Tag: statistics

BMC Womens Health. 2025 May 19;25(1):234. doi: 10.1186/s12905-025-03777-1.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Dysmenorrhea is a common gynecological complaint, affecting a significant percentage of menstruating women. The mainstay for the treatment of dysmenorrhea is NSAIDs and hormonal contraceptives while complementary and alternative therapies (CATs) are adjunct to it. This study investigates the perception of female medical students with dysmenorrhea towards the use of painkillers and CATs.

METHODS: We conducted this cross-sectional study among female medical students of Lahore by circulating the Google Forms-based questionnaire. Correlation analysis and logistic regression were applied using SPSS and descriptive statistics were given in frequencies and percentages.

RESULTS: Out of 202 participants, 76.7%(n = 155) experienced dysmenorrhea. 46%(n = 93) of the respondents reported using painkillers; paracetamol being the most common. 68.8% (n = 139) used CATs; bed rest and hot compresses were most used. The most common reason for using painkillers was their effectiveness (61.6%), followed by availability (42.5%). For CATs, the reason of choice included to reduce the need for analgesic (58%) and safety (38.3%). About 40.1% of respondents believed CATs were less effective than painkillers. 84.1% agreed that long-term consumption of painkillers causes stomach ulcers or kidney damage. The factors that led to CATs not being preferred over painkillers included less information about them (33.7%), time-consuming (25.7%), and the concept of non-effectiveness (20.3%). Uni-variate logistic regression analysis showed that students with severe dysmenorrhea had higher odds of using painkillers as compared to the students who had mild dysmenorrhea. (OR: 6.319, 95% CI: 3.244-12.309, P = 0.000).

CONCLUSIONS: The prevalence of the use of CATs is high among female students as compared to painkillers and hormonal contraceptives (first-line). The reason for choosing CATs included reducing the need for analgesics, safety, and availability. Females should be encouraged to use the first-line therapies after consultation with doctors; for the effective management of dysmenorrhea and improvement of their quality of life.

PMID:40389991 | DOI:10.1186/s12905-025-03777-1

BMC Med Inform Decis Mak. 2025 May 19;25(1):194. doi: 10.1186/s12911-025-03023-6.

ABSTRACT

BACKGROUND: Worldwide, involving patients in healthcare has become a focus point. Shared decision-making (SDM) is one element of patient involvement and, in many countries, including Denmark, requires culturally adapted and validated questionnaires to measure diverse patient populations’ perceptions of this concept. SDM-Q-9, a widely used nine-item generic questionnaire, assesses patients’ perception of nine elements during decision-making in consultations. The primary aim of this study is to assess the psychometric performance of the Danish version of the SDM-Q-9 through item response theory (IRT). Additionally, to assess the questionnaire’s generic applicability among patients with pelvic floor disorders or low back pain.

METHODS: After treatment decisions, Danish patients with pelvic floor disorders or low back pain rated the level of SDM by completing the SDM-Q-9 questionnaire. Iitem response theory (the Graded Response Model by Samejima) was applied to assess each item’s psychometric performance and the questionnaire’s generic applicability (among others discriminative ability, precision and item differential functioning).

RESULTS: The study invited 825 patients for participation and comprised 758 patients for analysis;73% were women, with a mean age of 52 years and a mean SDM score of 3.87. Discrimination parameters (a-scores) for the model ranged from 2.39 (item 1) to 4.48 (item 8). Analysis of the item-information function curves reflected that item 8 demonstrated the highest maximum, indicating higher precision, while items 1, 2 and 9 showed the lowest maxima. Chi²-test statistics showed no significant differential item functioning at the 0.01-significance level for any item between the two patient groups. A ceiling effect was observed as most patients selected the highest score, while a low information load was identified in the SDM’s upper load for each item and the overall instrument.

