Category: Statistics

Adv Rheumatol. 2025 Dec 17. doi: 10.1186/s42358-025-00510-2. Online ahead of print.

ABSTRACT

BACKGROUND: Oxidative stress and inflammation contribute to telomere length (TL) attrition, a hallmark of cellular senescence. Systemic lupus erythematosus (SLE) is associated with premature cellular aging; however, the clinical relevance of TL shortening remains unclear. This study aimed to compare the relative TL of SLE patients and healthy controls and explore its association with clinical features and disease burden.

METHODS: We conducted a cross-sectional study including adult SLE patients and age- and sex-matched healthy controls (18-60 years). Demographic and clinical data were collected, and TL was measured using quantitative polymerase chain reaction (qPCR). Among SLE patients, disease activity, cumulative damage, fatigue, depression, anxiety, stress, and physical activity were also assessed. Statistical analyses included descriptive statistics, Student’s t-test or Mann-Whitney test for group comparisons, Spearman’s correlation, and multiple linear regression models selected based on the lowest Akaike information criterion (AIC).

RESULTS: Sixty SLE patients (37 years ± 11.5) and 55 controls (38 years ± 10.5) were enrolled. SLE patients exhibited significantly shorter TL [median (IQR): 0.80 (0.29-2.94)] compared to controls [1.07 (0.38-2.32); p = 0.005]. In multivariate analysis, moderate anxiety was associated with shorter TL compared to none/low anxiety [β= -0.353 (95%CI: -0.645; -0.061); p = 0.019]. An alternative model indicated that moderate stress was also associated with reduced TL [β= -0.411 (95%CI: -0.771; -0.050); p = 0.026]. No significant associations were found between TL and disease activity or cumulative damage.

CONCLUSIONS: SLE patients presented significantly shorter telomeres than healthy controls, with anxiety and stress symptoms contributing to TL attrition. Longitudinal studies are warranted to elucidate the clinical implications of TL shortening in SLE.

PMID:41402941 | DOI:10.1186/s42358-025-00510-2

Eur J Med Res. 2025 Dec 16. doi: 10.1186/s40001-025-03594-0. Online ahead of print.

ABSTRACT

AIM: The prevalence of metabolic-associated fatty liver disease (MAFLD) is rapidly increasing, posing a pressing challenge to global health. The purpose of this study is to establish a predictive model based on the immunoinflammatory marker, the albumin-gamma-glutamyl transferase ratio (AGTR), to facilitate the early recognition and risk assessment of MAFLD.

METHODS: This study used data from 2331 participants in the NHANES database from 2017 to 2018. LASSO and logistic regression analyses were employed to identify risk factors and to establish a nomogram prediction model for MAFLD. External validation was conducted using data from the NHANES 2021-2023. Sensitivity analysis was employed to investigate the independent predictive value of AGTR for MAFLD.

RESULTS: The results indicated that among 67 variables, BMI, waist-to-hip ratio, waist circumference, AGTR and the triglyceride-glucose index (TyG) were all independent influencing factors for MAFLD. These risk factors were used to create a nomogram prediction risk model, which had AUCs for the training set, internal validation and external validation sets of 0.847 (95% CI 0.830-0.866), 0.834 (95% CI 0.806-0.863) and 0.851 (95% CI 0.834-0.868), respectively. The Hosmer-Lemeshow test p values were all greater than 0.05. Calibration and DCA indicate that the predictive model possesses good consistency and clinical validity. The sensitivity analysis revealed that AGTR remained an independent predictor following adjustment for demographic and lifestyle confounders.

CONCLUSIONS: As an independent immune-inflammatory predictor of MAFLD, early monitoring of AGTR may be crucial for predicting the emergence of MAFLD. Meanwhile, the nomogram model established in this study can identify high-risk patients for MAFLD.

PMID:41402919 | DOI:10.1186/s40001-025-03594-0

Biol Sex Differ. 2025 Dec 16. doi: 10.1186/s13293-025-00804-6. Online ahead of print.

ABSTRACT

OBJECTIVES: A scoping review was conducted to investigate knowledge gaps in the informatics research literature regarding sex differences in cognitive decline and impairment, identifying existing studies and areas requiring further exploration.

