Category: Statistics

Iran Biomed J. 2025 Nov 1;29(6). doi: 10.61882/ibj.5018.

ABSTRACT

BACKGROUND: Accurate detection of actionable EGFR mutations is essential for guiding targeted therapy in NSCLC. Liquid biopsy approaches using ctDNA and exoDNA offer noninvasive alternatives for molecular profiling. This study evaluated the diagnostic performance of nested PCR combined with sanger sequencing for detecting common EGFR mutations (exon 19 deletions and the L858R point mutation) in plasma samples from Iranian NSCLC patients.

METHODS: In this retrospective observational study, blood samples were collected from 30 NSCLC patients with confirmed EGFR mutations. ctDNA was extracted from plasma and analyzed using nested PCR followed by sanger sequencing. Specificity was assessed in 20 EGFR-wild type NSCLC patients serving as controls. Diagnostic performance was further evaluated in relation to clinicopathological factors.

RESULTS: EGFR mutations were detected in plasma ctDNA in 63.3% of patients. Detection sensitivity was significantly associated with tumor stage but was independent of mutation subtype, age, sex, or smoking status. The assay showed high specificity, with no false positive results in control samples (95% CI: 83.9-100.0%). Although exoDNA analysis demonstrated a higher sensitivity than ctDNA (76.6% vs. 63.3%), this difference was not statistically significant. Notably, combined analysis of ctDNA and exoDNA increased overall detection sensitivity to 80%.

CONCLUSIONS: Nested PCR with sanger sequencing represents a reliable rule in strategy for EGFR mutation detection in plasma. Integrating ctDNA and exoDNA analyses substantially improves sensitivity and may enhance noninvasive molecular diagnostics in NSCLC.

PMID:41420326 | DOI:10.61882/ibj.5018

J Dent Res. 2025 Dec 19:220345251401861. doi: 10.1177/00220345251401861. Online ahead of print.

ABSTRACT

This study investigated the efficacy of the polymer-induced liquid precursor (PILP) process and of an experimental composite containing dicalcium phosphate dihydrate (DCPD) particles for in vitro remineralization of artificial dentin lesions. The hypothesis was that pretreatment with the PILP solution associated with an external Ca²⁺/PO₄^3- source represented by the composite containing DCPD would increase dentin remineralization in comparison to each strategy alone. Dentin discs with a 2.5-mm × 2.5-mm demineralized window (acetic acid, pH 5, for 66 h) were assigned to one of four experimental conditions, defined by the pretreatment (20 μL for 20 s: PILP solution or deionized water) and by the composite placed on the dentin surface: “control” (50% barium glass, BG) or “DCPD” (40% DCPD and 10% BG). Specimens were placed in artificial pulp chambers with the lower compartment filled with simulated body fluid for 28 d. Remineralization was assessed by changes in the mineral-to-matrix ratio (MMR) at the dentin-composite interface (attenuated total reflection-Fourier transform infrared spectroscopy) and by nanoindentation. Data were analyzed by repeated-measures 2-way analysis of variance/Tukey test (α = 0.05). Selected specimens were observed under scanning electron microscopy/energy-dispersive X-ray spectroscopy (EDS) and transmission electron microscopy with selected area electron diffraction analysis (SAED). All groups recovered MMR to levels similar to sound dentin, but only PILP + DCPD reached MMR levels similar to sound dentin after 14 d (P > 0.05). At the external lesion (0-90 µm), both DCPD and PILP + DCPD groups showed an elastic modulus (EM) statistically higher than the control, but only PILP + DCPD showed EM similar to sound dentin at the internal lesion (90-160 µm, P < 0.001). In relation to sound dentin, EM recovery reached 18% in the PILP group (not different from the control), 31% in the DCPD group, and 57% in the PILP + DCPD group. Micro- and ultramorphological analyses confirmed the increase in mineral content in the latter 2 groups. In conclusion, the association of both remineralization strategies improved dentin remineralization compared to either approach separately.

PMID:41420325 | DOI:10.1177/00220345251401861

Nurs Health Sci. 2025 Dec;27(4):e70271. doi: 10.1111/nhs.70271.

ABSTRACT

This study aims to assess the effectiveness of sling exercise training (SET) on walking ability, balance function, and activities of daily living (ADL) in patients with stroke. A systematic search was conducted across multiple databases (PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, and Wanfang) from inception to January 2025. A total of 23 studies involving 922 participants were included. Methodological quality was assessed using the Cochrane risk-of-bias tool. Meta-analyses were performed using standardized mean differences with 95% confidence intervals. The analysis revealed substantial improvements in balance function, as measured by the Berg balance scale. Lower limb motor function assessed by the Fugl-Meyer assessment showed notable enhancement. Balance ability measured by the Fugl-Meyer balance scale indicated significant progress, whereas walking ability assessed by the Holden functional walking rating showed marked improvement. However, improvements in ADL and 6-min walk test performance did not reach statistical significance. SET demonstrates substantial beneficial effects on balance function, lower limb motor function, and walking ability in patients with stroke. However, its impact on ADL and walking endurance requires further investigation.

