Category: Statistics

Ann Surg Oncol. 2025 Nov 15. doi: 10.1245/s10434-025-18738-z. Online ahead of print.

ABSTRACT

INTRODUCTION: The application of closed incision negative pressure therapy (ciNPT) systems over closed surgical incisions purportedly lowers postoperative complications; however, there is little evidence to support its use in oncoplastic breast surgery. The primary objective of this study was to compare major and minor wound complication rates in patients with breast cancer undergoing oncoplastic procedures, with and without the use of the ciNPT.

PATIENTS AND METHODS: A prospectively maintained database of patients undergoing breast conserving oncoplastic procedures with placement of ciNPT system at a single institution was queried. This cohort was compared with a retrospective contemporaneous control group receiving primary two-layered suture and skin adhesive closure only. Major complications included abscess/hematoma/seroma needing drainage, and wound breakdown or asymmetry requiring return to the OR. Minor complications included breast lymphedema/erythema, minor nipple necrosis, and wound breakdown or mild asymmetry not requiring return to OR. Analyses were performed using Chi-square test or Fisher’s exact test, where applicable, and univariate logistic regression models, with statistical significance set at p < 0.05.

RESULTS: Of 186 patients, there were 93 in the ciNPT and 93 in the control group. There were significantly fewer major complications in the ciNPT group (1.1% ciNPT versus 10.8% control, p = 0.010). There was no significant difference in the rates of minor complications, and no difference in complication rates based on comorbidities or tumor characteristics.

CONCLUSIONS: ciNPT decreases major postoperative wound complications in patients with breast cancer undergoing oncoplastic procedures. Minimization of major postoperative complications can help ensure the timely initiation of adjuvant therapy following breast conserving oncoplastic procedures.

PMID:41241710 | DOI:10.1245/s10434-025-18738-z

Spinal Cord. 2025 Nov 15. doi: 10.1038/s41393-025-01140-7. Online ahead of print.

ABSTRACT

STUDY DESIGN: Cohort study.

OBJECTIVES: To determine the prevalence and to identify predictors of prescription opioid use among persons with non-traumatic spinal cord dysfunction within one year after discharge from inpatient rehabilitation.

SETTING: Ontario, Canada.

METHODS: We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the one year after discharge from inpatient rehabilitation among persons with non-traumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modelled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals.

RESULTS: We identified 3468 individuals with non-traumatic spinal cord dysfunction (50.35% male) with 66.58% who were aged ≥66. Over half of the cohort (59.46%) received opioids during the observation period. Being female, previous opioid use before rehabilitation, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis were significant risk factors for receiving opioids after discharge, as shown in an adjusted multivariable analysis. Increasing length of rehabilitation stay was protective against opioid receipt after discharge. Risk of receiving opioids varied with age. Younger individuals had a significantly higher risk of future opioid use, a risk that peaked around 30-40 years of age (aRR 1.54, 95% CI 1.42-1.67 for age 40, as compared to age 80). Risk of opioid use following discharge decreased as age increased beyond 40 years, as compared to age 80.

CONCLUSIONS: Many individuals with non-traumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.

PMID:41241697 | DOI:10.1038/s41393-025-01140-7

Metabolomics. 2025 Nov 15;21(6):174. doi: 10.1007/s11306-025-02376-3.

ABSTRACT

This study builds on a prior proof-of-concept metabolomic analysis of post-mortem pericardial fluid to assess its reproducibility and validate its utility for estimating the post-mortem interval. Sixty-five pericardial fluid samples were collected during medico-legal autopsies in two different Forensic Medicine Institutes with post-mortem intervals spanning 16 to 199 h. Samples underwent liquid-liquid extraction and ¹H NMR analysis, quantifying 50 metabolites. Multivariate statistical analyses were employed to develop post-mortem interval estimation models, controlling for age to minimize its confounding effects. Reproducibility was confirmed, with 92% of metabolites showing high similarity (cosine similarity ≥ 0.90) in 23 re-analyzed samples, demonstrating robust intra-laboratory consistency. For post-mortem intervals of 16 to 100 h, the regression model achieved presented a prediction error of 16.7 h, identifying nine key predictors, including choline, glycine, citrate, betaine, ethanolamine, glutamate, ornithine, uracil, and β-alanine. For intervals of 16 to 130 h, the prediction error was 23.2 h, and for 16 to 199 h, it was 42.1 h. A classification model distinguishing intervals below 48 h from those above 48 h showed high accuracy for detecting longer intervals, with key predictors including aspartate, histidine, and proline. These findings underscore the stability and reproducibility of pericardial fluid metabolomics, establishing its potential as a reliable forensic tool for post-mortem interval estimation, particularly beyond 48 h, with significant implications for forensic investigations.

