Category: Statistics

Epilepsy Behav. 2025 Jul 24;171:110618. doi: 10.1016/j.yebeh.2025.110618. Online ahead of print.

ABSTRACT

INTRODUCTION: An aneurysmal subarachnoid hemorrhage (aSAH) is a severe type of hemorrhagic stroke associated with substantial morbidity and long-term cognitive sequelae even when functional recovery appears to be satisfactory. Epilepsy-a common complication in aSAH survivors-is associated with worse outcomes, including increased mortality and disability and a diminished quality of life. This cross-sectional study investigates the long-term cognitive, functional, and quality-of-life outcomes for aSAH patients who develop epilepsy, comparing them to controls without epilepsy.

METHODS: This study involved 20 patients with epilepsy and 18 control subjects, recruited using the Kuopio Intracranial Aneurysm Database. The participants were evaluated 12 years after their aSAH at Kuopio University Hospital. Cognitive abilities, fatigue levels, depressive symptoms, and quality of life were measured using neuropsychological assessments and validated self-report instruments.

RESULTS: The analysis revealed no statistically significant differences in cognitive performance between the two groups, encompassing areas such as working memory, verbal and visual memory, processing speed, executive function, and verbal skills. Similarly, the assessments of fatigue, depression, and quality of life revealed no disparities.

CONCLUSIONS: Our study suggests that the neuropsychological outcomes in this population are primarily sequelae of the aSAH itself rather than additive cognitive effects of epilepsy. An important strength of this study is the relatively long median follow-up time of 12 years, allowing the evaluation of long-term outcomes after aSAH. However, the study’s limitations include a small sample size and a considerable number of patients being lost to follow-up. Future research with larger participant groups is needed to further clarify the intricate cognitive and psychological effects of epilepsy in survivors of aSAH and to develop targeted interventions intended to improve their long-term outcomes.

PMID:40712206 | DOI:10.1016/j.yebeh.2025.110618

Epilepsy Behav. 2025 Jul 24;171:110616. doi: 10.1016/j.yebeh.2025.110616. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The association of environmental noise with new-onset epilepsy has not yet been explored. Therefore, the study’s objective was to assess whether long-term road traffic noise exposure is associated with the risk of new-onset epilepsy among adult residents of Toronto, Canada.

METHODS: We conducted a nested case-control study using linked health administrative and environmental data. We included adult residents of Toronto as of January 1, 2010, with no history of seizures or epilepsy. Cases were those who developed epilepsy before December 31, 2016, and were each matched with up to five controls. We measured exposure to road traffic noise using three-year averages of the nighttime average (LA_{eq, 8 hr}), daytime average (LA_{eq, 16 hr}), and the 24-hour average (LA_{eq, 24 hr}) road traffic noise levels at participants’ postal code of residence. We estimated the associations of these three-year noise averages with the risk of new-onset epilepsy using conditional logistic regression models.

RESULTS: We included 4,608 cases and 20,765 controls; 46.3 % were female and the mean age was 48.3 (± 17.4) years. The incidence rate ratios associated with a 10-dB increase in LA_{eq, 8 hr} was 1.043 (95 % CI: 0.994, 1.095), 0.999 (95 % CI: 0.946, 1.054) for LA_{eq, 16 hr}, and 1.031 (95 % CI: 0.980, 1.086) for LA_{eq, 24 hr}.

DISCUSSION: Although not statistically significant, these results point to a potential association between long-term exposure to road traffic noise, particularly average levels at night, and the risk of new-onset epilepsy. Future research should continue to explore this potential association.

PMID:40712204 | DOI:10.1016/j.yebeh.2025.110616

Epilepsy Behav. 2025 Jul 24;171:110545. doi: 10.1016/j.yebeh.2025.110545. Online ahead of print.

ABSTRACT

BACKGROUND: Effective self-management is essential for patients with epilepsy to achieve optimal health outcomes. However, previous studies indicate that self-management performance remains suboptimal in this population. This study aimed to evaluate the relationships between patient empowerment, disease-related fear, self-regulatory fatigue, and self-management behaviors in patients with epilepsy in China, utilizing dual systems theory as a framework.

