pyroglutamate, acetate, and leucine and a decreased glutamate-to-glutamine ratio (EQR) and decreased levels of glutamine, pyruvate, and myo-inositol in TB patients. These metabolic changes suggest that TB-infection involves activated glutaminolysis and elevated host lipid metabolism. ROC curve analysis revealed several metabolites with high diagnostic potential (AUC > 0.8), including glutamate, pyroglutamate, and glutamine (AUC > 0.98).

CONCLUSION: In conclusion, this study underscores the potential of serum metabolic profiling as a noninvasive tool for distinguishing SARs from LNTBs. However, further studies are imperative to validate these findings on independent patient cohorts and to facilitate their integration into routine clinical practice.

PMID:41044523 | DOI:10.1186/s12890-025-03756-0

BMC Surg. 2025 Oct 3;25(1):435. doi: 10.1186/s12893-025-03176-1.

ABSTRACT

BACKGROUND: Appendicitis, as a prevalent acute abdominal condition in general surgery, has established a comprehensive diagnostic and therapeutic framework. However, significant academic debate persists regarding the optimal treatment strategy. With advancements in minimally invasive techniques, endoscopic retrograde appendicitis therapy (ERAT) has emerged as an innovative therapeutic approach, providing new options for clinical decision-making. This study employed network meta-analysis to systematically evaluate and compare the clinical efficacy and safety profiles of three treatment modalities: conventional appendectomy, the ERAT, and pharmacological conservative therapy.

METHODS: We systematically reviewed randomized controlled trials (RCTs) published through 2024 that evaluated the three treatment strategies for acute uncomplicated appendicitis. Databases searched included PubMed, Web of Science, Embase, CNKI, Cochrane Central Register of Controlled Trials, and Wanfang. The surface under the cumulative ranking curve (SUCRA) was used to rank the comparative effectiveness of each intervention.

RESULTS: A total of 23 RCTs were included. Regarding complications, the ERAT group (SUCRA, 99.7%) demonstrated significantly lower rates than antibiotics (SUCRA, 37.8%; OR, 0.20; 95% CI, 0.06-0.67), while appendectomy (SUCRA, 12.5%) showed significantly higher rates versus the ERAT (OR, 6.33; 95% CI, 2.35-17.03), with no significant difference between appendectomy and antibiotics. For recurrence, appendectomy (SUCRA, 99.9%) exhibited lower rates than both antibiotics (SUCRA, 2.2%; OR, 0.06; 95% CI, 0.03-0.11) and the ERAT (SUCRA, 53.2%; OR, 0.27; 95% CI, 0.12-0.64), while the ERAT showed significantly lower recurrence than antibiotics (OR, 0.22; 95% CI, 0.08-0.57). Treatment failure analysis revealed appendectomy (SUCRA, 94.6%) had significantly lower rates than antibiotics (SUCRA, 2.2%; OR, 0.05; 95% CI, 0.02-0.15), with no other significant intergroup differences. Hospital stay showed no statistical differences. Cochrane RoB 2.0 assessment indicated overall sound methodological quality. Network meta-analysis demonstrated good consistency (P > 0.05) with low heterogeneity (τ² low-to-moderate; I² < 50%), and adult subgroup analysis yielded similar trends.

CONCLUSION: Each treatment modality demonstrates unique value in specific clinical scenarios. Conventional appendectomy remains the most reliable definitive treatment approach at present. As a minimally invasive alternative, the ERAT shows promising potential in select patient populations, though broader clinical implementation requires further evidentiary support. While antibiotic therapy avoids surgical intervention, it carries significantly higher risks of recurrence and treatment failure. Additional rigorously designed multicenter randomized controlled trials are needed to optimize current therapeutic decision-making frameworks.

TRIAL REGISTRATION: The network meta-analysis and systematic review were registered in PROSPERO on December 2, 2024. (CRD42024616515).

PMID:41044518 | DOI:10.1186/s12893-025-03176-1

BMC Health Serv Res. 2025 Oct 3;25(1):1293. doi: 10.1186/s12913-025-13294-4.

ABSTRACT

BACKGROUND: The achievement of an emergency caesarean response time of ≤ 30 min in Indonesia is still far below the target. This can impact the patient experience. This study aims to explore the factors causing delays in emergency caesarean response time and quality improvement strategies to address this issue.

