Category: Statistics

JAMA Netw Open. 2025 Jan 2;8(1):e2455622. doi: 10.1001/jamanetworkopen.2024.55622.

ABSTRACT

IMPORTANCE: There has been a great deal of interest in mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) and their association with one another, yet their interaction and subsequent associations with long-term outcomes remain poorly understood.

OBJECTIVE: To compare the long-term outcomes of mTBI that occurred in the context of psychological trauma (peritraumatic context) with mTBI that did not (nonperitraumatic context).

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of post-9/11 US veterans used data from the Translational Research Center for Traumatic Brain Injury and Stress Disorders (TRACTS) study at the Veterans Affairs Boston Healthcare System, which began in 2009; the current study utilized data from baseline TRACTS visits conducted between 2009 and 2024. Data analysis occurred from January to October 2024.

EXPOSURES: Peritraumatic mTBI, nonperitraumatic mTBI, or no TBI.

MAIN OUTCOMES AND MEASURES: The primary outcomes were PTSD severity (measured by the Clinician-Administered PTSD Scale-4th edition), postconcussive symptoms (measured by the Neurobehavioral Symptom Inventory), and self-reported disability status (measured by the World Health Organization Disability Assessment Schedule II). Differences between groups were compared using analyses of covariance with least significant difference comparisons.

RESULTS: This sample of 567 post-9/11 veterans (mean [SD] age, 33.72 [9.29] years; 507 men [89.4%]; mean [SD] years of education, 14.19 [2.16]) included 183 individuals with no TBI, 189 individuals with nonperitraumatic mTBI, and 195 individuals with peritraumatic mTBI. Veterans with a history of peritraumatic mTBI had greater PTSD severity (F2,552 = 8.45; P < .001), postconcussive symptoms (F2,533 = 11.09; P < .001), and disability (F2,527 = 11.13; P < .001) than the nonperitraumatic mTBI and no TBI groups. Importantly, no significant differences in any outcome measure between nonperitraumatic mTBI and no TBI groups were observed.

CONCLUSIONS AND RELEVANCE: This cohort study found that mTBI was only associated with long-term consequences when it co-occurred with a traumatic event exposure. This finding raises a novel hypothesis of the association of mTBI with PTSD, in which the acute biological and physiological outcomes of mTBI may be associated with temporarily scaffolding the formation of PTSD symptoms, which could enhance the production of long-term postconcussive symptoms and disability.

PMID:39841473 | DOI:10.1001/jamanetworkopen.2024.55622

JAMA Surg. 2025 Jan 22. doi: 10.1001/jamasurg.2024.6394. Online ahead of print.

ABSTRACT

IMPORTANCE: Chronic limb-threatening ischemia (CLTI) is a major public health issue that requires considerable human and physical resources to provide optimal patient care. It is essential to characterize the disease severity and resource needs of patients with CLTI presenting to facilities of varying resource capacities.

OBJECTIVE: To investigate the association between facility-level Medicaid payer proportions and the incidence of nonelective admissions among patients admitted for CLTI.

DESIGN, SETTING, AND PARTICIPANTS: In this retrospective multicenter cohort study, 876 026 CLTI-related inpatient admissions at 8769 US facilities from January 1, 1998, through October 31, 2020, were identified in the National Inpatient Sample. Facilities were ranked into quintiles according to increasing Medicaid burden, defined as the annualized proportion of Medicaid patient discharges for all hospitalizations. Inpatient admissions for CLTI were identified using International Classification of Diseases codes for rest pain, foot ulcers, and gangrene. Patients younger than 18 years or older than 100 years were excluded, as were those with missing admission type. Statistical analysis was conducted from January to August 2024.

EXPOSURE: Facility-level Medicaid burden quintiles.

MAIN OUTCOMES AND MEASURES: Emergency and urgent admissions defined as nonelective admissions.

