Category: Statistics

Neurology. 2025 May 13;104(9):e213560. doi: 10.1212/WNL.0000000000213560. Epub 2025 Apr 4.

ABSTRACT

BACKGROUND AND OBJECTIVES: Poor long-term blood pressure (BP) control due to undertreatment of hypertension is not uncommon after intracerebral hemorrhage (ICH). It heightens the risk of ICH recurrence and subsequent stroke, which is the highest within the first year. Promptly achieving BP targets would significantly reduce these risks. To accomplish this, upfront triple antihypertensive medications could be prescribed soon after ICH because many ICH survivors require ≥3 antihypertensives. However, not all would suit this approach, particularly those with cerebral amyloid angiopathy (CAA), where elevated admission BP may be due to acute hypertensive response rather than underlying hypertension. In addition, overtreatment and excessive BP lowering would cause more side effects and have been associated with increased mortality in older patients. Hence, to facilitate individualized treatment, we aimed to develop a score (TRICH) to predict the need for ≥3 antihypertensives at 3 months after ICH.

METHODS: We developed the score using data from the University of Hong Kong prospective ICH registry (2011-2022) and validated it in 3 hospitals (2020-2022) locally. Consecutive patients with spontaneous ICH who survived >90 days and had follow-up BP 3 months after ICH were included. Predictors for needing ≥3 antihypertensive medications at 3 months were identified using multivariate logistic regression, and the score was created using the β-coefficients.

RESULTS: The TRICH score was developed from 462 patients (mean age 66.6 ± 14.3 years, 60% male) and validated in 203 patients (mean age 66.3 ± 14.6 years, 62% male). The 9-point score (age younger than 60 years = 1, male = 1, ischemic heart disease = 1, admission estimated glomerular filtration rate <60 mL/min/1.73 m² = 2, admission systolic BP 190-230 mm Hg = 2 while >230 mm Hg = 4) has a c-statistic (95% CI) of 0.79 (0.75-0.83) in the development cohort and 0.76 (0.69-0.82) in validation. A dichotomized score (≥3 points) predicted the need for ≥3 antihypertensives with 0.73 (95% CI 0.67-0.80) sensitivity and 0.76 (95% CI 0.70-0.81) specificity. The score performed better in patients with untreated/uncontrolled hypertension before ICH than in controlled patients (c-statistic [95% CI] 0.81 [0.77-0.86] vs 0.74 [0.69-0.80], p = 0.037) but showed no difference between patients with CAA and non-CAA patients.

DISCUSSION: The TRICH score identifies patients with ICH who need ≥3 antihypertensive medications 3 months after ICH with good discrimination ability. It may guide upfront triple antihypertensive prescription, but further research is warranted, particularly in non-Han Chinese populations.

PMID:40184593 | DOI:10.1212/WNL.0000000000213560

Retina. 2025 Apr 2. doi: 10.1097/IAE.0000000000004477. Online ahead of print.

ABSTRACT

PURPOSE: To report the 5-year outcomes of intravitreal aflibercept in patients with macular edema due to central retinal vein occlusion(CRVO).

METHODS: Participants in this study were 51 treatment naïve patients with macular edema due to CRVO, who received intravitreal aflibercept 2.0mg using a treat-and-extend regimen after a loading dose of three-monthly injections. The primary outcomes were the mean change in best-corrected visual acuity(BCVA) and central subfield thickness(CST) at month 60 compared to baseline.

RESULTS: At month 60, there was a statistically significant improvement in BCVA with a mean change of 11.5 letters compared to baseline(p<0.001). 19.6% of patients gained ≥15 ETDRS letters compared to baseline. Accordingly, at month 60, there was a statistically significant reduction in CST of about 195 μm compared to baseline(p<0.001). The mean number of injections at month 60 was 23.7. At month 60, about 50% of patients were found to have “good” treatment response, which was associated with ellipsoid zone integrity and the absence of hyperreflective foci on optical coherence tomography. It is worthy to note that 60.8% of patients achieved treatment interval of ≥8 weeks, while 31.4% of patients ≥12 weeks. Factors associated with an extended treatment interval was intact ellipsoid zone, lower baseline CST and the absence of disorganization of inner retinal layers.

