Category: Statistics

Injury. 2025 Sep 2;56(11):112746. doi: 10.1016/j.injury.2025.112746. Online ahead of print.

ABSTRACT

INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for Type 2 diabetes and obesity due to their cardiometabolic benefits. However, their effects on fracture healing remain controversial. This study investigates perioperative GLP-1 RA use and outcomes following surgical treatment of lower extremity (LE) fractures.

METHODS: A retrospective analysis utilizing a large multicenter database compared patients on GLP-1 RAs within one year prior to and after lower extremity index surgery (+GLP) with those not on GLP-1 RAs (-GLP). Propensity score matching was performed on 275,970 included patients, matching 1:1 on age, sex, tobacco use, diabetes mellitus, primary hypertension, hyperlipidemia, chronic ischemic heart disease, chronic lower respiratory disease, and body mass index (BMI), resulting in 6125 “best-matched” patients per group. This was conducted utilizing multivariate logistic regression with a 0.1 caliper. Outcomes were assessed at 1 month, 3 months, and 1 year.

RESULTS: At 1-year follow-up, GLP-1 RA users demonstrated a significantly higher rate of nonunion compared to matched controls (5.4% vs 4.4%, Risk Ratio 1.2, 95% CI 1.0-1.4, P < 0.05) when assessing patients who also continued GLP-1 RAs postoperatively. There were no significant differences in wound dehiscence, deep or superficial surgical site infections, or hematoma. Importantly, the +GLP group experienced significantly lower rates of cardiac arrest (0.8% vs 1.6%, RR 0.5, 95% CI 0.3-0.7, P < 0.01) and all-cause mortality (4.4% vs 8.0%, RR 0.5, 95% CI 0.4-0.6, P < 0.01).

CONCLUSIONS: Perioperative GLP-1 RA use was associated with a higher risk of nonunion following lower extremity fracture surgery, though without increased wound complication rates. Importantly, GLP-1 RA use was linked to reduced cardiac arrest and mortality within one year. These findings suggest that while the increased rate of nonunion is statistically significant, its clinically significance is limited. Thus, the mortality reduction may be more clinically meaningful for patient counseling and perioperative management. Further study is required to clarify the balance between systemic benefits and surgical outcomes of GLP-1 RAs in orthopedic trauma.

PMID:40915058 | DOI:10.1016/j.injury.2025.112746

Clin Neurol Neurosurg. 2025 Sep 3;258:109142. doi: 10.1016/j.clineuro.2025.109142. Online ahead of print.

ABSTRACT

OBJECTIVE: Severity and outcome of stroke may be associated with a concomitant or subsequent inflammatory response. C-reactive protein (CRP) may correlate with length of stay (LOS) in hospital, indicating increased complexity of stroke patients with an ongoing inflammatory reaction upon admission.

METHODS: This retrospective cross-sectional study used data from admissions to the non-comprehensive Stroke Unit, which receives patients ineligible for revascularization therapy at Herlev-Gentofte hospital, in 2019 and 2020. We extracted data from electronic health records, including age, sex, diagnosis upon discharge (ICD-10), comorbidities, CRP-level, date and time of admission and discharge. CRP-levels were subcategorized as normal (<10 mg/L), moderate elevation (10-40 mg/L) and high elevation (> 40 mg/L). Discharge diagnosis was subcategorized as acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), or transient ischemic attack (TIA). Statistical analyses were performed in R 4.3.3.

RESULTS: 2077 patients were included, whereof 1169 had AIS, 831 had TIA and 77 had ICH. 97 had CRP > 40 mg/L, 249 had CRP 10-40 mg/L and 1574 had normal CRP-levels, whereas CRP-levels were unavailable in 157 cases. Our adjusted analysis revealed that CRP-levels > 40 mg/L were associated with longer LOS compared to CRP-levels 0-10 mg/L. No significant association was found between CRP-levels 10-40 mg/L and a longer LOS. Age ≥ 65 years and ICH were associated with prolonged LOS, whereas TIA and COVID-19 lockdown periods were associated with shorter LOS.

CONCLUSION: The study demonstrates the potential of CRP as a prognostic marker for increased LOS in hospital among patients with acute stroke or TIA.

PMID:40915039 | DOI:10.1016/j.clineuro.2025.109142

Soc Sci Med. 2025 Sep 2;384:118528. doi: 10.1016/j.socscimed.2025.118528. Online ahead of print.

ABSTRACT

BACKGROUND: An upward trend in self-reported mental distress among adolescents has been documented in Norway and several other countries, yet the causes remain unclear. This study aims to identify potential explanations for this trend by testing hypothesized factors using repeated cross-sectional data.

