Tag: statistics

J Eur Acad Dermatol Venereol. 2025 Dec 19. doi: 10.1111/jdv.70247. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis affects at least 60 million people worldwide, and 80% also live with overweight or obesity. Excess weight increases susceptibility to psoriasis and is associated with more severe disease.

OBJECTIVE: To evaluate the impact of weight-loss interventions on psoriasis severity (Psoriasis Area and Severity Index [PASI], PASI50, PASI75, PASI100 [50%/75%/100% reduction in baseline PASI, respectively]) and quality of life (Dermatology Life Quality Index [DLQI]).

METHODS: We systematically searched five databases and two trial registries (inception to 03/09/2025). Outcomes were informed by patient focus-group discussions. Randomized controlled trials (RCTs) in adults with psoriasis, comparing any weight-loss intervention versus usual care or a lower-intensity weight-loss intervention, were included. Studies had to report a change in weight and ≥1 psoriasis severity or quality-of-life measure. Random effects meta-analyses were used.

RESULTS: Thirteen RCTs (1145 participants) with 14 comparisons were included. Eleven interventions advised dietary changes, of which four included physical activity. Three used weight-loss medications. Across 14 comparisons (n = 1145, mean difference (MD) in weight change: -6.7 kg), weight-loss interventions produced a greater reduction in PASI versus control: MD -2.5 (95%CI: -3.8 to -1.1, I² = 85.2%). We found a significant effect of weight-loss interventions on the likelihood of achieving PASI75 (RR = 1.6, 95%CI: 1.1-2.2, I² = 22.6% [based on six comparisons, n = 681, MD in weight change: -7.3 kg]). There was no statistically significant effect of the interventions on the likelihood of achieving PASI50 (RR = 1.5, 95%CI: 0.9-2.4, I² = 72.8% [based on four comparisons, n = 509, MD in weight change: -4.0 kg]) or PASI100 (RR = 1.6, 95%CI: 0.3-9.7, I² = 0.0% [based on two comparisons, n = 334, MD in weight change: -5.2 kg]), but both analyses were limited by few studies. Across seven comparisons (n = 364; MD in weight change -7.8 kg), weight-loss interventions were associated with a significant improvement in DLQI compared to control: MD -5.0 (95%CI: -9.7 to -0.3, I² = 96.0%).

CONCLUSION: High-certainty evidence suggests weight-loss interventions can improve psoriasis severity and quality of life, and should be considered as part of routine treatment.

PMID:41416383 | DOI:10.1111/jdv.70247

Stroke. 2025 Dec 19. doi: 10.1161/STROKEAHA.125.053004. Online ahead of print.

ABSTRACT

BACKGROUND: Recent research has shown that neuroinflammation progresses rapidly within a few hours after stroke; however, the relationship between its progression and clinical outcomes remains unclear. Therefore, this study aimed to investigate the effect of neuroinflammation, measured by serum GFAP (glial fibrillary acidic protein), on patient outcomes, as well as the influence of baseline peripheral inflammation on the progression of neuroinflammation.

METHODS: This prospective cohort study enrolled patients with acute ischemic stroke who received intravenous thrombolysis (IVT) between September 2016 and April 2023 across 16 centers in China. Serum GFAP levels were measured before (baseline, within 4.5 hours of onset) and at 24 hours after IVT. GFAP changes were determined by subtracting baseline levels from those measured 24 hours post-IVT. Outcome measures included final infarct volume during hospitalization, National Institutes of Health Stroke Scale scores at 24 hours and 7 days post-IVT, early neurological deterioration within 24 hours, delayed neurological deterioration within 7 days, and 3-month modified Rankin Scale scores. A modified Rankin Scale score of ≥2 was classified as an unfavorable outcome. Peripheral inflammation indicators were measured at baseline. Binary logistic and linear regressions were used as the main statistical methods.

RESULTS: Overall, 743 patients were included. A significant increase in GFAP levels was observed, indicating progression of neuroinflammation. Regression analyses revealed that increased GFAP after IVT was independently associated with larger infarct volume (β, 30.965 [95% CI, 19.185-42.745]; P<0.001), higher 24-hour and 7-day National Institutes of Health Stroke Scale scores (24-hour: β, 2.632 [95% CI, 1.644-3.620]; P<0.001; 7-day: β, 3.298 [95% CI, 2.179-4.417]; P<0.001), and unfavorable outcomes (odds ratio, 3.631, [95% CI, 2.159-6.106]; P<0.001). Furthermore, baseline peripheral inflammation, assessed using peripheral inflammation indicators, was significantly associated with elevated GFAP levels.

