Category: Statistics

Eur J Med Res. 2025 Apr 21;30(1):311. doi: 10.1186/s40001-025-02567-7.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate the role of ⁶⁸Ga-labeled prostate specific membrane antigen HBED-CC (⁶⁸Ga-PSMA-11) PET/MRI in primary staging and to evaluate the relationship between PSMA-derived parameters and clinicopathological characteristics in newly diagnosed prostate cancer (PCa).

MATERIALS AND METHODS: This study reports the findings from 72 patients newly diagnosed with primary PCa, all of whom underwent ⁶⁸Ga-PSMA-11 PET/MRI scans. Calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ⁶⁸Ga-PSMA-11 PET/MRI for T, N, M staging, respectively. The maximum standardized uptake value (SUVmax), PSMA-tumor volume (PSMA-TVp), and total lesion-PSMA (TL-PSMAp) of primary lesion, PSMA-TV of total lesions (PSMA-TVt), and TL-PSMA of total lesions (TL-PSMAt) were measured, and Spearman correlation analysis was performed to assess their correlation with baseline prostate-specific antigen (PSA). Non-parametric Mann-Whitney U test was conducted to assess the difference of PSMA-derived parameters among clinicopathological characteristics of PCa. Receiver operating characteristic (ROC) curve was used to evaluate the performance of PSMA-derived parameters in diagnosing the clinicopathological characteristics of PCa.

RESULTS: The overall accuracy of ⁶⁸Ga-PSMA-11 PET/MRI in detecting T staging of PCa was 80.7%. Diagnostic accuracy for T2a, T2b, T2c, T3a, and T3b were 94.2%, 92.3%, 90.4%, 90.4%, and 94.2%, respectively. Diagnostic accuracy for N and M staging were 96.1% and 97.2% based on patients-level, respectively. There were significant correlation between the SUVmax, PSMA-TVp, TL-PSMAp, PSMA-TVt, TL-PSMAt and baseline PSA values. Significant differences were observed in SUVmax, PSMA-TVp, TL-PSMAp, PSMA-TVt, and TL-PSMAt between T3 and T2 staging. Statistical differences were observed in SUVmax, TL-PSMAp, PSMA-TVt, and TL-PSMAt between Gleason Score (GS) > 7 and GS ≤ 7, as well as positive and negative regional lymph node metastasis. TL-PSMAt show the highest value in assessing clinicopathological characteristics.

CONCLUSIONS: ⁶⁸Ga-PSMA-11 PET/MRI can provide accurate TNM staging for PCa, particularly in local staging. TL-PSMAt accurately evaluate overall tumor burden and aids in diagnosing clinicopathological characteristics in mid-to-late-stage patients, outperforming SUVmax.

PMID:40259392 | DOI:10.1186/s40001-025-02567-7

BMC Palliat Care. 2025 Apr 21;24(1):109. doi: 10.1186/s12904-025-01745-y.

ABSTRACT

PURPOSE: Head and neck cancer is the seventh most prevalent cancer, with over 660,000 new cases and 325,000 annual fatalities, accounting for 30% of all cancer cases. Chronic cancer-related pain affects 15-75% of patients, with myofascial pain being especially common in those with head and neck cancers, ranging from 11.9 to 44.8%. Surgery and radiotherapy, the primary treatments for these cancers, contribute to myofascial pain development. Additionally, head and neck cancer patients face higher psychological distress, with rates up to 50%. This study estimates the prevalence, topography of the musculoskeletal group, and emotional impact of myofascial pain in terms of depression in patients three months post-treatment, emphasizing early diagnosis for improved quality of life.

METHODS: We conducted a time-bound cross-sectional observational study using convenience sampling of 120 patients with head and neck cancer who were post-surgery or radiotherapy over a 12-month period from April 2023 to March 2024. Data were collected using structured proforma and validated tools. Descriptive statistics summarized continuous variables, and chi-square tests compared categorical variables. Pearson correlation measured linear relationships, while regression analysis estimated the relationship between pain and explanatory variables. A two-sided p-value of < 0.05 was considered statistically significant.