METHODS: We analyzed responses from 979,043 Norwegian adolescents, collected across 1417 municipality level surveys between 2011 and 2024. Eight explanatory factors with prior evidence of association with mental distress were examined: family financial difficulty, evenings spent at home, physical inactivity, bullying victimization, dissatisfaction with parents, social media use, cannabis use, and school dissatisfaction. Following a published epidemiological framework, we assessed changes in prevalence, virulence (strength of association), and the degree to which each factor statistically explained the trend in mental distress.

RESULTS: Mental distress increased significantly for both sexes over time. Increased school dissatisfaction accounted for a large share of the observed trend. Time spent on social media, also explained a part of the trend. Spending more evenings at home and cannabis use contributed modestly. Other factors, including financial difficulty, bullying victimization, physical inactivity, and dissatisfaction with parents, showed limited explanatory value.

CONCLUSIONS: The rising trend in adolescent mental distress in Norway appears most plausibly linked to growing school dissatisfaction, with a possible contributory role of social media use. These findings underscore the need for further research into school-related factors and adolescent digital experiences, as well as preventive measures.

PMID:40915028 | DOI:10.1016/j.socscimed.2025.118528

Mult Scler Relat Disord. 2025 Sep 1;103:106716. doi: 10.1016/j.msard.2025.106716. Online ahead of print.

ABSTRACT

BACKGROUND: Differentiating ischemic myelopathies from inflammatory demyelinating diseases is challenging due to overlapping imaging and clinical manifestations. Needle electromyography (EMG) is highly sensitive to spinal anterior horn damage.

OBJECTIVES: This study investigates the diagnostic value of spontaneous EMG activity in distinguishing ischemic myelopathies from inflammatory demyelinating diseases.

METHODS: We retrospectively analyzed medical records of patients diagnosed with ischemic myelopathies or inflammatory demyelinating diseases at the Neurology Department of Chinese PLA General Hospital from January 2019 to May 2024. All patients underwent needle EMG to evaluate abnormal spontaneous activities. Age- and sex-matched groups were created using 1:1 propensity score matching, and EMG findings were compared. Diagnostic efficacy was evaluated using ROC curve analysis.

RESULTS: Among 119 patients (ischemic myelopathies, 44; inflammatory demyelinating disease, 75), significant differences in age, sex, and EMG spontaneous activity were observed (p < 0.001). After matching, the difference in EMG spontaneous activity remained statistically significant (56.3% vs. 9.4 %, p < 0.001). ROC analysis revealed that EMG spontaneous potential had an AUC of 0.734 (95 % CI 0.609-0.837), with 56.25 % sensitivity and 90.62 % specificity for identifying ischemic myelopathies.

CONCLUSIONS: EMG spontaneous potentials may aid in differentiating ischemic myelopathies from inflammatory demyelinating diseases. Their high specificity for ischemic myelopathies (90.62 %) suggests a potential role in improving diagnostic accuracy in spinal cord disorders.

PMID:40915014 | DOI:10.1016/j.msard.2025.106716

J Surg Educ. 2025 Sep 6;82(11):103687. doi: 10.1016/j.jsurg.2025.103687. Online ahead of print.

ABSTRACT

INTRODUCTION: Senior residents near the end of their training must be prepared to start an independent practice. To become board-certified they must pass an oral exam, the ABS Certifying Exam (ABSCE). Prior work has introduced the resident Individual Clinical Evaluations (rICE), a low-cost tool developed to assess residents’ clinical judgment in level-appropriate clinical scenarios. rICE is a comprehensive program/curriculum that supports residents in preparing for their ABSCE. We evaluated residents’ perceived utility of the rICE, present curricular components, and compared mock oral and ABSCE pass rates.

DESIGN: PGY1-3 surgical residents completed 3 level-appropriate rICE per AY. Immediate feedback was provided after each encounter. After passing all scenarios, residents were invited to take a post-rICE survey on their perceived curriculum utility. A mixed methods approach was used for data analysis.

SETTING: This study occurred at an academic tertiary care center in Boston, Massachusetts, USA.

PARTICIPANTS: All PGY1-3 surgical residents between AY 2016-2020 were eligible to participate.

RESULTS: We collected 102 post-rICE surveys. Most trainees agreed that they felt better prepared to manage the evaluated clinical scenarios after rICE (81.37%), that these evaluations were an outstanding learning experience (87.25%), and that they would recommend the curriculum to other residents (85.29%). Relevant free-text comments were favorable toward the utility of this curriculum. rICE participants had an increase in mock orals pass rates over time (trending towards significance; p ≈ 0.06), and a 44% absolute increase in ABSCE pass rates (p ≈ 0.01) compared to non-rICE participants.

