Category: Statistics

Ann Intensive Care. 2025 Jan 25;15(1):17. doi: 10.1186/s13613-025-01424-4.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Its complications often require renal replacement therapy (RRT). Invasive mechanical ventilation (IMV) and infections are considered risk factors for the occurrence of AKI. The use of IMV and non-invasive ventilation (NIV) has changed over the course of the pandemic. Concomitant with this change in treatment a reduction in the incidences of AKI and RRT was observed. We aimed to investigate the impact of IMV on RRT initiation by comparing critically ill patients with and without COVID-19. Furthermore, we wanted to investigate the rates and timing of RRT as well as the outcome of patients, who were treated with RRT.

RESULTS: A total of 8,678 patients were included, of which 555 (12.8%) in the COVID-19 and 554 (12.8%) in the control group were treated with RRT. In the first week of ICU stay the COVID-19 patients showed a significantly lower probability for RRT initiation (day 1: p < 0.0001, day 2: p = 0.021). However, after day 7 a reversed HR was found. In mechanically ventilated patients the risk was significantly higher for the initiation of RRT over the entire stay. While in non-COVID-19 patients this was a non-significant trend, in COVID-19 patients the risk for RRT was significantly increased. The median delay between initiation of IMV and requirement of RRT was observed to be longer in COVID-19 patients (5 days [IQR: 2-11] vs. 2 days [IQR: 1-5]). The analysis restricted to patients with RRT showed a significantly higher risk for ICU death in patients requiring IMV compared to patients without IMV.

CONCLUSION: The analysis demonstrated that IMV as well as COVID-19 are associated with an increased risk for initiation of RRT. The association between IMV and risk of RRT initiation was given for all investigated time intervals. Additionally, COVID-19 patients showed an increased risk for RRT initiation during the entire ICU stay within patients admitted to an ICU due to respiratory disease. In COVID-19 patients treated with RRT, the risk of death was significantly higher compared to non-COVID-19 patients.

PMID:39862353 | DOI:10.1186/s13613-025-01424-4

Sci China Life Sci. 2025 Jan 22. doi: 10.1007/s11427-024-2748-4. Online ahead of print.

ABSTRACT

Genomic sources from China are underrepresented in the population-specific reference database. We performed whole-genome sequencing or genome-wide genotyping on 1,207 individuals from four linguistically diverse groups (1,081 Sinitic, 56 Mongolic, 40 Turkic, and 30 Tibeto-Burman people) living in North China included in the 10K Chinese People Genomic Diversity Project (10K_CPGDP) to characterize the genetic architecture and adaptative history of ethnic groups in the Silk Road Region of China. We observed a population split between Northwest Chinese minorities (NWCMs) and Han Chinese since the Upper Paleolithic and later Neolithic genetic differentiation within NWCMs. The observed population substructures among ethnically/linguistically diverse NWCMs suggested that differentiated admixture events contributed to the differences in their genomic and phenotypic diversity. We estimated that the Dongxiang, Tibetan, and Yugur people inherited more than 10% of the Western Eurasian ancestry, which is much greater than that of the Salar and Tu people (<7%), while Han neighbors showed less West Eurasian ancestry (∼1%-3%). Male-biased admixture introduced Western Eurasian ancestry in the Dongxiang, Tibetan, and Yugur populations. We found that the eastern-western admixture in NWCMs occurred ∼800-1,100 years ago, coinciding with intensive economic and cultural exchanges during the Tang and Song dynasties. Additionally, we identified the signatures of natural selection associated with cardiovascular system diseases or lipid metabolism and developmental/neurogenetic disorders. Moreover, the EPAS1 gene showed relatively high population branch statistic values in NWCMs. The well-fitted demographical models presented the vast landscape of complex admixture processes of the Silk Road people, and the newly reported functionally important variations suggested the importance of including ethnolinguistically diverse populations in Chinese genetic studies for uncovering the genetic basis of complex traits/diseases.

PMID:39862346 | DOI:10.1007/s11427-024-2748-4

Mol Cell Pediatr. 2025 Jan 25;12(1):2. doi: 10.1186/s40348-025-00189-x.

ABSTRACT

BACKGROUND: Patent ductus arteriosus is one of the most common cardiac conditions affecting the neonates. Considering the lack of studies done on this topic in healthcare settings in Khyber Pakhtunkhwa province, this study aims to find out the comparative effectiveness of paracetamol and ibuprofen in management of PDA in our healthcare setting to conclude a better management option for the condition.