METHODS: A convenience sampling method was employed to collect data from 655 patients with epilepsy at a tertiary hospital in Hangzhou, China, between June and November 2023. Validated scales were used to assess patient empowerment, disease-related fear, self-regulatory fatigue, and self-management behaviors. A structural equation model (SEM) based on dual systems theory was used for data analysis.

RESULTS: Among the included patients, 377 (57.60 %) were male, 360 (55.00 %) were from urban areas, and 361 (55.11 %) were unmarried.The average score for self-management behavior was 122.91 ± 18.48, indicating a moderate level of performance. SEM analysis revealed that patient empowerment had a direct positive effect on self-management behaviors (β = 0.236), a direct negative effect on illness-related fear (β = -0.608) and self-regulatory fatigue (β = -0.561), and an indirect effect on self-management behaviors (β = 0.433). All path coefficients were statistically significant (p < 0.0001). The model demonstrated excellent fit indices: χ2/df = 1.422, RMSEA = 0.025, GFI = 0.954, AGFI = 0.954, CFI = 0.952, TLI = 0.959, NFI = 0.954, IFI = 0.925.

CONCLUSION: The results of structural equation modeling show that the impact of patient empowerment on self-management is mediated through disease-related fear and self-regulatory fatigue. Therefore, enhancing patient empowerment and reducing patients’ disease-related fear and self-regulatory fatigue may help promote effective self-management in patients with epilepsy.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40712202 | DOI:10.1016/j.yebeh.2025.110545

Clin Genitourin Cancer. 2025 Jun 30;23(5):102395. doi: 10.1016/j.clgc.2025.102395. Online ahead of print.

ABSTRACT

INTRODUCTION: Retrospective data suggest poorer survival for female, racial minority, and older advanced urothelial carcinoma (aUC) patients. However, data on survival disparities in the modern era remain limited.

METHODS: This cohort study used Flatiron Health’s nationwide de-identified electronic health record (EHR)-derived database. Patients who initiated systemic therapy for aUC between January, 2017 and May, 2024 were included. Baseline characteristics, treatment history, and clinical outcomes were abstracted. PFS and OS were compared by sex (male vs. female), race (White, Black, vs. Asian/Pacific Islander [API]), and age at diagnosis (> 65 years [y] vs. ≤ 65 y), using Kaplan-Meier log-rank analysis and Cox proportional hazards models. Independent sample t-tests and chi-square analyses were used for univariate comparisons. P-values < .05 were considered statistically significant.

RESULTS: A total of 5142 patients with aUC were identified. 1419 were (28%) female and 575 (11%) were > 65 y. Of those with recorded race (n = 3492), 1% were API, 5% Black, 14% categorized as “other,” and 80% White. There was no difference in PFS (8.7 vs. 9.0 months [m], HR1.03; P = .82) or OS (13.2 vs. 13.5 m; HR1.05, P = .31) between women and men. Women had shorter PFS to men on immune checkpoint inhibitors (ICI) (P = .002) but not with other first-line (1L) therapy. API patients had comparable PFS (9.6 vs. 8.9 m; HR0.91; P = .45) but longer OS (28.5 vs. 14.1 m; HR0.56; P = .008) compared to White patients. Black patients had comparable PFS (7.9 vs. 8.5; HR1.06; P = .81) and OS (11.5 vs. 14.1 m; HR1.32; P = .73) vs White patients. Patients > 65 y had shorter PFS to ≤ 65 y (7.6 vs. 9.0 m; HR1.14, P = .019); however, OS was longer in older patients (16.5 vs. 12.8 m; HR0.80, P < .001). Only on 1L ICI, OS was longer in those > 65 y compared to those ≤ 65 y (HR0.71; P = .021) CONCLUSION: In this large real-world database, female aUC patients had comparable PFS and OS to males. API patients showed superior OS to White patients. Patients > 65 y had inferior PFS but superior OS to patients ≤ 65 y.

PMID:40712200 | DOI:10.1016/j.clgc.2025.102395

Child Abuse Negl. 2025 Jul 24;167:107600. doi: 10.1016/j.chiabu.2025.107600. Online ahead of print.

