Category: Statistics

High Blood Press Cardiovasc Prev. 2025 Aug 9. doi: 10.1007/s40292-025-00734-9. Online ahead of print.

ABSTRACT

INTRODUCTION: The Chinese visceral adiposity index (CVAI), a favorable surrogate index for assessing visceral fat distribution and function, has been proven to be associated with various conditions, including diabetes mellitus, cardiovascular diseases, and strokes. Nevertheless, evidence on the association of CVAI with the risk of incident hypertension among older adults is limited.

AIM: This study aimed to explore the association between CVAI and the risk of incident hypertension among older adults.

METHODS: Data were collected from the annual health examination dataset in Xinzheng, Henan Province from 2018 to 2023. A total of 10,353 participants aged ≥ 60 years were included. Cox proportional hazard models were used to examine the association between CVAI and the risk of incident hypertension by using hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed to confirm the association’s robustness. Additionally, the restricted cubic spline (RCS) was used to fit the dose-response association between CVAI and the risk of incident hypertension.

RESULTS: During a median of 2.72 years of follow-up, hypertension developed in 6990 participants. In the fully-adjusted model, compared with participants in the tertile 1 of CVAI, the tertile 3 (HR = 1.26, 95% CI: 1.19-1.34) of CVAI was associated with an increased risk of incident hypertension and per standard deviation (SD) increase was associated with a 12% (HR = 1.12, 95% CI: 1.09-1.15) increased risk of incident hypertension. Similar significant associations were observed in subgroup and sensitivity analyses. Additionally, the RCS analysis showed a significant dose-response association of CVAI with the risk of incident hypertension (P overall < 0.001 and P nonlinear = 0.238).

CONCLUSIONS: These results suggested a positive association between CVAI and the risk of incident hypertension among older adults.

PMID:40782245 | DOI:10.1007/s40292-025-00734-9

Jpn J Radiol. 2025 Aug 9. doi: 10.1007/s11604-025-01849-8. Online ahead of print.

ABSTRACT

PURPOSE: To assess the efficacy of super-resolution deep learning reconstruction (SR-DLR) with motion reduction algorithm (SR-DLR-M) in mitigating aorta motion artifacts compared to SR-DLR and deep learning reconstruction with motion reduction algorithm (DLR-M).

MATERIALS AND METHODS: This retrospective study included 86 patients (mean age, 65.0 ± 14.1 years; 53 males) who underwent contrast-enhanced CT including the chest region. CT images were reconstructed with SR-DLR-M, SR-DLR, and DLR-M. Circular or ovoid regions of interest were placed on the aorta, and the standard deviation of the CT attenuation was recorded as quantitative noise. From the CT attenuation profile along a line region of interest that intersected the left common carotid artery wall, edge rise slope and edge rise distance were calculated. Two readers assessed the images based on artifact, sharpness, noise, structure depiction, and diagnostic acceptability (for aortic dissection).

RESULTS: Quantitative noise was 7.4/5.4/8.3 Hounsfield unit (HU) in SR-DLR-M/SR-DLR/DLR-M. Significant differences were observed between SR-DLR-M vs. SR-DLR and DLR-M (p < 0.001). Edge rise slope and edge rise distance were 107.1/108.8/85.8 HU/mm and 1.6/1.5/2.0 mm, respectively, in SR-DLR-M/SR-DLR/DLR-M. Statistically significant differences were detected between SR-DLR-M vs. DLR-M (p ≤ 0.001 for both). Two readers scored artifacts in SR-DLR-M as significantly better than those in SR-DLR (p < 0.001). Scores for sharpness, noise, and structure depiction in SR-DLR-M were significantly better than those in DLR-M (p ≤ 0.005). Diagnostic acceptability in SR-DLR-M was significantly better than that in SR-DLR and DLR-M (p < 0.001).

CONCLUSIONS: SR-DLR-M provided significantly better CT images in diagnosing aortic dissection compared to SR-DLR and DLR-M.

PMID:40782239 | DOI:10.1007/s11604-025-01849-8

Ir J Med Sci. 2025 Aug 9. doi: 10.1007/s11845-025-04025-z. Online ahead of print.

ABSTRACT

INTRODUCTION: On 20 May 2024, the Irish government legalized e-scooter use on public roads under the Road Traffic and Roads Act 2023, requiring users to be over 16 years old and adhere to a 20 km/h speed limit. With the rising popularity of e-scooters, this study examines the impact of this legislation on the incidence, clinical presentation, and management of maxillofacial injuries.

AIMS: To compare the demographics, incidence rates, clinical presentation, injury patterns, and management of patients presenting to the National Maxillofacial Trauma Unit with e-scooter-related injuries before and after the legislative change.