OBJECTIVE: To find and compare the effectiveness of paracetamol and ibuprofen in the closure of patent ductus arteriosus in preterm neonates.

METHODOLOGY: This randomized controlled trial was conducted in the Department of Nursery and Neonatal Intensive Care Unit, Khyber Teaching Hospital, Peshawar, Pakistan, from 10th April 2024 to 10th October 2024. A total of 256 neonates of both genders with patent ductus arteriosus were included. Group A received oral paracetamol, and Group B received oral ibuprofen. The effectiveness of the treatments was evaluated at the end of the treatment period.

RESULTS: The age range in this study was from 48 to 96 h, with a mean age of 71.79 ± 13.10 h in Group A and 73.40 ± 11.81 h in Group B. Efficacy was observed in 107 (83.6%) patients in Group A compared to 90 (70.3%) patients in Group B, showing a statistically significant difference (P = 0.011).

CONCLUSION: Our study has concluded that paracetamol is more effective than ibuprofen in closing patent ductus arteriosus. The trials were retrospectively registered at NIH Trial Registry (NCT06601114) https://clinicaltrials.gov/study/NCT06601114 dated 15/09/2024.

PMID:39862321 | DOI:10.1186/s40348-025-00189-x

Ann Med. 2025 Dec;57(1):2457522. doi: 10.1080/07853890.2025.2457522. Epub 2025 Jan 25.

ABSTRACT

BACKGROUND: Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain.

MATERIALS AND METHODS: We conducted a systematic review and meta-analysis of RCTs reporting clinical outcomes of systematic AF screening in participants without known AF. Pooled risk ratios (RRs) were computed for all-cause stroke or systemic embolism, major bleeding, and all-cause mortality, comparing screening with no screening.

RESULTS: Seven RCTs encompassing 76 458 participants were identified. One trial utilized implantable loop recorders for rhythm monitoring, while the others employed non-invasive screening methods. Pooled results indicated that AF screening was associated with a significant reduction in all-cause stroke or systemic embolism (RR 0.932, 95% CI 0.873-0.996, I² = 0%, p = 0.037), but had no effect on major bleeding (RR 0.996, 95% CI 0.935-1.060, I² = 0%, p = 0.876) or all-cause mortality (RR 0.987, 95% CI 0.945-1.031, I² = 0%, p = 0.550). We estimated a number needed to screen of 148 to prevent one stroke or systemic embolism over a 10-year period in a population of 75-year-olds. When only non-invasive screening methods were considered, the reduction in strokes was not statistically significant (RR 0.942, 95% CI 0.880-1.008, I² = 0%, p = 0.083).

CONCLUSIONS: Systematic AF screening is associated with a modest yet statistically significant 7% relative reduction in stroke and systemic embolism, with no observed impact on major bleeding or all-cause mortality.

PMID:39862317 | DOI:10.1080/07853890.2025.2457522

Clin Oral Investig. 2025 Jan 25;29(1):90. doi: 10.1007/s00784-025-06166-y.

ABSTRACT

OBJECTIVE: This study investigated the associations among endodontic instruments, ultrasonic tips and various final irrigation protocols for removing intracanal and intratubular biofilms in long oval canals.

METHODOLOGY: One hundred mandibular premolars inoculated with Enterococcus faecalis were divided into two groups: the control group (CG: n = 10), which received no treatment; and the test groups (n = 30), which included saline (SS), sodium hypochlorite (2.5% NaOCl) and chlorhexidine (2% CHX). The samples were prepared with Reciproc^® Blue 25/0.08, Flatsonic, Clearsonic and Reciproc Blue 40/0.06. Each test group was divided into three subgroups (n = 10): conventional irrigation (CI) with syringes and needles, passive ultrasonic irrigation (PUI) and continuous ultrasonic irrigation (CUI) with an Irrisonic tip. The root canals were examined using confocal laser scanning microscopy. Mann‒Whitney and Kruskal‒Wallis tests followed by Dunn post hoc tests (p < 0.05) were used for statistical analysis.

RESULTS: NaOCl and CHX were effective for intracanal and intratubular decontamination. Saline showed significant decontamination in the intratubular areas when CUI was used. The CI method was the least effective for intracanal decontamination.

CONCLUSION: The use of Flatsonic and Clearsonic ultrasonic tips is promising for root canal disinfection.