METHOD: This qualitative study was conducted in five hospitals in the city of Makassar, Indonesia, from November 2024 to January 2025. The phenomenological approach, along with in-depth interviews, was employed in this research. Data were collected through semi-structured interviews. A total of 14 healthcare workers were interviewed using purposive sampling, consisting of obstetricians, general practitioners, midwives, and nurses, and the data were analyzed using thematic analysis. The inclusion criteria for selecting informants are healthcare professionals who possess knowledge and expertise in the field of emergency cesarean sections, as well as having at least two years of work experience handling patients with such cases in hospitals.

RESULTS: This study identifies four main factors that can impact the patient experience in achieving emergency caesarean response time, namely: system factors, patient and family factors, staff factors, and internal hospital policy factors. This study also produces quality improvement strategies to achieve emergency caesarean response times across various health professions, such as the importance of patient and family education, emotional support, the need for comprehensive hospital facilities to ensure the smooth operation of emergency caesarean procedures, the need for periodic performance evaluations of healthcare workers regarding response time achievements and most importantly the availability of documented, socialized, and actively used standard operating procedures by all healthcare workers.

CONCLUSION: This study provides a comprehensive understanding of the factors that cause delays in achieving emergency cesarean response times. This can have both positive and negative impacts on the patient experience. Therefore, policy support and commitment from various health professions are essential for the successful implementation of achieving emergency cesarean response times in Indonesia.

PMID:41044517 | DOI:10.1186/s12913-025-13294-4

BMC Pediatr. 2025 Oct 3;25(1):753. doi: 10.1186/s12887-025-06161-y.

ABSTRACT

BACKGROUND: This study aimed to evaluate the efficacy of different treatment modalities in children with cystic fibrosis (CF) and determine the superiority of specific treatment modalities.

METHODS: A comprehensive literature search was conducted using different search strings across multiple databases, including PubMed, Cochrane Library, EMBASE, WOS, Scopus, CINAHL, PsycINFO, and Google Scholar, up to October 2024. Randomized controlled trials (RCTs), case-control studies and cohort studies were included.

RESULTS: The triple therapy indicated a significant reduction in CF-related complications, with an OR of 0.29 and an RR of 0.54, accompanied by low heterogeneity (I² = 0% for both). Physiotherapy and pulmonary exercises also yielded a beneficial effect, with an OR of 0.24 and an RR of 0.49, without heterogeneity. In contrast, nutritional interventions revealed non-significant outcomes (OR = 6.91 and RR = 2.63), suggesting the need to re-evaluate these strategies. Ivacaftor alone did not achieve statistical significance (OR = 0.34 and RR = 0.58), and the confidence intervals were broad, indicating uncertainty in the effect estimates. Azithromycin exhibited a positive effect on CF management, with an OR of 2.37 and an RR of 1.54. The overall pooled OR across all treatments was 0.71, with an RR not computed due to substantial heterogeneity (I²=93%).

CONCLUSION: The study underscores the effectiveness of certain treatments, such as triple therapy and physiotherapy exercises, for CF while highlighting the considerable variability in treatment outcomes. Notably, nutritional interventions need to be carefully reassessed. The findings emphasize integrating physiotherapy and targeted pharmacological interventions into standard CF management tailored to individual needs.

PMID:41044511 | DOI:10.1186/s12887-025-06161-y

BMC Public Health. 2025 Oct 3;25(1):3325. doi: 10.1186/s12889-025-23867-x.

ABSTRACT

BACKGROUND: Studies have indicated that the risk of death on the first day of life (day 0) was higher than risk of death during other periods (days 1 to 6 and 7 to 27). However, little is known about whether the pattern of mortality trends on day 0 differs from those on days 1 to 6 and 7 to 27. We aimed in this study to examine NMRs trends by age at death in Japan, Korea, and Taiwan.

METHODS: In this cross-sectional study, we calculated NMRs (deaths per 1000 live births) by age at death from 2005 to 2021 in Japan, 2005 to 2022 in Korea, and 2005 to 2023 in Taiwan. Joinpoint regression model was used to estimate the annual percent change (APC) for each segment of the trend in NMRs to examine whether the trend changed significantly.

RESULTS: A slowdown of decreasing trend on days 0 to 27 was observed from 2015 to 2021 with APC of – 4.3% to – 1.5% in Japan and from 2008 to 2018 with APC of – 8.5% to – 1.4% in Korea. In contrast, an initial decline followed by an increase pattern of trend was noted in Taiwan with APC of – 2.5% from 2005 to 2014 to 2.1% from 2014 to 2023. In Japan, the slowdown was mainly due to the levelling-off in the decline in NMRs for days 1 to 6. In Korea, the slowdown was mainly attributed to the levelling-off in the decline in NMRs for days 7 to 27. In Taiwan, the prominent change was primarily due to the changes in day 0 NMRs.