METHODS: A retrospective cohort study at St James’s Hospital analysed two 9-month periods: pre-legislation (May 2023-Feb 2024) and post-legislation (May 2024-Feb 2025). All patients presenting with e-scooter-related maxillofacial injuries were included. Data collected encompassed demographics, risk factors, injury details, head and non-maxillofacial injuries, admission details (length of stay, time to treatment), treatment methods, and clinical outcomes. Statistical analysis compared the two periods.

RESULTS: The pre-legislation period included 22 patients with 26 injuries, while the post-legislation period had 28 patients with 36 injuries. E-scooter injuries increased from 1.7 to 2.3% of trauma presentations. Post-legislation, male patients increased from 59 to 71.4%, and non-Irish nationals from 41 to 46.4%. Injuries among Dublin residents rose from 45.5 to 75%. The mean age remained consistent (~ 33 years), and patients under 16 years decreased from 3 to 1. Helmet use dropped from 22.7 to 17.9%, while alcohol/substance involvement increased from 18.2 to 35.7%. Facial injuries rose from 26 to 36, with admission rates increasing from 31.2 to 35.7%. Surgical procedures increased from 9 to 13.

CONCLUSION: While the legislation may have reduced injuries among those under 16 and head trauma incidence, overall injury rates and surgical interventions continue to rise with growing e-scooter use. Ongoing surveillance and policy evaluation are essential for effective injury prevention strategies.

PMID:40782230 | DOI:10.1007/s11845-025-04025-z

Ir J Med Sci. 2025 Aug 9. doi: 10.1007/s11845-025-04003-5. Online ahead of print.

ABSTRACT

BACKGROUND: Lipoprotein(a) is a low-density lipoprotein-like particle covalently bound to apolipoprotein(a). It exhibits pro-atherogenic and pro-inflammatory effects and is an established independent monogenic determinant of atherosclerotic cardiovascular disease and aortic valve stenosis [1-4].

AIMS: To establish the Lp(a) distribution in a native Irish population and to explore if a certain lipid profile was associated with high Lp(a) level.

METHODS: We retrospectively included all subjects with Lp(a) results tested in our laboratory between January 2021 and December 2022. Patients were divided into Irish and non-Irish name subgroups [16]. We analysed the Lp(a) distribution across lipidaemic subgroups. Statistical analyses were completed in Jamovi programme V2.3.26.

RESULTS: In total 2762 patients of which 1899 had also a lipid profile. Eighty-five percent (n = 2359) of individuals had Irish surnames and 60% (n = 1419) were males. Mean age of all patients was 56 ± 17 years. The median lipoprotein(a) level was 34.5 nmol/L (interquartile interval < 20 to 153). The Lp(a) median in females was 37.3 (interquartile interval < 20 to 169) versus males 32.9 (interquartile interval < 20 to 147) (p = 0.029). A total of 62.9% (n = 1738) of Irish subjects had Lp(a) levels < 75 nmol/L, 7.56% of them (n = 209) between 75 and 125 nmol/L and 29.5% (n = 815) of subjects had Lp(a) > 125 nmol/L.

CONCLUSIONS: This is the largest study of Lp(a) distribution in an Irish population revealing positively skewed Lp(a) serum levels. This is not entirely reflective of the general population but brings to the fore the additional hidden high risks in those patients attending cardiovascular services. More education is needed to increase the use of Lp(a) measurements and guide further therapy.

PMID:40782229 | DOI:10.1007/s11845-025-04003-5

Eur Radiol. 2025 Aug 9. doi: 10.1007/s00330-025-11778-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the discriminative power of coronary artery calcium (CAC) score-based Cox models for predicting cardiovascular disease (CVD) in older adults with longstanding diabetes, a population at elevated CVD risk. We also aimed to determine whether adding computed tomography (CT)-derived costal cartilage calcification (CCC) improves risk prediction, given the potential limitation of CAC due to widespread soft tissue calcification.

MATERIALS AND METHODS: We analyzed adults ≥ 65 years from the multi-ethnic study of atherosclerosis with longstanding diabetes mellitus (DM, ≥ 5 years, n = 231) and compared them to non-DM participants (n = 1148). We evaluated CAC-based risk models (adjusted for Framingham Risk Score, race/ethnicity, and statin use) and assessed the impact of adding CCC on model performance using Cox proportional-hazards regression and Harrell’s C-statistic to predict CVD and coronary heart disease (CHD) incidence. CHD events included fatal coronary events, resuscitated cardiac arrest, myocardial infarction, adjudicated angina, and revascularization with angina. CVD events encompassed CHD, stroke (excluding transient ischemic attack), cardiovascular death, or other atherosclerotic deaths.