CONCLUSIONS: At the 5-year follow-up, intravitreal aflibercept showed a mean gain of 11.5 letters in BCVA with an average of 23.7 injections. 31.4% of patients achieved a treatment interval of ≥12 weeks, while about half of patients showed good treatment response.

PMID:40184581 | DOI:10.1097/IAE.0000000000004477

JCO Glob Oncol. 2025 Apr;11:e2400212. doi: 10.1200/GO.24.00212. Epub 2025 Apr 4.

ABSTRACT

PURPOSE: Although lung cancer is a major cause of cancer incidence and mortality worldwide, lung cancer studies in sub-Saharan Africa are scarce. Here, we present outputs from a designated lung cancer program in western Kenya, part of the Multi-National Lung Cancer Control Program, which focused on case finding, diagnosis, and treatment.

METHODS: We retrospectively reviewed patients with pathologically confirmed non-small cell lung cancer (NSCLC) enrolled in this program at Moi Teaching and Referral Hospital from January 2018 to December 2022. Clinical data were analyzed using descriptive statistics, Kaplan-Meier methods, and proportional hazards regression model.

RESULTS: Two hundred forty-nine patients diagnosed with NSCLC were included with a median age at diagnosis of 61 (IQR, 52-70) years. Most patients were married (n = 177; 71%) and nonsmokers (n = 177; 71%) with 58 (23%) having received tuberculosis treatment and 93 (37%) having Eastern Cooperative Oncology Group (ECOG) performance status (PS) of $\ge$2. At diagnosis, adenocarcinoma was the prominent histology (n = 187; 75%) along with clinical stage IV (n = 195; 78% stage IV) or unstaged (n = 40; 16%) disease. Most patients received chemotherapy and radiotherapy (n = 176; 71%) with few palliative care referrals (n = 2; 0.8%). The median overall survival (OS) was only 3.7 months (IQR, 2.7-5.4). ECOG PS (3 or 4) and being unstaged were predictors of poor 1-year OS.

CONCLUSION: Patients with NSCLC enrolled in this program presented with advanced disease and poor survival. Despite a designated case finding effort, late diagnosis remained common and highlights a need for locally relevant interventions targeting community and provider education as well as innovative diagnostics that can improve early recognition of lung cancer. These interventions must also be paired with access to proven treatments including molecular therapies and palliative care which can extend lung cancer survival.

PMID:40184569 | DOI:10.1200/GO.24.00212

JCO Glob Oncol. 2025 Apr;11:e2400543. doi: 10.1200/GO-24-00543. Epub 2025 Apr 4.

ABSTRACT

PURPOSE: Sub-Saharan Africa carries one of the highest burdens of hepatocellular carcinoma (HCC) in the world, with hepatitis B virus (HBV) as the most common cause. Studies in several regions of the world suggest important cancer differences in rural versus urban settings, but limited studies have been performed in Africa.

METHODS: We performed a scoping review and pooled analysis of studies on HCC in Africa. Using land use data from the European Space Agency, we calculated the distance in kilometers from each study site to the nearest rural area. Regression models were fit to estimate the association between distance to the nearest rural area and HBV, sex, and weighted mean age.

RESULTS: Data from 57 studies including 10,907 patients across 36 towns/cities were included in our analysis. Proximity to rural areas was associated with a higher frequency of HBV-associated HCC in assessment of distance both at midpoint and at quartiles after controlling for country: risk ratio (RR) 1.71 (95% CI, 1.52 to 1.93) and RR 1.51 (95% CI, 1.25 to 1.84), respectively. No association was found between sex and proximity to a rural area: RR 1.02 (95% CI, 0.96 to 1.08). The weighted mean age across the four distance quartiles was 50.09, 53.43, 47.98, and 53.35 years with no statistically significant difference found across the quartiles (P = .81).

