Category: Statistics

Hum Reprod. 2025 Jan 10:deae300. doi: 10.1093/humrep/deae300. Online ahead of print.

ABSTRACT

In recent years, the transfer of more than one embryo has become less frequent to diminish multiple pregnancies. Even so, there is still a risk of one embryo splitting into two or even three. This report presents the case of a triamniotic monochorionic gestation in a 35-year-old woman, obtained after the transfer of a single day 5 embryo that had been previously hatched with a laser and subsequently transferred in a fresh IVF cycle. The morphokinetics of this embryo as well as another eight that produced monozygotic twins were compared with nine embryos that achieved singleton gestations. An artificial intelligence (AI) system was used to perform this analysis objectively. Embryo divisions leading to multiple gestations were slower across all analysed parameters. This was most evident in the time taken to reach the 5-cell stage (t5) (48.74 ± 3.21 versus 44.69 ± 5.61 h) and the morula stage (tM) (85.08 ± 10.00 versus 78.13 ± 5.35 h). Moreover, blastocyst diameter (161.80 ± 26.50 versus 179.10 ± 25.88 μm) and area (21 684 ± 7267.4 versus 26 516 ± 7254.8 μm2) were smaller in these embryos, but the differences did not reach statistical significance. This is the first report, to our knowledge, to use AI to analyse and compare morphokinetic parameters between singleton pregnancies and a group of embryos that produced twin and triplet pregnancies.

PMID:39792920 | DOI:10.1093/humrep/deae300

J Med Internet Res. 2025 Jan 10;27:e52591. doi: 10.2196/52591.

ABSTRACT

BACKGROUND: The COVID-19 pandemic demonstrated the global need for accessible content to rapidly train health care workers during health emergencies. The massive open access online course (MOOC) format is a broadly embraced strategy for widespread dissemination of trainings. Yet, barriers associated with technology access, language, and cultural context limit the use of MOOCs, particularly in lower-resource communities. There is tremendous potential for MOOC developers to increase the global scale and contextualization of learning; however, at present, few studies examine the adaptation and sharing of health MOOCs to address these challenges.

OBJECTIVE: The World Health Organization’s Health Emergencies Programme Learning and Capacity Development Unit and the Stanford Center for Health Education collaborated to survey learners from 4 emergency health MOOCs on the OpenWHO platform to examine differences in course use by World Bank country income classification across three dimensions: (1) how health education MOOCs are used and shared, (2) how health workers adapt MOOC content to meet local training and information needs, and (3) how content adaptations help frontline health workers overcome barriers to using MOOCs.

METHODS: This study draws upon two sources of data: (1) course enrollment data collected from the 4 emergency health MOOCs (N=96,395) and (2) survey data collected from learners who participated in at least 1 of the 4 MOOCs (N=926). Descriptive statistics are used to summarize learner characteristics. Differences in enrollment, sharing, and adaptation by country income classification are examined using Pearson chi-square test.

RESULTS: Of the enrollees who indicated their country of residence, half were from lower-middle-income countries (LMICs; 43,168/85,882, 50%) and another 9% (7146/85,882) from low-income countries. The majority of all respondents shared content (819/926, 88%) and used content in official trainings (563/926, 61%). Respondents were more likely to share and use content for trainings in LMICs than in high-income countries (91% vs 81%; P=.001). Learners in LMICs also shared content with more people on average compared with high-income country learners although the difference is not statistically significant (9.48 vs 6.73 people; P=.084). Compared with learners in high-income countries, learners in LMICs were more likely to adapt materials to distribute via offline formats or technologies, such as WhatsApp or text message (31% vs 8%; P<.001); to address cultural, linguistic, or other contextual needs (20% vs 12%; P=.076); and to meet local guidelines (20% vs 9%; P=.010). Learners in LMICs indicated greater accessibility challenges due to technological and linguistic barriers.

CONCLUSIONS: Learners commonly share content from MOOCs about public health emergencies; this is especially true in low-income countries and LMICs. However, content is often adapted and shared via alternative formats. Our findings identify a critical opportunity to improve MOOC design and dramatically scale the impact of MOOCs to better meet diverse global needs.

PMID:39792445 | DOI:10.2196/52591

J Cancer Res Ther. 2024 Dec 1;20(7):2061-2065. doi: 10.4103/jcrt.jcrt_1281_24. Epub 2025 Jan 10.

