Tag: statistics

J Orthop Surg Res. 2025 Dec 16;20(1):1072. doi: 10.1186/s13018-025-06495-4.

ABSTRACT

OBJECTIVE: The current study aimed to systematically and quantitatively evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in predicting mortality among surgical patients with hip fractures through a systematic review and meta-analysis.

DESIGN: Systematic review and meta-analysis.

METHODS: Four databases-The Cochrane Library, PubMed, Embase, and Web of Science-were comprehensively retrieved to identify studies published from database inception to May 2025 that investigated NLR as a predictor of postoperative survival in hip fracture individuals. Two independent researchers performed study selection, data extraction, and quality assessment, with consistency verified via cross-checking. Statistical analyses were performed using Stata 15.0 for meta-regression and heterogeneity testing, while prognostic performance metrics (sensitivity, area under the curve [AUC], specificity) were synthesized via Meta-Disc 1.4.

RESULTS: Our meta-analysis incorporated 12 studies, involving 10,015 individuals who underwent surgery for a hip fracture. With cut-off values ranging from 3.2 to 8.4, preoperative NLR demonstrated high prognostic efficacy for mortality prediction, yielding a combined sensitivity of 0.69 (95% CI 0.55-0.83), specificity of 0.84 (0.74-0.93), diagnostic odds ratio (DOR) of 12 (6-26), and an area under the summary receiver operating characteristic curve (sAUC) of 0.84 (0.81-0.87). Subgroup analysis of preoperative NLR thresholds revealed that higher cut-off values (NLR > 5) significantly improved prognostic performance. NLR exhibited superior sensitivity but slightly lower specificity in patients from developing countries, with particular prognostic utility for long-term mortality (≥ 1 year). Postoperative NLR showed moderate prognostic efficacy, with a combined sensitivity of 0.64 (0.57-0.70), specificity of 0.58 (0.55-0.61), DOR of 2 (2-3), and sAUC of 0.62 (0.58-0.66).

CONCLUSION: This meta-analysis confirms that the preoperative NLR is a promising albeit preliminary predictor of postoperative mortality in hip fractures.

PMID:41402900 | DOI:10.1186/s13018-025-06495-4

Virol J. 2025 Dec 16. doi: 10.1186/s12985-025-03047-4. Online ahead of print.

ABSTRACT

BACKGROUND: Persistent infection with high-risk human papillomavirus (HR-HPV) is a necessary cause of cervical cancer and its precancerous lesions. This study aimed to identify factors associated with HR-HPV persistence in Chinese women.

METHODS: This study is a population-based, nationwide, multi-center prospective cohort study initiated in 2017, and a total of 10,481 women undergoing cervical cancer screening were enrolled. A subset of 1,684 women who tested HR-HPV positive at baseline were included in the analysis. The results of their HPV testing at baseline and during three follow-up visits (2018-2020) were used to assess 1-, 2-, and 3-year HR-HPV persistence. Variables with statistically significant associations in univariate analyses, expressed as odds ratios (ORs) with 95% confidence intervals (CIs), were subsequently entered into a stepwise multivariate logistic regression model to identify independent predictors of HR-HPV persistence.

RESULTS: The mean age of 1,684 HPV-positive women at baseline was 47.6 ± 9.5 (interquartile range (IQR) = 42-54) years. The most prevalent genotypes at baseline were HPV52 (28.3%), HPV16 (20.2%), HPV58 (17.8%), HPV33 (6.7%), and HPV18 (6.2%). Overall HR-HPV persistence rates declined over time were 66.8% at 1 year, 48.3% at 2 years, and 39.9% at 3 years. Infection with HPV33 (OR = 2.40, 95% CI: 1.42-4.01), HPV52 (OR = 1.95, 95% CI: 1.45-2.64), or HPV58 (OR = 2.01, 95% CI: 1.40-2.88), as well as postmenopausal status (OR = 2.84, 95% CI: 2.17-3.72), were significantly associated with 3-year persistence, and alcohol consumption was associated with a reduced risk of persistence (OR = 0.49, 95% CI: 0.30-0.79). Furthermore, HPV16 was the most frequently detected genotype in cervical intraepithelial neoplasia grades 2 and worse (CIN2+), indicating it plays a predominant role in chronically pathogenic of high cervical disease.