RESULTS: The prevalence of myofascial pain was 68.3% (n = 82), though no statistically significant relationship was found between its occurrence and time since therapy (p > 0.05). The most affected muscle was sternocleidomastoid (55%), followed by masseter (29.2%), trapezius (25.8%), temporalis (15%), levator scapulae (8.3%), posterior cervical (5.8%), and splenius capitis (3.3%). Additionally, 75.8% (n = 91) of participants had depression on PHQ-9, with 85.4% (n = 70) with myofascial pain experiencing depressive symptoms. Pain score and depression in patients with myofascial pain were positively correlated with a value of 0.579 (p-value < 0.05).

CONCLUSION: Myofascial pain is common in patients with head and neck cancer post-treatment with a negative impact on emotional well-being. It primarily affects the muscles involved in the neck and shoulder movements. It is important to identify early and manage the complications to enhance quality of life.

CLINICAL TRIAL REGISTRATION: The study is registered with the Clinical Trials Registry India and the assigned registration number for this study is CTRI/2023/03/050268 on 02/03/2023.

PMID:40259373 | DOI:10.1186/s12904-025-01745-y

BMC Oral Health. 2025 Apr 21;25(1):614. doi: 10.1186/s12903-025-05988-2.

ABSTRACT

BACKGROUND: To evaluate surface microhardness, roughness, and gloss changes of tooth-colored restorative materials [a direct composite (G-aenial A’Chord), an indirect composite (Gradia Plus), an ormocer (Admira Fusion), a giomer (Beautifil II), and an alkasite (Cention N)] after exposure to simulated gastric acid.

METHODS: A total of 110 disc-shaped specimens (22 discs of each material) were prepared using silicone molds (8 mm×2 mm) and exposed to either gastric acid or artificial saliva (control). Surface roughness (Ra), gloss (GU), and microhardness (VHN) were measured at baseline and after 96-hour of immersion in the solutions and the respective changes (∆Ra, ∆GU, ∆VHN) were calculated. Intergroup comparisons were performed using ANOVA (Tukey post hoc) or Kruskal-Wallis tests (Bonferroni correction). Independent samples t-test or Mann-Whitney U test was used for comparisons of each material across immersion media, while paired t-test was applied for time-dependent analyses.

RESULTS: In the gastric acid medium, changes in all parameters led to significant differences among restorative materials, while in the artificial saliva medium, significant differences were observed in ∆VHN and ∆GU. The statistically significant difference between immersion media was observed in both ∆VHN and ∆Ra values for the giomer group, and in only ∆VHN values for the alkasite and indirect composite groups. In the gastric acid medium, the decrease in VHN and GU values was significant across all subgroups, while the increase in Ra was statistically significant only in the giomer and alkasite groups.

CONCLUSIONS: While the giomer group exhibited the most significant changes in roughness and microhardness following exposure to gastric acid, all tested materials executed clinically admissible results regarding surface gloss.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40259372 | DOI:10.1186/s12903-025-05988-2

World J Surg Oncol. 2025 Apr 21;23(1):147. doi: 10.1186/s12957-025-03790-6.

ABSTRACT

OBJECTIVE: This meta-analysis evaluates the diagnostic value of SOX1 methylation across different cervical cancer types, including squamous cell carcinoma and adenocarcinoma, to assess its efficacy as a biomarker.

METHODS: We reviewed studies published up to March 2024, employing a PICOS-based search strategy in databases like PubMed and Web of Science. We included clinical studies providing diagnostic performance indicators while excluding non-clinical and small-sample studies. Meta-Disc1.4 and Stata15.1 were used for statistical analyses focusing on SOX1 methylation’s sensitivity, specificity, and diagnostic odds ratio.

RESULTS: Twelve articles encompassing 18 studies with 3,213 subjects were analyzed. The overall DOR for SOX1 methylation in cervical cancer diagnosis was 68.95 (95%CI: 27.63-172.07), with a Summary Receiver Operating Characteristic AUC of 0.92, indicating high diagnostic accuracy. Specifically, the DOR for adenocarcinoma was 87.57 (95%CI: 7.05-1087.44) with an AUC of 0.89, and for squamous cell carcinoma, it was 245.87 (95% CI: 26.49-2282.40) with an AUC of 0.93, reflecting significant diagnostic potential for both cancer types. No substantial publication bias was detected (P > 0.10).