ABSTRACT

PURPOSE: To investigate and compare the feasibility, safety, and clinical outcomes of antegrade and retrograde laparoscopic bilateral inguinal lymphadenectomy for penile cancer.

METHODS: We retrospectively analyzed the clinical data of 32 patients with penile cancer admitted between 2018 and 2022. Among them, 17 patients underwent antegrade laparoscopic inguinal lymphadenectomy (ALIL group) and 15 underwent retrograde laparoscopic inguinal lymphadenectomy (RLIL group). The key surgical procedures and techniques are described. Operative time, intraoperative blood loss, hospital stay, drainage duration, postoperative complications, and follow-up data in both groups were statistically analyzed.

RESULTS: Surgery in both groups was successfully completed without the need for intraoperative conversion to open surgery. The operative time was significantly shorter for ALIL than for RLIL (P < 0.001). Significantly less intraoperative blood loss was reported with ALIL than with RLIL (P < 0.001). The ALIL group had a significantly shorter hospital stay than the RLIL group (P = 0.027). The number of removed lymph nodes in the ALIL group differed insignificantly from that in the RLIL group (P = 0.360). Postoperative drainage duration, recurrence, short-term survival, and postoperative complications were similar between both groups.

CONCLUSION: In the patients with penile cancer, ALIL and RLIL yielded similar perioperative outcomes. However, ALIL was associated with shorter operative time, less blood loss, and shorter hospital stays. ALIL did not require repositioning of the laparoscopic instruments, thereby simplifying the procedure and minimizing patient trauma. Additionally, if needed, pelvic lymphadenectomy could be performed simultaneously from the same trocar position used in ALIL.

PMID:39792416 | DOI:10.4103/jcrt.jcrt_1281_24

J Cancer Res Ther. 2024 Dec 1;20(7):2013-2020. doi: 10.4103/jcrt.jcrt_338_24. Epub 2025 Jan 10.

ABSTRACT

OBJECTIVE: Carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) serve as pivotal tumor markers in colorectal cancer (CRC). However, uncertainty persists regarding the prognostic significance of the two tumor markers when falling within the normal range. We attempt to compare the prognostic differences of tumor markers at different levels within the reference range.

METHODS: This retrospective study scrutinized 2,167 cases of stage II CRC verified by pathology after surgery at the Fudan University Shanghai Cancer Center. Using R software to calculate the optimal critical value to compare the clinical and pathological characteristics and prognosis of different levels of tumor markers. The survival and regression modeling strategies packages of R software drew the nomograms.

RESULTS: Utilizing R software, the optimal critical value of CA19-9 was determined as 12.12 U/mL and that of CEA as 1.89 U/mL. Kaplan-Meier survival analysis unveiled that, within the normal range, higher levels of CEA were linked to poorer overall survival (OS) [HR = 1.829 (1.280, 2.989), P = 0.0033] and disease-free survival (DFS) [HR = 1.472 (1.114, 1.944), P = 0.0444]. Similarly, heightened levels of CA19-9 also indicated inferior OS [HR = 1.750 (1.203, 2.455), P = 0.0076] and DFS [HR = 1.361 (1.098, 1.686), P = 0.0049]. Furthermore, multivariate analysis identified CA19-9 as an independent risk factor for OS (HR = 1.49,95% CI: 1.086-2.045, P = 0.014) and DFS (HR = 1.327,95% CI: 1.070-1.647, P = 0.01), while the impact of CEA on OS and DFS was not statistically significant. A nomogram constructed based on the Cox regression model can effectively evaluate the prognosis of CRC patients.

CONCLUSION: Although within the normal range, elevated CA19-9 was associated with an inferior prognosis, chemotherapy decisions of different intensities can be adjusted based on nomograms. This work will contribute to standardizing the diagnosis and treatment of stage II CRC and provide clinicians with essential insights for chemotherapy decisions.

PMID:39792411 | DOI:10.4103/jcrt.jcrt_338_24

JAMA Netw Open. 2025 Jan 2;8(1):e2453807. doi: 10.1001/jamanetworkopen.2024.53807.

ABSTRACT

IMPORTANCE: An unhealthy lifestyle is believed to increase the development and persistence of low back pain, but there is uncertainty about whether integrating support for lifestyle risks in low back pain management improves patients’ outcomes.