CONCLUSION: Individuals living in rural Africa have a higher rate of HBV-related HCC compared with other liver diseases. Increased HBV awareness efforts in these areas should be considered.

PMID:40184566 | DOI:10.1200/GO-24-00543

PLoS Comput Biol. 2025 Apr 4;21(4):e1012904. doi: 10.1371/journal.pcbi.1012904. eCollection 2025 Apr.

ABSTRACT

Cell type annotation is crucial in single-cell RNA sequencing data analysis because it enables significant biological discoveries and deepens our understanding of tissue biology. Given the high-dimensional and highly sparse nature of single-cell RNA sequencing data, most existing annotation tools focus on highly variable genes to reduce dimensionality and computational load. However, this approach inevitably results in information loss, potentially weakening the model’s generalization performance and adaptability to novel datasets. To mitigate this issue, we developed scTrans, a single cell Transformer-based model, which employs sparse attention to utilize all non-zero genes, thereby effectively reducing the input data dimensionality while minimizing information loss. We validated the speed and accuracy of scTrans by performing cell type annotation on 31 different tissues within the Mouse Cell Atlas. Remarkably, even with datasets nearing a million cells, scTrans efficiently perform cell type annotation in limited computational resources. Furthermore, scTrans demonstrates strong generalization capabilities, accurately annotating cells in novel datasets and generating high-quality latent representations, which are essential for precise clustering and trajectory analysis.

PMID:40184563 | DOI:10.1371/journal.pcbi.1012904

PLoS Comput Biol. 2025 Apr 4;21(4):e1012906. doi: 10.1371/journal.pcbi.1012906. eCollection 2025 Apr.

ABSTRACT

Contact tracing is an important public health measure used to reduce transmission of infectious diseases. Contact tracers typically conduct telephone interviews with cases to identify contacts and direct them to quarantine, with the aim of preventing onward transmission. However, in situations where caseloads exceed the capacity of the public health system, timely interviews may not be feasible for all cases. Here we present a modelling framework for assessing the impact of different case interview prioritisation strategies on disease transmission. Our model is based on Australian contact tracing procedures and informed by contact tracing data on COVID-19 cases notified in Australia from 2020 to 2021. Our results demonstrate that last-in-first-out strategies (where cases with the most recent swab or notification dates are interviewed first) are more effective at reducing transmission than first-in-first-out strategies (where cases with the oldest swab or notification dates are interviewed first) or strategies with no explicit prioritisation. To maximise the public health benefit from a given case interview capacity, public health practitioners may consider our findings when designing case interview prioritisation protocols for outbreak response.

PMID:40184558 | DOI:10.1371/journal.pcbi.1012906

JMIR Ment Health. 2025 Apr 4;12:e67190. doi: 10.2196/67190.

ABSTRACT

BACKGROUND: Mental health issues like occupational stress and burnout, compounded with the after-effects of COVID-19, have affected health care professionals (HCPs) around the world. Digital mental health interventions (DMHIs) can be accessible and effective in supporting well-being among HCPs. However, low engagement rates of DMHIs are frequently reported, limiting the potential effectiveness. More evidence is needed to reveal the factors that impact HCPs’ decision to adopt and engage with DMHIs.

OBJECTIVE: This study aims to explore HCPs’ motivation to engage with DMHIs and identify key factors affecting their engagement. Amongst these, we include cultural factors impacting DMHI perception and engagement among HCPs.

METHODS: We used a mixed method approach, with a cross-sectional survey (n=438) and semistructured interviews (n=25) with HCPs from the United Kingdom and China. Participants were recruited from one major public hospital in each country.

