Category: Statistics

Eur J Neurol. 2025 Sep;32(9):e70273. doi: 10.1111/ene.70273.

ABSTRACT

BACKGROUND: Changes in handgrip strength have recently been adapted as clinical biomarkers for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) under the assumption of a disease-specific peripheral neuromuscular dysfunction. However, some have proposed that strength impairments in ME/CFS are better explained by alterations in higher-order motor control. In serial measurements, exertion can been assessed through analysis of variation, since maximal voluntary contractions exhibit lower coefficients of variation (CV) than submaximal contractions.

METHODS: Serial handgrip strength measurements of 105 ME/CFS patients and 66 healthy controls from a previously published biomarker validation study are analyzed post hoc regarding their CV. CV is separately compared in a subsample of participant with normal indexes of fatigability.

RESULTS: Compared to healthy controls, patients had significantly higher CV, largely over the conservative 15% cutoff associated with submaximal exertion. In the subsample of study participants, whose within-session fatigability was within normal bounds, CV was still significantly higher in female patients; the difference in male patients was not statistically significant (p = 0.06).

CONCLUSIONS: This analysis suggests that loss of grip strength is likely compounded by alterations in higher-order motor control, challenging its utility as a biomarker of peripheral dysfunction. Functional weakness is discussed within a framework that sees motor fatigue as a result of reduced implicit self-efficacy acquired in the context of chronic dyshomoeostasis and disability.

PMID:40923211 | DOI:10.1111/ene.70273

Rhinology. 2025 Sep 9. doi: 10.4193/Rhin23.271. Online ahead of print.

ABSTRACT

BACKGROUND: Smell tests in children need to be standardized and validated, include odors familiar to children, and be defined by age-dependent standards. This study aimed to adapt the Sniffin Kids Test (SKT) for Polish children and conduct validation and evaluation of the Sniffin Kids Poland Test (SKPOL).

METHODOLOGY: The study included 382 children (4-14 years old) recruited in Poland, who were allocated into healthy (n=343) and sick (with subjective olfactory disorders, n=39), divided into 3 age subgroups, but also 13 anosmic children with Kallmann syndrome (KS) and olfactory bulb aplasia. Firstly, the smell testing was performed in 382 children using SKT, and subsequently, SKPOL was created using odors identified by at least 75% of healthy individuals. The 10th percentile of SKPOL results in healthy children was adopted as a cutoff point between norm and pathology. SKPOL validation and reliability were assessed using the KS group results.

RESULTS: Odor identification score in SKT of Polish children in healthy 6-14-year-olds did not meet the criteria for a test adapted for population studies. An odor identification rate was obtained for 5 odors in 4-7 years old, 7 odors in 8-10 years old, and 9 odors in 11-14 years old. SKPOL was created using these odors. Age-dependent norms for SKPOL were ≥4, ≥5, and ≥7, respectively. All KS children had SKPOL results below the 10th percentile.

CONCLUSIONS: Validation and evaluation of SKPOL confirmed good adaptation and high reproducibility of the test for Polish children aged 4-14 years.

PMID:40923196 | DOI:10.4193/Rhin23.271

Int Endod J. 2025 Sep 9. doi: 10.1111/iej.70030. Online ahead of print.

ABSTRACT

INTRODUCTION: Accurate diagnosis of pulpal health is crucial to identify the most effective therapeutic approach. However, differentiating pulpal conditions, which may require different treatment approaches, remains a challenge. This study aimed to address this gap by investigating the protein levels of 17 inflammatory biomarkers simultaneously in the dental pulp with different clinical diagnoses.

METHODS: This study employed a cross-sectional exploratory design, enrolling 64 adult patients. After obtaining ethical approval, researchers conducted clinical and radiographic examinations to categorise teeth into four diagnostic groups: normal pulp, reversible pulpitis, symptomatic irreversible pulpitis and asymptomatic irreversible pulpitis. Pulpal blood samples were then collected and analysed using Luminex technology to measure the levels of inflammatory proteins and matrix metalloproteinases (MMPs). Statistical analyses, including the Mann-Whitney U test and Spearman’s rank correlation, were used to compare the levels of these markers across the different diagnoses and to assess their correlation with patient symptoms.