CONCLUSIONS: The increase in GFAP levels over the first 24 hours after IVT is independently associated with clinical outcomes, with higher baseline peripheral inflammation correlating with greater GFAP elevation during that period.

PMID:41416382 | DOI:10.1161/STROKEAHA.125.053004

J Biomed Mater Res B Appl Biomater. 2026 Jan;114(1):e70011. doi: 10.1002/jbmb.70011.

ABSTRACT

Upconverting nanoparticles (UCNPs) have attracted much attention in nanomedicine due to their ability to upconvert photons. However, their adverse effects hinder the biomedical applications. In this paper, bisphosphonate-modified poly(isobutylene-alt-maleic acid)-graft-poly(N,N-dimethylacrylamide)-coated NaYF₄:Yb,Er,Pr UCNPs (UCNP@PIMAPDMA) nanoparticles were designed, which exhibited luminescence emission simultaneously in the visible and NIR-II regions. The developed UCNPs were characterized by a range of physicochemical methods, including transmission electron and energy dispersive microscopy (TEM and EDAX), dynamic light scattering (DLS), X-ray diffraction analysis (XRD), spectrofluorometry, X-ray photoelectron spectroscopy (XPS), and so forth. The UCNP@PIMAPDMA nanoparticles were also evaluated in cell cultures and experimental animals. The particles showed good biocompatibility with cultured human embryonic kidney HEK293 cells commonly used in toxicological studies. Neat UCNPs were cytotoxic towards these cells, which was confirmed by measuring their viability using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay. Blood serum proteins adhered to the surface of UCNP@PIMAPDMA particles, forming a protein corona that may contribute to particle biosafety. After intravenous injection of these particles into laboratory mice, there were no statistically significant changes in body mass of the treated animals. Also, no big adverse effects on blood cell profile, enzymatic and metabolic markers of hepatotoxicity and nephrotoxicity were observed. Finally, the application potential of UCNP@PIMAPDMA nanoparticles was confirmed by successfully imaging the cytoplasm of rat mesenchymal stem cells and rat C6 glioblastoma cells using laser scanning confocal microscopy.

PMID:41416380 | DOI:10.1002/jbmb.70011

J Yeungnam Med Sci. 2026;43:3. doi: 10.12701/jyms.2026.43.3. Epub 2025 Dec 18.

ABSTRACT

BACKGROUND: Japan and South Korea, two advanced East Asian nations with universal health coverage and similar demographic challenges, have developed markedly different emergency medical services (EMS) systems. Despite growing interest in international benchmarking, structured, comparative studies that yield policy-relevant insights remain limited.

METHODS: We conducted a multisource comparative health-systems analysis using statutory laws, government publications, academic society reports, peer-reviewed literature, and national statistics. Key domains included EMS governance, workforce, prehospital organization, hospital-based emergency care, legal obligations for EMS patient transport and hospital acceptance, and governance and quality assurance mechanisms. Data were synthesized in comparative tables and narrative summaries to highlight structural and operational differences.

RESULTS: Japan’s EMS operates under decentralized municipal control through 722 fire departments, serving 4,100 designated emergency institutions with 6,139 board-certified emergency physicians. In 2023, over 6.64 million ambulance dispatches occurred, and 8.6% were classified as critical cases (1.3% death and 7.3% severe). Korea’s EMS is centrally governed with 412 designated facilities in a tiered system and 2,464 specialists. Annual ambulance activations exceeded 3.5 million, with severe cases accounting for approximately 5% to 10%. Japan employs dual statutory frameworks (Fire Service Act and Medical Practitioners Act), allowing clinical discretion, whereas Korea enforces unified regulations with stricter obligations and criminal penalties for hospital refusal of emergency patients.

CONCLUSION: The contrasting systems suggest that hybrid governance that combines centralized standard settings with local operational flexibility may optimize EMS performance. These findings provide lessons for EMS reform, cross-border collaboration, and disaster preparedness in high-income nations facing similar demographic and healthcare challenges.

PMID:41416366 | DOI:10.12701/jyms.2026.43.3

Biomed Res Int. 2025 Dec 17;2025:9923869. doi: 10.1155/bmri/9923869. eCollection 2025.

ABSTRACT

BACKGROUND: Despite the increasing incidence of cancer worldwide, the knowledge about the trend of cancer incidence in Ethiopia is limited. The paucity of core cancer diagnostic services like pathology, diagnostic imaging technology, and the absence of a comprehensive national cancer registry masked the exact magnitude of cancer incidence in Ethiopia in general and the Wolaita area in particular. This study is aimed at filling the gap by analyzing diagnostic data from a referral clinic. The clinic used to serve as a primary diagnostic center for patients referred from over 25 healthcare facilities in the region.