RESULTS: The study included 876 026 CLTI-related admissions (mean [SD] patient age, 68.6 [14.5] years; 54.3% men). Increasing nonelective admission rates were associated with increasing facility Medicaid burden (low Medicaid burden, 59.7%; low-moderate Medicaid burden, 62.2%; moderate Medicaid burden, 63.6%; moderate-high Medicaid burden, 63.6%; and high Medicaid burden, 66.8%; P < .001). This trend persisted across all CLTI-related diagnoses (patients with rest pain: low Medicaid burden, 29.8%; high Medicaid burden, 36.1%; patients with lower-limb ulceration: low Medicaid burden, 63.5%; high Medicaid burden, 71.5%; and patients with gangrene: low Medicaid burden, 61.2%; high Medicaid burden, 67.4%; P < .001). In the adjusted model, odds of nonelective admission for CLTI indications increased progressively among facilities as Medicaid burden increased from low to high (adjusted odds ratio for low-moderate Medicaid burden, 1.05 [95% CI, 1.00-1.11]; P = .06; adjusted odds ratio for high Medicaid burden, 1.44 [95% CI, 1.36-1.52]; P < .001).

CONCLUSIONS AND RELEVANCE: High Medicaid burden facilities were associated with increased nonelective admissions for CLTI. This highlights an important mismatch: that resource-constrained facilities are at greater odds of seeing more resource-intensive admissions. Facility-level patient cohort characteristics should be considered when planning for resource allocation to achieve equitable patient care.

PMID:39841471 | DOI:10.1001/jamasurg.2024.6394

JAMA Psychiatry. 2025 Jan 22. doi: 10.1001/jamapsychiatry.2024.4465. Online ahead of print.

ABSTRACT

IMPORTANCE: Intermittent explosive disorder (IED) is an understudied psychiatric condition marked by impulsive aggression and poorly regulated emotional control, often resulting in interpersonal and societal consequences. Better understanding of comorbidities can improve screening, diagnosis, and treatment.

OBJECTIVE: To investigate the prevalence of IED and its associations with psychiatric, neurological, and somatic disorders.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, matched groups of patients with and without IED were identified from the TriNetX Research Network (dated January 31, 2024). Electronic medical record data were analyzed. The mean (SD) time from the first to last known visits was 4.8 (5.4) years.

EXPOSURE: Lifetime diagnosis of IED.

MAIN OUTCOMES AND MEASURES: Main outcomes were International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnostic categories and root codes. Cox proportional hazard models were used to estimate and compare probabilities of acquiring other diagnoses. Key measures include the numbers and proportions of patients with these diagnoses and adjusted hazard ratios (HRs) for IED.

RESULTS: Overall, 30 357 individuals with IED and 30 357 demographically matched controls were included. In each group, 21 313 (70%) were male, with a mean (SD) age at the first visit 26 (17) years. Despite only 0.03% of the total patient population having an IED diagnosis, extensive comorbidities with psychiatric, neurological, and somatic conditions were found. A notable 95.7% of individuals with IED (29 054 individuals) had another psychiatric diagnosis. All psychiatric subcategories and 92% of the psychiatric diagnoses were significantly associated with IED, with HRs ranging from 2.1 (95% CI, 2.0-2.2) for substance use disorder to 76.6 (95% CI, 65.4-89.6) for disorders of adult personality and behavior (excluding IED). Among neurological conditions, neurodegenerative diseases (HR, 5.0; 95% CI, 4.1-6.1) and epilepsy (HR, 4.9; 95% CI, 4.3-5.6) had the highest HRs, followed by movement disorders (HR, 3.1; 95% CI, 2.8-3.5), cerebral palsy (HR, 2.6; 95% CI, 2.2-3.0), and sleep disorders (HR, 2.2; 95% CI, 2.1-2.3). Significant associations with IED were also observed for many somatic diseases, including obesity (HR, 1.6; 95% CI, 1.5-1.7), hyperlipidemia (HR, 1.5; 95% CI, 1.4-1.5), hypertension (HR, 1.6; 95% CI, 1.5-1.7), and gastroesophageal reflux disease (HR, 1.7; 95% CI, 1.7-1.9).

CONCLUSION AND RELEVANCE: These findings highlight the extensive comorbidities between IED and psychiatric, neurological, and somatic disorders, emphasizing the need for integrated diagnostic and treatment approaches addressing both psychological and physical health aspects of IED. Limitations related to reliance on medical records and low diagnostic rates of IED caution the generalizability of these findings, underscoring the need for further validation in prospective studies and more accurate, inclusive diagnosis of IED in patients with mental disorders.

PMID:39841469 | DOI:10.1001/jamapsychiatry.2024.4465

Acta Crystallogr D Struct Biol. 2025 Feb 1. doi: 10.1107/S2059798325000415. Online ahead of print.