CONCLUSION: SOX1 gene methylation demonstrates significant diagnostic value for both adenocarcinoma and squamous cell carcinoma of the cervix, particularly effective in large sample sizes and cervical exfoliated cell samples for early detection and screening, supporting its utility as a reliable biomarker.

PMID:40259371 | DOI:10.1186/s12957-025-03790-6

BMC Palliat Care. 2025 Apr 21;24(1):107. doi: 10.1186/s12904-025-01748-9.

ABSTRACT

BACKGROUND: End-stage kidney disease (ESKD) significantly burdens healthcare systems and increases mortality. In India, approximately 175,000 individuals are relying on maintenance hemodialysis (mHD). This study aims to analyze the place of death, mortality patterns and clinical issues surrounding death in patients with ESKD undergoing mHD at a tertiary care hospital in south India.

METHODS: This retrospective study reviewed the medical records of 280 patients with ESKD who underwent mHD between January 2016 and April 2022. Data were collected on demographics, financial details, comorbidities, cause of death, clinical issues, and location of death. Descriptive statistics, including means, frequencies, and proportions, were used to summarize findings.

RESULTS: Among the 280 patients on mHD, there were 98 deaths. Of these, 73.5% died in hospitals, primarily in intensive care units. Of all the patient deaths, 57.7% patients who died at home and 41.6% of hospitalized patients paid out of pocket treatment expenses. Infections and cardiovascular complications were the leading causes of death. High comorbidity and symptom burden were reported, with edema, fatigue, and breathlessness being the most common symptoms. Among the hospital deaths, withholding or withdrawing life sustaining treatments was documented in only 22.2% of cases.

CONCLUSIONS: Our study provides critical insights into mortality patterns and the need for improved kidney supportive care integration in patients with ESKD. Addressing symptom burden, enhancing ACP, and implementing end of life care protocols could align healthcare delivery with patient preferences, ultimately improving the quality of end of life care in this vulnerable population. Further research is recommended to explore broader interventions and their impact on patient outcomes.

PMID:40259368 | DOI:10.1186/s12904-025-01748-9

BMC Rheumatol. 2025 Apr 21;9(1):46. doi: 10.1186/s41927-025-00500-3.

ABSTRACT

BACKGROUND: Immune-mediated necrotizing myopathy (IMNM) and dermatomyositis (DM) are characterized by weakness, hyperCKemia, associated autoantibodies, and varying extramuscular manifestations. Muscle MRI, currently subordinate to histopathology and serology in idiopathic inflammatory myopathy (IIM) classification, has an evolving role. Our study aims to define thigh muscle MRI involvement in IMNM and DM by direct comparison.

METHODS: This single-center, retrospective, cross-sectional study included 25 participants, who met IIM classification criteria (14 IMNM, 11 DM) and had available thigh MRI. Clinical and paraclinical data were available and reviewed. 11 muscles were graded for edema on MRI using a semi-quantitative scale (0: normal, 1: <30% of muscle involvement, 2: 31-75%, 3: > 75%). For 3 participants with no significant muscle edema, muscle fatty infiltration was scored according to the same scale. Using linear mixed-effects models, muscle scores were compared between the two groups and a secondary analysis was performed of only edema scores, excluding the 3 participants with fatty infiltration scores.

RESULTS: The most affected muscles in IMNM were the semimembranosus (3.0 [2.7-3.0] {median [IQR]}), biceps femoris-long head (BF-LH) (2.7 [2.0-3.0]), and adductors (2.5 [2.0-3.0]). In DM, the most affected muscles were the vastus lateralis (2.7 [2.3-3.0]), vastus intermedius (2.9 [2.2-3.0]), vastus medialis (2.3 [1.7-2.7]), semitendinosus (2.2 [1.0-2.7]), rectus femoris (RF) (2.0 [1.0-2.8]), biceps femoris-short head (BF-SH) (1.9 [1.0-2.7]), gracilis, and sartorius. Intergroup statistical difference of scores was significant (p < 0.01) for 10/11 thigh muscles excluding the RF (p = 0.19), supporting an inverse relationship of muscle involvement for DM and IMNM. The secondary comparative analysis of only muscle edema scores was significant (p < 0.05) for the same 10/11 muscles with a consistent direction for all comparisons.

