Tag: statistics

BMC Musculoskelet Disord. 2025 Oct 7;26(1):925. doi: 10.1186/s12891-025-09197-4.

ABSTRACT

OBJECTIVE: To investigate the relationship between spinal-pelvic parameters in the coronal and sagittal planes and preoperative coronal imbalance (CIB) in degenerative scoliosis, aiming to prevent preoperative CIB and restore coronal balance(CB) for improved surgical outcomes.

METHODS: From May 2018 to May 2024, adult patients who underwent full-length spine imaging, were analyzed at the Southwest Medical University Affiliated Hospital. The inclusion criteria were: (1) availability of clear full-length spinal images in the coronal and sagittal planes that allowed for measurement of relevant parameters; (2) complete demographic information; (3) a major curve angle greater than 10°; and (4) skeletal maturity. Exclusion criteria were as follows : (1) history of previous spinal surgery; (2) pre-existing spinal or pelvic deformities; (3) history of trauma to the spine or pelvis; and (4) history of spinal infectious disease.A total of 162 cases were collected based on the inclusion and exclusion criteria.The general and imaging data of 162 patients were collected. These included the major curve (MC), fractional curve (FC), L5 tilt angle (L5TA), coronal pelvic inclination (CPI), apical vertebra translation (AVT), the number of vertebrae in the primary curve, apical vertebral rotation (AVR), sacral slope (SS), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Pearson correlation analysis and linear regression were employed to assess the relationship of each parameter with preoperative coronal balance distance (CBD). CBD was then converted to a binary variable (Patients with a CBD less than 3.0 cm were categorized into the CB group, while those with a CBD of 3.0 cm or greater were placed in the CIB group.). Univariate screening, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis were conducted to identify associations between preoperative CIB and the specified parameters.A total of 162 patients were classified into three groups based on the classification criteria of the Gulou Hospital: Type A (120 cases), Type B (25 cases), and Type C (17 cases). The differences in imaging data among the three groups were compared.

RESULTS: Pearson analysis demonstrated that L5TA, CPI, number of vertebrae in the primary curve, LL, SS, and SVA were correlated with preoperative CBD (p < 0.05). Moreover, further linear regression indicated that merely L5TA (R² = 0.204, p < 0.05), CPI (R² = 0.128, p < 0.05), and SVA (R² = 0.172, p < 0.05) were substantially associated with preoperative CBD, despite the fact that the relationship was not strictly linear. Multivariate logistic regression and ROC curve analysis revealed that age < 60.5 years was a protective factor against preoperative CIB, while preoperative L5TA > 5.75°, CPI > 3.55°, and SVA > 5.305 cm were risk factors for preoperative CIB. Among the 162 patients, 120 were classified as Type A, 25 as Type B, and 17 as Type C. Significant differences in age and L5TA were observed between the A and C groups. CBD, CPI, and SVA exhibited statistically significant differences between the A group and both the B and C groups, whereas no significant difference was found between the B and C groups.

CONCLUSION: Preoperative L5TA is an independent risk factor for preoperative CIB. When the preoperative C7PL is located on the convex side of the major curve, L5 tilt becomes more pronounced. In the surgical treatment of DS, leveling the L5 vertebra can help reduce the incidence of postoperative CIB. Patients with degenerative scoliosis (DS) under 60.5 years of age might reduce CIB incidence through enhanced paraspinal muscle strength. Additionally, imbalances in CPI and SVA may contribute to preoperative CIB, and pelvic and sagittal alignment maintenance may offer spinal support essential for preserving coronal balance.

PMID:41057829 | DOI:10.1186/s12891-025-09197-4

BMC Med Educ. 2025 Oct 7;25(1):1363. doi: 10.1186/s12909-025-07969-z.

ABSTRACT

BACKGROUND: Evidence links the oral microbiome to systemic diseases, yet its integration into dental practice remains limited, particularly in Saudi Arabia, where non-communicable diseases are prevalent. Equipping dental practitioners with microbiome-related competencies is essential. This study evaluated the knowledge, confidence, and counseling practices of dental practitioners, identifying predictors and barriers to the clinical application of these practices.

METHODS: A convergent mixed-methods design involved 286 dental practitioners (general dentists, specialists, academics) across Saudi Arabia. Participants completed a 23-item validated questionnaire (13 assessing objective knowledge, 8 evaluating beliefs, confidence, and barriers, 2 open-ended). Quantitative data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression. Qualitative data from 30 open-ended responses were qualitatively analyzed to explore contextual factors.

RESULTS: Practitioners exhibited moderate-to-high objective knowledge (mean score: 9.14 ± 1.87 out of 13), with 55.9% in the medium category, 28.3% high, and 15.7% low. Confidence in counseling was moderate, with 39.6% reporting high or very high confidence. Prior microbiome training (OR = 3.21, 95% CI: 1.82-5.65, p < 0.001), frequent participation in Continuing Professional Development (CPD), and journal use (OR = 2.15, 95% CI: 1.25-3.70, p = 0.006) predicted higher confidence. Barriers included lack of formal training (52.6%), time constraints (17.9%), and patient disinterest (29.5%). Social media was a key knowledge source (24.2%), while dental curricula were underutilized (14.4%). Qualitative themes reinforced barriers and highlighted conditional motivation linked to patient risk factors.

