Category: Statistics

BMC Med. 2025 Aug 4;23(1):454. doi: 10.1186/s12916-025-04257-x.

ABSTRACT

BACKGROUND: Ensuring adherence to clinical practice guidelines (CPGs) is critical for improving patient outcomes. However, how the impact of guideline adherence on clinical outcomes is studied remains unclear. Our objectives are (1) to identify studies that assess the impact of adherence to CPGs; (2) to describe the research questions of these studies; and (3) to describe their study designs, methods, and reporting. We focused on CPGs addressing the pharmacologic management of major chronic diseases, specifically musculoskeletal diseases (rheumatoid arthritis, osteoarthritis, axial spondyloarthritis, and psoriatic arthritis), diabetes, and hypertension.

METHODS: We conducted a scoping review. We searched PubMed on March 3, 2023, for studies published since 2013. We included studies assessing the impact of adherence to CPGs for the pharmacologic management of adult patients. One reviewer screened the titles and abstracts and full texts and a second reviewer independently screened 20%. Two reviewers independently extracted data using a standardized pilot-tested data extraction form. Data were analyzed descriptively.

RESULTS: Of 7952 records retrieved, 16 studies were eligible for inclusion. The studies addressed CPGs for the management of diabetes (n = 8), hypertension (n = 6), and axial spondyloarthritis (n = 2). All studies were cohort studies, but none emulated a target trial. The median number of participants analyzed was 511 (IQR 350; 10,536) and the median follow-up time was 9 months (IQR 4; 18). Four studies explicitly reported the recommendations for which the impact of adherence was assessed, nine precisely defined adherence, and eight studies evaluated only surrogate outcomes. Thirteen studies accounted for confounding factors. There was serious or critical risk of bias in selection of participants in 13 studies.

CONCLUSIONS: The impact of adherence to clinical practice guidelines is rarely and inadequately evaluated. Future research should employ rigorous study designs and reporting standards to generate more reliable insights into the impact of CPG adherence.

PMID:40754575 | DOI:10.1186/s12916-025-04257-x

Neurosurg Rev. 2025 Aug 4;48(1):587. doi: 10.1007/s10143-025-03713-9.

ABSTRACT

BACKGROUND AND OBJECTIVES: Elderly patients with subarachnoid hemorrhage (SAH) face a disproportionately high burden of morbidity and mortality. While endovascular coiling is often favored in this population, direct comparisons with surgical clipping are limited. We conducted a meta-analysis to compare outcomes of clipping versus coiling in SAH patients aged ≥ 60 years.

METHODS: A systematic search of PubMed, Embase, and Cochrane databases identified studies comparing the two treatments in this age group. The primary outcome was a composite of unfavorable outcomes (modified Rankin Scale [mRS] > 2 and mortality). Secondary outcomes included mortality, favorable outcome (mRS 0-2), rebleeding, and hospital length of stay. Heterogeneity was assessed using I² statistics, with subgroup analysis by age decade.

RESULTS: Twenty-seven studies (2 randomized controlled trials [RCTs]) involving 51,415 patients (59.6% treated with clipping) were included. There were no significant differences between clipping and coiling for unfavorable outcome (RR 1.03; 95% CI 0.96-1.11), favorable outcome (RR 1.02; 95% CI 0.93-1.11), mortality (RR 1.08; 95% CI 0.97-1.19), or rebleeding (RR 1.21; 95% CI 0.57-2.57). However, coiling was associated with shorter hospital stays (MD -2.53 days; 95% CI -4.58 to -0.49; p = 0.0152). RCTs showed a non-significant trend favoring coiling, while observational studies leaned toward clipping. Heterogeneity for main outcomes was moderate (I² = 57.7%). Using the GRADE framework, overall certainty of evidence was rated very low, mainly due to the predominance of non-randomized studies, moderate risk of bias, and inconsistency across studies.

CONCLUSIONS: In SAH patients aged ≥ 60 years, clipping and coiling show comparable outcomes, with coiling associated with shorter hospital stays. Given the very low certainty of evidence, these findings should be interpreted with caution. Prospective multicenter cohorts are needed to establish more definitive evidence.

PMID:40754563 | DOI:10.1007/s10143-025-03713-9

Sci Rep. 2025 Aug 3;15(1):28320. doi: 10.1038/s41598-025-14219-1.

