Category: Statistics

BJOG. 2025 Dec 14. doi: 10.1111/1471-0528.70109. Online ahead of print.

ABSTRACT

OBJECTIVE: A randomised controlled trial found no significant reduction in severe postpartum haemorrhage (≥ 3 packed red blood cell units and/or total blood loss > 1000 mL) when intrauterine balloon tamponade and second-line uterotonics were used simultaneously compared with balloon use after failure of second-line uterotonics. However, one quarter of participants had already lost more than 1000 mL at randomisation, increasing heterogeneity and coagulopathy risk. This may have obscured a potential benefit in women with moderate bleeding (500-1000 mL). We aimed to assess the effect of early versus later balloon use in this subgroup.

DESIGN: Exploratory analysis of a randomised controlled trial.

SETTING: Maternity units across France.

POPULATION: Women with 500-1000 mL of blood loss at the time of second-line uterotonic administration after vaginal delivery (n = 264).

METHODS: Outcomes were compared between women randomised to early intrauterine balloon tamponade (n = 128) and those who received balloon after failure of second-line uterotonics (n = 136). Risk ratios were estimated using multivariate Poisson regression with robust variance.

MAIN OUTCOME MEASURES: Severe postpartum haemorrhage (≥ 3 packed red blood cell units and/or total blood loss > 1000 mL).

RESULTS: Severe postpartum haemorrhage occurred in 57.8% of the early group and 70.6% of the later group (adjusted risk ratio 0.83; 95% CI 0.69-1.01; p = 0.06).

CONCLUSIONS: Early intrauterine balloon tamponade was not associated with a statistically significant reduction in severe haemorrhage among women with moderate bleeding; estimates are compatible with a modest benefit and should be considered hypothesis-generating.

PMID:41392334 | DOI:10.1111/1471-0528.70109

Int Wound J. 2025 Dec;22(12):e70789. doi: 10.1111/iwj.70789.

ABSTRACT

Self-treatment of benign symptoms using hot water bottles, steam inhalation or hot tea is common in households and poses risks of severe scald injuries. This study aims to investigate associated hazards and identify high-risk patient groups to facilitate targeted prevention. A retrospective, single-center descriptive study was conducted on adult burn patients with scald injuries from hot water bottles, steam inhalation or hot tea. Demographic information, injury mechanism and outcomes were analysed. A total of 43 patients (mean age: 37.5 years; female:male ratio 23:20) were included. Injuries were caused by hot water/tea (37.2%), steam (34.9%) and hot water bottles (27.9%). The average burned total body surface area (TBSA) was 4%, with 79.1% of injuries being superficial partial-thickness burns. Surgical intervention was required in 13.9% of cases. Hot water bottle injuries predominantly affected young females (75%, mean age 32.6 years), with a high incidence of genital burns (58.3%). Hot tea-related injuries were more frequent in older males (62.5%, mean age 41.6 years), involving greater TBSA (6.5%) and a higher necessity for skin grafting (18.8%). Common self-treatment strategies can cause serious scalds, particularly in specific demographic groups, thereby burdening healthcare systems. Awareness of these risks is pivotal for effective education and prevention.

PMID:41392332 | DOI:10.1111/iwj.70789

Eur J Cardiothorac Surg. 2025 Dec 14:ezaf451. doi: 10.1093/ejcts/ezaf451. Online ahead of print.

ABSTRACT

OBJECTIVES: Mitral valve (MV) disease shows sex-specific differences in morphology and outcomes. Women often present later, undergo replacement more frequently, and experience worse survival. This study investigated sex-related disparities in surgical approach, repair rates and outcomes of MV surgery.

METHODS: 1,531 consecutive patients undergoing MV surgery with or without concomitant tricuspid valve procedure were analyzed retrospectively. Baseline characteristics, operative strategies, and outcomes were compared between sexes. Propensity score matching was used to adjust for baseline differences. Primary outcomes were 30-day and 5-year mortality. Baseline and procedural characteristics, including morphology, repair rates, use of minimally invasive MV surgery (MIMVS), and concomitant tricuspid disease, were compared between groups.