ABSTRACT

BACKGROUND: Nurse-Family Partnership’s (NFP’s) effectiveness at improving child outcomes is likely influenced by patterns of program provision and engagement, or ‘intensity’.

OBJECTIVE: To investigate program effectiveness by patterns of intensity.

PARTICIPANTS AND SETTING: We analyzed secondary data from the Canadian NFP randomized controlled trial (RCT) involving 739 maternal participants and their 737 children in British Columbia.

METHODS: Participants were randomly allocated 1:1 to NFP and existing services (n = 368) or existing services (n = 371). We collected data on child injuries, language, cognition and problem behavior (mental health) at age two years (by November 2019). We estimated principal causal effects (PCE) using propensity score (PS) methods.

RESULTS: We identified three NFP intensity patterns: Low (median [Mdn] 14 visits), Partial (Mdn 52) and Sustained (Mdn 83). For NFP participants, we found statistically-significant differences in group mean scores (mean M [SD]): for Sustained on observed language (NFP 94.55 [16.71] versus PS-matched controls 89.97 [16.76]; PCE = 5.8, 95 % CI 0.57, 11.03, p = 0.030) and problem behavior (NFP 51.33 [9.04] versus PS-matched controls 56.43 [9.38]; PCE = -5.10, 95 % CI -8.27, -1.93, p = 0.002); and for Partial on maternal-reported language (NFP 313.43 [200.36]) versus PS-matched controls (255.99 [183.56]; PCE = 65.05, 95 % CI 24.09, 106.00, p = 0.013).

CONCLUSIONS: Delivering NFP as intended, with sustained intensity, led to greater benefits regarding child language and problem behavior (mental health) but not cognition or injuries by age two years. These complementary analyses provide crucial information, beyond standard RCT analyses, on NFP’s effectiveness in this Canadian cohort. Our results highlight the importance of ensuring full NFP intensity to maximize program benefits for children.

PMID:40712198 | DOI:10.1016/j.chiabu.2025.107600

Chemosphere. 2025 Jul 24;385:144565. doi: 10.1016/j.chemosphere.2025.144565. Online ahead of print.

ABSTRACT

This study addresses the treatment of polluted Yamuna river water in Delhi using a green-synthesized ZnO@MoS₂/Rheum emodi (ZMR) nanocomposite as adsorbent. The ZMR was comprehensively characterized by FT-IR, XRD, BET, SEM, TEM, SAED, EDS, XPS, and TGA techniques. Yamuna water was collected and analysed for various pollutants using ICP-OES technique. It was found to contain 0.52 mg L^-1 of Cr(VI), which exceeds the permissible limits. For removal, the adsorption conditions were optimized via central composite design (CCD) of the response surface methodologies (RSM) which yielded optimal performance at 80 min contact time, pH 9.0, and 0.15 g L^-1 ZMR dose, achieving 98.84 % Cr(VI) removal. The adsorption followed pseudo-second order kinetics and Langmuir isotherm (Q_m = 684 mg g^-1). Thermodynamic analysis confirmed the process to be spontaneous, endothermic, and governed by electrostatic forces, hydrogen bonding, and complexation. The ZMR nanocomposite exhibited structural integrity, excellent regeneration (three cycles), and negligible Zn/Mo leaching across acidic, neutral, and basic media which was supported by UV-Vis. and post-treatment XRD analysis. Also, antibacterial efficacy against Serratia marcescens demonstrated colony reduction and inhibition zone formation. Additionally, physiochemical analysis of Yamuna river water revealed improvements in water quality parameters, such as DO, BOD, COD, pH, and salinity. Furthermore, a toxicity evaluation was conducted using the toxicity estimation software tool (TEST), which confirmed low ecological risk from major Rheum emodi phytoconstituents and a phytotoxicity assay with Trigonella foenum-graecum seeds showed high germination and healthy growth in ZMR-treated water. Overall, ZMR nanocomposite offered a cost-effective, eco-friendly, and multifunctional approach for Cr(VI) remediation and holistic improvement of river water quality.

PMID:40712195 | DOI:10.1016/j.chemosphere.2025.144565

Cognition. 2025 Jul 24;265:106258. doi: 10.1016/j.cognition.2025.106258. Online ahead of print.