CONCLUSION: DM and IMNM affect disparate thigh muscles on MRI. DM preferentially affects the anterior thigh, semitendinosus and BF-SH in the posterior thigh, and gracilis in the medial thigh, whereas IMNM preferentially affects the posterior thigh (semimembranosus and BF-LH) and adductors in the medial thigh.

PMID:40259367 | DOI:10.1186/s41927-025-00500-3

BMC Musculoskelet Disord. 2025 Apr 21;26(1):389. doi: 10.1186/s12891-025-08634-8.

ABSTRACT

OBJECTIVE: To estimate the prevalence of flatfoot and to analyze the gender difference of plantar pressure in third-year high school students in Tongzhou District Beijing.

METHODS: From March 2019 to March 2021, 1217 third-year high school students in Tongzhou District, Beijing were tested for plantar pressure. The prevalence of flatfoot was calculated and related plantar pressure parameters were analyzed, including contact area and plantar pressure. The differences of plantar pressure parameters between different genders were analyzed.

RESULTS: The prevalence of flatfoot among third-year high school students in Tongzhou District, Beijing was 5.5% (95% CI: 4.3-6.7%), among which, the prevalence of flatfoot among boys was 5.3% (95% CI: 3.8-6.8%) and that among girls was 5.9% (95% CI: 3.9-7.9%). There was no significant difference in the prevalence of flatfoot among different genders (P = 0.326), and the left and right foot types were basically the same. The mean BMI of the study population was 22.6 ± 3.4 kg/m², with males having a slightly higher mean BMI (23.1 ± 3.6 kg/m²) compared to females (21.9 ± 3.0 kg/m²). In static phase, there were statistically significant differences in contact area, plantar pressure at great toe, plantar pressure at 2nd – 5th toe, plantar pressure at 2nd – 4th metatarsal, and plantar pressure at middle foot(P < 0.05) between male students and female students. In dynamic phase, there were significant differences in contact area, plantar pressure at great toe, plantar pressure at 2nd – 5th toe and plantar pressure at 5th metatarsal (P < 0.05).

CONCLUSION: The findings of this study suggest that while flatfoot prevalence is similar between genders in third-year high school students, significant gender-specific differences exist in plantar pressure distribution patterns. These differences persist in both static and dynamic phases, with potential implications for gender-specific foot health assessment and preventive interventions. Understanding these patterns may help in early detection of foot abnormalities and implementation of appropriate interventions to prevent long-term biomechanical issues in this age group.

PMID:40259362 | DOI:10.1186/s12891-025-08634-8

Int J Equity Health. 2025 Apr 21;24(1):109. doi: 10.1186/s12939-025-02475-6.

ABSTRACT

BACKGROUND: Black individuals in the U.S. report experiencing the highest levels of racial discrimination in healthcare. Racial discrimination in healthcare contributes to mental health issues and has been shown to be associated with loneliness. Despite this, there is limited research on the role loneliness plays in the relationship between racial discrimination in healthcare settings and mental health outcomes. This study explored the relationship between racial discrimination in healthcare, loneliness, and mental health outcomes (depression and anxiety) among Black individuals.

METHODS: This study was part of the PhillyCEAL (Community Engagement Alliance) initiative. Between February 2024 and April 2024, 327 Black Philadelphia residents completed online surveys. Multiple linear regression analyses examined the associations between racial discrimination in healthcare, loneliness, depression, and anxiety. Covariates included Hispanic ethnicity, age, insurance, lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) status, sex assigned at birth, relationship status, employment, medical conditions, income, and education.