PMID:41241694 | DOI:10.1007/s11306-025-02376-3

J Immigr Minor Health. 2025 Nov 16. doi: 10.1007/s10903-025-01822-7. Online ahead of print.

ABSTRACT

Patients with Non-English Language Preference face significant barriers to healthcare, often due to inadequate use of professional medical interpreters. Despite evidence showing that medical interpreters improve patient outcomes, many healthcare providers lack training in effective medical interpreter use. This study evaluates the impact of the Med Interpreter website on first-year medical students’ comfort and proficiency in working with interpreters during clinical encounters. The intervention involved a 30-minute presentation on the Med Interpreter website, which offers guidelines and resources for interpreter use in English and Spanish. Following the presentation, students participated in a simulated patient encounter using standardized patients and interpreters. Pre- and post-intervention surveys assessed changes in students’ comfort, confidence, and understanding of interpreter use. A total of 98 out of 130 participants completed both surveys. Statistically significant improvements were observed in student comfort, confidence, and knowledge of interpreter guidelines and resources, highlighting the intervention’s effectiveness. The results highlight the effectiveness of Med Interpreter in enhancing students’ knowledge and skills related to interpreter use. This intervention demonstrates the importance of structured training in addressing language barriers in healthcare and underscores the potential for scalable tools like Med Interpreter to improve patient-provider communication and reduce health disparities.

PMID:41241691 | DOI:10.1007/s10903-025-01822-7

J Mol Neurosci. 2025 Nov 15;75(4):151. doi: 10.1007/s12031-025-02439-z.

ABSTRACT

Spinal cord injury (SCI), a traumatic type of central nervous system injury, is closely associated with neuronal apoptosis. However, the specific biomarkers and regulatory mechanisms of neuronal apoptosis in SCI patients remain unclear. In this study, we aimed to identify differentially expressed proteins (DEPs) that regulate neuronal apoptosis after SCI and reveal potential diagnostic and therapeutic targets. Spinal cord tissues were collected for LC‒MS/MS analysis at five different time points after injury. Enrichment analysis, WGCNA, random forest, support vector machine recursive feature elimination, and receiver operating characteristic (ROC) curve analysis methods were used to identify proteins and pathways associated with neuronal apoptosis. Validation was performed using a rat model and PC12 cells. A total of 351 DEPs were identified. By integrating DEPs, WGCNA, and machine learning methods, filamin A (FLNA), an apoptosis-related protein, was identified. The reliability of this finding was confirmed in the above three datasets. Spearman correlation analysis was performed to identify the top 100 proteins whose expression correlated with that of FLNA, which were then subjected to enrichment analysis. GO enrichment analysis and KEGG enrichment analysis revealed that expression of these proteins was enriched in mitochondrial oxidative phosphorylation. Western blot and qRT‒PCR analyses confirmed the upregulation of FLNA expression in a rat model of SCI. In vitro experiments revealed that silencing FLNA expression using siRNA reduced H₂O₂-induced apoptosis and ROS production in PC12 cells. Additionally, FLNA expression knockdown inhibited the PI3K/AKT signalling pathway. FLNA is a critical molecular target for neuronal apoptosis following SCI.

PMID:41241686 | DOI:10.1007/s12031-025-02439-z

Intern Emerg Med. 2025 Nov 16. doi: 10.1007/s11739-025-04201-0. Online ahead of print.

ABSTRACT

Sepsis and septic shock represent significant health concerns in emergency departments due to their high mortality rates. This study aimed to evaluate the prognostic predictive ability of the HOTEL score in patients diagnosed with sepsis and septic shock in the emergency department. This single-center, prospective, observational diagnostic evaluation study included a total of 151 patients who presented to the emergency department between August 1, 2023, and March 1, 2024, and were diagnosed with sepsis or septic shock. The demographic, clinical, and laboratory data of the patients were recorded. The HOTEL score was calculated based on parameters including systolic blood pressure, oxygen saturation, body temperature, electrocardiographic changes, and loss of independence. Statistical analyses included receiver operating characteristic curves, logistic regression, and diagnostic test performance metrics. The median age of the included patients was 75 (interquartile range: 66.5-83.5) years. In terms of 30-day mortality, the HOTEL score (area under the curve [AUC]: 0.607) and SOFA score (AUC: 0.612) demonstrated similar predictive ability. Regarding the need for intubation in the emergency department, the HOTEL score (AUC: 0.773) and SOFA score (AUC: 0.835) were statistically significant. Multivariate analysis identified the HOTEL score, C-reactive protein levels, and the presence of active malignancy as independent predictors of 30-day mortality. Among the parameters of the HOTEL score, loss of independence emerged as the most significant predictor. According to the results of our study, the HOTEL score serves as an independent predictor of short-term mortality in patients with sepsis and septic shock. It may be a useful tool in predicting short-term mortality and the need for intubation in the emergency department for patients with sepsis and septic shock. However, it is recommended that the HOTEL score be used in combination with other clinical parameters rather than alone. In particular, clinical parameters such as loss of independence appear to contribute significantly to the predictive power of the score. Future studies should focus on modifying the HOTEL score and evaluating its utility in different patient populations and larger sample sizes.