ABSTRACT

This research seeks to explore the application value of carbon nanoparticle (CN) in transoral endoscopic thyroidectomy vestibular approach (TOETVA) with the goal of providing more reliable clinical evidence for minimally invasive treatment of thyroid cancer.A total of 110 patients with differentiated thyroid cancer (DTC) met the inclusion and exclusion criteria from September 2019 to January 2020. They were divided into an experimental group (TOETVA group) of 80 patients and a control group (OT group) of 30 patients based on their cosmetic preferences. All patients were treated with CN during surgery, and the surgeon actively selected lymph nodes and sent them separately for examination according to < 5 mm (small) and ≥ 5 mm (large), recording the number of row retrieved lymph nodes (RRLN). Routine medical examination was conducted to report the number of retrieved lymph nodes (RLN) and positive central lymph nodes (PLNs) detected one week after surgery. The positive rate (PR) of lymph nodes and the proportion of lymph node positive individuals were calculated. Compared with the control group, there was no significant difference between the experimental group and the control group in the proportion of RRLN, RLN, PLN, PR, and lymph node positivity. The differences in the number of lymph nodes of the same group: small lymph nodes have more RRLN and RLN than large lymph nodes, and the difference is statistically significant. In the experimental group, RRLN is larger than RLN, the difference is statistically significant. There is a slight difference between the control group and the experimental group, RRLN is generally higher than RLN. The lymph node clearance effect of TOETVA and OT is basically consistent. The use of CN can improve the detection rate of small lymph nodes in TOETVA, and it is recommended to use CN during the procedure.

PMID:40754562 | DOI:10.1038/s41598-025-14219-1

EJNMMI Rep. 2025 Aug 4;9(1):27. doi: 10.1186/s41824-025-00258-4.

ABSTRACT

BACKGROUND: In the last decade, immunotherapy, particularly immune checkpoint inhibitors, has revolutionized cancer treatment and improved prognosis. However, severe checkpoint inhibitor-induced liver injury (CHILI), which can lead to treatment discontinuation or death, occurs in up to 18% of the patients. The aim of this study is to evaluate the value of PET/CT radiomics analysis for the detection of CHILI.

MATERIALS AND METHODS: Patients with CHILI grade 2 or higher who underwent liver function tests and liver biopsy were retrospectively included. Minors, patients with cognitive impairments, and patients with viral infections were excluded from the study. The patients’ liver and spleen were contoured on the anonymized PET/CT imaging data, followed by radiomics feature extraction. Principal component analysis (PCA) and Bonferroni corrections were used for statistical analysis and exploration of radiomics features related to CHILI.

RESULTS: Sixteen patients were included and 110 radiomics features were extracted from PET images. Liver PCA-5 showed significance as well as one associated feature but did not remain significant after Bonferroni correction. Spleen PCA-5 differed significantly between CHILI and non-CHILI patients even after Bonferroni correction, possibly linked to the higher metabolic function of the spleen in autoimmune diseases due to the recruitment of immune cells.

CONCLUSION: This pilot study identified statistically significant differences in PET-derived radiomics features of the spleen and observable changes in the liver on PET/CT scans before and after the onset of CHILI. Identifying these features could aid in diagnosing or predicting CHILI, potentially enabling personalized treatment. Larger multicenter prospective studies are needed to confirm these findings and develop automated detection methods.

PMID:40754557 | DOI:10.1186/s41824-025-00258-4

Sci Rep. 2025 Aug 3;15(1):28330. doi: 10.1038/s41598-025-12851-5.

ABSTRACT

Cervical cancer, a leading cancer among women, is strongly associated with Human Papillomavirus infection, but host genetic factors also contribute to the progression from high-grade squamous intraepithelial lesions (HSIL) to invasive cancer. Interleukin-10 (IL-10), an immunosuppressive cytokine, may influence susceptibility to HSIL and cervical cancer through genetic variations. This study aimed to compare IL-10 gene promoter polymorphisms, -1082 A > G and – 819T > C, in women diagnosed with HSIL or cervical cancer and those with negative for intraepithelial lesion or malignancy (NILM). In this case-control study, 309 women were analyzed, including 142 with HSIL or cervical cancer and 167 controls with NILM. Blood samples were collected for DNA extraction and genotyping of polymorphisms through PCR amplification. Statistical analyses included comparisons of genotype and allele frequencies, haplotype frequency, and assessments of Hardy-Weinberg equilibrium and linkage disequilibrium. The mean age was 33.4 years for cases and 41.7 years for controls (p < 0.05). For the – 1082 A > G polymorphism, the GG genotype was significantly associated with a decreased risk of HSIL and cervical cancer (p = 0.0266, OR = 0.35). Recessive model (GG vs. AA + AG) confirmed this association (p = 0.0045, OR = 0.29). AC/GC diplotype was associated with a 2-fold increased risk of cervical lesions. Further studies are needed to confirm our results.