ABSTRACT

The human visual system can recognise familiar forms, most notably faces, in other objects or patterns, a phenomenon known as pareidolia. The patterns that elicit pareidolia range from meaningful to ambiguous and random images, making it hard to generalise across the featural or configurational properties that trigger different types of pareidolia. Here, we aim to characterise the minimal stimuli associated with different types of pareidolia and investigate the extent to which pareidolia is tuned to variations in natural scene statistics and symmetry. Participants in the current study viewed a range of synthetic noise patterns varying in their spatiotemporal spectral and symmetry characteristics and reported any shapes or structure perceived in these patterns. The patterns with spatiotemporal properties typical of natural scenes generated the highest number of responses with more animate, rather than inanimate, forms overall. While faces were the most reported animacy-related percept, responses covered a wide range of animate agents including animals and mythical creatures. The greatest number and the highest proportion of animacy-related percepts were observed in vertically symmetrical patterns compared to other types of pattern symmetry. Together, the current study establishes that pareidolia is tuned to natural scene statistics and biased towards animate forms, especially in patterns with vertical symmetry. It also demonstrates the usefulness of synthetic noise stimuli for pareidolia research.

PMID:40712183 | DOI:10.1016/j.cognition.2025.106258

EBioMedicine. 2025 Jul 24;118:105863. doi: 10.1016/j.ebiom.2025.105863. Online ahead of print.

ABSTRACT

BACKGROUND: Spinal cord injury (SCI) clinical trials typically rely on a single primary endpoint to assess drug efficacy. This strategy fails to adequately capture the full impact of treatment in heterogenous neurological conditions like SCI. A more patient-centric analysis requires assessment of neurological function, functional capacity, and quality of life, incorporating meaningful patient-reported outcomes. The global statistical test (GST) addresses this challenge using a unified statistical conclusion regarding the superiority of a treatment strategy over another by evaluating multiple trial endpoints simultaneously.

METHODS: The RISCIS trial (Safety and Efficacy of Riluzole in Acute Spinal Cord Injury Study) data was analysed using a multivariate nonparametric GST, integrating the total American Spinal Injury Association (ASIA) motor score (TOTM), Spinal Cord Independence Measure (SCIM), and SF-36 PCS (Short Form-36 Physical Component Scale) scores. In the RISCIS trial, patients with severe cervical SCI (AIS A, B, and C) were randomised to receive riluzole or placebo within 12 h of injury in a double blinded fashion. We compared six-month outcomes between groups using a modified O’Brien’s rank sum test with sample variance adjustment. Higher summed ranks represent better global outcomes. The overall probability of improvement was computed using a summary estimate, the global treatment effect (GTE).

FINDINGS: A total of 131 patients (mean age 45.8 years old, 82% males) completed the six-month outcome assessment. Among these, 49.6% were classified as AIS A, 20.6% as AIS B, and 29% as AIS C. Riluzole was administered within 12 h from injury for 14 days in 65 patients, while 66 received a placebo. The unadjusted mean change from baseline to six months showed a favourable response in the riluzole group compared to placebo across TOTM (p = 0.28 by t-test; p = 0.26 by Wilcoxon test), SCIM (p = 0.04 by t-test; p = 0.02 by Wilcoxon test), or SF-36 PCS (p = 0.23 by t-test; p = 0.21 by Wilcoxon test) scores. Using the GST to simultaneously assess these measures, the riluzole group exhibited a higher rank sum compared to placebo [median rank sum = 207 (IQR: 166-246) in riluzole vs 185 (IQR: 146-236) in placebo, p = 0.04]. Subgroup analysis revealed the greatest treatment benefit among patients with AIS A injuries (GTE = 0.16, 95% CI: 0.01-0.31, p = 0.02). At six months, the probability that riluzole treatment resulted in overall better outcomes than placebo across all assessed outcomes was 58%.

INTERPRETATION: Riluzole was associated with improved global outcomes in patients with severe traumatic SCI, based on a composite score integrating ASIA total motor scores, SCIM, and SF36 outcomes at six months. Riluzole is a promising therapeutic option in SCI, but further investigation through higher-quality studies incorporating multidimensional assessments is warranted.