RESULTS: Female patients (44%) were older (68 vs 62 years, p < 0.001), more symptomatic (NYHA III: 60% vs 46%, p < 0.001) and more likely to have annular calcification (15% vs 5%, p < 0.001) or concomitant tricuspid disease (25 vs 36%, p < 0.001). Carpentier type IIIa was more prevalent in women (21% vs 4%), while type II predominated in men (75% vs 49%). MIMVS and repair were less frequent in women (49% vs 65% and 67% vs 85%, both p < 0.001). Female sex was associated with increased 30-day (HR 4.07, 95% CI 1.51-11.0; p = 0.006) and five-year mortality (HR 1.58, 1.02-2.46; p = 0.043). After adjusting for morphology and calcification, sex was no longer an independent predictor of repair rates or long-term mortality.

CONCLUSIONS: Women present at a later stage of the disease and with more complex MV pathology, resulting in lower repair and MIMVS rates and higher perioperative mortality. These disparities are largely attributable to disease morphology rather than sex per se. Earlier referral of women is essential to improve outcomes.

PMID:41392323 | DOI:10.1093/ejcts/ezaf451

J Health Popul Nutr. 2025 Dec 14. doi: 10.1186/s41043-025-01187-5. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic utility of the triglyceride-glucose (TyG) index and its anthropometry-enhanced variants (TyG-WC, TyG-WHtR, TyG-BMI) for mortality risk in advanced cardiovascular-liver-kidney-metabolic syndrome (CLKM), a multisystem condition involving heart, liver, kidney, and metabolic health, remains unknown.

METHODS: This nationwide prospective cohort study included 1384 adults with advanced CLKM syndrome from NHANES 1999-2018. The associations between the TyG index, its modified variants, and all-cause mortality were assessed using weighted multivariable Cox proportional hazards models. Restricted cubic splines (RCS) were used to identify nonlinear associations. To compare predictive performance, C-index, net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated. RESULTS: Over a mean 56-month follow-up, 360 deaths were recorded. RCS revealed U-shaped associations (i.e., lower risk at intermediate levels and higher risk at both low and high levels) between TyG indices and mortality (P for nonlinear< 0.05), with inflection points at TyG = 9.56, TyG-WC = 1,039.11, TyG-WHtR = 5.17, and TyG-BMI = 215.85. At values below the inflection points, higher indices were associated with reduced mortality risk. Comparison based on the C-index, NRI, and IDI showed that the modified TyG indices did not outperform the original TyG in mortality prediction. Subgroup analyses confirmed consistency (P for interaction >0.05). CONCLUSION: In advanced CLKM syndrome, TyG indices exhibit U-shaped mortality association, revealing dual metabolic roles. The original TyG index performs comparably to anthropometry-enhanced variants, supporting its use as a parsimonious risk-stratification tool. Identified inflection points offer actionable thresholds for personalized management.

PMID:41392320 | DOI:10.1186/s41043-025-01187-5

Eur J Med Res. 2025 Dec 15. doi: 10.1186/s40001-025-03645-6. Online ahead of print.

ABSTRACT

BACKGROUND: The updated metabolic dysfunction-associated steatotic liver disease (MASLD) framework highlights the systemic impact of hepatic steatosis, including kidney dysfunction. We investigated both cross-sectional and 5-year longitudinal associations between Fatty Liver Index (FLI) and estimated glomerular filtration rate (eGFR), and between MASLD and Chronic kidney disease (CKD), using region-specific FLI cutoffs and the latest definitions and robust methodology.

METHODS: We analyzed 9,911 adults from the Fasa Adults Cohort Study (FACS), including 2,906 with 5-year follow-up. FLI was calculated using sex-specific regionally validated cutoffs. eGFR was estimated using the 2021 CKD-EPI equation. Regression models assessed continuous FLI-eGFR and binary MASLD-CKD associations, with scatter plots to visualize patterns. Models were adjusted for extensive confounders. Subgroup analyses were stratified by sex, obesity, and physical activity, with formal interaction testing. Sensitivity analyses applied the commonly used European FLI ≥ 60 threshold.