OBJECTIVE: To assess the effectiveness of the Healthy Lifestyle Program (HeLP) compared with guideline-based care for low back pain disability.

DESIGN, SETTING, AND PARTICIPANTS: This superiority, assessor-blinded randomized clinical trial was conducted in Australia from September 8, 2017, to December 30, 2020, among 346 participants who had activity-limiting chronic low back pain and at least 1 lifestyle risk (overweight, poor diet, physical inactivity, and/or smoking), referred from hospital, general practice, and community settings. Statistical analysis was performed from January to December 2021.

INTERVENTIONS: Participants were block randomized to the HeLP intervention (n = 174; 2 postrandomization exclusions) or guideline-based physiotherapy care (n = 172), stratified by body mass index, using a concealed function in REDCap. HeLP integrated healthy lifestyle support with guideline-based care using physiotherapy and dietetic consultations, educational resources, and telephone-based health coaching over 6 months.

MAIN OUTCOMES AND MEASURES: The primary outcome was low back pain disability (Roland Morris Disability Questionnaire [RMDQ] score; 0-24 scale, where higher scores indicate greater disability) at 26 weeks. Secondary outcomes were weight, pain intensity, quality of life, and smoking. Analyses were performed by intention to treat. We estimated the complier average causal effect (CACE) as sensitivity analyses.

RESULTS: The sample of 346 individuals (mean [SD] age, 50.2 [14.4] years; 190 female participants [55%]) had a baseline mean (SD) RMDQ score of 14.7 (5.4) in the intervention group and 14.0 (5.5) in the control group. At 26 weeks, the between-group difference in disability was -1.3 points (95% CI, -2.5 to -0.2 points; P = .03) favoring HeLP. CACE analysis revealed clinically meaningful benefits in disability among compliers, favoring HeLP (-5.4 points; 95% CI, -9.7 to -1.2 points; P = .01). HeLP participants lost more weight (-1.6 kg; 95% CI, -3.2 to -0.0 kg; P = .049) and had greater improvement in quality of life (physical functioning score; 1.8, 95% CI, 0.1-3.4; P = .04) than control participants.

CONCLUSIONS AND RELEVANCE: Combining healthy lifestyle management with guideline-based care for chronic low back pain led to small improvements in disability, weight, and quality of life compared with guideline-based care alone, without additional harm. Targeting lifestyle risks in the management of chronic low back pain may be considered safe and may offer small additional health benefits beyond current guideline-based care.

TRIAL REGISTRATION: http://anzctr.org.au Identifier: ACTRN12617001288314.

PMID:39792385 | DOI:10.1001/jamanetworkopen.2024.53807

JAMA Netw Open. 2025 Jan 2;8(1):e2454319. doi: 10.1001/jamanetworkopen.2024.54319.

ABSTRACT

IMPORTANCE: Understanding environmental risk factors for gestational diabetes (GD) is crucial for developing preventive strategies and improving pregnancy outcomes.

OBJECTIVE: To examine the association of county-level radon exposure with GD risk in pregnant individuals.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, population-based cohort study used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) cohort, which recruited nulliparous pregnant participants from 8 US clinical centers between October 2010 and September 2013. Participants who had pregestational diabetes or were missing data on GD or county-level radon measurements were excluded from the current study. Data were analyzed from September 2023 to January 2024.

EXPOSURES: County-level radon data were created by the Lawrence Berkeley National Laboratory based on the Environmental Protection Agency’s short- and long-term indoor home radon assessments. Radon exposure was categorized into 3 groups: less than 1, 1 to less than 2, and 2 or more picocuries (pCi)/L (to convert to becquerels per cubic meter, multiply by 37). Because radon, smoking, and fine particulate matter air pollutants (PM2.5) may share similar biological pathways, participants were categorized by joint classifications of radon level (<2 and ≥2 pCi/L) with smoking status (never smokers and ever smokers) and radon level with PM2.5 level (above or below the median).

MAIN OUTCOMES AND MEASURES: The main outcome was GD, identified based on glucose tolerance testing and information from medical record abstraction. Multiple logistic regression models were used to assess the association between radon exposure and GD.