METHODS AND MATERIALS: Our scoping review follows the Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA – ScR) guidelines. We searched Ovid and other databases (APA PsychInfo, EMB Reviews, and Embase) for studies on sex differences in cognitive decline and impairment, focusing on peer-reviewed informatics journals and conference proceedings from 2000 to 2025. The selected manuscripts were analyzed based on metadata statistics, study attributes, and thematic content.

RESULTS: A total of 17 full articles met the inclusion criteria. Most studies were conducted in North America (n = 7) and the European Union (n = 5). More than half of the studies were published after 2020 (n = 10). Our analyses highlight key aspects of selected studies, including bibliometric metadata, study attributes (e.g., study types, methods, and data sources), and thematic findings. Statistical modeling (n = 8) and machine learning (n = 4) are the most widely used study methods. Majority (n = 11) of the publications are single-site studies, while the other multi-site collaborations (n = 6) have emerged among hospitals, academic institutions, and research institutions.

DISCUSSION: Sex-specific disparities in cognitive decline and impairment remain a critical issue in healthcare. Most informatics research has primarily concentrated on identifying generic sex differences in cognitive decline and impairment progression, rather than exploring the complex underlying mechanisms such as observational studies with causal analysis. While these studies are valuable, they lack a holistic approach to understanding sex-specific disparities.

CONCLUSION: There is a significant gap in using informatics to understand how biological, social, and behavioral factors contribute to sex-specific disparities in cognitive decline and impairment. This limitation underscores the need for more comprehensive informatics research that goes beyond mere identification to find the root cause of these disparities in healthcare.

PMID:41402904 | DOI:10.1186/s13293-025-00804-6

BMC Res Notes. 2025 Dec 16. doi: 10.1186/s13104-025-07600-w. Online ahead of print.

ABSTRACT

OBJECTIVE: Human leptospirosis is an endemic disease in northern Iran. residents of northern provinces are at increased risk of exposure to Leptospira due to the region’s unique geographical characteristics, occupational patterns, cultural practices, lifestyle, and recreational activities, all of which contribute to the higher burden of the disease in this area. Therefore, this study aimed to examine the epidemiological patterns of leptospirosis in Babol County over six years (2019-2024).

RESULTS: During the study period, 344 cases of human leptospirosis were reported. Of these, 86.0% occurred in males, and 70.3% of the cases were among rural residents. Among occupational groups, agricultural workers exhibited the highest frequency, with 42.4% of cases occurring among rice farmers and 22.1% among other farmers. The crude and age-standardized incidence rates of leptospirosis in 2019 were 10.1 and 8.1 per 100,000 population, respectively. These rates showed an increasing trend over the study period, reaching 17.3 and 14.4 per 100,000 population in 2024. The upward trend was statistically significant (P < 0.001). During the study period, the highest incidence was observed in May, with a rate of 2.9 per 100,000 population.

PMID:41402902 | DOI:10.1186/s13104-025-07600-w

J Orthop Surg Res. 2025 Dec 16;20(1):1072. doi: 10.1186/s13018-025-06495-4.

ABSTRACT

OBJECTIVE: The current study aimed to systematically and quantitatively evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in predicting mortality among surgical patients with hip fractures through a systematic review and meta-analysis.

DESIGN: Systematic review and meta-analysis.

METHODS: Four databases-The Cochrane Library, PubMed, Embase, and Web of Science-were comprehensively retrieved to identify studies published from database inception to May 2025 that investigated NLR as a predictor of postoperative survival in hip fracture individuals. Two independent researchers performed study selection, data extraction, and quality assessment, with consistency verified via cross-checking. Statistical analyses were performed using Stata 15.0 for meta-regression and heterogeneity testing, while prognostic performance metrics (sensitivity, area under the curve [AUC], specificity) were synthesized via Meta-Disc 1.4.