RESULTS: Cross-sectionally, MASLD was associated with 58% higher odds of CKD (OR = 1.58; 95% CI 1.35-1.85), and each ten-unit increase in FLI was associated with a 2.4 mL/min/1.73 m² lower eGFR (p < 0.001). A U-shaped FLI-eGFR association was detected, most prominent in men. Longitudinally, higher FLI predicted greater eGFR decline (β = -1.92; p = 0.005) and MASLD increased CKD risk (OR = 1.41; 95% CI 1.07-1.86), especially among males (OR = 2.27), non-obese (OR = 1.47) and physically active individuals (OR = 1.64). Subgroup differences by obesity and physical activity were descriptive only, as interaction terms were not significant (p > 0.05). Using FLI ≥ 60, cross-sectional results remained significant, whereas longitudinal associations attenuated, suggesting potential misclassification when non-population-specific cutoffs are applied.

CONCLUSIONS: Higher FLI and MASLD were associated with impaired kidney function cross-sectionally and prospectively. Region-specific FLI cutoffs resulted in more stable longitudinal associations than the European FLI ≥ 60 threshold, underscoring the relevance of population-calibrated indices. Although sex differences were evident, obesity- and activity-related variations were not statistically confirmed. FLI may offer a practical, scalable tool for early identification of CKD risk. Further studies should validate these findings across diverse populations and assess whether interventions targeting MASLD can mitigate kidney function decline.

PMID:41392317 | DOI:10.1186/s40001-025-03645-6

Sci Rep. 2025 Dec 14. doi: 10.1038/s41598-025-30471-x. Online ahead of print.

ABSTRACT

Image data has been generated massively by devices in medical imaging modalities, cameras, and even by artificial intelligence. Encryption is the powerful method to keep the image content confidential, in which an encryption algorithm must include the confusion and diffusion properties. For massive images, a efficient method of encryption must be chosen to meet the demands of encryption speed and confidentiality. So far, chaos-based image encryption has been an active topic of research because it is considered an effective method to remove the correlation in image data as well as to keep confidential by the involvement of chaotic system in the encryption process. Besides, multiple image encryption algorithms encrypt multiple images in parallel, and it provides highly efficient performance in term of speed if it is implemented on a parallel computing platform such as multiple core processing as well as digital hardware design. Chaos-based multiple image encryption is constructed by integrating a chaotic system into multiple image encryption. Recently, many algorithms of chaos-based multiple image encryption have been proposed, and they are proved to have high efficient in terms of both speed and confidentiality. However, all the existing algorithms of chaos-based multiple image encryption require images of the same size and of the same number of bits representing pixels. Further, they encrypt a cohort of plain images at the same time, and all ciphertext images of a cohort must also be decrypted at the same time. It means that if it does not allow to decrypt one or some selected ciphertext images from a cohort separately; and as a result, it wastes time and energy to decrypt unwanted images. In this paper, three novel structures of chaos-based multiple image encryption are proposed which overcome the drawbacks of existing algorithms. That is, the proposed cryptosystems accept cohort images of different sizes; pixels of images can be represented by different numbers of bits; and any selected ciphertext images from a cohort can be decrypted separately. The security is improved by using the session keys of image-content dependency. The proposed structures of multiple image encryption consist of permutation, substitution, and diffusion processes. The difference between three structures is the order of such processes. A perturbed chaotic map and a linear-feedback shift register are employed to generate pseudo-random bit sequences for session keys. The simulation results for the exemplar designs using the proposed structures show the effectiveness by means of the statistical analysis for the session keys using the NIST randomness test, information entropy, histogram, and correlation coefficients of adjacent pixels in ciphertext images, and security analysis by means of space and sensitivity of the secret key. The hardware implementation on the FPGA platform demonstrates the feasibility of the proposed structures by means of throughput and hardware efficiency.