RESULTS: Among the 9107 participants, mean (SD) age was 27.0 (5.6) years; 3782 of 9101 (41.6%) had ever used tobacco. The mean (SD) county-level radon concentration was 1.6 (0.9) pCi/L, and 382 participants (4.2%) had GD recorded. After adjusting for potential confounders, individuals living in counties with the highest radon level (≥2 pCi/L) had higher odds of developing GD compared with those living in counties with the lowest radon level (<1 pCi/L) (odds ratio [OR], 1.37; 95% CI, 1.02-1.84); after additional adjustment for PM2.5, the OR was 1.36 (95% CI, 1.00-1.86). Elevated odds of GD were also observed in ever smokers living in counties with a higher (≥2 pCi/L) radon level (OR, 2.09; 95% CI, 1.41-3.11) and participants living in counties with higher radon and PM2.5 levels (OR, 1.93; 95% CI, 1.31-2.83), though no statistically significant interactions were observed.

CONCLUSIONS AND RELEVANCE: This cohort study suggests that higher radon exposure is associated with greater odds of GD in nulliparous pregnant individuals. Further studies are needed to confirm the results and elucidate the underlying mechanisms, especially with individual-level residential radon exposure assessment.

PMID:39792382 | DOI:10.1001/jamanetworkopen.2024.54319

JAMA Netw Open. 2025 Jan 2;8(1):e2454330. doi: 10.1001/jamanetworkopen.2024.54330.

ABSTRACT

IMPORTANCE: Preventive efforts in pregnancy-related alloimmunization have considerably decreased the prevalence of hemolytic disease of the fetus and newborn (HDFN). International studies are therefore essential to obtain a deeper understanding of the postnatal management and outcomes of HDFN. Taken together with numerous treatment options, large practice variations among centers may exist.

OBJECTIVES: To assess variations in postnatal management and outcomes of HDFN among international centers and to identify opportunities to improve care.

DESIGN, SETTING, AND PARTICIPANTS: In this international, retrospective, cohort study, 31 expert centers from 22 countries retrieved data on neonates with HDFN managed between January 1, 2006, and July 1, 2021. Statistical analysis was performed from July 19, 2023, to October 28, 2024.

MAIN OUTCOMES AND MEASURES: Main outcomes included the frequency of exchange transfusions, administration of intravenous immunoglobulin, administration of erythropoiesis-stimulating agents, and red blood cell transfusions, as well as the association of gestational age at birth with exchange transfusion frequency and risk factors for adverse neonatal outcomes.

RESULTS: The study included 1855 neonates (median gestational age at birth, 36.4 weeks [IQR, 35.0-37.3 weeks]; 1034 boys [55.7%]), of whom 1017 (54.8%) received any form of antenatal treatment. Most neonates (1447 [78.0%]) had anti-D antibodies. Exchange transfusions were performed in 436 neonates (23.5%), with proportions in exchange transfusion frequency varying from 0% to 78% among centers. Intravenous immunoglobulin was administered to 429 of 1743 neonates (24.6%), with proportions varying from 0% to 100% among centers. A higher gestational age at birth was associated with a reduction in exchange transfusion frequency in neonates with intrauterine transfusion, decreasing from approximately 38.2% (13 of 34) at 34 weeks to 16.8% (18 of 107) after 37 weeks and 0 days. A weekly increase in gestational age at birth was associated with a 43.3% decrease (95% CI, 36.1%-49.7%) in the likelihood of adverse neonatal outcomes, and neonates who received an exchange transfusion were 1.55 (95% CI, 1.10-2.18) times more likely to experience unfavorable outcomes.

CONCLUSIONS AND RELEVANCE: In this cohort study of neonates with HDFN managed at 31 centers in 22 countries, significant practice variations in the postnatal management of HDFN were identified, highlighting the lack of, and need for, consensus. The study suggests that there is a potential beneficial clinical association of waiting for delivery until after 37 weeks and 0 days with frequency of exchange transfusions among neonates with HDFN. The framework to implement international guidelines is provided.

PMID:39792381 | DOI:10.1001/jamanetworkopen.2024.54330

Am J Phys Med Rehabil. 2025 Jan 6. doi: 10.1097/PHM.0000000000002706. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to analyze the effect of a novel supervised exercise therapy (SET) program based on intermittent treadmill walking and circuit-based moderate-intensity functional training (MIFT) on walking performance and HRQoL in PAD patients.