CONCLUSION: These findings underscore the importance of genotype-specific and host-related factors in HR-HPV persistence and support the implementation of tailored cervical cancer screening strategies. Women infected with HPV33, HPV52, or HPV58, along with HPV16 may require closer long-term monitoring to prevent progression to high-grade cervical lesions.

PMID:41402897 | DOI:10.1186/s12985-025-03047-4

BMC Sports Sci Med Rehabil. 2025 Dec 17. doi: 10.1186/s13102-025-01474-y. Online ahead of print.

ABSTRACT

BACKGROUND: Active myofascial trigger points (MTrPs) in the upper trapezius are a leading source of neck pain and functional limitation in athletes. Although myofascial release (MFR) and stretching are frequently used, their comparative effectiveness when combined with high-power pulsed therapeutic ultrasound (HPPT-US) remains unclear.

OBJECTIVE: To compare the efficacy of MFR + HPPT-US versus stretching + HPPT-US on pain intensity, cervical range of motion (Cx-ROM), muscle length (ML), and neck disability in amateur overhead athletes with unilateral upper trapezius active MTrPs.

TRIAL DESIGN: A two-arm parallel group, randomized clinical trial design.

METHODS: Thirty-two athletes meeting Travell and Simons’ criteria for active MTrPs were randomized to receive either MFR + HPPT-US (Group A) or stretching + HPPT-US (Group B), administered thrice weekly for two weeks. Primary outcome measure-Pain intensity and secondary outcomes-Cx-ROM, ML, and Neck Disability Index (NDI) were recorded using a visual analog scale (VAS), universal goniometer, Vernier caliper, and neck disability index (NDI) questionnaire, at baseline, week 1, week 2, and one-week follow-up. 26 out of 32 data of enrolled participants were analyzed using a two-way mixed repeated-measures ANOVA (Group × Time) with Bonferroni-adjusted post-hoc tests; statistical significance was set at p < 0.05, and effect sizes were reported as partial eta-squared (η²ₚ) for ANOVA and Cohen’s d for pairwise differences.

RESULTS: Significant main effects of Group (η²ₚ = 0.07-0.26) and Time (η²ₚ = 0.83-0.92) were observed for all outcomes, with a significant Group × Time interaction for ML (η²ₚ = 0.34). Both interventions produced significant improvements across time points; however, Group A demonstrated greater gains following treatment. At follow-up, between-group differences favored Group A for VAS (MD = – 0.77; 95% CI – 1.31 to – 0.39; d = 1.12), Cx-ROM (MD = 2.69°; 95% CI 0.80 to 4.58; d = 1.07), ML (MD = 0.80 cm; 95% CI 0.27 to 1.33; d = 1.14), and NDI (MD = – 4.70; 95% CI – 8.04 to – 1.36; d = 1.09). Improvements were consistent across post-baseline assessments, although the magnitude of change varied by outcome.

CONCLUSION: The combination of MFR and HPPT-US was more effective than stretching with HPPT-US in reducing pain, increasing ML and Cx-ROM, and improving functional outcomes in amateur overhead athletes with active upper trapezius MTrPs. This combined approach may offers superior clinical benefits for managing MTrP-related neck pain and promoting faster recovery in athletic rehabilitation settings.

TRIAL REGISTRATION: The study protocol was retrospectively registered to the “ClinicalTrials.gov” under an assigned Identifier: NCT07002593 on 25/05/2025 (https://clinicaltrials.gov/study/NCT07002593).

PMID:41402896 | DOI:10.1186/s13102-025-01474-y

Diagn Progn Res. 2025 Dec 16;9(1):33. doi: 10.1186/s41512-025-00204-9.

ABSTRACT

BACKGROUND: When developing a clinical prediction model using time-to-event data (i.e. with censoring and different lengths of follow-up), previous research focuses on the sample size needed to minimise overfitting and precisely estimating the overall risk. However, instability of individual-level risk estimates may still be large.

METHODS: We propose using a decomposition of Fisher’s information matrix to help examine and calculate the sample size required for developing a model that aims for precise and fair risk estimates. We propose a six-step process which can be used either before data collection or when an existing dataset is available. Steps 1 to 5 require researchers to specify the overall risk in the target population at a key time-point of interest: an assumed pragmatic ‘core model’ in the form of an exponential regression model, the (anticipated) joint distribution of core predictors included in that model and the distribution of censoring times. The ‘core model’ can be specified directly or based on a specified C-index and relative effects of (standardised) predictors. The joint distribution of predictors may be available directly in an existing dataset, in a pilot study or in a synthetic dataset provided by other researchers.