CONCLUSIONS: The Danish SDM-Q-9 demonstrates strong overall performance, with the ability to differentiate between the distinct levels of the underlying construct of SDM. However, the high ceiling effect is a critical limitation. While the SDM-Q-9 could serve as a generic questionnaire across samples with varying demographic composition, further exploration of these findings is warranted, particularly across patient samples encompassing more diverse decisions, e.g. patients with life-threatening diseases.

PMID:40389982 | DOI:10.1186/s12911-025-03023-6

Clin Imaging. 2025 May 11;123:110495. doi: 10.1016/j.clinimag.2025.110495. Online ahead of print.

ABSTRACT

BACKGROUND: Vestibular schwannomas (VS) are benign tumors that can lead to hearing loss, balance issues, and tinnitus. Gamma Knife Radiosurgery (GKS) is a common treatment for VS, aimed at halting tumor growth and preserving neurological function. Accurate monitoring of VS volume before and after GKS is essential for assessing treatment efficacy.

PURPOSE: To evaluate the accuracy of an artificial intelligence (AI) algorithm, originally developed to identify NF2-SWN-related VS, in segmenting non-NF2-SWN-related VS and detecting volume changes pre- and post-GKS. We hypothesize this AI algorithm, trained on NF2-SWN-related VS data, will accurately apply to non-NF2-SWN VS and VS treated with GKS.

METHODS: In this retrospective cohort study, we reviewed data from an established Gamma Knife database, identifying 16 patients who underwent GKS for VS and had pre- and post-GKS scans. Contrast-enhanced T1-weighted MRI scans were analyzed with both manual segmentation and the AI algorithm. DICE similarity coefficients were computed to compare AI and manual segmentations, and a paired t-test was used to assess statistical significance. Volume changes for pre- and post-GKS scans were calculated for both segmentation methods.

RESULTS: The mean DICE score between AI and manual segmentations was 0.91 (range 0.79-0.97). Pre- and post-GKS DICE scores were 0.91 (range 0.79-0.97) and 0.92 (range 0.81-0.97), indicating high spatial overlap.

CONCLUSION: AI-segmented VS volumes pre- and post-GKS were consistent with manual measurements, with high DICE scores indicating strong spatial overlap. The AI algorithm processed scans within 5 min, suggesting it offers a reliable, efficient alternative for clinical monitoring.

CLINICAL IMPORTANCE: DICE scores showed high similarity between manual and AI segmentations. The pre- and post-GKS VS volume percentage changes were also similar between manual and AI-segmented VS volumes, indicating that our AI algorithm can accurately detect changes in tumor growth.

PMID:40388858 | DOI:10.1016/j.clinimag.2025.110495

Eur J Surg Oncol. 2025 May 13;51(9):110109. doi: 10.1016/j.ejso.2025.110109. Online ahead of print.

ABSTRACT

BACKGROUND: Therapeutic mammoplasty (TM) is a Level 2 oncoplastic procedure that improves cosmetic outcome in patients undergoing breast conserving surgery (BCS) for breast cancer. The contralateral reduction may be performed at the same time as the index procedure (synchronous) or later (metachronous); commonly cited reasons for the latter include fewer complications, reduced need for revisional surgery and less delay to adjuvant therapies. This study aims to compare synchronous and metachronous approaches to therapeutic mammoplasty.

MATERIALS AND METHODS: A database between 2010 and 2019 was hand searched. The primary outcome measure was the trend of synchronous vs unilateral operating by year. Secondary outcome measures included demographic variables, type of mammoplasty, tumour biology, revisional surgery rate, type and timing of planned revisional surgery, complications, type and time to adjuvant therapy, type of axillary surgery, and tumour trends by year.

RESULTS: 155 patients had synchronous mammoplasties and 107 patients had unilateral procedures, of which 26 had delayed contralateral symmetrising surgery. There was a significant increase in the total number of TMs (p < 0.03) and synchronous TMs (p < 0.02) over time. There were no differences in time to chemotherapy (p > 0.05), time to radiotherapy (p > 0.05) or time till re-excision of margins/revision mastectomies (p > 0.05). In the unilateral group, mean time to contralateral symmetrising surgery was 14 months.