RESULTS: The study revealed significant increases in several inflammatory proteins, including IL-4, IL-8, MCP-1, MIP-1α, RANTES and MMP-9, in both types of irreversible pulpitis cases compared with other diagnostic categories p < 0.05. These elevated levels exhibited positive correlations with patient-reported pain scores, instances of spontaneous pain and bleeding times. Notably, only IL-4 and IL-7 exhibited correlations with prolonged bleeding times (over 10 min) p < 0.05, while IL-1α and MMP-2 were associated with shorter bleeding times (under 10 min) p < 0.05. Additionally, IL-8 and MCP-1 levels were significantly associated with positive palpation findings p < 0.05, whereas MIP-1α and MMP-1 were correlated with positive percussion results p < 0.05.

CONCLUSION: Differential specific inflammatory potential biomarker levels may differentiate pulpal disease states. Integrating molecular diagnostics into longitudinal clinical trials and eventually into routine endodontic practice, could revolutionise treatment decisions.

PMID:40923157 | DOI:10.1111/iej.70030

Emerg Med Australas. 2025 Oct;37(5):e70135. doi: 10.1111/1742-6723.70135.

ABSTRACT

OBJECTIVE: This study aimed to identify presentations to the Alice Springs Emergency Department that could be managed in an Urgent Care Centre (UCC).

METHODS: We reviewed 1 year of ED presentation data at Alice Springs Hospital (ASH) from August 2022 to August 2023 and used a sequence of exclusion criteria to identify patients most likely to be eligible for UCC management.

RESULTS: Our model indicated that 35.0% of ED presentations at ASH during this period could have been managed in a UCC. Only 41.5% of these presentations (14.5% of total presentations) occurred during UCC operating hours.

CONCLUSIONS: According to this model, a significant proportion of ED presentations could potentially be managed in a UCC, although a large proportion of these occurred outside of UCC opening hours. The impact of the introduction of a UCC into a remote community on ED presentations, patient experience, patient outcomes and the broader system requires further study.

PMID:40923149 | DOI:10.1111/1742-6723.70135

Cancer Rep (Hoboken). 2025 Sep;8(9):e70341. doi: 10.1002/cnr2.70341.

ABSTRACT

BACKGROUND AND AIMS: Breast cancer is the most commonly diagnosed cancer in women worldwide. Several studies have investigated the relationship between breast cancer and specific foods or nutrients, rather than examining an overall dietary pattern. This study aims to investigate the association between breast cancer and the predominant dietary pattern in Ahvaz city.

METHODS: This hospital-based case-control study was conducted on 106 women with breast cancer and 107 controls. Dietary intake data were collected using a 147-item food frequency questionnaire. We merged the data on the 147 foods into 20 food groups to identify major dietary patterns. Factor analysis with varimax rotation was then employed to determine the primary dietary patterns. Binary logistic regression was used to assess the association between dietary patterns and breast cancer, with adjustment for potential confounders.

RESULTS: Three dietary patterns were identified: healthy, western, and traditional. The Western dietary pattern was robustly associated with a higher risk of breast cancer in premenopausal women (OR = 4.22; 95% CI: 1.09, 16.31; p = 0.03) in the adjusted model. However, no association was found between a healthy and traditional pattern and breast cancer.

CONCLUSION: These findings suggest that the Western dietary pattern is positively associated with breast cancer risk in premenopausal Iranian women.

PMID:40923112 | DOI:10.1002/cnr2.70341

Brain Behav. 2025 Sep;15(9):e70839. doi: 10.1002/brb3.70839.

ABSTRACT

BACKGROUND: Living with multiple sclerosis (MS) means facing significant obstacles in managing the unpredictable nature of this lifelong condition. Studies highlight a concerning connection between the disease and an elevated risk of suicide. In this study, we assessed the prevalence of suicide and suicide mortality risk in people with MS (PwMS).

METHODS: A comprehensive and systematic search of Medline, EMBASE, Scopus, and Web of Science databases was conducted. Studies of any design were included if they reported at least one of the following outcomes: (1) the prevalence of suicide ideation, suicide attempts, suicide deaths, and the proportion of suicide deaths among total deaths in MS populations (2) the risk of suicide mortality in PwMS compared to healthy controls.