METHODS: A pathology sample retrospective analysis-based prevalence study was conducted for the period between December 2017 and February 2022. Records saved in computers were subjected to analysis by using Statistical Package for Social Sciences (SPSS) software Version 22. The data were used to analyze the types and distribution of cancers in the region across age, sex, and diagnosis.

RESULTS AND DISCUSSIONS: The results showed notable gender disparities, with women experiencing a greater prevalence of breast cancer and men mostly receiving diagnoses for soft tissue sarcomas. The most prevalent forms of cancer were determined, along with the locations of each. The study also emphasized how different referral facilities, such as general hospitals, primary hospitals, and medium-sized clinics, had varying cancer incidence rates. Although generalizability may be limited by the study’s clinic-based design, its relevance to comparable healthcare settings in Ethiopia and other low-resource locations is strengthened by the large and diverse sample drawn from a variety of referral institutions. This study emphasizes the necessity of focused screening programs and greater cancer awareness in Wolaita Zone, particularly in rural regions. The results also suggest possible directions for future investigation, such as population-based studies to confirm and build upon these findings.

CONCLUSIONS: This study provides crucial insights into the cancer burden in Wolaita Zone and emphasizes the importance of improving diagnostic and preventive measures. Further research, including broader, population-based studies, is necessary to confirm these findings and inform regional cancer control strategies.

PMID:41416348 | PMC:PMC12709645 | DOI:10.1155/bmri/9923869

Cureus. 2025 Nov 17;17(11):e97096. doi: 10.7759/cureus.97096. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Rapid cycle deliberate practice (RCDP) is a form of simulation debriefing that incorporates repeated cycles of hands-on practice, characterized by within-simulation directed feedback and repeated practice with the goal of mastering a skill. RCDP debriefing has been shown to improve immediate performance; however, evidence of improved retention and superiority to traditional styles of debriefing is lacking.

OBJECTIVES: To compare RCDP and traditional debriefing for knowledge and skills acquisition and retention as part of a longitudinal residency simulation curriculum.

DESIGN: Participants were first-year pediatrics residents who underwent two simulation scenarios, focusing on basic airway and cardiac arrest management, at the beginning of their intern year. Participants were block randomized to either the RCDP or the traditional debriefing arm. Knowledge was assessed in a pre-post format at time 0 and at 12 months using a multiple-choice quiz. All interns received a repeat simulation teaching session at three, six, nine, or 12 months, remaining in their RCDP or traditional debriefing arm. Skills were assessed via a video-recorded simulated scenario prior to an initial simulation session (RCDP vs. traditional debriefing) at time 0 and three, six, nine, and 12 months, and before and after their repeat simulation teaching session. Videos were scored by two pediatric emergency medicine physicians using a resuscitation skills assessment tool.

RESULTS: There was no statistical difference in overall knowledge (via paired t-test) or skills acquisition (via linear mixed effects model) between residents who received traditional debriefing and those who received RCDP debriefing. The RCDP group showed significant improvement in skills when compared with the traditional group for those who received repeat education at three months; however, there was no difference in the other time groups. There was no difference between groups in skills retention at three months after the repeat teaching session, as assessed via the ANOVA analysis.

CONCLUSION: Overall, we demonstrated similar knowledge and skills gain and retention in traditional debriefing and RCDP groups, with the exception of those residents who received repeat teaching at the three-month time point. This may indicate that a three-month time interval could be the most appropriate timing for repeated RCDP resuscitation teaching. Higher power randomized controlled trials comparing RCDP to traditional simulation and/or qualitative studies assessing the efficacy of RCDP would add to current evidence.

PMID:41416338 | PMC:PMC12711249 | DOI:10.7759/cureus.97096

Cureus. 2025 Nov 17;17(11):e97084. doi: 10.7759/cureus.97084. eCollection 2025 Nov.

ABSTRACT

Pantoprazole is a proton pump inhibitor commonly used to treat gastroesophageal reflux disease (GERD) by reducing stomach acid production. Although widely used for gastrointestinal issues, its effects on embryonic development remain underexplored. This study investigated the impact of pantoprazole on neural tube closure using a chick embryo model. Fertilised chicken eggs were divided into groups and treated with varying doses of pantoprazole. All embryos were collected on the eighth day of incubation. Both macroscopic and microscopic examinations were conducted to assess developmental abnormalities. Macroscopic analysis revealed malformations, particularly in embryos exposed to medium and high doses of pantoprazole. These groups exhibited statistically significant developmental delays compared to controls. Microscopic examination further demonstrated that high-dose pantoprazole resulted in delayed vertebral lamina ossification and midline closure defects-key indicators of neural tube defects. Overall, the study concluded that high levels of pantoprazole exposure during embryonic development can lead to structural malformations and delayed growth. Specifically, neural tube defects were identified, indicating a risk to early neural development. These findings suggest that pantoprazole use during pregnancy may pose teratogenic risks and should be approached with caution. This research highlights the need for further studies on the safety of commonly used medications like pantoprazole during pregnancy, as their use may adversely affect embryonic development, particularly neural tube formation.