CONCLUSION: Residents had a favorable impression of rICE; offering an adaptable and implementable curriculum that provides a platform for self-reflection on their knowledge base and presentation skills. rICE is sustainable and low-resource intensive, providing residents early exposure to face-to-face clinical evaluations, and was associated with improved board pass rates, and possibly improved mock oral pass rates (although not statistically significant).

PMID:40915009 | DOI:10.1016/j.jsurg.2025.103687

Brief Bioinform. 2025 Sep 6;26(5):bbaf459. doi: 10.1093/bib/bbaf459.

ABSTRACT

With the rapid development of genomic sequencing technologies, there is an increasing demand for efficient and accurate sequence analysis methods. However, existing methods face challenges in handling long, variable-length sequences and large-scale datasets. To address these issues, we propose a novel encoding method-Energy Entropy Vector (EEV). This method encodes gene sequences of arbitrary length into fixed-dimensional vector representations by modeling nucleotide energy characteristics based on information entropy. Experiments conducted on five microbial datasets demonstrate that, compared to traditional alignment-free methods, EEV achieves higher accuracy in convex hull classification and species classification tasks, with improvements of 15% to 30% in family-level classification. In phylogenetic tree construction, EEV significantly accelerates the process relative to multiple sequence alignment methods while maintaining high tree quality, enabling rapid and accurate phylogenetic reconstruction. Moreover, EEV supports flexible dimensional expansion by superimposing nucleotide energies, enhancing its ability to represent complex genomic sequences while effectively alleviating sparsity issues in high-dimensional representations. This study provides an efficient gene encoding strategy for large-scale genomic analysis and evolutionary research.

PMID:40914969 | DOI:10.1093/bib/bbaf459

Postgrad Med J. 2025 Sep 7:qgaf109. doi: 10.1093/postmj/qgaf109. Online ahead of print.

ABSTRACT

PURPOSE: This retrospective study assessed the effectiveness of Mohs micrographic surgery (MMS) combined with adjuvant radiotherapy for the treatment of extramammary Paget’s disease (EMPD).

METHODS: This retrospective study included 87 patients with pathologically confirmed EMPD and complete follow-up data who were treated at the Radiation Therapy Department of Peking University First Hospital between January 2012 and December 2021. The surgical approach for the primary lesion involved MMS, followed by postoperative radiotherapy with doses ranging from 50 to 60 Gy administered over 25-30 fractions. Lymph node dissection was performed on selected patients exhibiting clinical lymphatic metastasis. The primary endpoint of this study was the disease-specific survival (DSS) rate, while secondary endpoints included local recurrence-free survival (LRFS). Survival rates were calculated using the Kaplan-Meier method and statistically analyzed using the log-rank test.

RESULTS: The study population comprised 78 men and 9 women. The median age was 65 years (range: 44-84). The median follow-up period was 71 months (range: 5-139). The 1-, 3-, 5-, and 10-year DSS rates were 99%, 95%, 92%, and 92%, respectively. The LRFS rates at 1, 3, 5, and 10 years were 100%, 100%, 97%, and 94%, respectively. The LNM rates at 1, 3, 5, and 10 years were 1.1%, 2.3%, 5.7%, and 5.7%, respectively. The DM rates at 1, 3, 5, and 10 years were 1.1%, 5.7%, 8.0%, and 9.2%, respectively.

CONCLUSION: The combination of MMS and adjuvant radiotherapy offers excellent local control in the treatment of extramammary Paget’s disease. Key messages What is already known on this topic: Surgical excision is the established primary treatment for extramammary Paget’s Disease (EMPD). However, the role of adjuvant radiotherapy in improving outcomes was not definitively established. What this study adds: This study provides robust evidence that adjuvant radiotherapy combined with surgical excision significantly improves local disease control rates in EMPD compared to surgery alone. How this study might affect practice: These findings strongly support the integration of adjuvant radiotherapy into the standard management paradigm for EMPD, particularly for cases with risk factors for local recurrence.

PMID:40914962 | DOI:10.1093/postmj/qgaf109

Cerebrovasc Dis. 2025 Sep 7:1-16. doi: 10.1159/000546508. Online ahead of print.