RESULTS: Our meta-analysis incorporated 12 studies, involving 10,015 individuals who underwent surgery for a hip fracture. With cut-off values ranging from 3.2 to 8.4, preoperative NLR demonstrated high prognostic efficacy for mortality prediction, yielding a combined sensitivity of 0.69 (95% CI 0.55-0.83), specificity of 0.84 (0.74-0.93), diagnostic odds ratio (DOR) of 12 (6-26), and an area under the summary receiver operating characteristic curve (sAUC) of 0.84 (0.81-0.87). Subgroup analysis of preoperative NLR thresholds revealed that higher cut-off values (NLR > 5) significantly improved prognostic performance. NLR exhibited superior sensitivity but slightly lower specificity in patients from developing countries, with particular prognostic utility for long-term mortality (≥ 1 year). Postoperative NLR showed moderate prognostic efficacy, with a combined sensitivity of 0.64 (0.57-0.70), specificity of 0.58 (0.55-0.61), DOR of 2 (2-3), and sAUC of 0.62 (0.58-0.66).

CONCLUSION: This meta-analysis confirms that the preoperative NLR is a promising albeit preliminary predictor of postoperative mortality in hip fractures.

PMID:41402900 | DOI:10.1186/s13018-025-06495-4

Virol J. 2025 Dec 16. doi: 10.1186/s12985-025-03047-4. Online ahead of print.

ABSTRACT

BACKGROUND: Persistent infection with high-risk human papillomavirus (HR-HPV) is a necessary cause of cervical cancer and its precancerous lesions. This study aimed to identify factors associated with HR-HPV persistence in Chinese women.

METHODS: This study is a population-based, nationwide, multi-center prospective cohort study initiated in 2017, and a total of 10,481 women undergoing cervical cancer screening were enrolled. A subset of 1,684 women who tested HR-HPV positive at baseline were included in the analysis. The results of their HPV testing at baseline and during three follow-up visits (2018-2020) were used to assess 1-, 2-, and 3-year HR-HPV persistence. Variables with statistically significant associations in univariate analyses, expressed as odds ratios (ORs) with 95% confidence intervals (CIs), were subsequently entered into a stepwise multivariate logistic regression model to identify independent predictors of HR-HPV persistence.

RESULTS: The mean age of 1,684 HPV-positive women at baseline was 47.6 ± 9.5 (interquartile range (IQR) = 42-54) years. The most prevalent genotypes at baseline were HPV52 (28.3%), HPV16 (20.2%), HPV58 (17.8%), HPV33 (6.7%), and HPV18 (6.2%). Overall HR-HPV persistence rates declined over time were 66.8% at 1 year, 48.3% at 2 years, and 39.9% at 3 years. Infection with HPV33 (OR = 2.40, 95% CI: 1.42-4.01), HPV52 (OR = 1.95, 95% CI: 1.45-2.64), or HPV58 (OR = 2.01, 95% CI: 1.40-2.88), as well as postmenopausal status (OR = 2.84, 95% CI: 2.17-3.72), were significantly associated with 3-year persistence, and alcohol consumption was associated with a reduced risk of persistence (OR = 0.49, 95% CI: 0.30-0.79). Furthermore, HPV16 was the most frequently detected genotype in cervical intraepithelial neoplasia grades 2 and worse (CIN2+), indicating it plays a predominant role in chronically pathogenic of high cervical disease.

CONCLUSION: These findings underscore the importance of genotype-specific and host-related factors in HR-HPV persistence and support the implementation of tailored cervical cancer screening strategies. Women infected with HPV33, HPV52, or HPV58, along with HPV16 may require closer long-term monitoring to prevent progression to high-grade cervical lesions.

PMID:41402897 | DOI:10.1186/s12985-025-03047-4

BMC Sports Sci Med Rehabil. 2025 Dec 17. doi: 10.1186/s13102-025-01474-y. Online ahead of print.

ABSTRACT

BACKGROUND: Active myofascial trigger points (MTrPs) in the upper trapezius are a leading source of neck pain and functional limitation in athletes. Although myofascial release (MFR) and stretching are frequently used, their comparative effectiveness when combined with high-power pulsed therapeutic ultrasound (HPPT-US) remains unclear.

