Tag: statistics

Cureus. 2025 May 21;17(5):e84560. doi: 10.7759/cureus.84560. eCollection 2025 May.

ABSTRACT

BACKGROUND AND OBJECTIVES: The relationship between the maxillary posterior teeth and the level of the maxillary sinus varies across different populations and can significantly impact the success of endodontic, prosthodontic, orthodontic, and surgical treatments. This study aimed to evaluate the alveolar bone anatomy of maxillary posterior teeth and the vertical relationship to the maxillary sinus in Mongolian adults using cone-beam computed tomography (CBCT) images.

MATERIALS AND METHODS: The study was designed as a retrospective study. We selected 30 CBCT images and examined a total of 202 maxillary posterior teeth using these CBCT images. We measured the alveolar bone thickness at six different distances (L1-L6) by millimeter scale, and the vertical relationship between the maxillary sinus and the maxillary molars was classified into five categories according to Kwak’s classification. Statistical analyses were done using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York).

RESULTS: The average distances measured were 1.66±1.10 mm at L1, 2.13±1.00 mm at L2, 3.03±2.21 mm at L3, 6.04±3.50 mm at L4, 2.41±3.54 mm at L5, and 0.74±2.09 mm at L6, with statistical significance (p<0.001). According to Kwak’s classification, the most commonly observed types are Type I (82.1%) at the maxillary first premolars, Type III (63.3%) at the maxillary second premolars, Type II (43.3%) at the maxillary first molars, and Type I (43.3%) at the maxillary second molars (p<0.001).

CONCLUSION: The horizontal distances between the buccal and palatal roots to the alveolar plate were shorter in molars than in premolars due to root numbers, indicating a narrower bone structure that may limit implant stability. Additionally, the vertical distance between the root apex and the maxillary sinus was shortest in second molars, increasing the risk of sinus perforation during implant placement.

PMID:40546554 | PMC:PMC12182215 | DOI:10.7759/cureus.84560

Cureus. 2025 May 22;17(5):e84640. doi: 10.7759/cureus.84640. eCollection 2025 May.

ABSTRACT

Malignant pleural mesothelioma (MPM) is an aggressive malignancy with limited evaluates the efficacy and safety of these treatments. A systematic review and meta-analysis were conducted, including 14 studies that compared multimodal therapies for early-stage MPM. Continuous variables were analyzed using random-effects modeling, with heterogeneity assessed using I² statistics. The primary outcomes included physical function, social function, and lethargy. The meta-analysis found no statistically significant differences between experimental and control groups in terms of physical function (standardized mean difference [SMD]: -0.34, 95% confidence interval [CI]: -1.14 to 0.45), social function (SMD: 0.01, 95% CI: -0.52 to 0.53), or lethargy (SMD: -0.34, 95% CI: -0.96 to 0.27). Heterogeneity across studies was moderate to high (I²: 47%-76%). These findings suggest limited improvements in quality-of-life domains with experimental approaches compared to controls. This systematic review and meta-analysis highlights the need for individualized, multimodal treatment strategies in MPM management. While extrapleural pneumonectomy and extended pleurectomy/decortication offer specific benefits, their impact on quality of life varies and may not consistently provide significant improvements. Future research should focus on large-scale, randomized trials with standardized protocols to optimize treatment outcomes.

PMID:40546549 | PMC:PMC12182882 | DOI:10.7759/cureus.84640

Cureus. 2025 May 22;17(5):e84649. doi: 10.7759/cureus.84649. eCollection 2025 May.

ABSTRACT

Background Despite the rising burden of end-stage renal disease (ESRD), cognitive assessment is not routinely incorporated into dialysis care, particularly in low-resource settings. This study aimed to assess the prevalence, severity, and predictors of cognitive impairment among patients on maintenance hemodialysis. Methods A descriptive cross-sectional study was conducted at a tertiary dialysis center from December 2023 to May 2024. Patients aged ≥18 years undergoing hemodialysis for six months or more were enrolled. Exclusion criteria included neurological disorders, severe psychiatric illness, or medications affecting cognition. Cognitive function was evaluated using the Urdu-validated Montreal Cognitive Assessment (MoCA), with scores <26 indicating impairment. Domain-wise deficits were classified using 1.5 standard deviation below the normative mean. Statistical analysis included chi-square tests, t-tests, and multivariable logistic regression. Results Out of 198 hemodialysis patients, 116 (58.6%) exhibited cognitive impairment. Severity was categorized as mild in 79 (39.9%), moderate in 31 (15.7%), and severe in eight (4.0%) patients. Multidomain impairment was present in 108 (54.5%), while 18 (9.1%) had single-domain and 72 (36.4%) had no impairment. Older age (p<0.001), lower education (p<0.001), low socioeconomic status (SES) (p=0.045), and longer dialysis duration (p<0.001) were significantly associated with cognitive impairment. Biochemical predictors included lower hemoglobin and albumin (p=0.018 and p=0.034), and higher phosphate and intact parathyroid hormone (iPTH) (p=0.001 and p=0.042). On regression analysis, age (adjusted odds ratio (AOR)=1.088, 95% confidence interval (CI)=1.031-1.149), education ≤12 years (AOR=10.423, 95% CI=1.199-90.633), low SES (AOR=9.075, 95% CI=1.473-55.916), dialysis duration (AOR=1.047, 95% CI=1.010-1.085), and biochemical markers remained significant. Conclusion Cognitive impairment, particularly multidomain, is highly prevalent among hemodialysis patients and frequently unrecognized. Integration of cognitive screening into routine nephrology care is essential to enable early intervention and improve long-term patient outcomes.