RESULTS: We derive closed-form solutions that decompose the variance of an individual’s estimated event rate into Fisher’s unit information matrix, predictor values and total sample size; this allows researchers to calculate and examine uncertainty distributions around individual risk estimates and misclassification probabilities for specified sample sizes. We provide an illustrative example in breast cancer and emphasise the importance of clinical context, including any risk thresholds for decision-making, and examine fairness concerns for pre- and postmenopausal women. Lastly, in two empirical evaluations, we provide reassurance that uncertainty interval widths based on our exponential approach are close to using more flexible parametric models.

CONCLUSIONS: Our approach allows users to identify the (target) sample size required to develop a prediction model for time-to-event outcomes, via the pmstabilityss module. It aims to facilitate models with improved trust, reliability and fairness in individual-level predictions.

PMID:41402895 | DOI:10.1186/s41512-025-00204-9

Eur J Med Res. 2025 Dec 16. doi: 10.1186/s40001-025-03693-y. Online ahead of print.

ABSTRACT

BACKGROUND: The CCAT2 gene is associated with carcinogenesis, but its effect on neuroblastoma, the most common extracranial tumor in children, remains unclear.

METHODS: We conducted a case-control study involving 402 children with neuroblastoma and 473 children without neuroblastoma. TaqMan genotyping of two CCAT2 polymorphisms (rs3843549 A > G and rs6983267 T > G) was conducted for all participants. Correlations were analyzed by calculating the odds ratio (OR) and 95% confidence interval (CI). Furthermore, we performed stratified analyses for both polymorphisms to evaluate their associations more comprehensively.

RESULTS: We performed a statistical analysis employing three distinct genetic models to evaluate the rs3843549 A > G polymorphism and the rs6983267 T > G polymorphism. Moreover, we further investigated the potential protective polymorphisms (rs3843549 AG/GG and rs6983267 TG/GG) by stratified analysis. There was no significant association between CCAT2 gene polymorphisms and neuroblastoma susceptibility.

CONCLUSION: CCAT2 gene polymorphisms (rs3843549 A > G and rs6983267 T > G) were not associated with susceptibility to neuroblastoma. However, the accuracy of this conclusion may be limited by various confounding factors. Future analyses would benefit from a more comprehensive approach that accounts for additional variables.

PMID:41402887 | DOI:10.1186/s40001-025-03693-y

BMC Sports Sci Med Rehabil. 2025 Dec 17. doi: 10.1186/s13102-025-01485-9. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis aimed to quantify the risk of subsequent all-cause, recurrent concussion, upper extremity, and lower extremity injuries in athletes with a history of sport-related concussion.

METHODS: Following PRISMA guidelines, cohort studies published from inception through August 2025 were retrieved from PubMed, Cochrane Library, Embase, Web of Science, and EBSCO. The methodological quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Pre-specified subgroup and meta-regression analyses were conducted to investigate sources of heterogeneity, including injury timing, study design, sport type, and athlete competition level.

RESULTS: Nineteen cohort studies involving 86,879 athletes were included. Athletes with a history of concussion had significantly higher odds of sustaining a subsequent all-cause injury (OR = 1.93; 95% CI = 1.39-2.68). The risk was most pronounced for recurrent concussion (OR = 3.06; 95% CI = 1.81-5.17), and was also significantly elevated for upper extremity (OR = 1.76; 95% CI = 1.10-2.81) and lower extremity injuries (OR = 1.49; 95% CI = 1.06-2.09). Given the high heterogeneity observed in the primary outcomes (I² > 90%), the pooled effect sizes should be interpreted with caution as average associations across varying study contexts, rather than as precise predictions applicable to all settings. Subgroup analysis revealed that injury risk was statistically significant in studies with follow-up periods beyond six months (OR = 1.94) but not for shorter durations. The association was strongest and statistically significant among college athletes (OR = 2.29; 95% CI = 1.53-3.44), while estimates for professional and high school athletes were not significant. Meta-regression identified sport type as a significant moderator of injury risk (p = 0.038).

CONCLUSION: A history of concussion significantly increases the risk of subsequent injuries, with the odds being highest for recurrent concussion. The persistence of this risk beyond six months suggests that clinical recovery does not equate to full functional recovery. These findings underscore the need for enhanced return-to-play protocols that incorporate objective functional assessments and targeted rehabilitation to mitigate the heightened vulnerability to injury in post-concussed athletes.