CLINICAL RELEVANCE: The disinfection techniques in endodontic treatment focus on the removal of biofilms from long oval canals, which is crucial for effective cleaning during root canal procedures.

PMID:39862315 | DOI:10.1007/s00784-025-06166-y

Updates Surg. 2025 Jan 25. doi: 10.1007/s13304-025-02109-0. Online ahead of print.

ABSTRACT

Clinical risk prediction models are ubiquitous in many surgical domains. The traditional approach to develop these models involves the use of regression analysis. Machine learning algorithms are gaining in popularity as an alternative approach for prediction and classification problems. They can detect non-linear relationships between independent and dependent variables and incorporate many of them. In our work, we aimed to investigate the potential role of machine learning versus classical logistic regression for the preoperative risk assessment in proctological surgery. We used clinical data from a nationwide audit: the database consisted of 1510 patients affected by Goligher’s grade III hemorrhoidal disease who underwent elective surgery. We collected anthropometric, clinical, and surgical data and we considered ten predictors to evaluate model-predictive performance. The clinical outcome was the complication rate evaluated at 30-day follow-up. Logistic regression and three machine learning techniques (Decision Tree, Support Vector Machine, Extreme Gradient Boosting) were compared in terms of area under the curve, balanced accuracy, sensitivity, and specificity. In our setting, machine learning and logistic regression models reached an equivalent predictive performance. Regarding the relative importance of the input features, all models agreed in identifying the most important factor. Combining and comparing statistical analysis and machine learning approaches in clinical field should be a common ambition, focused on improving and expanding interdisciplinary cooperation.

PMID:39862313 | DOI:10.1007/s13304-025-02109-0

J Med Syst. 2025 Jan 25;49(1):17. doi: 10.1007/s10916-024-02138-z.

ABSTRACT

Predicting health-related outcomes can help with proactive healthcare planning and resource management. This is especially important on the older population, an age group growing in the coming decades. Considering longitudinal rather than cross-sectional information from primary care electronic health records (EHRs) can contribute to more informed predictions. In this work, we developed prediction models using longitudinal EHRs to inform resource allocation. In this study, we developed deep-learning-based prognostic models to predict 1-year and 5-year all-cause mortality, nursing home admission, and home care need in people over 65 years old using all the longitudinal information from EHRs. The models included attention mechanisms to increase their transparency. EHRs were drawn from SIDIAP (primary care, Catalonia (Spain)) from 2010-2019. Performance on the test set was compared to that from baseline models using cross-sectional one-year history only. Data from 1,456,052 individuals over 65 years old were considered. Cohen’s kappa obtained using longitudinal data was 3.4-fold (1-year all-cause mortality), 10.3-fold (5-year all-cause mortality), 1.1-fold (5-year nursing home admission), and 1.2-fold (5-year home care need) higher than that obtained by the one-year history baseline models. Our models performed better than those not considering longitudinal data, especially when predicting further into the future. However, nursing home admission and home care need in the long term were harder to predict, suggesting their dependence on more abrupt changes. The attention maps helped to understand the predictions, enhancing model transparency. These prediction models can contribute to improve resource allocation in the general population of aging adults.

PMID:39862306 | DOI:10.1007/s10916-024-02138-z

Matern Child Health J. 2025 Jan 25. doi: 10.1007/s10995-025-04039-0. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to determine the effect of supplemental nursing system on, sucking success, weight gain findings and bilirubin levels in newborns.

DESIGN AND METHODS: The study was conducted as a randomized controlled trial. The population of the research consisted of 71 infants who received care and treatment at the Neonatal Intensive Care Clinic of the hospital located in a province in eastern Turkey between February and June 2023. In the study, the “Infant Follow-up Form” to access the birth-related characteristics of infants and mothers, the “LATCH Breastfeeding Diagnostic Scale,” to diagnose the process of switching to full breastfeeding and the “Mother-Infant Communication Form” were used. The body weights of the infants were monitored using a Charder baby scale and bilirubin levels were measured using a Drager brand transcutaneous bilirubin measuring device.

RESULTS: The difference between the groups in terms of the mean sucking success, weight gain findings and bilirubin levels scores was statistically significant (p < 0.05).

CONCLUSIONS: Feeding an infant with the supplemental nursing system had a positive effect on sucking success, weight gain findings and bilirubin levels.

PMID:39862297 | DOI:10.1007/s10995-025-04039-0

Arch Gynecol Obstet. 2025 Jan 25. doi: 10.1007/s00404-024-07916-1. Online ahead of print.