PMID:40546548 | PMC:PMC12182912 | DOI:10.7759/cureus.84649

Cureus. 2025 May 22;17(5):e84597. doi: 10.7759/cureus.84597. eCollection 2025 May.

ABSTRACT

Oral squamous cell carcinoma (OSCC), a malignant neoplasm of the oral cavity, is commonly observed in the northeastern region of India, likely due to dietary habits, the prevalence of infections, and possibly genetic predisposition. Hypoxia plays a crucial role in regulating tumor proliferation and survival. In the absence of sufficient oxygen, several mechanisms and factors become instrumental in driving tumorigenesis. One such factor is hypoxia-inducible factor-1 alpha (HIF-1α), a key transcription factor from the inducible factor family that regulates gene expression in response to reduced cellular oxygen levels. Despite its significance, studies investigating HIF-1α overexpression in OSCC remain limited, and only a few have explored its correlation with clinical and pathological parameters. This study involved a retrospective analysis of histopathologically confirmed OSCC cases from resected oral specimens collected over a four-year period (2020-2024). HIF-1α overexpression was evaluated in relation to clinical variables such as age and sex and pathological features including histological grade, stage, depth of invasion (DOI), tumor size, lymphovascular invasion, perineural invasion, and worst pattern of invasion. A statistically significant association was observed between HIF-1α overexpression and both higher tumor stage and greater DOI, supporting its link to more aggressive disease behavior. Given the complexity of OSCC, identifying markers that may serve as therapeutic targets is of critical importance. HIF-1α emerges as one such marker – its presence not only indicates a more aggressive tumor phenotype but also suggests potential for future targeted therapies.

PMID:40546546 | PMC:PMC12181812 | DOI:10.7759/cureus.84597

Breast Cancer Res Treat. 2025 Jun 22. doi: 10.1007/s10549-025-07733-3. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies have shown that residing in regions with high area deprivation index (ADI) is associated with worse outcomes. We evaluated associations between ADI and breast cancer (BC) outcomes among patients in Western New York (WNY), a region that includes multiple underserved areas.

METHODS: This retrospective, single-institution study analyzed data from 404 BC patients diagnosed between 2014 and 2018. Demographic and clinicopathological data were abstracted. Data were compared between high (≥ 60) and low (< 60) ADI groups, reflective of high and low levels of socioeconomic disadvantage, respectively. The primary objective was overall survival (OS) by ADI. Secondary objectives included assessment of recurrence free survival (RFS) or time to next treatment (TNT) by ADI and frequency of germline and somatic testing.

RESULTS: Over half of the patients (59%) resided in ADI ≥ 60. 77% of patients had stage I-III BC and 23% had de novo metastatic BC. Patients in ADI ≥ 60 had a lower 5-year OS rate (73%) than those in ADI < 60 (84%) (95%CI: 67.5-79.7, P = 0.05). In multivariable analysis, similar trend was observed but was not statistically significant (HR 1.56, 95%CI: 0.98-2.46, P = 0.058). There were no differences in TNT or RFS by ADI. Germline testing was performed less frequently (33%) in ADI ≥ 60 than ADI < 60 group (45%) (P = 0.04) for patients with stage I-III BC, while no difference observed for stage IV patients. Finally, prevalence of somatic mutations in TP53, PIK3CA, and ESR1 were higher in ADI ≥ 60.

CONCLUSIONS: We observed a trend towards worse OS in areas with high ADI, though not statistically significant. The incidence of germline testing was lower in high ADI compared to low ADI regions.

PMID:40544410 | DOI:10.1007/s10549-025-07733-3

J Thromb Thrombolysis. 2025 Jun 22. doi: 10.1007/s11239-025-03133-y. Online ahead of print.