PMID:41420322 | DOI:10.1111/nhs.70271

Psychophysiology. 2025 Dec;62(12):e70211. doi: 10.1111/psyp.70211.

ABSTRACT

Emotion and fairness play a key role in mediating socioeconomic decisions in humans; however, the underlying neurocognitive mechanism remains largely unknown. This exploratory study unraveled the interplay between agents’ emotions and the fairness of their monetary proposal in rational decision-making, backed by ERP analyzes of N170, Late Positive Potential (LPP), Feedback Related Negativity (FRN) and P3a at a group as well as a strategic level. In a time- bound ultimatum-game paradigm, 40 participants were exposed to three distinct proposers’ emotions (Happy, Neutral, Disgusted) followed by one of the three offer ranges (Low, Intermediate, High). Our findings show a robust influence of economic fairness on acceptance rates. A multilevel generalized linear model showed offer as the dominant predictor of trial-specific responses. Subsequent clustering grouped participants into five clusters, which the Drift Diffusion Model corroborates. Pertinent neural markers demonstrated the recognition of facial expressions; however, they had minimal effect during socioeconomic decision-making. Our study explores individualistic decision-making processes revealing different cognitive strategies.

PMID:41420291 | DOI:10.1111/psyp.70211

J Anat. 2025 Dec 19. doi: 10.1111/joa.70086. Online ahead of print.

ABSTRACT

Shoulder anatomy is complex, varying in shape and pose. Studies have related bone shape and joint function, which can predict each other but not yet in the shoulder. This project aims to investigate bone shape and pose relationships in the healthy shoulder via partial least square regressions (PLSR). Sixty-eight registered humeri, scapulae, and clavicles were segmented (47 males and 15 females, age: 30.7 ± 9.5 years) from medical images (computed tomography and magnetic resonance images) and constituted the shape input (principal component analysis scores). Local bone coordinate systems (three axes and origin) composed the pose information. PLSR analyses were conducted using the shape of one or all three bones to predict the pose and vice versa. The main variation mode explained scaling for shape (38% variation explained) and the three shoulder bones’ anteroposterior (AP) and superoinferior translations, and humeral and clavicular AP rotations for pose (8%). There was no difference in explained pose variation whether using the humerus, scapula, or clavicle as predictors. However, pose variations were more intertwined between the scapula and the clavicle when using all three shoulder bones as predictors compared to single-bone models, suggesting a stronger coupling between these bones that likely originates from their shared anatomical constraints with the thoracic cage. The dataset showed a mild to excellent fit to the analysis (R² = 0.4-0.9); however, the findings lacked generalizability (Q² = 0.0-0.1), suggesting that PLSRs require additional information-such as soft tissue contributions-to enhance predictive performance. These findings have potential clinical applications in surgical planning, where individual bone shape could be used to estimate native shoulder poses in trauma patients; however, stronger predictive models incorporating additional anatomical or biomechanical parameters are needed to support such use.

PMID:41420279 | DOI:10.1111/joa.70086

Br J Clin Pharmacol. 2025 Dec 19. doi: 10.1002/bcp.70427. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this is to test the feasibility of identifying unsuspected, previously unknown drug-outcome associations, that is, collateral drug benefits (CDBs), through a systematic screening analysis of real-world health-care databases. Ultimately, such screening could lead to drug repurposing.

METHODS: We analysed data from the Danish National Prescription Registry and the Danish Patient Registry, covering 1996-2022. The study employed the sequence symmetry analysis (SSA), an exposure-anchored self-controlled design that compares the number of clinical outcomes in symmetrical windows before and after the exposure drug initiation. To verify the directionality and robustness of these associations, we incorporated the case-crossover (CCO) design, another self-controlled design. The obtained associations were ranked according to the hypothetical number of averted outcomes, if a causal effect could be assumed.