CONCLUSIONS: Synchronous TMs are increasingly popular and appear safe for patients undergoing BCS for breast cancer. Further work is necessary to establish patient preferences between the two groups.

PMID:40388851 | DOI:10.1016/j.ejso.2025.110109

Ann Plast Surg. 2025 Apr 28. doi: 10.1097/SAP.0000000000004361. Online ahead of print.

ABSTRACT

PURPOSE: The use of a concomitant panniculectomy (PAN) during a ventral hernia repair (VHR) has been debated because of concerns of higher wound complications and longer operative times. However, PAN offers significant advantages including increased intraoperative exposure, improved patient quality of life, and offering an aesthetic benefit. In the treatment of large hernia defects the senior author utilizes the component separation technique with onlay placement of acellular dermal matrix (ADM). Additionally, the ADM is secured using progressive quilting suturing. This study aimed to evaluate the outcomes of patients who underwent VHR + PAN utilizing the component separation technique alongside onlay placement of ADM.

METHODS: A single-center retrospective analysis was conducted on the senior author’s technique in treating VHR + PAN over 10 years. The patients were identified utilizing Current Procedural Codes for ventral hernia repairs and myofascial muscle flaps. Following identification of patients, they were further stratified for undergoing a panniculectomy. Patients treated without the use of onlay acellular dermal matrix placement or with fewer than 6 months of follow-up time were excluded from the study. Descriptive statistics were used to summarize the findings.

RESULTS: A total of 29 patients met the inclusion criteria, with the majority being obese (79.3%) and female (93.1%). Most patients (82.8%) had a history of previous hernia repair, with majority undergoing previous mesh placement. No hernia recurrences were observed during an average follow-up period of 21.3 months. Seromas were the most common postoperative complication (34.4%, all managed in clinic), followed by wound necrosis (20.7%) and infection (6.9%).

CONCLUSIONS: Combining VHR with panniculectomy offers potential functional, aesthetic, and quality-of-life benefits while reducing the need for multiple surgeries, particularly in patient populations with large hernia defects and prior hernia repairs. The absence of recurrences and acceptable complication rates in this study highlights the safety and efficacy of utilizing the component separation technique with onlay placement of ADM secured by progressive quilting sutures. Further research with larger, multicenter cohorts is warranted to validate these outcomes and explore strategies for optimizing complication management.

PMID:40388842 | DOI:10.1097/SAP.0000000000004361

JMIR AI. 2025 May 18. doi: 10.2196/68144. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is transforming medical imaging, with large language models such as ChatGPT-4 emerging as potential tools for automated image interpretation. While AI-driven radiomics has shown promise in diagnostic imaging, the efficacy of ChatGPT-4 in liver ultrasound analysis remains largely unexamined.

OBJECTIVE: This study evaluates the capability of ChatGPT-4 in liver ultrasound radiomics, specifically its ability to differentiate fibrosis, steatosis, and normal liver tissue, compared to conventional image analysis software.

METHODS: Seventy grayscale ultrasound images from a preclinical liver disease model, including fibrosis (n=31), fatty liver (n=18), and normal liver (n=21), were analyzed. ChatGPT-4 extracted texture features, which were compared to those obtained using Interactive Data Language (IDL), a traditional image analysis software. One-way ANOVA was used to identify statistically significant features differentiating liver conditions, and logistic regression models were employed to assess diagnostic performance.

RESULTS: ChatGPT-4 extracted nine key textural features-echo intensity, heterogeneity, skewness, kurtosis, contrast, homogeneity, dissimilarity, angular second moment, and entropy-all of which significantly differed across liver conditions (p < 0.05). Among individual features, echo intensity achieved the highest F1-score (0.85). When combined, ChatGPT-4 attained 76% accuracy and 83% sensitivity in classifying liver disease. ROC analysis demonstrated strong discriminatory performance, with AUC values of 0.75 for fibrosis, 0.87 for normal liver, and 0.97 for steatosis. Compared to Interactive Data Language (IDL) image analysis software, ChatGPT-4 exhibited slightly lower sensitivity (0.83 vs. 0.89) but showed moderate correlation (R = 0.68, p < 0.0001) with IDL-derived features. However, it significantly outperformed IDL in processing efficiency, reducing analysis time by 40%, highlighting its potential for high throughput radiomic analysis.