ABSTRACT

PURPOSE: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, often leading to anovulatory infertility. Obesity exacerbates the reproductive, metabolic and psychological features of PCOS, making fertility treatment and patient satisfaction difficult. Despite guidelines from the European Society of Human Reproduction and Embryology (ESHRE) emphasizing lifestyle modifications and specific treatments, there remains a significant gap in adherence to these guidelines by both healthcare providers and patients.

METHODS: A cross-sectional online survey was conducted from 1 January to 14 March 2021 among PCOS patients in Germany, Austria and Switzerland. A non-standardized, non-validated questionnaire covering several aspects of reproductive health was distributed via online channels. Data were analyzed using descriptive statistics, chi-squared tests, Student’s t-tests and Jonckheere-Terpstra tests, with significance set at p < 0.05.

RESULTS: Out of 2029 participants, 1902 completed the fertility questionnaire. Of these, 73.9% perceived their fertility to be impaired, with this perception being higher in obese women (80.8% vs. 67.4%, p < 0.001). The analysis focused on 564 childless women with a current desire to have children, 67.0% of whom met WHO criteria for infertility. Obese women (BMI ≥ 30 kg/m²) reported lower satisfaction with fertility treatment (40.9 vs. 47.8, p = 0.009) and were less likely to receive fertility treatment (56.7% vs. 75.8%, p < 0.001). Despite recommendations, only 34.1% reported lifestyle changes as part of their treatment. Letrozole, the recommended first-line treatment, was underused (14.6%) and clomiphene citrate was more commonly prescribed (35.4%). Obese women reported fewer current pregnancies (4% vs. 13.9%, p < 0.001) and were more likely to be infertile for more than one year (77.0% vs. 53.0%, p < 0.001). They also expressed a greater desire for possibilities to ask more questions about PCOS and fertility and to undergo more infertility tests. (56.1% vs. 45.3%, p = 0.013; 69.4% vs. 59.8%, p = 0.020).

CONCLUSIONS: Fertility management in PCOS patients, especially in obese patients, shows significant gaps in adherence to recommended guidelines, highlighting the need for improved patient education, professional training and individualized treatment strategies. Improved health care is essential to address reproductive concerns and improve outcomes in this population.

PMID:39862270 | DOI:10.1007/s00404-024-07916-1

Arch Orthop Trauma Surg. 2025 Jan 25;145(1):146. doi: 10.1007/s00402-025-05767-2.

ABSTRACT

PURPOSE: The adoption of robotic-assisted total hip arthroplasty (THA) is increasingly widespread, yet its influence on outcomes in outpatient surgery remains uncertain. This study aimed to evaluate whether robotic assistance reduces the rate of 90-day postoperative events in patients undergoing outpatient THA, compared to those in inpatient procedures.

METHODS: This historical-prospective cohort study analyzed 706 primary THA cases performed between January 2017 and January 2023 by three senior surgeons. Patients were grouped into outpatient (n = 132) and inpatient (n = 576) cohorts. From December 2019, robotic-assisted THA using the MAKO™ system was implemented. Propensity score matching was used to minimize baseline differences between groups. The primary outcome was the occurrence of any event within 90 days post-surgery, including readmissions, reoperations, and other complications. Secondary outcomes included functional scores, length of hospital stay, and intraoperative factors such as blood loss and Operative Room (OR) time.

RESULTS: No significant differences were found between inpatient and outpatient groups in terms of gender, age, BMI, ASA score, or surgeon. The 90-day event rates were similar between the two groups (8.59% vs. 9.38%, p > 0.999). However, outpatient THA was associated with lower blood loss (p = 0.02) and shorter hospital stays (p < 0.001). Multivariate analysis identified prolonged OR time (> 2 h), BMI ≥ 25, and manual surgical techniques as significant risk factors for 90-day events. Robotic-assisted surgery, although not statistically significant (p = 0.105), showed a trend towards reducing complications in outpatient THA.

CONCLUSION: Outpatient THA is a safe alternative to inpatient surgery, with no significant difference in 90-day postoperative events. Robotic-assisted surgery appears to reduce complications, particularly in the outpatient setting, and may optimize outpatient care pathways. Further research is needed to confirm these findings and explore long-term outcomes.

LEVEL OF EVIDENCE: III.

PMID:39862256 | DOI:10.1007/s00402-025-05767-2