ABSTRACT

P-clusters have been statistically analysed using the bond-valence sum (BVS) method together with weighting schemes. The crystallographic data come from the VFe proteins deposited in the Protein Data Bank (PDB) with high resolutions of better than 1.35 Å. Calculations show that the formal oxidation state of a P¹⁺ cluster can be assigned as 2Fe³⁺6Fe²⁺ with high electron delocalization, giving the same oxidation state as that of P^N clusters in VFe proteins. Further comprehensive comparisons of the bond distances suggest that the hydroxyl groups of the β-153 serine residues in P¹⁺ and P^N clusters are in the protonated state, where the Fe6 atoms have the same oxidation state as Fe²⁺. During the transition from P^N to P¹⁺, cleavage of the Fe6-S1 bond is accompanied by the formation of a weak coordination between the Fe6 atom and the hydroxyl group of the β-153 serine residue in the P¹⁺ cluster of the VFe protein. Similarly, oxidation of P^N to P¹⁺/P²⁺ clusters corresponds to the coordination of Fe6(II) by the hydroxyl group of the β-188 serine residue and of Fe5(II) by the peptide amine group of the α-88 cysteine residue in the MoFe protein of Azotobacter vinelandiis without electron and proton transfers.

PMID:39841458 | DOI:10.1107/S2059798325000415

Egypt Heart J. 2025 Jan 22;77(1):13. doi: 10.1186/s43044-025-00612-8.

ABSTRACT

BACKGROUND: Many studies have validated the use of antiplatelet or anticoagulant therapy in coronary artery ectasia (CAE) to reduce major adverse cardiovascular events (MACE); however, it is not completely known which group of these antithrombotic medications is more effective. The purpose of this systematic review and network meta-analysis was to evaluate the efficacy of different anti-thrombotic treatments in adult patients with CAE.

METHODS: This systematic review and meta-analysis followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines as well as PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses and adhered to a registered predetermined methodology noted in the prospective register of systematic reviews (PROSPERO) protocol. Comprehensive searches were conducted until October 2024. Study selection, data extraction, and risk-of-bias assessments were independently performed by two reviewers. The pairwise meta-analysis compared the odds of MACE among patients receiving different antithrombotic therapies versus no treatment. The network meta-analysis (NMA) combined direct and indirect evidence to compare the efficacy of antithrombotic therapies for MACE.

RESULTS: Our systematic review included 5,039 adult patients suffering from CAE. The odds of MACE were higher in patients with no treatment when compared with those on dual antiplatelet therapy (DAPT) and aspirin monotherapy; although patients on anticoagulation demonstrated a lower incidence of MACE, the difference with the no treatment group did not reach statistical significance. Among various types of interventions in NMA, DAPT was the best in the treatment of CAE.

CONCLUSIONS: Based on the surface under the cumulative ranking curve (SUCRA) value, DAPT is the most effective treatment in the prevention of MACE for CAE patients, followed by aspirin monotherapy and anticoagulant treatment.

PMID:39841407 | DOI:10.1186/s43044-025-00612-8

Intensive Care Med Exp. 2025 Jan 22;13(1):9. doi: 10.1186/s40635-024-00708-6.

ABSTRACT

PURPOSE: The landiolol and organ failure in patients with septic shock (STRESS-L study) included a pre-planned sub-study to assess the effect of landiolol treatment on inflammatory and metabolomic markers.

METHODS: Samples collected from 91 patients randomised to STRESS-L were profiled for immune and metabolomic markers. A panel of pro- and anti-inflammatory cytokines were measured through commercially acquired multiplex Luminex assays and statistically analysed by individual and cluster-level analysis (patient). Metabolite fingerprinting was carried out by flow infusion electrospray ionisation high-resolution mass spectrometry and metabolomic data were analysed using the R-based platform MetaboAnalyst. The metabolites were identified using DIMEdb (dimedb.ibers.aber.ac.uk) from their mass/charge ratios. These metabolomic data were also re-analysed using individual and cluster-level analysis. The individual-level models were adjusted for confounders, such as age, sex, noradrenaline dosage and patient (random effect).