RESULTS: The systematic review and meta-analysis included 64 studies across 19 countries, predominantly from Europe and North America, encompassing over 200,000 PwMS. The pooled prevalence of suicide ideation was 22.6% (95% CI: 16.9-28.3). Suicide attempts were reported at 3.4% (95% CI: 1.6-5.2), while suicide mortality was 0.5% (95% CI: 0.3-0.7), accounting for 2.1% (95% CI: 1.5-2.7) of total mortality in PwMS. PwMS had a significantly higher suicide mortality risk compared to healthy controls (standardized mortality ratio [SMR] = 1.49, 95% CI: 1.08-2.05).

CONCLUSION: This study highlights the elevated suicide mortality risk among PwMS, underscoring the urgent need for integrated mental health care in MS management. Future research should explore the impact of disease-modifying therapies, protective factors, and standardized risk assessment tools to improve early intervention and reduce suicidal behavior in this vulnerable population.

PMID:40923110 | DOI:10.1002/brb3.70839

Br J Nutr. 2025 Sep 9:1-107. doi: 10.1017/S0007114525103607. Online ahead of print.

ABSTRACT

Although numerous clinical studies suggest that ginseng supplementation may benefit cardiovascular disease (CVD) risk factors, results remain inconclusive. This systematic review and meta-analysis evaluated the effects of ginseng supplementation on CVD-related risk factors. Relevant studies were identified through electronic searches in Embase, Web of Science, Scopus, PubMed, and CENTRAL up to August 2024. Statistical analyses, including a random-effects model, meta-regression, and non-linear modeling, were used to assess heterogeneity, dose-response relationships, and the overall effects of ginseng supplementation. A total of 70 studies, published between 1998 and 2024 and involving 4,506 participants, were included. Ginseng supplementation significantly affected several biochemical markers, including high-sensitivity C-reactive protein (hs-CRP) (SMD: -0.23; 95% CI: -0.38, -0.08; P = 0.002), gamma-glutamyl transferase (GGT) (SMD: -0.20; 95% CI: -0.36, -0.04; P = 0.015), glutathione reductase (GSH-Rd) (SMD: 0.90; 95% CI: 0.38, 1.42; P = 0.001), reactive oxygen species (ROS) (SMD: -0.94; 95% CI: -1.27, -0.60; P < 0.001), and superoxide dismutase (SOD) (SMD: 0.48; 95% CI: 0.10, 0.87; P = 0.014). Meta-regression analysis showed significant linear associations between ginseng dosage and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (P = 0.044), and between supplementation duration and malondialdehyde (MDA) (P = 0.007). Dose-response analysis revealed significant associations between ginseng dose and fasting blood glucose (FBG) (P < 0.001), hs-CRP (P = 0.043), Interleukin-6 (IL-6) (P = 0.041), diastolic blood pressure (DBP) (P = 0.022), Interleukin-10 (IL-10) (P = 0.048), fasting insulin (P = 0.012), and total protein (P = 0.010). Supplementation duration was positively associated with MDA levels (P = 0.008). Ginseng supplementation was associated with improvements in inflammatory markers, liver function, and oxidative stress parameters. No significant effects were observed on anthropometric indices, blood pressure, glycemic profile, lipid profile, adipokines, or heart rate.

PMID:40923100 | DOI:10.1017/S0007114525103607

Scientifica (Cairo). 2025 Aug 31;2025:8232143. doi: 10.1155/sci5/8232143. eCollection 2025.

ABSTRACT

The gelada (Theropithecus gelada), Ethiopia’s only endemic primate and the last surviving graminivorous cercopithecid, was studied in Susgen Natural Forest, South Wollo, to examine seasonal variations in activity budgets and ranging ecology. From February to August 2023, encompassing both dry and wet seasons, 3519 behavioral scans were collected from 1680 group observations using instantaneous scan sampling at 15-min intervals (07:00-17:00 h). Data were analyzed with descriptive statistics and nonparametric tests (Kruskal-Wallis H and Mann-Whitney U), while home ranges were mapped via minimum convex polygon (MCP) and kernel density estimation (KDE). Results revealed that geladas allocated 43.2% of their time to feeding, 15% to movement, 15.5% to social activities, 13.1% to resting, and 13.2% to other behaviors. Dry seasons elicited significantly greater feeding effort (46.1% vs. 40.4%; p < 0.05) and daily travel distances (3658.4 ± 0.902 m vs. 3132.1 ± 2.367 m in wet season; Mann-Whitney U, p ≤ 0.05), with home ranges analyzed through the MCP method expanding to 190.1 ha in dry season as compared with 118.18 ha in wet season. KDE analysis identified the intensive use of core areas (54 ha) within broader ranges (164.95 ha). These findings underscore how geladas in human-modified landscapes face chronic nutritional stress, adapting through extended foraging and ranging patterns. We recommend immediate conservation measures, including habitat restoration and buffer zone establishment, to mitigate anthropogenic pressures on this threatened endemic species.