PMID:40754553 | DOI:10.1038/s41598-025-12851-5

Sci Rep. 2025 Aug 3;15(1):28306. doi: 10.1038/s41598-025-13555-6.

ABSTRACT

Mycoplasma pneumonia pneumonia(MPP) is a common respiratory disease that often occurs in children. The purpose of this study was to explore the clinical characteristics of children with mycoplasma pneumoniae pneumonia, the first outbreak after the prevalence of COVID-19 epidemic. Meanwhile, this study also analyzed the predictive value of serum protein indicators and coagulation parameters in the MPP group, as well as the correlation between these indicators. Children with Mycoplasma pneumoniae admitted to the pediatric ward of Chengdu Fifth People’s Hospital from May 2023 to March 2024 were selected. After screening, 411 children who met the research criteria were selected as the study subjects. All of the blood samples were tested for coagulation function, procalcitonin, serum protein and glucose among MPP group and control group. All data were processed for statistical analysis using GraphPad Prism 10.2.3. Comparison of the serum proteins and coagulation function between the MPP group and control group showed that prothrobin time(PT), thrombin time (TT), fibrinogen(Fbg), activated partial thromboplastin time (APTT), international normalized ration(INR), D-Dimer(DD) were significantly higher(P < 0.05) in MPP group. Total protein, albumin, prealbumin, alkaline phosphatase, lactate dehydrogenase, adanosine deaminase, glucose, platelet, procalcitonin also were significantly higher(P < 0.05) in MPP group. A multiple logistic regression analysis showed that the children in MPP group were a statistically significant difference in comparison of TT, Fbg, total protein, albumin, glucose, platelet expression in predicting the development. Then we analyzed the area under the ROC curve and correlation of serum parameters with significant differences in MPP group children. These results indicate that the coagulation function and serum protein of MPP patients who first broke out after the COVID-19 epidemic are different from the previous clinical characteristics, which can be used as a reference for auxiliary diagnosis.

PMID:40754552 | DOI:10.1038/s41598-025-13555-6

Urol Oncol. 2025 Aug 2:S1078-1439(25)00257-1. doi: 10.1016/j.urolonc.2025.07.007. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study is to determine residual tumor characteristics for high grade Ta and T1 bladder tumors following transurethral resection of bladder tumor (TURBT) at a facility where initial aggressive resection is standard.

METHODS: This is a retrospective review of patients who had multiple TURBTs done by 2 urologic oncologists at a single facility. During a 5-year period from 2018 to 2022 using specific ICD-10 and CPT codes, the institutional electronic health record was used to identify patients requiring repeat resection for high grade Ta and all T1 bladder cancer. Data compilation and statistical analysis was performed on points of interest from initial to repeat resection, most notably, tumor upstaging and tumor persistence while accounting for multiple demographic variables.

RESULTS: Analysis of our institutional data indicates 143 patients who underwent an initial and repeat TURBT at our facility during the 5-year period of interest. Retrospective data demonstrates a tumor persistence rate of 27.7% and 34.6% for Ta and T1 bladder cancer, respectively. Additionally, our data reveals an upstaging rate of only 3.1% and 3.8% for Ta and T1 bladder cancer, respectively.

CONCLUSION: Per current American Urological Association (AUA) guidelines, patients with T1 or high-grade Ta bladder cancer should undergo repeat transurethral resection within 6 weeks as previously published literature reports high rates of tumor upstaging and progression. Our data shows a dramatically lower rate of tumor persistence and tumor upstaging on repeat TURBT compared to historical literature, and our surgical approach could potentially challenge the need for repeat resection for certain patients.

PMID:40754546 | DOI:10.1016/j.urolonc.2025.07.007

Vaccine. 2025 Aug 2;62:127562. doi: 10.1016/j.vaccine.2025.127562. Online ahead of print.

ABSTRACT

BACKGROUND: In this phase 3, single-arm, open-label trial in Japanese adults who had previously received a COVID-19 mRNA primary vaccination (NCT05299359), two NVX-CoV2373 boosters, administered 5 months apart in the main and extension parts of the study, respectively, induced robust immune responses up to day (D) 15 after each dose. This final report presents immunogenicity and safety findings at 1-year follow-up.