FUNDING: No funding was received for the present work. The original clinical trial (NCT01597518) was funded by the AO Foundation, United States Department of Defense (DOD), and the Praxis Spinal Cord Institute.

PMID:40712181 | DOI:10.1016/j.ebiom.2025.105863

J Neurosurg. 2025 Jul 25:1-6. doi: 10.3171/2025.3.JNS242385. Online ahead of print.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (cSDH) recurrence is a significant cause of morbidity in neurosurgical patients. Middle meningeal artery embolization (MMAe) effectively reduces cSDH recurrence by targeting its associated inflammatory cascade. Delayed recanalization can occur from proximal branches of the middle meningeal artery (MMA) after use of particle embolic agents. Surgeons may utilize coil embolization in addition to particle embolic agents to achieve proximal vessel control. This study compares reaccumulation rates for cSDH patients undergoing particle embolization of the MMA with and without coil embolization.

METHODS: A retrospective review of prospectively collected data was performed on the records of patients who underwent particle MMAe with or without coils for cSDH at the authors’ institution from 2021 to 2023 The primary outcome was cSDH recurrence at CT follow-up at least 1 month after MMAe.

RESULTS: Sixty-two patients underwent 81 embolization procedures with particles alone (n = 32) or particles and coils (n = 49). There was no significant difference in recurrence between particles versus particles and coils (6.3% vs 10.2%, p = 0.698). There was a statistical difference in procedure length (54.8 ± 28.7 vs 85.9 ± 26.5 minutes, p < 0.001) and fluoroscopy time (34.9 ± 20.8 vs 48.8 ± 24.7 minutes, p = 0.01) between patients who underwent particle embolization versus those who underwent embolization with particles and coils. A noninferiority analysis demonstrated no significant difference between groups in treatment failure, hematoma expansion, and follow-up size > 1 cm.

CONCLUSIONS: In the setting of cSDH, MMAe using particles only versus particles with coils shows similar rates of hematoma reaccumulation and resolution. Procedural time and fluoroscopy time were significantly reduced within the particle embolization-alone cohort. When comparing hematoma resolution and expansion, follow-up hematoma size > 1 cm, and decrease in hematoma size > 1 cm between groups, embolization using particles alone was not inferior to embolization using particles supplemented with coils.

PMID:40712175 | DOI:10.3171/2025.3.JNS242385

Retina. 2025 Jul 23. doi: 10.1097/IAE.0000000000004617. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effectiveness of using DisCoVisc as an alternative to perfluorocarbon liquid (PFCL) in stabilizing the detached retina during rhegmatogenous retinal detachment (RRD) surgery.

METHODS: Thirty eyes of 30 patients with RRD underwent the DisCoVisc technique for stabilizing the detached retina. Following intraoperative air-fluid exchange and the aspiration of subretinal fluid, DisCoVisc was applied to seal retinal breaks, thereby stabilizing the detached retina. Subsequent removal of the peripheral and basal vitreous was then performed. Intraoperative vitrectomy duration, retinal reattachment rate, postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications were analyzed.

RESULTS: Retinal reattachment was achieved in 28 eyes (28/30, 93.3%). The base of the vitreous was removed with a mean time of 10.17±2.94 min, and the total vitrectomy time was 22.93±4.97 min. At the last follow-up, the BCVA was 0.74±0.70 LogMAR, showing a significant improvement over the preoperative value of 1.44±1.25 LogMAR (Z=2.700, P=0.007). On the first postoperative day, the IOP was measured at 25.71±12.41 mmHg, exhibiting a statistically significant elevation compared to the preoperative IOP of 13.94±5.23 mmHg (P=0.000). There was no statistical difference in IOP at the last follow-up 14.01±2.68 mmHg compared to the preoperative IOP of 13.94±5.23 mmHg (P = 0.923). One patient developed macular hole after the operation, and there were no obvious complications during the operation.

CONCLUSIONS: DisCoVisc can effectively stabilize the detached retina during vitrectomy for RRD. Most significantly, it eliminated the risk of subfoveal PFCL residue-related complications.

PMID:40712142 | DOI:10.1097/IAE.0000000000004617