PMID:41392316 | DOI:10.1038/s41598-025-30471-x

Rheumatology (Oxford). 2025 Dec 14:keaf672. doi: 10.1093/rheumatology/keaf672. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the relationship between disease duration and the prevalence/distribution of nailfold videocapillaroscopy (NVC) patterns, named according to the current classification as “early”, “active”, and “late”, in a large cohort of systemic sclerosis (SSc) patients.

METHODS: A cross-sectional analysis was conducted on 1,689 patients undergoing standardised NVC. Clinical-serological data and treatments were collected. Statistical comparisons and multivariable logistic regression models were applied, including analyses based on disease duration.

RESULTS: The prevalence of NVC patterns was as follows: “early” 21.6%, “active” 47.4%, “late” 25.7%, and normal/non-specific 5.3%. The distribution by disease duration showed that the three main patterns were always present. While the “early” and “active” progressively decreased (from 30.3% and 51.9% in patients with ≤5 yrs, to 14.6% and 43.5% in those >10 yrs, p< 0.01), the “late” pattern increased from 13.2% (≤5 yrs) to 36.0% (>10 yrs) (p< 0.001) and was associated with internal organ involvement, anti-topoisomerase antibodies, and more therapies (p< 0.01). Conversely, the “early” and “active” patterns were associated with the limited-cutaneous subset (p< 0.01), and anti-centromere antibodies (p< 0.001). Multivariable analysis confirmed a strong association between the “late” pattern and skin/peripheral vascular involvement. Notably, the presence of the “late” pattern in patients with ≤2 yrs (10.9%) was significantly associated with scleroderma renal crisis (p= 0.012).

CONCLUSIONS: SSc-NVC patterns are not strictly time-dependent and can be observed at any stage of the disease, suggesting that microvascular damage progression is heterogeneous across different disease periods. Therefore, a revised classification of NVC changes considering both disease duration and NVC severity could improve its prognostic accuracy.

PMID:41392303 | DOI:10.1093/rheumatology/keaf672

Sci Rep. 2025 Dec 14. doi: 10.1038/s41598-025-28723-x. Online ahead of print.

ABSTRACT

Chest radiography (CXR is widely used for triage and follow-up of pulmonary disease, yet COVID-19 classification remains vulnerable to bias, label noise, and domain shift. We propose a multi-stage Bayesian deep learning framework that combines lung segmentation, segmentation-guided classification, calibrated ensembling, and uncertainty estimation to classify four classes (COVID-19, normal, viral pneumonia, bacterial pneumonia) and to grade COVID-19 severity. Models are trained and tested on 1,531 CXRs (100 COVID-19 images from 70 patients; 1,431 non-COVID images from ChestX-ray14) with patient-wise splits. The final ensemble achieves 98.33% test accuracy; COVID-19 sensitivity reaches 100% on this split. Robustness is quantified by stress-testing five image degradations (Gaussian noise, motion/defocus blur, JPEG compression, and downsampling), with macro AUC drops remaining small at moderate severities and larger under strong blur or heavy downsampling. Saliency and context-relevance analyses are used to identify spurious cues. The study is limited by dataset size and lack of external multi-site validation; a planned evaluation on COVIDx and BIMCV-COVID19 + is outlined.

PMID:41392298 | DOI:10.1038/s41598-025-28723-x

Gut Pathog. 2025 Dec 14. doi: 10.1186/s13099-025-00776-3. Online ahead of print.

ABSTRACT

BACKGROUND: Antimicrobial resistance, particularly in clinical Enterococcus isolates, poses a serious global health threat because of difficult-to-treat nosocomial infections. The emergence of vancomycin-resistant enterococci (VRE), mediated by VanA or VanB operons, has significantly limited treatment options. This study aimed at identifying antibiotic resistance and virulence genes in enterococci and exploring potential correlations between these genetic traits.

METHODS: A total of 100 suspected enterococci were gathered from two hospitals and identified through phenotypic methods and the VITEK 2 Compact system. The Kirby-Bauer disk diffusion and MIC by microbroth dilution methods were employed for antimicrobial susceptibility. The gelatinase production and biofilm were evaluated phenotypically, while the presence of vancomycin resistance (vanA, vanB) and virulence (esp, gelE, hyl) genes was confirmed by PCR and sequenced for genetic characterization.