RESULTS: Analysis was undertaken at cluster- and individual-level. There were no significant differences in cytokine concentration level between trial arms nor survivors and non-survivors over the duration of the observations from day 1 to day 4. Metabolomic analysis showed some separation in the levels of ceramides and cardiolipins between those who survived and those who died. Following adjusted analysis for confounders, plasma metabolite concentrations remained statistically different between landiolol and standard care arms for succinic acid, L-tryptophan, L-alanine, 2,2,2-trichloroethanol, lactic acid and D-glucose.

CONCLUSIONS: In a study of ICU patients with established septic shock and a tachycardia, landiolol treatment used to reduce the heart rate from above 95 to a range between 80 and 94 beats per minute did not induce significant cytokine changes. D-Glucose, lactic acid, succinic acid, L-alanine, L-tryptophan and trichloroethanol were pathways that may merit further investigation.

TRIAL REGISTRATION: EU Clinical Trials Register Eudra CT: 2017-001785-14 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2017-001785-14/GB ); ISRCTN registry Identifier: ISRCTN12600919 ( https://www.isrctn.com/ISRCTN12600919 ).

PMID:39841388 | DOI:10.1186/s40635-024-00708-6

Matern Child Health J. 2025 Jan 22. doi: 10.1007/s10995-025-04057-y. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aimed to evaluate the quality of life (QoL) of caregivers of children diagnosed with CZS and to assess the association of findings with socioeconomic and CZS-associated variables.

METHODS: This was a cross-sectional, quantitative study, carried out over three days of multidisciplinary care for patients with CZS. Sixty-four participants underwent a quality of life assessment using the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) in Portuguese.

RESULTS: Both groups of caregivers attributed regular scores for Global QoL, and all WHOQOL-BREF domains. Among caregivers of children with CZS, QoL correlated with three of the four WHOQOL-BREF domains (psychological health: rho = 0.49, p < 0.001; social relationships: rho = 0.28, p < 0.023; and environment: rho = 0.11, p < 0.006), while general health perception correlated with three other domains (physical health: rho = 0.49, p < 0.001; psychological health: rho = 0.31, p < 0.012; and social relationships: rho = 0.30, p < 0.016). The environment domain was associated with the level of education in this population (p < 0.001). Macular scarring and focal pigmentary retinal mottling were significantly associated with the physical environment (p = 0.039), negative feelings (p = 0.035), support and social aid (p = 0.020).

CONCLUSION: The present study demonstrates that the WHOQOL-BREF is an effective method to evaluate the general perception of QoL among caregivers of children with CZS. Our results also suggest that caregivers of children with CZS do not experience a reduced quality of life compared to caregivers of typically developing children.

PMID:39841322 | DOI:10.1007/s10995-025-04057-y

Lasers Med Sci. 2025 Jan 22;40(1):27. doi: 10.1007/s10103-024-04243-4.

ABSTRACT

OBJECTIVE: This study aims to quantitatively compare the effects of standard needle irrigation (SNI), passive ultrasonic irrigation (PUI), EDDY, photon-initiated photoacoustic streaming (PIPS), and shock wave-enhanced emission photoacoustic streaming (SWEEPS) on the apical extrusion of irrigation solutions in teeth with severe canal curvature.

MATERIALS AND METHODS: Seventy-five teeth with a single root and canal, and curvature angles ranging from 20° to 40°, were selected for this study. Root canal curvatures were measured from buccolingual and mesiodistal radiographs using ImageJ software (version 1.48v; National Institutes of Health, Bethesda, MD, USA). The samples were randomly assigned to five groups (n = 15) based on the irrigation activation methods: SNI, PUI, EDDY, PIPS, and SWEEPS. An irrigation activation procedure was performed for 90 s using a total of 6 ml of 2.5% sodium hypochlorite (NaOCl) (Wizard, Istanbul, Turkey) in all samples. The Myers-Montgomery experimental model was used to simulate periapical tissues and limit the amount of extruded solution. The extruded irrigation solution was collected from the drainage cannula using an insulin syringe.

RESULTS: The data on the amount of apical extrusion of irrigation solution were analyzed statistically using the Kruskal-Wallis and Mann-Whitney U tests, with a significance level set at P < 0.05. While the highest mean solution extrusion was observed in the SNI and PUI groups, the PIPS group showed less extrusion compared to the other groups. However, no statistically significant difference in the amount of apical extrusion of irrigation solution was found among all the irrigation activation methods tested.