RESULTS: Over 8.7 years, CVD and CHD events occurred in 17% and 10% of DM participants and 11% and 5% of non-DM participants, respectively. In longstanding DM participants, doubling of CAC was associated with higher CVD risk (HR: 1.13; 95% CI: 1.01-1.26), with model discrimination improving from C-statistic 0.66 to 0.69 (p = 0.02) after adding CCC. For CHD, the corresponding HR was 1.05 (95% CI: 0.98-1.13), and the C-statistic rose from 0.65 to 0.69 (p = 0.04). In non-DM participants, CCC did not enhance model performance for either CVD or CHD (p > 0.5).

CONCLUSION: CCC, a measurable biomarker of non-cardiovascular calcification from any conventional CT, improves CVD and CHD risk prediction models’ performance in older adults with longstanding DM.

KEY POINTS: Question Coronary artery calcium (CAC) may have limited discriminative power for predicting cardiovascular outcomes in older adults with longstanding diabetes. Findings Costal cartilage calcification (CCC), a biomarker of non-cardiovascular calcification from CT, improves the prediction of cardiovascular disease and coronary heart disease risks in this population. Clinical relevance Incorporating CCC, which can be easily measured using existing CAC assessment tools on CT scans, into cardiovascular risk assessment could refine clinical decision-making and improve individualized risk stratification in older adults with longstanding diabetes.

PMID:40782222 | DOI:10.1007/s00330-025-11778-9

Eur Radiol. 2025 Aug 9. doi: 10.1007/s00330-025-11813-9. Online ahead of print.

ABSTRACT

OBJECTIVES: Cholesteatomas (CSs) are locally aggressive and can infiltrate adjacent structures as they expand. This study aimed to establish a straightforward scoring system using dual-layer detector dual-energy CT (DL-DECT) to improve the identification of cholesteatomas in patients.

MATERIALS AND METHODS: Between August 2023 and July 2024, 871 patients with soft tissue density shadows in the ear region who underwent DL-DECT examination were retrospectively enrolled at our institute. Surgical treatments followed by pathological examinations were performed. Based on pathological findings, the lesions were classified into cholesteatoma (CS) and non-cholesteatoma (non-CS) groups. The diagnostic performance of anatomical and quantitative parameters derived from DL-DECT was evaluated using receiver operating characteristic (ROC) curve analysis. Logistic regression was applied to develop a diagnostic scoring system.

RESULTS: A total of 87 patients (median age, 51 years; 45 men and 42 women) with suspected temporal bone CS were included, comprising 44 CS cases and 43 non-CS cases. The effective atomic number (Zeff) demonstrated the highest diagnostic accuracy (area under the curve [AUC] = 0.786), followed by the slope of the energy spectral curve (AUC = 0.784), scutum destruction (AUC = 0.759), and CT40 keV (AUC = 0.724). Logistic regression identified two significant predictors, which were incorporated into the scoring system. When the system score reached 2 points (Zeff ≤ 7.12 accompanied by scutum destruction), the AUC in the ROC analysis reached 0.868 (95% confidence interval: 0.778-0.931), significantly outperforming each individual parameter (all p < 0.05).

CONCLUSION: The DL-DECT-derived scoring system serves as an innovative imaging marker for detecting CSs.

KEY POINTS: Question Accurate differentiation between CSs and non-CSs is critical for selecting surgical approaches. However, high-resolution CT demonstrates limited discriminatory power. Findings A straightforward diagnostic scoring system incorporating Zeff ≤ 7.12 and scutum destruction was developed to efficiently identify patients with CS. Clinical relevance This scoring system may facilitate the early identification of CS, potentially improving patient outcomes through timely intervention.

PMID:40782221 | DOI:10.1007/s00330-025-11813-9

Support Care Cancer. 2025 Aug 9;33(9):773. doi: 10.1007/s00520-025-09775-1.

ABSTRACT

PURPOSE: This study aimed to develop and validate a Chinese version of the Frailty Risk Perception Questionnaire (FRPQ) for older adults with colorectal cancer.

METHODS: The study was conducted in two phases. In phase 1, a preliminary questionnaire was developed based on theoretical framework analysis, literature review, and qualitative interviews conducted in Chinese with 25 older adults with colorectal cancer. In phase 2, the reliability and validity of the Chinese FRPQ were evaluated through a cross-sectional survey of 350 older adults with colorectal cancer aged 65-85 years across different treatment stages.

RESULTS: Exploratory factor analysis identified a four-factor structure explaining 63.25% of the total variance: perceived susceptibility (17 items), perceived severity (8 items), cognitive risk (5 items), and emotional risk (6 items). The Chinese FRPQ demonstrated good construct validity, with satisfactory convergent validity (correlation coefficients with Fried Frailty Scale: r = 0.683, p < 0.001; with TFI: r = 0.715, p < 0.001) and known-group validity (significant differences among robust, pre-frail, and frail groups, p < 0.001). The Cronbach’s alpha coefficient for the total scale was 0.942, with subscale coefficients ranging from 0.867 to 0.923. Test-retest reliability over two weeks showed an intraclass correlation coefficient of 0.875.