CONCLUSIONS: Despite slightly lower sensitivity than IDL, ChatGPT-4 demonstrated high feasibility for ultrasound radiomics, offering faster processing, high-throughput analysis, and automated multi-image evaluation. These findings support its potential integration into AI-driven imaging workflows, with further refinements needed to enhance feature reproducibility and diagnostic accuracy.

PMID:40388838 | DOI:10.2196/68144

Medicine (Baltimore). 2025 May 16;104(20):e41975. doi: 10.1097/MD.0000000000041975.

ABSTRACT

This study aimed to determine whether the D-dimer/high-sensitivity troponin I (hs-TnI) ratio is useful in the differential diagnosis of acute pulmonary embolism (APE) and/or non-ST-elevation myocardial infarction (NSTEMI) in patients who presented to the emergency department with chest pain. The study included 219 patients with APE and 385 patients with NSTEMI over the age of 18 who presented to the emergency department with chest pain and were diagnosed with either APE or NSTEMI. Using statistical analysis, D-dimer, hs-TnI, creatine kinase myocardial band (CK-MB) levels, D-dimer/CK-MB, and D-dimer/hs-TnI ratios were compared in patients with APE and NSTEMI. The D-dimer/hs-TnI ratio in patients with APE was found to be considerably greater than in patients with NSTEMI. Similarly, the D-dimer/CK-MB levels in patients with APE were significantly higher than in individuals with NSTEMI. Patients with APE had higher D-dimer levels, while those with NSTEMI had higher hs-TnI levels. The D-dimer/hs-TnI ratio can be useful for emergency clinicians because it is affordable, quickly calculated, and easily accessible.

PMID:40388792 | DOI:10.1097/MD.0000000000041975

Medicine (Baltimore). 2025 May 16;104(20):e42411. doi: 10.1097/MD.0000000000042411.

ABSTRACT

Currently, there remains a significant gap in effective pharmacologic interventions for neonatal respiratory distress syndrome (NRDS). To address this critical unmet medical need, we aimed to systematically identify novel therapeutic targets and preventive strategies through comprehensive integration and analysis of multiple publicly accessible datasets. In this study, we employed an integrative approach combining druggable genome data, cis-expression quantitative trait loci (cis-eQTL) from human blood and lung tissues, and genome-wide association study summary statistics for neonatal respiratory distress. We performed two-sample Mendelian randomization (TSMR) analysis to investigate potential causal relationships between druggable genes and neonatal respiratory distress. To strengthen causal inference, we performed Bayesian co-localization analyses. Furthermore, we conducted phenome-wide Mendelian randomization (Phe-MR) to systematically evaluate potential side effects and alternative therapeutic indications associated with the identified candidate drug targets. Finally, we interrogated existing drug databases to identify actionable pharmacological agents targeting the identified genes. All 3 genes (LTBR, NAAA, CSNK1G2) were analyzed by Bayesian co-localization (PH4 > 75%). CSNK1G2 (lung eQTL, odds ratio [OR]: 0.419, 95% CI: 0.185-0.948, P = .037; blood eQTL, OR: 4.255, 95% CI: 1.346-13.455, P = .014; Gtex whole blood eQTL, OR: 4.966, 95% CI: 1.104-22.332, P = .037). LTBR (lung eQTL, OR: 0.550, 95% CI: 0.354-0.856, P = .008; blood eQTL, OR: 0.347, 95% CI: 0.179-0.671, P = .002; Gtex whole blood eQTL, OR: 0.059, 95% CI: 0.0.007-0.478, P = .008). NAAA (lung eQTL, OR: 0.717, 95% CI: 0.555-0.925, P = .011; Gtex whole blood eQTL, OR: 0.660, 95% CI: 0.476-0.913, P = .012). Drug repurposing analyses support the possibility that etanercept and asciminib hydrochloride may treat neonatal respiratory distress by activating LTBR. This study demonstrated that LTBR, NAAA, and CSNK1G2 may serve as promising biomarkers and therapeutic targets for NRDS.