RESULTS: Our results demonstrated a generally low engagement rate with DMHIs among HCPs from the 2 countries. Several key factors that affect DMHI engagement were identified, including belonging to underrepresented cultural and ethnic groups, limited mental health knowledge, low perceived need, lack of time, needs for relevance and personal-based support, and cultural elements like self-stigma. The results support recommendations for DMHIs for HCPs.

CONCLUSIONS: Although DMHIs can be an ideal alternative mental health support for HCPs, engagement rates among HCPs in China and the United Kingdom are still low due to multiple factors and barriers. More research is needed to develop and evaluate tailored DMHIs with unique designs and content that HCPs can engage from various cultural backgrounds.

PMID:40184553 | DOI:10.2196/67190

JMIR Mhealth Uhealth. 2025 Apr 4;13:e65782. doi: 10.2196/65782.

ABSTRACT

BACKGROUND: Cardiovascular diseases (CVDs) continue to be the leading cause of global morbidity and mortality. Aiming to reduce the risk of CVD development and better manage them, an increasing number of individuals are adopting mobile health (mHealth) apps and wearable devices (wearables). These technologies provide critical insights into heart health and fitness, supporting users to monitor their lifestyle behaviors and adhere to preventative medication.

OBJECTIVE: In this review, we aimed to investigate the current state of mHealth apps and wearables designed for cardiovascular health, with a specific focus on the DACH region (Germany, Austria, and Switzerland). We assessed the benefits these technologies provide to clinicians and patients, particularly in addressing unmet needs like sex-specific symptoms, while also examining their potential integration into the broader health care ecosystem.

METHODS: To identify heart health apps, a keyword search was performed on both the Swiss Apple App Store and Google Play Stores. A separate search was performed on Google to identify heart health wearables. The identified apps and wearables were evaluated using the foundational and contextual criteria of the sociotechnical framework for assessing patient-facing eHealth tools.

RESULTS: After filtering out apps and wearables that did not meet our inclusion criteria, 20 apps and 22 wearables were included in the review. While all the apps were available in the DACH region, only 30% (6/20) were specifically designed for these countries. Only 25% (5/20) of the apps included sex-specific information; 40% (8/20) provided information from evidence-based research, 35% (7/20) provided general health information without academic and clinical references, and 25% (5/20) did not include any evidence-based or general health information. While 20% (4/20) of the included apps had clinical integration features such as clinician dashboards, only 10% (2/20) had the potential to effectively enhance clinician workflows. Privacy policies were present in 95% (19/20) of the apps, with 75% (15/20) adhering to General Data Protection Regulation (GDPR) regulations; 1 app had no data protection policy. Only 20% (4/20) of the apps were medically certified. For wearables, only 9% (2/22) were tailored to the DACH region, and 40% (9/22) addressed women’s health. While around 60% (13/22) offered features to support clinical integration, only 9% (2/22) had the potential to improve clinical workflows. More than half (12/22) of the wearables were medically certified, and 77% (17/22) referenced scientific or peer-reviewed research. All wearables included a privacy policy.

CONCLUSIONS: While many mHealth tools for cardiovascular health are available, only a few provide meaningful value to both patients and clinicians or have the potential to integrate effectively into the health care system. Women’s sex-specific needs are often overlooked, and the benefits for clinicians are limited. In addition, mHealth apps largely lack robust evidence, whereas wearables showed comparatively stronger support through evidence-based and medical certification.

PMID:40184552 | DOI:10.2196/65782

Invest Radiol. 2025 Apr 7. doi: 10.1097/RLI.0000000000001186. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to compare the diagnostic quality of deep learning (DL) reconstructed balanced steady-state free precession (bSSFP) single-shot (SSH) cine images with standard, multishot (also: segmented) bSSFP cine (standard cine) in cardiac MRI.