RESULTS: Sixty-five Enterococcus isolates were characterized, with E. faecium (50.7%) and E. faecalis (41.5%) being the predominant species. Linezolid, teicoplanin, and chloramphenicol still retain good activity with 6.15%, 10.7%, and 29.2% resistance, respectively. About 40% of isolates were VRE, and all harbored the vanA gene. Biofilm formation and gelatinase production were most prevalent in E. faecium and E. faecalis, indicating enhanced virulence. Sequencing confirmed the chromosomal location and identity of the resistance and virulence genes, supporting their accurate detection and distribution among different Enterococcus species. Statistical analysis revealed that both esp and gelE genes were significantly associated with biofilm formation and gelatinase activity; however, esp showed a positive correlation with vanA and vancomycin resistance, while gelE demonstrated a negative correlation. Even though vanA is typically linked to high levels of resistance to both teicoplanin and vancomycin, only seven out of the twenty-six isolates that were vanA-positive showed phenotypic resistance to teicoplanin.

CONCLUSION: Enterococcus faecium and E. faecalis were identified as predominant multidrug-resistant species carrying multiple virulence determinants, with esp and gelE strongly linked to biofilm formation and gelatinase activity. Linezolid, teicoplanin, and chloramphenicol remained the most effective agents. Our findings demonstrate the coexistence of resistance and virulence traits, along with unexpected genotype-phenotype variations, underscoring the need for integrated molecular and phenotypic approaches in surveillance and clinical management.

PMID:41392292 | DOI:10.1186/s13099-025-00776-3

Arthroplasty. 2025 Dec 15;7(1):65. doi: 10.1186/s42836-025-00352-9.

ABSTRACT

PURPOSE: Accurate prediction of postoperative coronal alignment is essential for successful outcomes following medial unicompartmental knee arthroplasty (UKA). Traditionally, valgus stress femorotibial angle (FTA) has been used to estimate the correctability of varus deformity; however, its reliability is limited by dependence on soft tissue behavior and examiner technique. In contrast, the arithmetic hip-knee-ankle angle (aHKA), calculated from bony anatomy, offers an objective and reproducible measure of constitutional limb alignment. While early studies suggest aHKA correlates well with postoperative alignment, direct comparison with valgus stress FTA has been lacking. This study aimed to compare the predictive accuracy of aHKA and valgus stress FTA for postoperative alignment and alignment correction (ΔHKA) in medial UKA.

METHODS: This retrospective study included 125 knees undergoing medial fixed-bearing UKA. Preoperative aHKA was calculated from long-leg radiographs, and valgus stress FTA was measured using a Telos arthrometer. Postoperative hip-knee-ankle angle (HKA) was obtained from standardized radiographs. Correlation analyses were performed between postoperative HKA and both aHKA and 360°-valgus stress FTA. Similarly, correlations were assessed between ΔHKA and (aHKA-preoperative HKA) as well as (360°-valgus stress FTA-preoperative HKA). Fisher’s Z-test was used to assess differences in correlation strengths.

RESULTS: Postoperative HKA showed stronger correlation with aHKA (R² = 0.5003, P < 0.001) than with 360°-valgus stress FTA (R² = 0.1157, P < 0.001), with a statistically significant difference (Z = -4.12, P < 0.001). ΔHKA was more strongly associated with aHKA-preoperative HKA (R² = 0.3805, P < 0.001) than with 360°-valgus stress FTA-preoperative HKA (R² = 0.1111, P < 0.001) (Z = -2.92, P = 0.0036).

CONCLUSION: aHKA demonstrated superior predictive accuracy for both postoperative alignment and alignment correction compared to valgus stress FTA. As a bone-based and examiner-independent parameter, aHKA is a valuable tool for preoperative planning in medial UKA and may reduce the need for stress radiography. Video Abstract.

PMID:41392281 | DOI:10.1186/s42836-025-00352-9