ABSTRACT

BACKGROUND: Intracranial aneurysm (IA), known as pathological dilation of cerebral arteries,commonly occurring at bifurcating arteries,carries a high risk of severe morbidity and mortality if left untreated.Although the treatment and early diagnosis have significantly improved,the complex pathophysiological process of IA formation presents significant challenges in the development of targeted therapies.Efficient disease-modifying therapies for IA are not yet available.This study aims to utilize the Mendelian randomization (MR) approach to identify potential pharmaceutical targets for preventing and treating IA.

METHODS: We systematically identified genetic variants associated with 1577 druggable genes utilizing gene expression, DNA methylation, and protein expression quantitative trait loci. Genome-wide association study (GWAS) summary statistics were derived from a meta-analysis concentrating on IA, encompassing 10,754 cases and 306,882 controls.Subsequently, we conducted a TwoSample MR analysis integrating the identified druggable genes to estimate the causal effects on IAs. The robustness of the MR results was additionally validated through sensitivity analyses employing diverse techniques, such as bidirectional MR analysis, Steiger filtering, and Bayesian colocalization.

RESULTS: Our study reveals that increased expression of SLC22A5 and SLC22A4 in blood is associated with higher risk of IA and subarachnoid hemorrhage (SAH), while higher expression of NT5C2 is linked to a reduced risk of IA and SAH. Methylation of SLC22A5 is positively correlated with IA prevalence, while NT5C2 methylation shows an inverse correlation. We also found that higher methylation of CHRNA3 is associated with increased IA prevalence. Additionally, increased blood protein expression of HTRA1 is associated with elevated risks of both IA and SAH,the bayesian colocalization analysis further supports the involvement of HTRA1 in both IA and SAH.

CONCLUSION: This large-scale MR analysis pinpointed four druggable target genes associated with IA and SAH, also highlighting HTRA1 as a potential prior druggable protein for medical intervention of IA.

PMID:40914952 | DOI:10.1159/000546508

Clin Transl Oncol. 2025 Sep 7. doi: 10.1007/s12094-025-04048-z. Online ahead of print.

ABSTRACT

PURPOSE: To determine the real-world incidence and predictive factors for venous and arterial thromboembolic events (VTE/AT) in ovarian cancer patients treated with poly-(ADP-ribose) polymerase inhibitors (iPARP).

METHODS/PATIENTS: A multicenter retrospective study involving 329 ovarian cancer patients who initiated iPARP treatment between January 2015 and December 2022. The primary outcome was the incidence of VTE/AT. Secondary outcomes included predictive factors for thrombosis and the impact of thrombosis on overall survival (OS). Data were analyzed using logistic regression and Kaplan-Meier survival analysis.

RESULTS: The incidence of VTE/AT was 4.9% (16/329). BRCA2 mutations were significantly more prevalent among patients who developed VTE/AT (56.3% vs. 19.2%; p < 0.001). Combined treatment with bevacizumab was significantly associated with a decreased risk of thrombosis (OR: 0.262; 95% CI: 0.095-0.724; p = 0.010). No statistically significant differences were observed in the median OS between patients who experienced VTE/ATE (63 months) and those who did not (47 months), with a p value of 0.876.

CONCLUSIONS: BRCA2 mutations could be a significant predictor for VTE/AT among ovarian cancer patients treated with iPARP. Concomitant treatment with bevacizumab may offer protection against thrombotic events, although a concomitant bias cannot be ruled out. These findings may be of interest when designing future clinical trials in the field of thromboprophylaxis.

PMID:40914929 | DOI:10.1007/s12094-025-04048-z

J Relig Health. 2025 Sep 7. doi: 10.1007/s10943-025-02435-y. Online ahead of print.

ABSTRACT

This study aims to examine the effect of education interventions given to women with religious orientation on cervical cancer and Pap smear test health beliefs.The study used a quasi-experimental research design with the pre-test-post-test control group. It was conducted in Qur’an courses in a province in eastern Turkey between January and October 2023. The sample size was calculated using the Gpower computer program. The sample of the study constituted a total of 114 women, 38 women in each group. Data were collected through the Personal Information Form, the Religious Orientation Scale, and the Cervical Cancer and Pap Smear Test Health Belief Model Scale. The average age of the participating women was 43.41 ± 8.63 years, and 95.6% of them thought that early diagnosis was important in cancer. The groups demonstrated differences in terms of the perceived severity, Pap smear perceived benefit, and Pap smear perceived barrier pre-test mean scores. Pap smear perceived barrier mean score was found to decrease statistically significantly after the education given in the health education group (p < 0.05). This study found that while health education decreased perceived barriers to pap smear tests, religious-based education was found to have no effects.

PMID:40914909 | DOI:10.1007/s10943-025-02435-y