METHODS AND MATERIALS: This prospective study was performed in a cohort of participants with clinical indication for cardiac MRI. SSH compressed-sensing bSSFP cine and standard multishot cine were acquired with breath-holding and electrocardiogram-gating in short-axis view at 1.5 Tesla. SSH cine images were reconstructed using an industry-developed DL super-resolution algorithm (DL-SSH cine). Two readers evaluated diagnostic quality (endocardial edge definition, blood pool to myocardium contrast and artifact burden) from 1 (nondiagnostic) to 5 (excellent). Functional left ventricular (LV) parameters were assessed in both sequences. Edge rise distance, apparent signal-to-noise ratio (aSNR) and contrast-to-noise ratio were calculated. Statistical analysis for the comparison of DL-SSH cine and standard cine included the Student’s t-test, Wilcoxon signed-rank test, Bland-Altman analysis, and Pearson correlation.

RESULTS: Forty-five participants (mean age: 50 years ±18; 30 men) were included. Mean total scan time was 65% lower for DL-SSH cine compared to standard cine (92 ± 8 s vs 265 ± 33 s; P < 0.0001). DL-SSH cine showed high ratings for subjective image quality (eg, contrast: 5 [interquartile range {IQR}, 5-5] vs 5 [IQR, 5-5], P = 0.01; artifacts: 4.5 [IQR, 4-5] vs 5 [IQR, 4-5], P = 0.26), with superior values for sharpness parameters (endocardial edge definition: 5 [IQR, 5-5] vs 5 [IQR, 4-5], P < 0.0001; edge rise distance: 1.9 [IQR, 1.8-2.3] vs 2.5 [IQR, 2.3-2.6], P < 0.0001) compared to standard cine. No significant differences were found in the comparison of objective metrics between DL-SSH and standard cine (eg, aSNR: 49 [IQR, 38.5-70] vs 52 [IQR, 38-66.5], P = 0.74). Strong correlation was found between DL-SSH cine and standard cine for the assessment of functional LV parameters (eg, ejection fraction: r = 0.95). Subgroup analysis of participants with arrhythmia or unreliable breath-holding (n = 14/45, 31%) showed better image quality ratings for DL-SSH cine compared to standard cine (eg, artifacts: 4 [IQR, 4-5] vs 4 [IQR, 3-5], P = 0.04).

CONCLUSIONS: DL reconstruction of SSH cine sequence in cardiac MRI enabled accelerated acquisition times and noninferior diagnostic quality compared to standard cine imaging, with even superior diagnostic quality in participants with arrhythmia or unreliable breath-holding.

PMID:40184545 | DOI:10.1097/RLI.0000000000001186

ACS Sens. 2025 Apr 4. doi: 10.1021/acssensors.4c03260. Online ahead of print.

ABSTRACT

Raman spectroscopy in biological applications faces challenges due to complex spectra, characterized by peaks of varying widths and significant biological background noise. Convolutional neural networks (CNNs) are widely used for spectrum classification due to their ability to capture local peak features. In this study, we introduce a multiscale CNN designed to detect weak biomolecule signals and differentiate spectra with features that cannot be statistically distinguished. The approach is further enhanced by a new visualization technique tailored for multiscale spectral analysis, providing clear insights into classification results. Using the classification of cholera toxin B subunit (CTB)-treated versus untreated cell membrane samples, whose spectra cannot be statistically differentiated, the optimized multiscale CNN achieved superior performance compared to traditional machine learning methods and existing multiscale CNNs, with accuracy (99.22%), sensitivity (99.27%), specificity (99.16%), and precision (99.20%). Our new visualization method, based on gradients of activation maps with respect to class scores, generates saliency scores that capture sample variations, with decision-making relying on consistently identified peak features. By visualizing the effects of different kernel sizes, Grad-AM highlights features at varying scales, aligning closely with spectral features and enhancing CNN interpretability in complex biomolecular analysis. These advancements demonstrate the potential of our method to improve spectral analysis and reveal previously hidden peaks in complex biological environments.

PMID:40184533 | DOI:10.1021/acssensors.4c03260