ABSTRACT

In acute ischemic stroke, the first-pass effect, the occurrence of complete reperfusion after a single pass during endovascular therapy (EVT), is linked to favorable clinical outcomes. This study aimed to investigate the association between thrombus composition and first-pass recanalization (FPR), as well as symptomatic intracranial hemorrhage (sICH), in AIS patients undergoing mechanical thrombectomy (MT). We retrospectively analyzed thrombi retrieved from 172 patients treated with MT. Clots were classified as RBC-rich or platelet-rich. FPR was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3 after a single device pass. Associations with FPR and hemorrhagic outcomes were assessed. A total of 172 patients (91 women, 81 men; mean age 71 years) who were treated with mechanical thrombectomy were included in the study. First-pass recanalization (FPR) was achieved in 55.2% of the patients (95/172). There was no statistically significant relationship between clot composition and FPR (p = 0.991). The rate of intracranial hemorrhage (ICH) was 15.8% in the RBC-dominant group and 1.7% in the fibrin/platelet-dominant group. A statistically significant association was found between clot composition and ICH (p = 0.005), whereas no significant relationship was observed between clot composition and symptomatic intracranial hemorrhage (sICH) (p = 0.975). Successful FPR was associated with a lower rate of sICH (p = 0.003). The percentage of RBCs in clot composition was positively correlated with the presence of the dense artery sign. Gender was not significantly associated with clot composition (p = 0.455), and neither gender nor age showed a significant relationship with FPR (p = 0.316 and p = 0.470, respectively). These findings indicate that while clot composition does not significantly affect the success of FPR, it is significantly associated with the risk of intracranial hemorrhage. This underscores the potential clinical relevance of clot histology in predicting post-thrombectomy outcomes, beyond the well-established importance of FPR itself. Future studies with larger and more diverse patient cohorts are warranted to further elucidate these associations and optimize treatment strategies.

PMID:40544390 | DOI:10.1007/s11239-025-03133-y

J Thromb Thrombolysis. 2025 Jun 22. doi: 10.1007/s11239-025-03131-0. Online ahead of print.

ABSTRACT

Stroke is a leading cause of death and disability. Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the primary treatment for acute ischemic stroke (AIS), but outcomes remain suboptimal. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, has been explored as an adjunct to enhance reperfusion. This systematic review and meta-analysis assesses its effectiveness and safety compared to rt-PA alone. We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs). Primary outcomes included 90-day functional independence (modified Rankin Scale, mRS 0-1), mortality, and symptomatic intracranial hemorrhage (sICH). Meta-analyses used random-effects models to calculate Odds Ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed with I². We included 988 patients from four RCTs. Eptifibatide was administered to 566 patients (57.3%). Adjuvant therapy did not significantly improved mRS 0-1 rates at 90 days (OR 1.12, 95% CI 0.60-2.09, p = 0.72, I²=74%) and did not reduce mortality (OR 1.55, 95% CI 0.92-2.61, p = 0.099, I²=0%). sICH was not statistically significantly different between the groups (OR 0.38, 95% CI 0.09-1.65, p = 0.196, I²=56%). Eptifibatide as an adjunct to rt-PA does not significantly impact functional independence, mortality, or sICH risk in AIS. Larger studies are needed to clarify its potential benefits and risks.

PMID:40544389 | DOI:10.1007/s11239-025-03131-0

J Thromb Thrombolysis. 2025 Jun 22. doi: 10.1007/s11239-025-03130-1. Online ahead of print.

ABSTRACT

Percutaneous Coronary Intervention (PCI) is a widely used minimally invasive procedure that restores blood flow to the coronary artery, improving survival in STEMI patients. Despite its widespread application in clinical settings, the necessity and efficacy of postprocedural anticoagulation (PPAC) remain contentious. Our study aims to assess the outcomes of PPAC in STEMI patients who have undergone PCI. A comprehensive search of Embase, PubMed, and Clinicaltrials was conducted to identify randomized controlled trials (RCTs) comparing the clinical outcomes between PPAC and control (placebo or no PPAC) for STEMI after primary PCI. Statistical analyses were performed using RevMan version 5.4.1, employing a random-effects model to calculate odds ratios (ORs) and their 95% confidence intervals (CIs). Risk of Bias Assessment of the articles was assessed using RoB 2.0 software by the Cochrane Collaboration. A total of 5 RCTs comprising 13,586 patients were included, of which 6,829 patients (50.26%) received PPAC. Compared to the non-PPAC group, PPAC did not significantly reduce all-cause mortality (OR 1.08; 95% CI 0.84-1.39; P = 0.54, I² = 0%), cardiovascular mortality (OR 1.08; 95% CI 0.83-1.39; P = 0.57, I² = 0%), and MACE (major adverse cardiovascular events) (OR 1.13; 95% CI 0.92-1.37; P = 0.25, I² = 22%). Additionally, the odds of stent thrombosis (OR 1.07; 95% CI 0.77-1.47; P = 0.69, I² = 0%) and stroke (OR 1.50; 95% CI 0.49-4.57; P = 0.48, I² = 58%) did not differ significantly between the groups. However, PPAC was associated with higher odds of bleeding (OR 1.78; 95% CI 1.07-2.97; P = 0.03, I² = 94%). This meta-analysis reveals no significant differences in the odds of all-cause mortality, cardiovascular mortality, stent thrombosis, and stroke between PPAC and control following PCI for the management of STEMI. However, PPAC was associated with higher odds of bleeding. Further randomized controlled trials are warranted to corroborate these findings.