PMID:41402865 | DOI:10.1186/s13102-025-01485-9

BMC Nurs. 2025 Dec 17. doi: 10.1186/s12912-025-04214-2. Online ahead of print.

ABSTRACT

BACKGROUND: As the healthcare environment changes rapidly due to the spread of information and communication technology (ICT), nursing fields require nursing informatics competency to effectively utilize vast amounts of information, along with the ability to understand and utilize ICT. In addition, critical thinking competency, which is the ability to efficiently use nursing information systems and critically analyze and solve complex problems, has been emphasized. Previous studies have reported on nursing informatics competency and critical thinking or critical thinking disposition; however, few have identified moderators or mediators in these relationships. This study evaluated the mediating effect of self-control on the relationship between critical thinking disposition and nursing informatics competency.

METHODS: This study involved a secondary analysis of data from 235 questionnaires of undergraduate students from two Korean cities between October and November 2022. A direct questionnaire was used to collect the data. The study variables were analyzed using descriptive statistics, correlations, and a model tested using the Hayes PROCESS macro (Model 1) moderation model.

RESULTS: The mean scores for critical thinking disposition, self-control, and nursing informatics competency were 3.79 ± 0.52, 3.42 ± 0.60, and 3.80 ± 0.50, respectively. Critical thinking disposition and self-control were positively correlated with nursing informatics competency. In the moderation model, self-control had a conditional moderating effect on the relationship between critical thinking disposition and nursing informatics competency. The positive effect of critical thinking disposition on nursing informatics competency increased as self-control increased.

CONCLUSIONS: Critical thinking disposition and self-control may be important determinants of nursing informatics competency among undergraduate nursing students. To effectively increase nursing informatics competency, critical thinking disposition should be enhanced through educational programs or training with content, including increasing self-control.

PMID:41402858 | DOI:10.1186/s12912-025-04214-2

BMC Nurs. 2025 Dec 16. doi: 10.1186/s12912-025-04221-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Radiotherapy for nasopharyngeal cancer (NPC) frequently induces malnutrition, which is a serious complication that adversely affects patients’ quality of life and prognosis. Although there are currently nutritional assessment procedures for such patients, their clinical effectiveness requires further investigation.

OBJECTIVE: This study aims to evaluate the impact of implementing an optimal nutritional assessment strategy on the nutritional management skills of nurses and patients and on the nutritional status of NPC patients undergoing radiotherapy.

METHODS: The project followed a three-phase approach. In the first phase, a systematic search and critical appraisal of evidence on nutritional management for NPC radiotherapy patients was conducted, yielding 17 best-practice items and 18 audit indicators. A baseline assessment of these indicators was subsequently performed in a radiotherapy ward between November 2024 and January 2025. The findings from this audit informed the second phase, where barriers and facilitators were analyzed using the Consolidated Framework for Implementation Research. This analysis led to the development of the 4 C Nutrition pathway as the core intervention strategy, which was implemented in the third phase from March to May 2025. The effectiveness was evaluated by comparing pre- and post-implementation data on audit compliance, knowledge levels of nurses, patients’ treatment adherence, and nutritional status indicators. Comparative analyses used paired or independent-sample t-tests for continuous variables and chi-square tests for categorical variables, with significance set at P < 0.05 (SPSS software, version 25.0).

RESULTS: A total of 51 patients were included pre-implementation, compared to 52 post-implementation. Following evidence translation, the implementation rates of nurse review indicator increased overall from a range of 0% to 90.2% pre-implementation to 50.00% to 100.00% post-implementation. Nurse nutrition management knowledge questionnaire scores increased from (68.22 ± 5.90) to (85.11 ± 7.10). Patients’ nutritional management adherence scores increased from (103.43 ± 12.92) to (117.00 ± 5.97). Moreover, at the 4-week follow-up, the hemoglobin level in the post-implementation group (126.38 ± 6.19) g/L was significantly higher than the pre-implementation level (109.58 ± 17.15) g/L. All these differences were statistically significant (P < 0.05).

CONCLUSIONS: The implementation effectively enhanced the standardization of clinical nutritional assessment for nurses, significantly narrowed the gap between clinical practice and best evidence, and improved the knowledge of nutritional management among nurses and patients.

TRIAL REGISTRATION: This study has been retrospectively registered with the China Clinical Trial Registry.

