Category: Statistics

Eur J Radiol. 2025 Sep 1;192:112401. doi: 10.1016/j.ejrad.2025.112401. Online ahead of print.

ABSTRACT

OBJECTIVES: Preoperatively identifying patients with unresectable hepatocellular carcinoma (uHCC) who are likely to achieve an objective response to the treatment regimen of transarterial chemoembolization (TACE) plus lenvatinib and programmed death-1 inhibitors (TLP) remains challenging. We aimed to develop and validate a predictive model for tumor response to TLP treatment in patients with uHCC.

MATERIALS AND METHODS: Patients with uHCC who received TLP treatment were divided into training (n = 107), internal validation (n = 46), and external validation (n = 52) cohorts. A nomogram model was developed based on the clinical variables of the training cohort using multivariate logistic regression. The performance of this nomogram model was evaluated using the area under the curve (AUC) and calibration curves, and its performance was compared with that of other predictive models.

RESULTS: The Eastern Cooperative Oncology Group performance status, albumin-bilirubin grade, platelet-to-lymphocyte ratio, tumor distribution, and total bilirubin were identified as independent predictors of objective response. These variables were incorporated to develop the EAPTT model. The AUCs of the EAPTT model were 0.84, 0.90, and 0.85 in the training, internal validation, and external validation cohorts, respectively-statistical analysis via the DeLong test showed that these AUCs were significantly higher than those of the other seven predictive models. Stratification of patients into objective responders and non-responders via the EAPTT model revealed statistically significant progression-free survival and overall survival differences between the two groups.

CONCLUSION: The EAPTT model may enable precise stratification of the efficacy of patients with uHCC receiving TLP treatment, serving to assist in identifying the optimal candidates.

PMID:40911988 | DOI:10.1016/j.ejrad.2025.112401

Eur J Radiol. 2025 Aug 29;192:112398. doi: 10.1016/j.ejrad.2025.112398. Online ahead of print.

ABSTRACT

PURPOSE: Osteoarthritis of the trapeziometacarpal joint is very common, especially in females, and is closely associated with ligamentous laxity and joint subluxation. The dorsoradial ligament (DRL) remains largely unexplored in ultrasound studies despite its clinical relevance. This study aimed to identify the central fascicle of the DRL anatomically and ultrasonographically and to establish a standardized ultrasound examination protocol.

METHODS: This observational cross-sectional validation study was conducted in two phases. First, anatomical dissections were performed on five cadaveric specimens to define anatomical landmarks and guide the development of an ultrasound protocol. In the second phase, bilateral ultrasound examinations were performed on the thumbs of 26 healthy participants (n = 52) to assess ligament morphology and establish normative measurements.

RESULTS: The DRL was successfully identified in all cases, and ultrasound imaging allowed for the reproducible visualization of its central fascicle. The mean joint distance was 0.36 ± 0.13 cm, and the mean ligament area was 0.20 ± 0.08 cm². Significant differences were observed between the sexes, with males having statistically higher distances (p < 0.05) than females from the tubercle of the trapezium to the skin and from the tubercle of the trapezium to the upper edge of the first metacarpal. However, no significant correlations were found with age, and no significant asymmetries were found between both sides.

CONCLUSION: The DRL can be reliably assessed by ultrasound and provides clinically relevant parameters to assess ligament morphology. The standardized protocol developed provides a valuable tool for detecting ligamentous insufficiency and capsuloligamentous changes. These findings contribute to understanding the anatomy and function of the DRL and provide a basis for future research into its role in joint stability and osteoarthritic progression.

PMID:40911987 | DOI:10.1016/j.ejrad.2025.112398

Healthc (Amst). 2025 Sep 4;13(2):100767. doi: 10.1016/j.hjdsi.2025.100767. Online ahead of print.

NO ABSTRACT

PMID:40911956 | DOI:10.1016/j.hjdsi.2025.100767

Oral Oncol. 2025 Sep 4;169:107670. doi: 10.1016/j.oraloncology.2025.107670. Online ahead of print.

ABSTRACT

OBJECTIVE: Oral squamous cell carcinoma (OSCC) with bone invasion are staged as pT4a, potentially upstaging smaller tumors. This study aimed to evaluate the oncological benefit of postoperative radiotherapy (PORT) in pT4aN0 OSCC with respect to tumor size and without other risk factors.