PMID:41241685 | DOI:10.1007/s11739-025-04201-0

Environ Geochem Health. 2025 Nov 16;47(12):574. doi: 10.1007/s10653-025-02872-4.

ABSTRACT

This study highlights the critical environmental and human health risks posed by heavy metal contamination in oil and gas drilling regions. Heavy metal contamination in surface sediments resulting from oil and gas drilling activities presents a significant environmental and human health concern. This research critically examines the impacts of hydraulic fracturing wastewater on surface sediment quality, focusing on environmental consequences. For the first time in the region, sediment samples were analysed to identify heavy metals associated with oil and gas operations. A combination of pollution indices, positive matrix factorization (PMF), and health risk assessment (HRA) was applied to comprehensively assess sediment quality, contamination sources, and health risks. To evaluate contamination levels, various pollution indices were employed, including Geoaccumulation Index (Igeo), enrichment factor (EF), contamination factor (CF), pollution load index (PLI), potential ecological risk index (PERI), toxic risk index (TRI), and modified hazard quotient (mHQ). Source apportionment was conducted using PMF and multivariate statistical techniques to identify the potential origins of heavy metals in surface sediments. The results of the pollution indices indicate moderate to severe contamination, with As, Cr, and Pb showing elevated levels beyond sediment quality guidelines. The PERI and TRI values confirmed high ecological risk, with arsenic and chromium contributing the most to environmental toxicity. PMF analysis identified five major contamination sources, including geogenic weathering, petroleum drilling waste, industrial effluents, aquaculture inputs, and agricultural runoff. The HRA results demonstrated that children are at greater non-carcinogenic risk (HI > 1), particularly due to As, Cr, and Pb exposure via ingestion. The carcinogenic risks for As and Cr exceeded the USEPA threshold (1 × 10^-4), suggesting long-term health concerns for populations residing near contaminated sites. The integration of pollution indices, PMF source apportionment, and HRA provides a scientific framework for assessing contamination severity and health risks. These findings underscore the urgency of implementing proactive environmental monitoring, stricter regulatory controls, and effective remediation strategies to safeguard ecosystem and human health in hydrocarbon-extraction areas.

PMID:41241673 | DOI:10.1007/s10653-025-02872-4

Metabolomics. 2025 Nov 15;21(6):166. doi: 10.1007/s11306-025-02369-2.

ABSTRACT

INTRODUCTION: Identifying the phytochemistry underpinning a plant’s observed therapeutic benefits is essential for understanding mechanisms of action and developing novel therapeutics. More recent efforts fusing global metabolomics and multivariate predictive modeling have improved compound discovery; however, these models rely on chemical variations between samples, which often necessitates at least one round of fractionation and may result in compound loss or degradation.

OBJECTIVES: This study uses multiple whole botanical extracts to explore whether a metabolome-wide association study approach can accurately identify bioactive phytochemicals without prior fractionation.

METHODS: We employed 40 Ocimum extracts with a range of IC₅₀ levels against HT-29 cells in an in vitro MTT assay and combined this data with untargeted UPLC-MS/MS metabolomics for biochemometric modeling of the potential bioactives. Multiple chemometric tools and statistical filters were employed to improve feature selection.

RESULTS: The metabolomic profiles resulted in ca. 1600 metabolite features; implementing source-based filters, followed by LASSO dimension reduction, improved the reliability of Partial Least Squares (PLS) bioactivity predictions. The resulting model highlighted four biomarkers positively correlated with activity, one of which was putatively identified as gallic acid. Gallic acid’s cytotoxicity against HT-29 cells was confirmed with the purified compound.

CONCLUSION: This study results demonstrated that predictive modeling of botanicals using a metabolome-wide association study of extracts with no fractionation was capable of identifying biologically active compounds.