CLINICAL TRIAL NUMBER: ChiCTR2500107011. Registration date: 1 August 2025.

PMID:41402847 | DOI:10.1186/s12912-025-04221-3

Respir Res. 2025 Dec 16. doi: 10.1186/s12931-025-03447-8. Online ahead of print.

ABSTRACT

BACKGROUND: Flexible bronchoscopy (FB) is recommended for pediatric Mycoplasma pneumoniae pneumonia (MPP) with persistent consolidation or atelectasis, though substantial heterogeneity in treatment effects exists. This study aimed to develop a causal forest-based predictive model to identify pediatric MPP patients most likely to benefit from FB.

METHODS: This retrospective two-center study enrolled pediatric MPP patients in derivation (n = 753) and validation (n = 139) cohorts. Clinical, laboratory, and AI-quantified computed tomography (CT) data were analyzed. Individual treatment effects (ITEs) were estimated using causal forest algorithms. FB-beneficial subgroups were defined using receiver operating characteristic (ROC) analysis of ITEs, with the varying treatment effect across the subgroups validated via multivariable linear regression. Subgroup characteristics, feature importance, and heatmap-based feature interactions were also analyzed.

RESULTS: FB treatment significantly reduced total fever duration in identified FB-beneficial subgroups in both derivation (β = – 1.16, p < 0.001) and validation (β = – 0.68, p = 0.04) cohorts. These beneficial subgroups exhibited significantly higher consolidation/atelectasis volume (CAV), pneumonia attenuation (PA), and consolidation-to-pneumonia ratio (CAR) compared to non-beneficial groups (all p < 0.001). Heatmap analyses confirmed that increased CAV combined with elevated PA or lymphocyte counts could improve FB efficacy.

CONCLUSIONS: This study developed and validated an individualized prediction model to identify pediatric MPP patients most likely to benefit from FB treatment. Our model may serve as a tool to support clinicians in optimizing FB utilization, potentially reducing unnecessary interventions and associated risks. An accessible online tool of this model facilitates practical clinical implementation.

PMID:41402819 | DOI:10.1186/s12931-025-03447-8

BMC Oral Health. 2025 Dec 16;25(1):1912. doi: 10.1186/s12903-025-07225-2.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the effects of sintering speed and surface finishing on the optical, mechanical, microstructural, and surface properties of monolithic zirconia ceramics with different yttria content.

MATERIALS AND METHODS: Three different zirconia materials (Katana UTML, Katana STML, DD Cube Bio ZX²) were subjected to either speed or conventionally sintering, followed by the application of various surface treatments. Translucency parameters were measured before and after aging. The biaxial flexural strength was measured after aging. The microstructure of the specimens was examined using scanning electron microscopy (SEM) and X-Ray diffraction (XRD) analyses, while the surface roughness was analyzed using atomic force microscopy (AFM). Statistical analysis of the data was performed using three-way ANOVA, one-way ANOVA, the Kruskal-Wallis test, and Bonferroni post hoc comparisons.

RESULTS: The applied sintering speed, clinical adjustment, and aging processes did not produce a statistically significant effect on flexural strength (p = 0.245) or translucency (p = 0.478). The phase content of Katana UTML was not influenced by sintering speed or clinical adjustment either before or after aging. For the Katana STML material, phase content was unaffected by sintering speed and clinical adjustment prior to aging, but the monoclinic phase was detected in the structure after aging. In the DD Cube Bio ZX² material, the monoclinic phase was observed both before and after aging, and the proportion of the monoclinic phase increased after aging. SEM analysis revealed that speed sintering reduced the average grain size of monolithic zirconia. AFM analysis indicated that, after aging, the glazed samples of Katana UTML and Katana STML exhibited smoother surfaces compared to the grinding and polishing groups of the same materials. Furthermore, the speed sintering of DD Cube Bio ZX² material resulted in the formation of a more homogeneous surface. The increase in yttria content in the material decreased flexural strength and the amount of monoclinic phase formed after aging while increasing translucency, grain size, and the proportion of the cubic phase (p = 0.000).

CONCLUSION: Speed sintering, surface finishing, and aging did not significantly affect the translucency or flexural strength of monolithic zirconia. Polishing kits designed for zirconia can be used after speed sintering. Higher yttria content improved translucency, grain size, cubic phase, and aging resistance, but reduced flexural strength and monoclinic phase after aging.

PMID:41402817 | DOI:10.1186/s12903-025-07225-2