METHODS: This retrospective matched cohort study included pT4aN0 OSCC patients with bone invasion treated surgically (R0) between 2010 and 2022. Each case was 1:1 matched to a pT1-3 N0 OSCC patient based on tumor size, but without bone invasion. The primary endpoint was overall survival (OS), secondary endpoints included the recurrence-free survival and outcome predictors.

RESULTS: A total of 156 patients were analyzed (78 per group). There were no statistically significant differences in 3-year OS between both groups in general (78.2%, 95%CI: 68.6-87.8 vs. 80.0%, 95%CI: 68.4-91.6). After stratification for pT2 criteria, there was also no significant difference between both groups if PORT was omitted (63.9%, 95%CI: 44.2-92.4 vs. 70.5%, 95%CI: 55.0-90.0). Multivariate analysis identified age and poor differentiation (grade III) as significant predictors of worse OS, while PORT showed no independent survival benefit.

CONCLUSION: In small OSCC staged pT4a due to bone invasion and lacking other risk factors, PORT demonstrated no statistically significant improvement in OS when matched for tumor size. Further prospective trials and larger cohorts are warranted to confirm these findings.

PMID:40911948 | DOI:10.1016/j.oraloncology.2025.107670

Curr Pharm Teach Learn. 2025 Sep 4;17(12):102467. doi: 10.1016/j.cptl.2025.102467. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and evaluate the effectiveness of a two-step training pilot program in the Doctor of Pharmacy curriculum to prepare students to utilize medical language interpreters during patient interactions.

METHODS: The Advanced Communications and Counseling Skills course was a two-step program developed to train professional year two (P2) student pharmacists to effectively utilize interpreters during patient encounters. Training included completion of virtual modules and in-person standardized patient encounters where the use of an interpreter was required to counsel. Students then demonstrated the communication skills acquired at a health fair for patients that spoke a language other than English. Student perspective, comfort, and confidence of using interpreter services were measured and compared pre and post program implementation. Patient satisfaction with P2 communication skills were also assessed.

RESULTS: A total of 23 P2 students completed the program. Overall, summary statistics indicate trends for student improvement in all areas, with students’ confidence in using an interpreter improved. All students were satisfied with the training modules (100.0 %) and the majority felt prepared in using an interpreter (94.4 %). Patients were very satisfied (76.5 %) or satisfied (23.5 %) with the students’ ability to utilize an interpreter during the patient encounter at the health fair.

CONCLUSION: The Two-Step program provides students with training on how to utilize interpreters. Students are receptive to participating in the course and satisfied with the communication skills acquired. Embedding this course in the pharmacy curriculum could increase student confidence and have a positive impact on patient communication experience.

PMID:40911947 | DOI:10.1016/j.cptl.2025.102467

J Int Med Res. 2025 Sep;53(9):3000605251370327. doi: 10.1177/03000605251370327. Epub 2025 Sep 5.

ABSTRACT

ObjectiveThis study aimed to assess the prevalence and associated factors of male sexual dysfunction in a population of young men using validated tools to evaluate erectile function and its contributing factors.MethodsA community-based cross-sectional study was conducted between April 2023 and August 2024 among married men aged ≤40 years in Saudi Arabia. Participants were randomly selected from public gatherings across five regions and interviewed using the International Index of Erectile Function and Sexual Health Inventory for Men. Sociodemographic and clinical data were collected, including comorbidities, body mass index, physical activity, income, educational level, job, and depression screening result. Statistical analyses included descriptive statistics, nonparametric tests, and multivariable linear regression to identify factors associated with erectile dysfunction.ResultsA total of 196 men participated in the study. Of these, 77 (39.2%) were diagnosed with erectile dysfunction. According to the Sexual Health Inventory for Men score categories, 119 (60.7%) men had no significant erectile dysfunction, 29 (14.8%) had mild erectile dysfunction, 19 (9.7%) had mild-to-moderate erectile dysfunction, 15 (7.6%) had moderate erectile dysfunction, and 14 (7.14%) had severe erectile dysfunction. Multivariable linear regression analysis revealed several significant associated factors for better erectile function (based on the International Index of Erectile Function score), namely, higher income and an initial negative screening result for depression. The International Index of Erectile Function score was 12.65 points (95% confidence interval: -17.37 to -7.92; p < 0.0001) lower in participants with an initial positive screening result for depression than in those with an initial negative screening result for depression.ConclusionsThese results suggest that sexual dysfunction in younger men is not only influenced by physical health but also closely linked to psychosocial factors such as low income and depression. Further longitudinal research and multidisciplinary approaches are required to develop comprehensive targeted interventions for sexual dysfunction in young men, with an emphasis on mental health and socioeconomic conditions.