DESIGN: All participants underwent a 12-week SET that involved 15 to 30 minutes of treadmill walking followed by a 15-minute moderate-intensity functional training (MIFT) continued by 12-week of follow-up. Maximum walking distance (MWD), pain-free walking distance (PFWD), gait speed and estimated peak oxygen uptake (peak VO2) were calculated through the 6-minute walk test (6-MWT) and HRQoL through the Short Form-36 (SF-36) and the Vascular Quality of Life Questionnaire-6 (VascuQol-6).

RESULTS: There were statistically significant differences (p < 0.05) between baseline and post-intervention for walking performance outcomes [MWD (MD: 88.53 m), PFWD (MD: 62.89 m), gait speed (MD: 0.24 m·s-1) and peak VO2 (MD: 2.04 ml·kg-1·min-1)] and for HRQoL [physical functioning in SF-36 (MD: 6.93 points) and VascuQol-6 (MD: 1.46 points)]; while no differences were found between baseline and 12-week follow-up.

CONCLUSION: Results seem to show that 12-week of novel SET based on intermittent walking and MIFT induced significant clinical improvements in key functional variables of PAD while cessation of exercise leads to significant negative clinical changes in subsequent weeks of follow-up.

PMID:39792377 | DOI:10.1097/PHM.0000000000002706

Am J Clin Pathol. 2025 Jan 10:aqae178. doi: 10.1093/ajcp/aqae178. Online ahead of print.

ABSTRACT

OBJECTIVES: Social media platforms like Facebook, X (formally Twitter), and Instagram bridge pathology programs with other health professionals, prospective students, and the public, but the extent of social media usage by residency programs remains unexplored. This study investigates the current landscape of social media utilization by pathology programs.

METHODS: Using the National Resident Matching Program (NRMP) Match Data from 2022, 139 anatomic and clinical pathology residency programs were analyzed and categorized into 3 prestige tiers based on Doximity ratings. There were 32,067 posts examined between January 2018 and August 2022. Statistical analyses, including analysis of variance and Tukey honestly significant difference post hoc analysis, were performed to evaluate likes/views about post type.

RESULTS: X emerged as the most used platform (68%), focusing on pathology education (27.02%). Instagram centered on resident life (25.84%), while Facebook showcased person-specific posts (35.61%). Notably, there was a correlation between program prestige and the number of posts on X and Instagram, with the most prestigious programs posting more frequently than those considered more intermediate or low in prestige rank.

CONCLUSIONS: Social media is vital in connecting pathology programs with various stakeholders. Despite seasonal fluctuations, the overall utilization of social media continues to rise, underscoring its value as a long-term resource for pathology education and communication.

PMID:39792363 | DOI:10.1093/ajcp/aqae178

Esophagus. 2025 Jan 10. doi: 10.1007/s10388-025-01106-x. Online ahead of print.

ABSTRACT

BACKGROUND: Neoadjuvant chemotherapy is standard for advanced esophageal squamous cell carcinoma, though often ineffective. Therefore, predicting the response to chemotherapy before treatment is desirable. However, there is currently no established method for predicting response to neoadjuvant chemotherapy. This study aims to build a deep-learning model to predict the response of esophageal squamous cell carcinoma to preoperative chemotherapy by utilizing multimodal data integrating esophageal endoscopic images and clinical information.

METHODS: 170 patients with locally advanced esophageal squamous cell carcinoma were retrospectively studied, and endoscopic images and clinical information before neoadjuvant chemotherapy were collected. Endoscopic images alone and endoscopic images plus clinical information were each analyzed with a deep-learning model based on ResNet50. The clinical information alone was analyzed using logistic regression machine learning models, and the area under a receiver operating characteristic curve was calculated to compare the accuracy of each model. Gradient-weighted Class Activation Mapping was used on the endoscopic images to analyze the trend of the regions of interest in this model.

RESULTS: The area under the curve by clinical information alone, endoscopy alone, and both combined were 0.64, 0.55, and 0.77, respectively. The endoscopic image plus clinical information group was statistically more significant than the other models. This model focused more on the tumor when trained with clinical information.

CONCLUSIONS: The deep-learning model developed suggests that gastrointestinal endoscopic imaging, in combination with other clinical information, has the potential to predict the efficacy of neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma before treatment.

PMID:39792350 | DOI:10.1007/s10388-025-01106-x