PMID:40544386 | DOI:10.1007/s11239-025-03130-1

Asian Pac J Allergy Immunol. 2025 Jun 22. doi: 10.12932/AP-130325-2047. Online ahead of print.

ABSTRACT

BACKGROUND: Few studies have investigated the risk factors for recurrent anaphylaxis. Identifying these factors may help patients implement preventive measures.

OBJECTIVE: To determine the rate and risk factors for recurrent anaphylaxis, assess the time to recurrence, and compare the characteristics, triggers, and clinical manifestations between recurrent and non-recurrent cases.

METHODS: A retrospective cohort study was conducted at Naresuan University Hospital from March 2011 to February 2021, using medical records of patients with ICD-10-confirmed anaphylaxis. Risk factors for recurrence were analyzed using Cox proportional hazards regression model.

RESULTS: A total of 439 anaphylactic episodes were identified in 381 patients (49 children, 332 adults). Of these, 42 patients (11.2%) experienced 58 recurrent episodes (7/49 [14.3%] children, 35/332 [10.6%] adults). Food and medications were the most and second most common triggers. The median time to recurrence was 9.9 months (IQR: 3.1-18.8), while the median follow-up duration for non-recurrent cases was 41.8 months (IQR: 23.8-61.8). The recurrent anaphylaxis rate was 4.1 events per 100 person-years. Statistically significant risk factors included a history of food, a history of insect, a history of drug allergies, chest discomfort, and severe anaphylaxis (HR [95%CI]: 3.31 [1.50-7.29], p = 0.003; 4.96 [1.47-16.82], p = 0.010; 5.87 [2.64-13.07], p < 0.001; 2.43 [1.19-4.99], p = 0.015; and 2.29 [1.07-4.88], p = 0.033, respectively). Conversely, palpitations were associated with a lower risk of recurrence (HR 0.11 [0.01-0.86], p = 0.036).

CONCLUSIONS: Identifying risk factors in anaphylaxis patients enhances medical care and aids in preventing recurrence.

PMID:40544373 | DOI:10.12932/AP-130325-2047

Equine Vet J. 2025 Jun 22. doi: 10.1111/evj.14546. Online ahead of print.

ABSTRACT

BACKGROUND: Humeral stress fractures in racehorses can progress to catastrophic fracture if unrecognised. Scintigraphy is the gold standard diagnostic technique but is limited by accessibility and cost. It was hypothesised that ultrasonography could be used to visualise caudoproximal humeral stress fractures.

OBJECTIVES: To determine the utility of ultrasonography to identify caudoproximal humeral stress fractures in racehorses.

STUDY DESIGN: Clinical case series.

METHODS: Seven racehorses that had a clinical history consistent with the presence of a humeral stress fracture were examined using humeral ultrasonography and radiography with or without scintigraphy from June 2013 to June 2021. Clinical and imaging findings, outcomes and descriptive statistics are reported.

RESULTS: Seven Thoroughbred racehorses aged 2-4 years had a history of acute onset of a severe lameness, with four returning to training 3-12 months after layup for an unrelated reason. Nine of 10 humeral stress fractures (2 bilateral, 3 left, 2 right) were identified with ultrasonography. Ultrasonographic abnormalities included a step defect (5 humeri, 5 horses), periosteal callus/roughening (7 humeri, 4 horses) and/or an abnormally convex contour of the caudal aspect of the humeral neck (6 humeri, 5 horses). Radiographs revealed periosteal (8 humeri, 6 horses) and/or endosteal (6 humeri, 4 horses) proliferation adjacent to the caudoproximal aspect of the humeral cortex. Scintigraphy of five horses identified increased radiopharmaceutical uptake in the caudoproximal aspect of seven humeri. Serial recheck radiography and ultrasonography (5 horses) revealed bone remodelling. Horses were returned to intended use as racehorses (4) riding horses (2) or were retired (1).

MAIN LIMITATIONS: Small case series in only Thoroughbred racehorses with a clinical indication of possible humeral stress fracture. Ultrasonographic examination was limited to the caudoproximal aspect of the humerus. Not all cases underwent all imaging modalities.

CONCLUSIONS: Ultrasonography is useful for caudoproximal humeral stress fracture detection and can be used to monitor healing.

PMID:40544361 | DOI:10.1111/evj.14546