RESULTS: The analysis included 1.3 billion prescriptions and 260 million diagnosis records, resulting in 27 820 976 drug-diagnosis combinations and 7 920 323 drug-drug combinations. Preventive associations in both the SSA and CCO were found in 7795 drug-diagnosis and 5088 drug-drug combinations. A manual review of the highest ranked 100 associations resulted in 11 drug-diagnosis and 2 drug-drug associations as potential unknown CDBs. Notable findings included selective serotonin reuptake inhibitors linked to a lower risk of certain cardiovascular outcomes, anticholinesterases associated with fewer delirium diagnoses and progestogens associated with a reduced risk of obesity.

CONCLUSIONS: The study confirms that hypothesis-free screening is feasible and that combining sequence symmetry analysis and case-crossover designs can identify potential collateral drug benefits. Further validation studies are required to confirm these findings and explore their clinical implications.

PMID:41420263 | DOI:10.1002/bcp.70427

BMC Med Educ. 2025 Dec 19;25(1):1702. doi: 10.1186/s12909-025-08253-w.

ABSTRACT

BACKGROUND: Traditionally, checklists or evaluation templates have been utilized to assess psychological and health-related issues in fields like psychology and pediatrics. Currently, their use has expanded, particularly in medical research and healthcare evaluation. This study aims to develop and validate checklists for standardized patient use in the subject ” Special Care Health Needs patients” within the Dentistry Degree program, ensuring international applicability whenever clinical simulation is employed.

MATERIAL AND METHOD: Six different scenarios were developed for student evaluation. Along with each scenario, a script was also created for the simulated participant or the instructor voicing the simulator. An evaluation template was designed for each clinical scenario. Once the scenarios and checklists were designed, 11 experts in the field of Special Care Health Needs Patients from six different universities were provided with a file for each simulation scenario, which they had to complete. The data collected from the validation of the evaluation templates by the expert panel were sent to the Statistical Support Section (SAE) of the University of Murcia. Data analysis was performed using R version 4.0.3.

RESULTS: The level of agreement among experts regarding the importance and scoring of items in six clinical evaluation templates was analyzed. Most results were statistically significant (p < 0.05), except for the physical examination dimension in several templates, likely due to the low number of items. Overall, high concordance was observed across competency dimensions, particularly in communication.

CONCLUSIONS: The positive statistical outcomes observed in our implementation of these checklists highlight their potential not only to assess students’ clinical behavior with consistency but also to inform and refine educational strategies. The adoption of a standardized, rigorous approach to checklist development-such as the one applied in this study-may contribute significantly to the advancement of performance evaluation in healthcare education, promoting both learner competency and patient-centered care.

PMID:41420174 | DOI:10.1186/s12909-025-08253-w

BMC Womens Health. 2025 Dec 20. doi: 10.1186/s12905-025-04233-w. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer reduces quality of life. Hr-QoL after all types of surgeries in general and after elective breast surgeries like mastectomy in particular is, however an under-researched area worldwide. This gap is conspicuously felt and seen especially in developing countries like Ethiopia. The main objective of this study was to assess the Hr-QoL outcomes of breast cancer cases after curative-intent surgery in comparison with health institution-based normal individuals.

METHODS AND PATIENTS: A comparative cross-sectional study using SF-36 was conducted to compare Hr-QoL outcomes of representatively sampled 366 post-mastectomy women and health institution-based women as controls. The collected data were analyzed using SPSS windows version 21. The mean ranks of the Hr-QoL outcomes on a 0 to 100 scale were compared between the two groups using Mann-Whitney U test at p-value ≤ 0.05 (two-sided).

RESULTS: Three hundred sixty-six participants (366), 183 cases and 183 controls were included in the analysis. Post-mastectomy cases had a median Physical Functioning (PF) of 70.0; Role-Physical (RP) of 75.0; Bodily Pain (BP) of 44.0; General Health (GH) of 35.0; Vitality (VT) of 40.0; Social Functioning (SF) of 50.0; Role-Emotional (RE) of 33.3; and Mental Health (MH) of 44.0. The respective values for the control group were: 75.0; 75.0; 54.0; 50.0; 55.0; 62.5; 66.7; and 64.0. PF and RP showed no statistically significant difference between the two groups. On the other hand, BP, GH, VT, SF, RE and MH were significantly lower in the post-mastectomy group.

CONCLUSION: Quality of life of breast cancer patients after a curative-intent mastectomy was found to be lower. They had significantly lower scores in scales measuring mental health and those measuring both physical and mental health. Of the three scales assessing physical health, bodily pain was significantly lower.

PMID:41420168 | DOI:10.1186/s12905-025-04233-w

BMC Public Health. 2025 Dec 20. doi: 10.1186/s12889-025-25935-8. Online ahead of print.