OBJECTIVE: To compare the efficacy of MFR + HPPT-US versus stretching + HPPT-US on pain intensity, cervical range of motion (Cx-ROM), muscle length (ML), and neck disability in amateur overhead athletes with unilateral upper trapezius active MTrPs.

TRIAL DESIGN: A two-arm parallel group, randomized clinical trial design.

METHODS: Thirty-two athletes meeting Travell and Simons’ criteria for active MTrPs were randomized to receive either MFR + HPPT-US (Group A) or stretching + HPPT-US (Group B), administered thrice weekly for two weeks. Primary outcome measure-Pain intensity and secondary outcomes-Cx-ROM, ML, and Neck Disability Index (NDI) were recorded using a visual analog scale (VAS), universal goniometer, Vernier caliper, and neck disability index (NDI) questionnaire, at baseline, week 1, week 2, and one-week follow-up. 26 out of 32 data of enrolled participants were analyzed using a two-way mixed repeated-measures ANOVA (Group × Time) with Bonferroni-adjusted post-hoc tests; statistical significance was set at p < 0.05, and effect sizes were reported as partial eta-squared (η²ₚ) for ANOVA and Cohen’s d for pairwise differences.

RESULTS: Significant main effects of Group (η²ₚ = 0.07-0.26) and Time (η²ₚ = 0.83-0.92) were observed for all outcomes, with a significant Group × Time interaction for ML (η²ₚ = 0.34). Both interventions produced significant improvements across time points; however, Group A demonstrated greater gains following treatment. At follow-up, between-group differences favored Group A for VAS (MD = – 0.77; 95% CI – 1.31 to – 0.39; d = 1.12), Cx-ROM (MD = 2.69°; 95% CI 0.80 to 4.58; d = 1.07), ML (MD = 0.80 cm; 95% CI 0.27 to 1.33; d = 1.14), and NDI (MD = – 4.70; 95% CI – 8.04 to – 1.36; d = 1.09). Improvements were consistent across post-baseline assessments, although the magnitude of change varied by outcome.

CONCLUSION: The combination of MFR and HPPT-US was more effective than stretching with HPPT-US in reducing pain, increasing ML and Cx-ROM, and improving functional outcomes in amateur overhead athletes with active upper trapezius MTrPs. This combined approach may offers superior clinical benefits for managing MTrP-related neck pain and promoting faster recovery in athletic rehabilitation settings.

TRIAL REGISTRATION: The study protocol was retrospectively registered to the “ClinicalTrials.gov” under an assigned Identifier: NCT07002593 on 25/05/2025 (https://clinicaltrials.gov/study/NCT07002593).

PMID:41402896 | DOI:10.1186/s13102-025-01474-y

Diagn Progn Res. 2025 Dec 16;9(1):33. doi: 10.1186/s41512-025-00204-9.

ABSTRACT

BACKGROUND: When developing a clinical prediction model using time-to-event data (i.e. with censoring and different lengths of follow-up), previous research focuses on the sample size needed to minimise overfitting and precisely estimating the overall risk. However, instability of individual-level risk estimates may still be large.

METHODS: We propose using a decomposition of Fisher’s information matrix to help examine and calculate the sample size required for developing a model that aims for precise and fair risk estimates. We propose a six-step process which can be used either before data collection or when an existing dataset is available. Steps 1 to 5 require researchers to specify the overall risk in the target population at a key time-point of interest: an assumed pragmatic ‘core model’ in the form of an exponential regression model, the (anticipated) joint distribution of core predictors included in that model and the distribution of censoring times. The ‘core model’ can be specified directly or based on a specified C-index and relative effects of (standardised) predictors. The joint distribution of predictors may be available directly in an existing dataset, in a pilot study or in a synthetic dataset provided by other researchers.

RESULTS: We derive closed-form solutions that decompose the variance of an individual’s estimated event rate into Fisher’s unit information matrix, predictor values and total sample size; this allows researchers to calculate and examine uncertainty distributions around individual risk estimates and misclassification probabilities for specified sample sizes. We provide an illustrative example in breast cancer and emphasise the importance of clinical context, including any risk thresholds for decision-making, and examine fairness concerns for pre- and postmenopausal women. Lastly, in two empirical evaluations, we provide reassurance that uncertainty interval widths based on our exponential approach are close to using more flexible parametric models.