PMID:40923090 | PMC:PMC12414623 | DOI:10.1155/sci5/8232143

JTCVS Open. 2025 Jun 28;26:122-131. doi: 10.1016/j.xjon.2025.06.017. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: Proper risk stratification tools for patients with obstructive hypertrophic cardiomyopathy (oHCM) undergoing septal myectomy are lacking. Our objective was to assess the predictive value of preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) on perioperative outcomes and late survival in patients with oHCM undergoing transaortic septal myectomy.

METHODS: Between 2008 and 2021, 834 patients with preoperative NT-proBNP measurements underwent septal myectomy. Restrictive cubic splines, along with multivariable logistic and Cox regression models, were used to examine the association between NT-proBNP and the outcomes. The study endpoints were early postoperative complications (postoperative atrial fibrillation, need for blood transfusion, intensive care unit [ICU] length of stay [LOS], total hospital LOS), and long-term all-cause mortality.

RESULTS: A total of 834 patients were included in the study (median age, 58 [interquartile range (IQR), 48-65] years; 41.8% females). The median NT-proBNP concentration was 698 (IQR, 265-1446) pg/mL. Maximal septal thickness and maximal left ventricular outflow tract gradient, among other echocardiographic parameters, were linearly associated with NT-proBNP concentration (P < .001). Two patients died in the hospital (0.2%). On multivariable analysis, each 1000 pg/mL increase in NT-proBNP was independently associated with a 13% increase in blood transfusions (odds ratio, 1.13; 95% confidence interval [CI], 1.02-1.26), a 2-hour increase in ICU LOS (P < .001), and a 4-hour increase in total hospital LOS. Additionally, every 100 pg/mL increase in NT-proBNP within the range of 0 to 800 pg/mL was independently correlated with a 10% increase in the odds of postoperative atrial fibrillation. NT-proBNP also was associated with long-term mortality (hazard ratio, 1.1; 95% CI 1.04-1.14; P < .001).

CONCLUSIONS: Preoperative NT-proBNP has strong, independent associations with early and late outcomes and may be useful in stratifying, managing, and monitoring oHCM patients.

PMID:40923082 | PMC:PMC12414423 | DOI:10.1016/j.xjon.2025.06.017

JTCVS Open. 2025 May 20;26:132-137. doi: 10.1016/j.xjon.2025.05.003. eCollection 2025 Aug.

ABSTRACT

OBJECTIVE: Postoperative intraluminal thrombosis after frozen elephant trunk replacement has been reported to occur with a frequency of 6% to 17% and is associated with poor outcomes. The purpose of this institutional review is to analyze thrombosis rate, predisposing patient and operative factors, and assess different anticoagulation regimens.

METHODS: This retrospective cohort study includes 174 patients operated on over 10 years. one hundred forty-five of these underwent elective aortic arch replacement; 29 had the procedure for Type A aortic dissection repair.

RESULTS: Sixteen elective (11%) and 3 dissection patients (10%) had radiographic evidence of intraluminal thrombus. There were no statistical differences in demographic or intraoperative characteristics between the 2 groups. Of the 16 elective patients with thrombus, 12 (75%) had aneurysmal disease. Central graft position is associated with a higher incidence of intraluminal thrombus formation than eccentric position in both cohorts, 17% versus 7% in elective patients and 15% versus 0% in the dissection group. Patients with intraluminal thrombosis had significantly lower 6-month survival in both cohorts (69% vs 92% and 66% vs 88%; P = .0037) and this was also true for the elective group (69% vs 96%; P = .0001). Of several anticoagulation regimens employed over the study period, early introduction of warfarin proved superior.

CONCLUSIONS: The incidence of thrombus formation is higher in patients with aneurysmal disease and when the graft is positioned centrally. Early anticoagulation with warfarin appears to be protective. We advocate the creation of a registry to help improve outcomes after this complex surgery.

PMID:40923077 | PMC:PMC12414351 | DOI:10.1016/j.xjon.2025.05.003