PMID:41416336 | PMC:PMC12710982 | DOI:10.7759/cureus.97084

Cureus. 2025 Nov 17;17(11):e97097. doi: 10.7759/cureus.97097. eCollection 2025 Nov.

ABSTRACT

Background Patients presenting with neck-of-femur (NOF) fractures often require urgent surgery, as prolonged delays beyond 36 hours are associated with increased morbidity, mortality, and length of hospital stay, whereas shorter time-to-surgery intervals have been shown to improve outcomes. Many of these patients are elderly and on anticoagulant therapy; therefore, making accurate International Normalized Ratio (INR) assessment is crucial for determining surgical readiness and anaesthetic safety. The INR reflects the extrinsic pathway of coagulation and is prolonged in patients on warfarin or who have underlying coagulopathies. Inaccurate or rejected INR samples delay operative clearance, prolong fasting, and increase bed occupancy and cost of treatment. A frequent pre-analytical cause of INR rejection is underfilling of sodium citrate tubes, which alters the required 9:1 blood-to-anticoagulant ratio. Objective To improve the rejection rate of INR samples through a simple phlebotomy intervention involving staff education and the appropriate use of a discard tube before citrate collection. Methods A retrospective two-cycle closed-loop audit was conducted at Heartlands Hospital, part of the University Hospitals Birmingham (UHB) NHS Foundation Trust. The first cycle included NOF fracture patients admitted between July and August 2023, during which 399 INR samples were analysed. Of these, 66 (16.5%) were rejected, 62 (94%) due to underfilling and four (6%) due to haemolysis. Following targeted interventions, including staff education on correct discard-tube use with butterfly systems and the introduction of shorter-tubing blood collection sets, a second audit cycle was performed and included NOF patients admitted between July and August 2025. In this cycle, 261 INR samples were reviewed, of which 29 (11.1%) were rejected, 27 (93%) for underfilling and two (7%) for haemolysis. Rejection proportions were compared between cycles, and absolute and relative changes were calculated. Statistical significance of the observed difference was assessed using a two-proportion z-test (two-sided, α = 0.05). Data collection and review were performed using the UHB trust Prescribing Information and Communication System (PICS) electronic system. Results INR sample rejection rate decreased from 16.5% in cycle 1 to 11.1% in cycle 2, an absolute reduction of 5.4% and relative reduction of ~33% (p ≈ 0.11). Among patients taking some form of blood thinner (e.g. warfarin, direct oral anticoagulants, low molecular weight heparin), 132 (33%) in cycle 1 and 56 (25%) in cycle 2, INR rejection occurred in 17.4% and 19.6%, respectively. Most rejections were due to underfilling the INR sample tube. Conclusions In trauma patients, particularly those awaiting urgent NOF surgery, preventing INR sample rejection can significantly reduce avoidable operative delays. This closed-loop audit demonstrated that a simple, low-cost intervention focused on correct tube filling, discard-tube use, and appropriate equipment selection led to a clinically meaningful reduction in INR sample rejection rates. Most remaining rejections remain preventable, underscoring the importance of continuous education, reinforcement of best practice, and regular re-audit to sustain long-term improvement.

PMID:41416323 | PMC:PMC12711245 | DOI:10.7759/cureus.97097

Cureus. 2025 Nov 16;17(11):e96972. doi: 10.7759/cureus.96972. eCollection 2025 Nov.