CONCLUSIONS: Within the limitations of this study, all irrigation activation methods tested on teeth with severe curvature resulted in a certain amount of solution extrusion. However, no significant difference was identified among the irrigation activation methods tested.

CLINICAL RELEVANCE: When these irrigation activation methods are tested on teeth with varied canal anatomies, the amount of apical extrusion of the irrigation solution may vary.

PMID:39841307 | DOI:10.1007/s10103-024-04243-4

Clin Oral Investig. 2025 Jan 22;29(1):74. doi: 10.1007/s00784-024-06128-w.

ABSTRACT

OBJECTIVE: To evaluate the possible additional clinical benefit from autologous platelet concentrate (APC) treatment adjunct to non-surgical periodontal therapy (NSPT).

METHODS: Electronic (MEDLINE/Embase/Cochrane/MedNar/CORE) and hand searches were conducted. Following studies selection, evidence tables were formed, and meta-analyses were performed for the following outcomes: probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, and bleeding on probing (BoP) reduction. The protocol for this systematic review was registered in PROSPERO (CRD42023514388).

RESULTS: After de-duplication, the initial search yielded 194 citations, from which ten papers were eligible for quantitative synthesis. The APC group comprised 270 patients, while the control group included 230. The meta-analysis revealed that a single APC application resulted in a 0.6 mm greater PPD reduction (MD = -0.62; 95% CI: -1.03, -0.22) and 0.8 mm more CAL gain (MD = -0.77; 95% CI: -1.18, -0.37) at the 6-12 weeks follow-up. At six months, the APC group exhibited a 0.6 mm greater PPD reduction (MD = -0.61; 95% CI: -1.13, -0.09) and 1.1 mm more CAL gain (MD = -1.14; 95% CI: -1.94, -0.34) compared to the NSPT only group. In contrast, BoP indices did not reveal a statistically significant difference between the groups after 6-12 weeks (MD = -10.54; 95% CI: -25.21, 4.14). High heterogeneity and unclear to high risk of bias were detected.

CONCLUSION: Over six months, the adjunctive APC use appears to provide additional benefits in PPD reduction and CAL gain compared to NSPT alone.

CLINICAL RELEVANCE: The adjunctive use of APCs seems to promote further improvements in clinical outcomes following NSPT.

PMID:39841297 | DOI:10.1007/s00784-024-06128-w

Lung. 2025 Jan 22;203(1):30. doi: 10.1007/s00408-024-00784-1.

ABSTRACT

BACKGROUND: Guidelines specify steroids as therapy for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the duration of survival benefit associated with steroids and the optimal dosage of nebulized budesonide (NB) during hospitalization remain unclear.

METHODS: We conducted a retrospective study of hospitalized AECOPD patients. The primary endpoint was all-cause mortality after discharge. Cox regression analysis was used to determine the impact of steroid therapy on survival.

RESULTS: Wilcoxon analysis showed the positive impact of systemic corticosteroids (SCs) therapy on survival during the early stage of follow-up (P = 0.038). NB therapy was associated with a significantly reduced risk of death within six months after discharge (adjusted Hazard ratio (HR), 0.36; 95% confidence interval (CI) 0.15-0.88). Subgroup analysis suggested that fewer than two AEs in the previous year (adjusted HR 0.05; 95% CI 0.01-0.38), age > = 65 years (adjusted HR 0.31; 95% CI 0.11-0.90), body mass index (BMI) < 25 kg/m² (adjusted HR 0.33; 95% CI 0.12-0.92), and smoking index > 40 packets/year (adjusted HR 0.17; 95% CI 0.04-0.79) were involved in this association. Finally, treatment with a total dose of NB < = 60 mg during hospitalization reduced six-month mortality compared to treatment without steroids (adjusted HR 0.39; 95% CI 0.17-0.92), but not the total dose of NB > 60 mg.

CONCLUSIONS: NB therapy for hospitalized AECOPD patients significantly reduced six-month mortality. Subgroup analysis showed that certain populations benefited more from NB therapy, and < = 60 mg NB might be suitable treatment for hospitalized AECOPD patients.

PMID:39841274 | DOI:10.1007/s00408-024-00784-1