RESULTS: Racial discrimination in healthcare was positively associated with loneliness (b = 0.66, 95% CI: 0.29 to 1.04), depression (b = 0.52, 95% CI: 0.19 to 0.86), and anxiety (b = 0.85, 95% CI: 0.50 to 1.19). When controlling for loneliness, the association between racial discrimination in healthcare and depression became non-significant (b = 0.29, 95% CI: -0.03 to 0.61), while the association between racial discrimination in healthcare and anxiety remained significant (b = 0.62, 95% CI: 0.29 to 0.94).

CONCLUSION: Addressing racial discrimination within healthcare settings is crucial for improving mental health outcomes among Black populations. Given the significant role of loneliness in this relationship, interventions aimed at reducing loneliness may help mitigate the adverse mental health effects of racial discrimination in healthcare for Black populations.

PMID:40259356 | DOI:10.1186/s12939-025-02475-6

Eur J Med Res. 2025 Apr 21;30(1):312. doi: 10.1186/s40001-025-02527-1.

ABSTRACT

BACKGROUND: Lymphocyte-to-C-reactive protein ratio (LCR) has been linked to survival in malignancies. However, most studies are from Asia. The knowledge about the link between LCR levels and risks of all-cause mortality and cause-specific mortality among cancer participants in the US is lacking.

METHODS: Using multivariable Cox proportional hazards regression, we investigated the associations between LCR and mortalities in 1999 cancer participants from the National Health and Nutrition Examination Survey 1999-2008 with mortality follow-up through December 31, 2019.

RESULTS: The median follow-up time was 156 months. Cancer participants with low LCR levels were associated with increased risks for all-cause and cancer mortality. Based on the full adjustment model, compared to the lowest LCR tertile, the hazard ratios and 95% confidence interval (HR, 95% CI) of all-cause mortality were 0.75 (0.66-0.87) in the second tertile, 0.60 (0.49-0.72) in the top tertile. The HR of cancer mortality was 0.71 (0.52-0.99) in the second tertile and 0.53 (0.35-0.79) in the top tertile. The link between LCR level and all-cause and cancer mortality remained significant when individuals who died within 2 years of follow-up were excluded.

CONCLUSIONS: This prospective study provided evidence of inverse associations between LCR levels and all-cause and cause-specific mortalities based on representative noninstitutional US cancer survivors. Integrating LCR assessment in the clinical routine of US cancer patients may aid in identifying cancer individuals at high risk of mortalities.

PMID:40259355 | DOI:10.1186/s40001-025-02527-1

Health Qual Life Outcomes. 2025 Apr 21;23(1):42. doi: 10.1186/s12955-025-02366-y.

ABSTRACT

INTRODUCTION: Patients with multimorbidity who frequently require healthcare may experience a higher treatment burden. In this study, we investigated whether high perceived treatment burden and low perceived health-related quality of life (HRQoL) were associated with healthcare utilisation among patients who attended at least two medical outpatient hospital clinics.

METHODS: Patients who underwent medical treatment in two or more outpatient medical clinics at Silkeborg Regional Hospital in Denmark in August 2018 were included. The patients received a questionnaire containing the Multimorbidity Treatment Burden Questionnaire and the Short Form-12 questionnaire measuring HRQoL in terms of physical and mental health. Information on healthcare utilisation was collected from electronic registers one year prior to receiving the questionnaire. Logistic regression was applied to estimate the odds of ‘no/low’ and ‘high’ perceptions of treatment burden and ‘low’ self-rated HRQoL in relation to healthcare utilisation.

RESULTS: In total, 930 patients (59.8%) answered the questionnaire. The degree of patient-assessed treatment burden was not associated with the number of outpatient contacts, hospital admissions or admission days. A high perceived treatment burden was associated with a high number of general practice contacts, whereas a low treatment burden was associated with fewer contacts in general practice, indicating a dose‒response pattern. The same pattern of associations was observed for perceived physical and mental health.

CONCLUSION: Patients with high perceived treatment burden and low HRQoL seemed to consult their general practitioner primarily despite hospital involvement. These patients may require frequent primary care attention due to other factors than those being treated at the hospital. However, further research is warranted to explore the mechanisms underlying these associations and strategies for reducing treatment burden and enhancing HRQoL in patients with multiple medical conditions.

PMID:40259350 | DOI:10.1186/s12955-025-02366-y