PMID:40911929 | DOI:10.1177/03000605251370327

JMIR Ment Health. 2025 Sep 5;12:e73702. doi: 10.2196/73702.

ABSTRACT

BACKGROUND: Suicide-related internet use encompasses various web-based behaviors, including searching for suicide methods, sharing suicidal thoughts, and seeking help. Research suggests that suicide-related internet use is prevalent among people experiencing suicidality, but its characteristics among mental health patients remain underexplored.

OBJECTIVE: This study aimed to examine the sociodemographic, clinical, and suicidality-related characteristics of suicidal mental health patients who engage in suicide-related internet use compared with those who do not.

METHODS: A cross-sectional survey was conducted from June to December 2023, recruiting participants aged 18 years and older with recent contact with secondary mental health services in the United Kingdom. The survey assessed sociodemographic characteristics, psychiatric diagnoses, suicidal thoughts and behaviors, and engagement in suicide-related internet use. Statistical analyses included chi-square tests, Wilcoxon tests, and multivariable logistic regression to identify predictors of engaging in suicide-related internet use.

RESULTS: Of 696 participants, 75% (522) engaged in suicide-related internet use in the past 12 months. Those who engaged in suicide-related internet use were almost 3 times as likely to have attempted suicide in the past year (32.5% vs 9.2%, P<.001). They were more likely to have a diagnosis of personality disorder (34.4% vs 18.5%, P<.001) and to disclose suicidal thoughts to someone (87.8% vs 72.8%, P<.001). They also reported higher levels of suicidal ideation intensity (median =6.6 vs 5.1, P<.001). There were no significant sociodemographic differences between groups, including age.

CONCLUSIONS: The findings suggest that suicide-related internet use is a common behavior among suicidal mental health patients across various age groups, challenging the notion that it is primarily a concern for younger populations. The association between suicide-related internet use and increased suicidality highlights the need for clinicians to incorporate discussions about web-based behaviors in suicide risk assessments. Given the high rate of disclosure of suicidal thoughts among suicide-related internet users, clinicians may have an opportunity to engage in open, nonjudgmental discussions about their patients’ internet use.

PMID:40911924 | DOI:10.2196/73702

Am J Sports Med. 2025 Sep 5:3635465251366318. doi: 10.1177/03635465251366318. Online ahead of print.

ABSTRACT

BACKGROUND: No model exists to predict which patients with elbow ulnar collateral ligament (UCL) injuries will successfully return to play (RTP) after nonoperative treatment. The reported rates for successful RTP after the nonoperative management of UCL injuries are limited and vary widely. Furthermore, patient and injury characteristics that influence the failure of nonoperative treatment have not been established.

PURPOSE: To identify patient- and injury-specific factors predictive of successful RTP after the nonoperative management of UCL injuries in baseball players.

STUDY DESIGN: Retrospective cohort study; Level of evidence, 3.

METHODS: A total of 205 patients with a UCL injury were enrolled from 2010 to 2020. Of these patients, 130 underwent nonoperative treatment and were either cleared for RTP (n = 46) or eventually underwent a surgical intervention (n = 84) after a minimum 1-month trial of nonoperative management. The Elbow UCL Injury Prognosis Score is a close approximation of a logistic regression model that was developed by recursively selecting features using a combination of the backward stepwise and best subset methods. The criteria considered for feature selection included P values using the Fisher exact test, variable importance from intermediary logistic models, and accuracy and sensitivity of the final model. The final logistic model was tested and validated using 5-fold cross-validation, and the score was validated against the logistic model.

RESULTS: The Elbow UCL Injury Prognosis Score provided an individualized prediction of each patient’s need for surgery based on age, magnetic resonance imaging findings, and paresthesia of the fifth digit. The final model achieved an average accuracy of 78.7% and a consistently perfect sensitivity and negative predictive value on the test dataset. The area under the curve was 0.86. A simplified score to allow for calculation at the bedside was created by standardizing the weights from the logistic equation of the final model. The lower the score, the more likely that patients would successfully RTP without surgery.

CONCLUSION: The Elbow UCL Injury Prognosis Score was created to predict which patients would succeed with nonoperative management and avoid unnecessary surgery while simultaneously identifying patients for whom nonoperative management would delay the inevitable need for a surgical intervention. Patients with a score ≥8 had a >80% chance of requiring surgery. Overall, the Elbow UCL Injury Prognosis Score is a statistically rigorous and practical tool that can be used at the bedside to help counsel patients on their chances of needing surgery.