CONCLUSIONS: Further analyses are needed to explore potential factors associated with the particular pattern of trends of NMRs at specific age-at-death group. Neonatal mortality on the first day of life is not an appropriate indicator of neonatal care quality, as it may be influenced by artifacts related to birth certification practices.

PMID:41044502 | DOI:10.1186/s12889-025-23867-x

BMC Pediatr. 2025 Oct 3;25(1):756. doi: 10.1186/s12887-025-06175-6.

ABSTRACT

BACKGROUND: Nocturnal Enuresis (NE) is a prevalent childhood condition with a multifactorial pathogenesis comprising genetic, neurological, and connective tissue factors. Recent evidence points toward a possible link between joint hypermobility and NE, but the underlying mechanisms remain unclear, and existing data are limited. The objective of this study is to determine the prevalence of joint hypermobility in patients with primary nocturnal enuresis (PNE) relative to healthy controls and investigate potential correlations between these conditions.

METHODS: This cross-sectional study was conducted in 2024 at Imam Reza Clinic, the largest pediatric outpatient clinic affiliated with Shiraz University of Medical Sciences in Shiraz, Iran. A total of 180 children aged 6-13 years were recruited, including 90 children with primary nocturnal enuresis (study group) and 90 healthy children without nocturnal enuresis (control group). Participants were assessed for generalized joint hypermobility (GJH) using the Beighton score (≥ 6 indicating hypermobility). Demographic and clinical information was gathered on structured checklists. Statistical tests, such as chi-square tests, t-tests, and logistic regression, were carried out using SPSS (version 25) at a significance level of p < 0.05.

RESULTS: The prevalence of joint hypermobility was significantly higher in children with NE (87.8%) than in controls (28.9%) (p < 0.0001). Conversely, NE was present in 75.2% of hypermobile children compared with 14.7% of non-hypermobile children (p < 0.0001). Logistic regression analysis revealed that children with nocturnal enuresis were 19.87 times more likely to have joint hypermobility compared to non-enuretic children following the adjustment for age, gender, and BMI (p < 0.05). Gender-specific analysis indicated that hypermobile girls with nocturnal enuresis at a greater likelihood of suffering from urinary incontinence and frequent urinary tract infections (UTIs), whereas hypermobile boys with nocturnal enuresis had increased rates of constipation and urinary symptoms during the day.

CONCLUSION: This study shows a strong association between GJH and PNE. Further research is needed to determine causal direction and underlying mechanisms.

PMID:41044501 | DOI:10.1186/s12887-025-06175-6

Eur J Surg Oncol. 2025 Sep 11;51(12):110432. doi: 10.1016/j.ejso.2025.110432. Online ahead of print.

ABSTRACT

INTRODUCTION: Women over 70 years of age with operable oestrogen receptor positive (ER positive) breast cancer have worse survival outcomes than younger women. Primary surgery is the optimal treatment with primary endocrine therapy reserved for patients who are unfit or who have multiple co-morbidities. Inferior outcomes in this patient population might be explained by underuse of surgery, the rates of which vary considerably between geographical regions in the UK. We determined the rates of surgery versus primary endocrine therapy in a cohort of women aged over 70 in England, with potentially curable ER positive breast cancer, according to the presence of pre-existing cardiovascular disease (CVD), comorbidities, social deprivation, and by geographical location.

MATERIALS AND METHODS: 33,235 women aged 70 years or older with stage I to III ER positive breast cancer from the 20 regional NHS Cancers Alliances in England were identified from the cancer registry. Linked hospital records were used to identify patient demographics, tumour and treatment characteristics, resection rates, CVD prevalence and other co-morbidities.

RESULTS: 25,800 (77.6 %) patients underwent surgery, 6787 (20.4 %) patients received primary endocrine therapy alone, 648 (2 %) patients received no treatment. Both CVD and surgery prevalence varied by geographical location. After adjustment for case mix the differences between Cancer Alliances attenuated and no longer reached statistical significance.

CONCLUSIONS: We found regional differences in rates of surgery in patients with breast cancer across different centres. After adjustments, the variation is largely attributable to case mix. Under recording of endocrine therapy data in secondary care limits full interpretation.

PMID:41043195 | DOI:10.1016/j.ejso.2025.110432

J Neurosurg. 2025 Oct 3:1-11. doi: 10.3171/2025.5.JNS25705. Online ahead of print.