PMID:41241661 | DOI:10.1007/s11306-025-02369-2

Pediatr Res. 2025 Nov 15. doi: 10.1038/s41390-025-04569-x. Online ahead of print.

ABSTRACT

BACKGROUND: This multicenter prospective study, conducted between 2019 and 2022 in two neonatal intensive care units (NICUs) in Madrid (H. Severo Ochoa and H. La Paz), investigated the relationship between nasopharyngeal and gut microbiota in very preterm infants born at <32 weeks of gestation age and the development of recurrent wheezing during the first year of life.

METHODS: A total of 91 preterm neonates were enrolled, excluding those with major malformations, genetic disorders, or immunodeficiency. During hospitalization, weekly nasopharyngeal aspirates (NPAs) were collected, beginning in the first 7 days of life. Respiratory viruses were detected via PCR. Stool samples for microbiota were obtained only one time during the first week of life. Microbial composition was characterized through 16S rRNA gene sequencing. The analysis of associations with wheezing specifically included microbiota data from samples collected during the first week of life (stools and NPAs). Microbial profiles were analyzed using bioinformatic and statistical tools, including alpha and beta diversity metrics, redundancy analysis (RDA), and random forest predictive models. Wheezing was defined as ≥2 episodes of physician-confirmed wheezing requiring medical attention during the first year of life, as reported by caregivers and verified by clinical records.

RESULTS: The results showed that clinical factors such as delivery mode, antibiotic use, type of feeding, and mechanical ventilation significantly influenced microbial profiles. Infants who developed wheezing had a higher abundance of pathogens such as Klebsiella, Escherichia/Shigella, and Stenotrophomonas, whereas Bifidobacterium and Staphylococcus were more frequent in non-wheezing infants. Both nasopharyngeal and gut microbiota were significantly associated with respiratory outcomes, including hospital admissions and chronic respiratory treatments. Early-life dysbiosis-shaped by antibiotics and artificial feeding-was linked to heightened inflammation and increased risk of respiratory morbidity.

CONCLUSIONS: This study suggests that microbial composition during the first week of life can serve as an early predictor of wheezing in preterm infants. Targeted interventions, such as promoting breastfeeding and reducing unnecessary antibiotic use, may help preserve microbial diversity and improve long-term respiratory health in this vulnerable population.

IMPACT: The microbiota of preterm neonates during the first week of life plays a pivotal role in determining the risk of respiratory diseases, such as wheezing, later in life. Clinical factors such as antibiotic use, delivery mode, and breastfeeding have a profound impact on microbiota composition, with specific genera such as Moraxella, Corynebacterium, and Bifidobacterium emerging as key biomarkers, making them important targets for interventions to promote long-term respiratory health in preterm infants. To recognize microbial predictors of recurrent wheezing in preterm infants could allow to explore potential microbiota-modulating strategies to mitigate respiratory complications in this high-risk population.

PMID:41241657 | DOI:10.1038/s41390-025-04569-x

Ann Rheum Dis. 2025 Nov 14:S0003-4967(25)04511-X. doi: 10.1016/j.ard.2025.10.024. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the study was to determine the frequency of adverse pregnancy outcomes in women with spondyloarthritis (SpA) in comparison to controls from the French general population, and to identify factors associated with these adverse pregnancy outcomes.

METHODS: This French prospective multicentre cohort study included pregnant women with SpA (both axial and peripheral) according to their treating rheumatologist between December 2015 and June 2021. Maternal characteristics, disease activity, treatments, and pregnancy outcomes were analysed. Outcomes of pregnancies in women with SpA were compared to that of matched (1:4) general population women from the 2016 and 2021 French National Perinatal Surveys, including pregnancy, neonatal, and maternal outcomes. For adverse pregnancy outcomes that are significantly more frequent in patients with SpA, logistic regression analysis was performed to identify potential risk factors.

RESULTS: A total of 135 SpA pregnancies in 124 women were analysed: they have a mean age of 32.1 years, a mean disease duration of 6.3 years, and 50.4% were nulliparous. Small for gestational age (SGA) was the most common adverse pregnancy outcome and occurred more frequently in women with SpA compared to controls (17.4% vs 9.8%, odds ratios = 1.94, 95% CI 1.09-3.39). Other adverse pregnancy outcomes rates, including preterm birth and caesarean delivery, were comparable to the general population. No predictor of SGA was identified in women with SpA.

CONCLUSIONS: In this contemporary cohort, compared to the general population, SpA was associated with a higher risk of SGA, but no other adverse pregnancy outcomes, providing reassurance for most pregnant women with SpA.

PMID:41241656 | DOI:10.1016/j.ard.2025.10.024