PMID:40388790 | DOI:10.1097/MD.0000000000042411

Medicine (Baltimore). 2025 May 16;104(20):e42454. doi: 10.1097/MD.0000000000042454.

ABSTRACT

This study aimed to assess the diagnostic value of non-enhanced CT radiomics in preoperatively differentiating early-stage (T1-T2) from locally advanced (T3-T4) colon cancer, addressing the limitations of conventional empirical staging. A retrospective analysis was conducted on 170 patients with surgically confirmed primary colon cancer who underwent non-enhanced CT scans within 1 week before surgery. Three-dimensional segmentation of colonic tumors was performed on the non-enhanced images, followed by automated extraction of radiomic features. Feature selection was executed using the minimum redundancy maximum relevance (mRMR) algorithm, and key features associated with cancer stage were identified using the least absolute shrinkage and selection operator logistic regression. The performance of the radiomics model was compared with conventional T-staging by radiologists. The cohort comprised 170 patients with an average age of 61.69 ± 13.22 years, 43.3% of whom were female, and 75 (44.1%) presented with early-stage disease. Eight radiomic features from non-enhanced imaging were ultimately included. The radiomics model achieved an area under the curve (AUC) of 0.85 (95% confidence interval: 0.78-0.92) in the training set and 0.84 (95% confidence interval: 0.74-0.95) in the test set, with corresponding accuracies of 0.70 and 0.78, sensitivities of 0.87 and 0.87, and specificities of 0.69 and 0.71, respectively. Additionally, in the training set, the radiomics model (AUC = 0.85) significantly outperformed empirical T-staging by radiologists (AUC = 0.71, P < .009). A similar trend was observed in the test set, where the radiomics model (AUC = 0.85) surpassed empirical T-staging (AUC = 0.76), although this difference was not statistically significant (P = .27). Non-enhanced CT radiomics demonstrated superior performance over conventional radiologists’ T-staging in distinguishing early from advanced colon cancer stages.

PMID:40388788 | DOI:10.1097/MD.0000000000042454

Medicine (Baltimore). 2025 May 16;104(20):e42306. doi: 10.1097/MD.0000000000042306.

ABSTRACT

There is limited evidence regarding the association between myocardial function requiring extracorporeal membrane oxygenation (ECMO) and long-term survival rate in patients who reach hospital discharge. This study investigates the association between myocardial function parameters collected at different times from weaning from ECMO to long-term follow-up and the long-term mortality rate. This retrospective study investigates the effect of EF timing in the long-term. A cohort of 403 patients successfully weaned from veno-arterial ECMO (VA-ECMO) was identified from 1300 patients who underwent VA-ECMO between 2003 and 2018 after applying exclusion criteria for age and indications not of interest in the Chang Gung Memorial Hospital Research Database (CGRD). The study revealed that a notable improvement in ejection fraction (EF) percentile between ECMO placement and successful weaning was significantly linked to reduced cumulative mortality as were higher EF values before discharge. However, no significant association was found between lower long-term mortality and EF change from discharge to mid-term follow-up, or the maximum EF at mid-term follow-up. Improvements in cardiac function following the use of VA-ECMO and better baseline cardiac function are associated with lower long-term mortality. The study showed that EF monitoring at ECMO insertion and before discharge can inform physicians regarding patients’ long-term outcomes. EF percentile improvement from insertion to weaning could be a positive indicator of successful weaning.

PMID:40388785 | DOI:10.1097/MD.0000000000042306