CONCLUSION: The 33-item FRPQ is a valid and reliable instrument for assessing frailty risk perception among older adults with colorectal cancer. This tool may help healthcare providers better understand patients’ perceptions of frailty risk and develop targeted interventions.

PMID:40782220 | DOI:10.1007/s00520-025-09775-1

Neuroradiology. 2025 Aug 9. doi: 10.1007/s00234-025-03728-5. Online ahead of print.

ABSTRACT

PURPOSE: Guillain-Barré Syndrome (GBS) is an autoimmune disorder causing acute inflammatory polyneuropathy, resulting in muscle weakness. Timely diagnosis is critical to prevent complications such as respiratory failure and long-term disability. Ultrasound imaging of peripheral nerves, specifically assessing nerve cross-sectional area (CSA), has been suggested as a diagnostic tool for GBS. This systematic review aims to evaluate the utility of nerve ultrasound in diagnosing and monitoring GBS.

METHODS: A systematic review was conducted following PRISMA guidelines, searching databases including PubMed, Scopus, Web of Science, and Cochrane Library up to December 2024. Studies that used ultrasound to assess peripheral nerve size in GBS patients compared to healthy controls or other neuropathy patients were included. Statistical analysis was conducted using Review Manager 5.4 software.

RESULTS: Out of 848 studies, 25 met the inclusion criteria, with 12 included in the meta-analysis. A total of 528 patients with GBS were included. Ultrasound revealed significant increases in the CSA of cervical, peroneal, median, ulnar, and tibial nerves in GBS patients. Specifically, cervical nerve enlargement (MD: 1.45, P = 0.0008) and peroneal nerve enlargement (Mean Difference (MD): 2.09, P < 0.00001) were notable. Subgroup analysis revealed significant enlargement of the ulnar and tibial nerves across different anatomical regions.

CONCLUSION: Ultrasound imaging of peripheral nerves, particularly changes in CSA, provides valuable diagnostic insight for GBS, may be helpful in early recognition and intervention. Further studies are needed to establish consistent CSA patterns and improve diagnostic accuracy across various GBS subtypes.

PMID:40782205 | DOI:10.1007/s00234-025-03728-5

Eur Spine J. 2025 Aug 9. doi: 10.1007/s00586-025-09225-w. Online ahead of print.

ABSTRACT

PURPOSE: Anterior lumbar interbody fusion (ALIF) is commonly performed via a left-sided retroperitoneal approach, often in collaboration with access surgeons. However, the dominance of this laterality lacks clear evidence-based rationale. This study reports a standardized right-sided retroperitoneal approach for stand-alone ALIF performed solely by a spine surgeon, evaluates its feasibility and safety, and highlights its potential advantages.

METHODS: We conducted a retrospective, monocentric case series of all patients who underwent stand-alone ALIF via a primary right-sided approach between January 2017 and August 2024 by a single right-handed spine surgeon. A detailed surgical technique is described. Perioperative and demographic data were collected, including operative time, hospital stay, implant configuration, and complications. Descriptive statistics were computed using R and Python.

RESULTS: Fifty-nine patients (mean age 55.88 years, 64.41% female) underwent surgery, with most procedures at the L5-S1 level (89.83%). The mean operative time was 115.59 minutes (excluding complex and proctorship cases), and the adjusted mean hospital stay was 3.81 days. The complication rate was low (3.39%), with no severe adverse events or reoperations. All patients received stand-alone polyetheretherketone (PEEK) cages, predominantly 36 mm wide. No vascular injuries or mortality occurred.

CONCLUSION: The right-sided retroperitoneal approach for ALIF is feasible, safe, and efficient when performed by a trained spine surgeon. This approach offers potential strategic benefits as a primary alternative to the conventional left-sided route, especially in stand-alone L5-S1 procedures.

PMID:40782201 | DOI:10.1007/s00586-025-09225-w

Eur Spine J. 2025 Aug 9. doi: 10.1007/s00586-025-09261-6. Online ahead of print.

ABSTRACT

We appreciate the efforts of Maheshwari et al. in exploring CALM1 polymorphisms in degenerative cervical myelopathy (DCM) within an Indian cohort. While the study offers valuable insights, we respectfully highlight certain methodological concerns-particularly regarding statistical interpretation, control group heterogeneity, and age differences between groups. Furthermore, interpretations suggesting pathogenicity for a computationally benign variant may benefit from additional functional validation. We believe that addressing these aspects in future studies will enhance the robustness and translational relevance of genetic research in DCM.

PMID:40782200 | DOI:10.1007/s00586-025-09261-6