ABSTRACT

BACKGROUND: Health literacy is a dynamic and multidimensional concept. Examining health literacy among higher education students and teachers is crucial for promoting informed health decisions and encouraging healthier behaviors. Our study aimed to measure health literacy among higher education students and teachers, assess the impact of sociodemographic variables, and compare health literacy levels between these groups.

METHODS: This study is a Portuguese Academic Health Literacy Network (RALS) project. Data were collected via a questionnaire, including the HLS-EU-Q16 and sociodemographic and health information-seeking behavior items. The statistical analyses involved descriptive statistics and binary logistic regression. The executive boards of the participating universities and polytechnic institutes were initially informed about the objectives of the study and the prior approval obtained from an ethics committee. We then requested that the institutions use their official email databases to distribute invitations to students and teachers to complete the online questionnaire.

RESULTS: The sample consisted of 5,798 students and 1,823 teachers. The majority were women, with students predominantly aged 20-30 years and teachers mostly over 40 years. Compared with students, teachers presented higher health literacy levels (p < 0.001). Specifically, 45.0% of the students and 31.5% of the teachers had inadequate or problematic health literacy. Graduate students and PhD-holding teachers had superior literacy scores (p < 0.001). Economic sufficiency (highest OR: students 2.708; teachers 3.310) and self-health perception positively influenced health literacy (highest OR: students 1.974; teachers 2.284), whereas nonhealthy fields decreased the likelihood of positive health literacy (lowest OR: students 0.583; teachers 0.456). For students, age and educational level were significant factors for positive literacy levels, whereas for teachers, professional background in health was key. Sex and chronic disease presence were not significant for either group.

CONCLUSIONS: The study highlights a meaningful portion of students with inadequate health literacy (45%). Socioeconomic factors, including education and economic resources, significantly influence health literacy. Additionally, involvement in health-related fields and better self-assessed health correlate with higher health literacy. These findings underscore the need for targeted interventions and training to enhance health literacy across the academic community.

PMID:41420167 | DOI:10.1186/s12889-025-25935-8

Malar J. 2025 Dec 19. doi: 10.1186/s12936-025-05716-9. Online ahead of print.

ABSTRACT

BACKGROUND: Vector control is the most important malaria prevention strategy in Zambia. Attractive Targeted Sugar Baits (ATSB) are a potential new tool for vector control in this setting, which, if efficacious, would be intended to supplement insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS). ATSBs target and kill sugar feeding mosquitoes, potentially limiting the spread of malaria. No information on the cost or cost-effectiveness of deployment of ATSB stations is currently available.

METHODS: A cluster randomized control trial (cRCT) was carried out in Western Province, Zambia to assess the efficacy of Sarabi v.1.2 ATSB stations in a highly malarious setting. Costs associated with the procurement, distribution, maintenance, and disposal of the ATSB stations were collected over a two-year period. These costs were assessed alongside the main trial efficacy outcomes to determine cost-effectiveness and potential budget impact on the deployment of ATSB stations in this setting. Total costs, incremental costs, incremental cost-effectiveness ratios (ICER) and budget impact were estimated using trial data. One-way, scenario and probabilistic sensitivity analysis were performed to further determine the impact of assumptions and uncertainty on cost-effectiveness estimates, and the potential cost implications of alternative deployment scenarios. Sub-group analysis was performed to determine the impact of deployment in settings with the most favorable effect scenarios.

RESULTS: The total cost of the intervention in the context of the cRCT was USD 1,261,515. ATSB cost accounted for 46% of the total cost followed by personnel (25%), supplies and transport (13% each), equipment (2%) and storage (1%). Over the two year (14-month intervention) this resulted in an estimated ICER of USD 79 per malaria incident case averted or USD 919 per disability-adjusted life year (DALY) averted and USD 10.08 per person-year protected. In a subset of high-density ATSB clusters ICER was USD 42 per incident case averted and USD 493 per DALY averted and USD 4.35 per person-year protected. Probabilistic sensitivity analysis indicated that deployment in areas with higher structure density may be more cost-effective, especially if potential cost-savings are considered. However, effect estimates in this subgroup were highly uncertain and not statistically significant. While the scenario appeared more cost-effective than the base case on the cost-effectiveness acceptability curve (CEAC), the probability of cost-effectiveness reached only around 70%, falling short of the commonly used 80% threshold and remaining relatively weak.

CONCLUSIONS: ATSB Sarabi v.1.2 as deployed in western Zambia were not likely to be cost -effective. ATSB would need to demonstrate higher or more certain efficacy along with affordable alternative distribution strategies prior to any deployment at scale. Trial registration The trial is registered on clinicaltrials.gov under registration number: NCT04800055.

PMID:41420162 | DOI:10.1186/s12936-025-05716-9