ABSTRACT

Background Diffusion tensor imaging (DTI) is a sensitive neuroimaging modality that evaluates white matter microstructure by measuring parameters such as fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD). Alterations in these metrics can indicate myelin disruption, axonal injury, or generalized microstructural changes. This study aimed to assess white matter integrity in children with developmental delay and evaluate the diagnostic performance of DTI metrics using receiver operating characteristic (ROC) analysis. Methods A hospital-based observational study was conducted on pediatric subjects with neurodevelopmental abnormalities. DTI was performed, and FA, MD, RD, and AD were quantified across major tracts, including the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, superior longitudinal fasciculus (SLF), inferior fronto-occipital fasciculus (IFOF), and frontal and parietal white matter. Age-matched controls served as the comparison group. Statistical analysis included group comparisons and ROC curve evaluation for diagnostic accuracy. Results Significant reductions in FA were observed in the genu of the corpus callosum (0.34±0.07), frontal white matter (0.31±0.06), parietal white matter (0.33±0.05), SLF (0.35±0.06), and IFOF (0.37±0.05) (p<0.01 vs. controls). RD was significantly elevated in these regions (0.92-0.97×10⁻³ mm²/s; p<0.01), consistent with demyelination or delayed myelination. MD values were diffusely elevated (1.06-1.12×10⁻³ mm²/s), supporting generalized microstructural disruption, whereas AD showed mild but non-significant changes. ROC analysis demonstrated that FA had the highest diagnostic accuracy: genu of the corpus callosum (AUC 0.89), frontal white matter (AUC 0.91), and SLF (AUC 0.88). RD and MD also showed strong discriminatory ability, while AD performed less robustly. Conclusion Reduced FA, along with elevated RD and MD, reliably reflects white matter microstructural injury in pediatric populations. ROC analysis confirmed FA as the most sensitive biomarker, with high sensitivity and specificity. DTI metrics hold strong clinical potential for the early detection of neurodevelopmental white matter abnormalities.

PMID:41416317 | PMC:PMC12709428 | DOI:10.7759/cureus.96972

Cureus. 2025 Nov 17;17(11):e97048. doi: 10.7759/cureus.97048. eCollection 2025 Nov.

ABSTRACT

Introduction Laparoscopic cholecystectomy (LC) is traditionally performed under general anesthesia (GA). However, thoracic segmental spinal anesthesia (TSSA), where low doses of local anesthetics (LA), often with adjuvants, are used at thoracic spinal levels, is also being explored by some researchers. Shoulder pain is a common issue during LC, adversely impacting the patient’s perioperative experience. A combination of hypobaric and isobaric LA at the thoracic level has been described to mitigate this complication. The primary objective of the study was to compare the efficacy of a combination of hypobaric and isobaric bupivacaine versus isobaric bupivacaine alone during TSSA in LC in reducing intraoperative shoulder pain. The secondary objectives were to assess the incidence of adverse effects (hypotension, bradycardia, nausea, vomiting, etc.) and to evaluate patient and surgeon satisfaction. Methods This randomized, controlled, open-label study was conducted at a tertiary care center after receiving ethical approval and registration at the Clinical Trial Registry of India. A total of 90 patients were recruited, with 45 participants in each group, aged 20-70 years, with ASA Physical Status I-II, scheduled for elective LC. Exclusion criteria included BMI > 35, contraindications to regional anesthesia, allergy to study drugs, spinal deformity, and previous abdominal surgery. Patients were randomly assigned to two groups using computer-generated random numbers. Anesthesia was provided by a senior consultant proficient in TSSA. Group 2 received hypobaric and isobaric bupivacaine, and Group 1 received only isobaric bupivacaine. Both groups received 11 mg bupivacaine with 5 μg dexmedetomidine in TSSA. Data were collected using Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA). Continuous variables were expressed as means ± SD and analyzed using an independent t-test or the Mann-Whitney U-test, depending on the distribution of data. Categorical variables were compared using the Chi-square or Fisher’s exact test. A p-value of <0.05 was considered statistically significant. Results All 90 patients in both groups successfully underwent LC under TSSA with no conversion to GA. The mean age of the participants was 49.11 ± 7.4 years with 58 (64.4%) females. Both groups were comparable in terms of demographic parameters. Intraoperative clinical parameters were comparable in both groups, without any statistically significant differences. Six (13.3%) patients in Group 1 and five (11.1%) patients in Group 2 had hypotension, which was easily corrected with a fluid bolus and a single 6 mg dose of intravenous mephentermine. Six (13.3%) patients in Group 1 reported shoulder pain, whereas in Group 2 only one (2.2%) patient had shoulder pain intraoperatively. Patient and surgeon satisfaction scores were better in Group 2, which was statistically significant. The number needed to treat (NNT) of nine indicates that approximately nine patients would need to receive the hypobaric + isobaric regimen to prevent one case of intraoperative shoulder pain. Conclusions LC can be performed successfully under TSSA with stable hemodynamics. The addition of hypobaric bupivacaine to isobaric bupivacaine provided better shoulder-tip pain control and fewer postoperative complications. Further studies with larger sample sizes are needed to validate these findings.

PMID:41416305 | PMC:PMC12709560 | DOI:10.7759/cureus.97048