PMID:40911922 | DOI:10.1177/03635465251366318

J Neurosurg Spine. 2025 Sep 5:1-9. doi: 10.3171/2025.4.SPINE241232. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to introduce and evaluate foraminoplastic inferior pedicle subtraction osteotomy (FiPSO), a novel technique that involves downward resection of the pedicle and vertebral body, aimed at addressing rigid lower lumbar kyphosis.

METHODS: The clinical records were reviewed of the patients who underwent corrective surgery from January 2012 through December 2021 for adult spinal deformity using a combination of procedures: pedicle subtraction osteotomy (PSO) at the lumbar level and spinopelvic fixation. Inclusion criteria included patients older than 40 years with sagittal imbalance symptoms and significant radiographic findings: sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI) minus lumbar lordosis (LL) > 10°. Patients were categorized into three groups: L1-3 PSO, L4-S1 PSO, and FiPSO. The authors assessed thoracic kyphosis, LL, lower LL (LLL), PI, PT, sacral slope, SVA, global tilt (GT), and Global Alignment and Proportion (GAP) score preoperatively, postoperatively, and at the last follow-up. Complications were also analyzed.

RESULTS: A total of 65 patients were included in the final analysis: 25 in the L1-3 PSO group, 29 in the L4-S1 PSO group, and 11 in the FiPSO group. The FiPSO group showed significantly larger postoperative LLL (39.2° ± 7.7° vs 29.7° ± 10.7°, p < 0.05) and smaller PI-LL mismatch (9.6° ± 10.3° vs 24.6° ± 13.4°, p < 0.01) compared to the L4-S1 PSO groups. At the last follow-up, the FiPSO group maintained larger LLL (38.3° ± 8.9° vs 27.1° ± 10.0°, p < 0.05), lower PT (23.1° ± 9.9° vs 33.3° ± 10.7°, p < 0.05), and good global sagittal alignment (SVA, 64.0 ± 43.8 mm vs 106.8 ± 55.7 mm, p < 0.05; GT, 28.7° ± 13.9° vs 43.5° ± 15.5°, p < 0.05) compared to the L4-S1 PSO group. The FiPSO group had higher nerve deficits (45%) but lower proximal junctional kyphosis (18%) and revision surgery rates (9.1%) than the L1-3 or L4-S1 PSO groups. However, the differences were not statistically significant.

CONCLUSIONS: FiPSO provides effective lower lumbar correction and long-term sagittal alignment with comparable complication rates, offering a valuable option for overcoming the challenges associated with PSO in the lower lumbar spine.

PMID:40911915 | DOI:10.3171/2025.4.SPINE241232

J Neurosurg. 2025 Sep 5:1-10. doi: 10.3171/2025.4.JNS242393. Online ahead of print.

ABSTRACT

OBJECTIVE: Major depressive disorder is a significant cause of disability, impacting an estimated 193 million individuals worldwide. Forty percent are estimated to have little to no response to standard pharmacological therapies. Deep brain stimulation (DBS) has emerged as a favorable neuromodulation therapy for treatment-resistant depression, but it remains unclear which brain targets are optimal.

METHODS: The authors performed a systematic literature review and meta-analysis of articles published through January 2022 to examine the efficacy of DBS targets in reducing depressive symptoms in patients with treatment-resistant depression. The primary outcome was the reduction in depression severity measured by the Montgomery-Asberg Depression Rating Scale and Hamilton Rating Scale for Depression. Secondary outcomes were responder and remission rates.

RESULTS: The authors analyzed 22 trials, 15 of which were sham-controlled studies. This network meta-analysis identified that stimulation of the medial forebrain bundle (MFB) was associated with the greatest reduction in depressive symptoms, compared with stimulation of the subcallosal cingulate gyrus (SCG) and ventral capsule/ventral striatum (VC/VS). Stimulation of the MFB also exhibited a higher responder rate (86%) than stimulation of the SCG or anterior limb of the internal capsule. Stimulation of the rostral extension of the prefrontal cortex was associated with the highest remission rate (60%), but this was not statistically significant compared with stimulation of other brain regions.

CONCLUSIONS: The MFB shows promise as a DBS target for treatment-resistant depression, possibly a result of its involvement in the mesocortical and mesolimbic pathways mediating depression. However, additional trials directly comparing stimulation of different brain regions are necessary to establish MFB as the optimal neurostimulation target.

PMID:40911913 | DOI:10.3171/2025.4.JNS242393