CONCLUSIONS: Our approach allows users to identify the (target) sample size required to develop a prediction model for time-to-event outcomes, via the pmstabilityss module. It aims to facilitate models with improved trust, reliability and fairness in individual-level predictions.

PMID:41402895 | DOI:10.1186/s41512-025-00204-9

Eur J Med Res. 2025 Dec 16. doi: 10.1186/s40001-025-03693-y. Online ahead of print.

ABSTRACT

BACKGROUND: The CCAT2 gene is associated with carcinogenesis, but its effect on neuroblastoma, the most common extracranial tumor in children, remains unclear.

METHODS: We conducted a case-control study involving 402 children with neuroblastoma and 473 children without neuroblastoma. TaqMan genotyping of two CCAT2 polymorphisms (rs3843549 A > G and rs6983267 T > G) was conducted for all participants. Correlations were analyzed by calculating the odds ratio (OR) and 95% confidence interval (CI). Furthermore, we performed stratified analyses for both polymorphisms to evaluate their associations more comprehensively.

RESULTS: We performed a statistical analysis employing three distinct genetic models to evaluate the rs3843549 A > G polymorphism and the rs6983267 T > G polymorphism. Moreover, we further investigated the potential protective polymorphisms (rs3843549 AG/GG and rs6983267 TG/GG) by stratified analysis. There was no significant association between CCAT2 gene polymorphisms and neuroblastoma susceptibility.

CONCLUSION: CCAT2 gene polymorphisms (rs3843549 A > G and rs6983267 T > G) were not associated with susceptibility to neuroblastoma. However, the accuracy of this conclusion may be limited by various confounding factors. Future analyses would benefit from a more comprehensive approach that accounts for additional variables.

PMID:41402887 | DOI:10.1186/s40001-025-03693-y

BMC Sports Sci Med Rehabil. 2025 Dec 17. doi: 10.1186/s13102-025-01485-9. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis aimed to quantify the risk of subsequent all-cause, recurrent concussion, upper extremity, and lower extremity injuries in athletes with a history of sport-related concussion.

METHODS: Following PRISMA guidelines, cohort studies published from inception through August 2025 were retrieved from PubMed, Cochrane Library, Embase, Web of Science, and EBSCO. The methodological quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Pre-specified subgroup and meta-regression analyses were conducted to investigate sources of heterogeneity, including injury timing, study design, sport type, and athlete competition level.

RESULTS: Nineteen cohort studies involving 86,879 athletes were included. Athletes with a history of concussion had significantly higher odds of sustaining a subsequent all-cause injury (OR = 1.93; 95% CI = 1.39-2.68). The risk was most pronounced for recurrent concussion (OR = 3.06; 95% CI = 1.81-5.17), and was also significantly elevated for upper extremity (OR = 1.76; 95% CI = 1.10-2.81) and lower extremity injuries (OR = 1.49; 95% CI = 1.06-2.09). Given the high heterogeneity observed in the primary outcomes (I² > 90%), the pooled effect sizes should be interpreted with caution as average associations across varying study contexts, rather than as precise predictions applicable to all settings. Subgroup analysis revealed that injury risk was statistically significant in studies with follow-up periods beyond six months (OR = 1.94) but not for shorter durations. The association was strongest and statistically significant among college athletes (OR = 2.29; 95% CI = 1.53-3.44), while estimates for professional and high school athletes were not significant. Meta-regression identified sport type as a significant moderator of injury risk (p = 0.038).

CONCLUSION: A history of concussion significantly increases the risk of subsequent injuries, with the odds being highest for recurrent concussion. The persistence of this risk beyond six months suggests that clinical recovery does not equate to full functional recovery. These findings underscore the need for enhanced return-to-play protocols that incorporate objective functional assessments and targeted rehabilitation to mitigate the heightened vulnerability to injury in post-concussed athletes.

PMID:41402865 | DOI:10.1186/s13102-025-01485-9