ABSTRACT

OBJECTIVE: Resection of common peroneal nerve (CPN) schwannomas is generally believed to be associated with a high risk of postoperative deficit, especially the chance for development of a foot drop. The goal of this study was to investigate the surgical results for resection of schwannomas from the CPN around the knee and specifically the chance of developing a postoperative motor deficit.

METHODS: Data from 36 patients with sporadic schwannomas and 8 patients with schwannomatosis (12 schwannomas total) treated at two centers were retrospectively analyzed. For sporadic cases, different locations around the knee were compared (i.e., proximal to the fibular head [FH], at the FH, and distal to the FH), taking into account the preoperative duration of symptoms, size at presentation, and surgical results of resection. The literature was systematically reviewed for reported cases by searching the PubMed and Embase databases.

RESULTS: A total of 24 schwannomas proximal to the FH were surgically treated: 11 at the FH, and 13 distal to the FH. For the entire cohort, the mean size of CPN schwannomas distal to the FH at presentation was smaller (1.4 × 1.8 cm) compared with those proximal to (2.0 × 2.2 cm) and at (2.2 × 2.3 cm) the FH, although these differences were not statistically significant. The mean preoperative duration of symptoms was slightly longer for schwannomas distal to the FH (35 months) than for those proximal to the FH (21 months) and at the FH (27 months); however, this difference was not significant. Postoperative deficits occurred in 3 sporadic cases: 2 patients with temporary weakness (Medical Research Council grade 4) that completely resolved within several months and 1 patient who had previously undergone surgery elsewhere and presented with deficits and in whom weakness increased after resection. Improvement in preoperative deficits was observed in 1 patient with extensor hallucis longus muscle paralysis that completely recovered. One patient with schwannomatosis developed muscle weakness after resection of a plexiform schwannoma. A systematic review of 21 previously reported cases in the literature showed that larger CPN schwannomas (> 5 cm) were more likely to result in permanent motor deficits.

CONCLUSIONS: This retrospective study of 44 patients shows that peroneal nerve schwannomas around the knee can be safely removed with a low risk of deficits. The systematic review of the literature suggests that larger schwannomas are more likely to result in permanent deficit. In the authors’ opinion, CPN schwannomas can best be resected, preferably when the lesion is relatively small.

PMID:41043186 | DOI:10.3171/2025.5.JNS25705

J Neurosurg Pediatr. 2025 Oct 3:1-5. doi: 10.3171/2025.7.PEDS25256. Online ahead of print.

ABSTRACT

OBJECTIVE: Selective dorsal rhizotomy (SDR) is a proven surgical treatment of spastic diplegia to improve function in patients suffering from spasticity compared to physical therapy alone. Few studies have addressed the benefit for those with spastic hemiplegia. The aim of this study was to describe and evaluate the efficacy of SDR in patients with spastic hemiplegia.

METHODS: A retrospective chart review was performed on pediatric patients (< 18 years of age) who underwent SDR at Monroe Carell Jr. Children’s Hospital from July 2013 through January 2024 with a diagnosis of spastic hemiplegic cerebral palsy. Patients underwent pre- and postoperative physical therapy testing at approximately 1 year. Any patients found to have spastic triplegia with asymmetrical hypertonia in the lower extremities, or those without postoperative evaluations, were excluded. Outcome measures included the modified Ashworth Scale (mAS), Gross Motor Function Measure-66 (GMFM-66), timed (10 m) walk test, Gross Motor Function Classification System (GMFCS), and the Pediatric Quality of Life Cerebral Palsy (PedsQL CP) module. Pre- versus postoperative comparisons were performed using a Wilcoxon signed-rank test and the differences were considered statistically significant when p values were < 0.05.

RESULTS: Twenty-one patients underwent SDR for spastic hemiplegic cerebral palsy with pre- and postoperative physical therapy assessments. The patients were 52.4% male, 81.0% White, with a median age of 5 years at the time of surgery. The most common etiology for spastic hemiplegia was stroke (52.4%). All patients had a preoperative GMFCS level of I (85.7%) or II (14.3%). The median percentage of rootlets cut during the procedure was 60% on the affected side. The sum of the mAS extremity score was improved by 5 points (p < 0.001), the GMFM-66 score was improved by a median of 3.1 (p = 0.002), while the PedsQL CP module improved by a median of 12.3 percentage points (p = 0.003). Orthotic use was reduced from 90.5% preoperatively to 66.7% at follow-up.

CONCLUSIONS: SDR is an effective treatment in patients with spastic hemiplegia resulting in significant improvement in motor function, quality of life, and tone.

PMID:41043185 | DOI:10.3171/2025.7.PEDS25256