METHODS: Immunogenicity of the first NVX-CoV2373 booster (main part) and second NVX-CoV2373 booster (extension part) was assessed at D29, D91, D181, and D366 in each study part. Safety findings were evaluated for each study part at 1-year follow-up.

RESULTS: Of 150 participants who received a first NVX-CoV2373 booster on D1, 21 did not participate in the extension part and 17 completed the main part. In total, 129 participants received a second booster on extension day (ED) 1, and 121 completed the extension part. In the main and extension parts, anti-SARS-CoV-2 serum immunoglobulin G (IgG) responses to the boosters peaked on D29 and ED15, respectively; serum neutralizing antibody (nAb) responses to the boosters peaked on D15 and ED29, respectively. Serum IgG and nAb titres remained relatively high in both study parts throughout the 1-year follow-up compared with their pre-booster titres on D1 and ED1. There were no deaths or adverse events leading to study discontinuation at 1-year follow-up for both study parts. A SARS-CoV-2 infection was reported in 14.0 % (21/150) of participants in the main part and 10.9 % (14/129) in the extension part; all cases were mild/moderate in severity.

CONCLUSION: The two NVX-CoV2373 boosters induced durable anti-SARS-CoV-2 immune responses up to 1 year after each dose and are therefore expected to persistently protect against SARS-CoV-2 infections and severe disease outcomes in Japanese adults. No new safety concerns were identified, demonstrating the expected acceptable safety profile in healthy Japanese participants.

PMID:40753673 | DOI:10.1016/j.vaccine.2025.127562

Int J Food Microbiol. 2025 Jul 28;442:111368. doi: 10.1016/j.ijfoodmicro.2025.111368. Online ahead of print.

ABSTRACT

The post-fermentation phase of still wine plays a crucial role in determining wine quality. This study evaluates the impact of key winery practices (including nitrogen supplementation during fermentation, cooling methods, and SO₂ addition) on yeast lees viability and acetaldehyde production during the post-fermentation stage. Two commercial Saccharomyces cerevisiae strains with distinct technological characteristics were assessed under a real vinification protocol involving a decanting rest, two rackings, and bottling. Nitrogen was supplemented either as ammonium alone (NH₄⁺) or as a mix of ammonium and amino acids (MIX). In order evaluate the effect of the treatments independently to the yeast strain, statistical mixed models were applied. Results showed that generally MIX supplementation significantly enhanced yeast viability without increasing acetaldehyde levels. Fast cooling and absence of SO₂ addition after fermentation were associated with higher viable cell counts and lower acetaldehyde concentrations. Although SO₂ addition consistently increased acetaldehyde, the timing of its application did not significantly affect its final concentration. These findings suggest that optimizing nitrogen nutrition and post-fermentation cooling strategies can improve wine quality by modulating viable cells concentration and acetaldehyde production. Moreover, the observed persistence of viable yeast cells highlights the need for further studies on their role in oxidation protection and wine maturation, providing a foundation for refined fermentation management practices.

PMID:40753661 | DOI:10.1016/j.ijfoodmicro.2025.111368

Geriatr Nurs. 2025 Aug 2;65:103592. doi: 10.1016/j.gerinurse.2025.103592. Online ahead of print.

ABSTRACT

BACKGROUND: To explore the association between retirement status (normal vs. nonnormal) and depressive symptoms, focusing on the interaction of retirement status with self-assessed health.

METHODS: Using data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), 390 retirees aged 45 and older were analyzed. Depressive symptoms were measured using the CESD-10. Retirement status was categorized into normal and non-normal, and self-assessed health as healthy or unhealthy. Multilevel regression models were used to examine the associations and interactions between retirement status and depressive symptoms, adjusting for demographic, socioeconomic, lifestyle, and health-related factors.

RESULTS: The association between non-normal retirement and depressive symptoms (β=3.52, P = 0.001) and the interaction between non-normal retirement and unhealthy self-assessment (β = 4.58, P = 0.04) are statistically significant.

CONCLUSION: Non-normative retirement is associated with higher depressive symptoms among Chinese retirees, particularly among those with poor self-rated health. Targeted interventions and increased retirement policy flexibility are recommended.

PMID:40753656 | DOI:10.1016/j.gerinurse.2025.103592