CONCLUSIONS: A notable knowledge-to-practice gap persists in oral microbiome counseling. We propose integrating microbiome science into dental curricula and utilizing mobile Continuing Professional Development (CPD) tools to enhance confidence and increase counseling frequency, thereby addressing training gaps and infrequent updates. Additionally, Electronic Health Record (EHR) prompts are recommended to overcome time constraints and patient disinterest, aligning with Saudi Vision 2030’s goals for preventive care.

PMID:41057822 | DOI:10.1186/s12909-025-07969-z

BMC Med Educ. 2025 Oct 7;25(1):1365. doi: 10.1186/s12909-025-08020-x.

ABSTRACT

BACKGROUND: Preclinical training is essential in dental education for developing psychomotor and clinical skills. Conventional phantom models are widely used, though they lack real-time tactile feedback. This study aimed to compare the effectiveness of conventional phantom training with that of advanced simulation-based systems in improving dental students’ tooth preparation skills. METHODS: This randomized controlled trial included 40 s-year dental students (N = 40) with no prior experience in simulation. Participants were randomly assigned to either conventional phantom training or virtual reality (VR) based simulation. Both groups received 10 h of training. Pre- and post-tests involved preparing tooth 46 with a chamfer finish line. Performances were assessed using five criteria: parallelism, occlusal reduction, taper angle, finish line standardization, and presence of undercuts. Each was scored on a 0-10 scale by a blinded evaluator. Statistical analyses were performed using ANOVA with post hoc tests at a significance level of p < .05.

RESULTS: Both groups showed improvement in post-test scores The simulation group’s post-test performance was found to be significantly higher than that of the other groups. Post hoc analysis confirmed that the simulation group outperformed both its own pre-test and the conventional group’s post-test results.

CONCLUSIONS: Simulation-based training led to significantly higher outcomes in tooth preparation compared to conventional methods. The integration of digital simulation into dental education may enhance clinical readiness by providing individualized, repeatable, and measurable learning environments.

PMID:41057821 | DOI:10.1186/s12909-025-08020-x

BMC Pulm Med. 2025 Oct 7;25(1):455. doi: 10.1186/s12890-025-03916-2.

ABSTRACT

RATIONALE: Limited data exists on the long-term comparative efficacy and tolerability of pirfenidone and nintedanib, the two approved treatments for idiopathic pulmonary fibrosis (IPF).

METHODS: We retrospectively enrolled IPF patients treated with either pirfenidone or nintedanib at our centre between 2017 and 2023. Progression-free survival (PFS), defined as time to death or ≥ 10% decline in % predicted forced vital capacity (FVC) and continuous FVC decline were compared between groups defined by antifibrotic type or treatment intensity (full or reduced). Time to drug dose reduction was also compared. Statistical analysis included Kaplan-Meier curves with Log-Rank tests, Cox proportional hazards models and linear mixed-effects models.

RESULTS: A total of 292 IPF patients treated with pirfenidone (n = 142) or nintedanib (n = 150) were included with a mean follow-up time of 32.3 months (SD = 14.5). No significant differences in efficacy were observed between groups by antifibrotic type. Dose reduction was more frequent in the nintedanib group (59.3%) than pirfenidone group (16.9%, p < 0.001). Multivariate analysis showed that patients on nintedanib had a 4-fold higher risk of dose reduction compared to those on pirfenidone (p < 0.001). There were no significant differences in clinical outcomes between patients with dose reduction and those maintaining the full dose, both in the overall population and when stratified by antifibrotic type.

CONCLUSION: Nintedanib and pirfenidone exhibited similar long-term efficacy. Dose adjustment was more frequent with nintedanib, however it did not have impact on clinical outcomes.

PMID:41057813 | DOI:10.1186/s12890-025-03916-2

BMC Ophthalmol. 2025 Oct 7;25(1):551. doi: 10.1186/s12886-025-04394-0.

ABSTRACT

BACKGROUND: Optical coherence tomography angiography (OCTA) has shown promise in assessing microvascular and structural alterations in the retina and optic nerve. This study primarily aimed to evaluate the utility of OCTA in distinguishing aquaporin-4 antibody-positive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD) patients from healthy controls (HC). Additionally, exploratory analyses were conducted to examine differences between AQP4-Ab + and AQP4-Ab-, all MOG-Ab-negative(double-seronegative) groups in NMOSD patients.

METHODS: We retrospectively analyzed clinical data from NMOSD patients admitted to the Neurology Department of our First Hospital from January 2018 to December 2020. Patients were categorized into AQP4-Ab-positive (AQP4-Ab+) and double-seronegative groups, with an age-matched normal control group. OCTA examinations were conducted to compare differences in optic nerve fiber layer thickness, macular central thickness, optic disc, macular blood flow, and clinical characteristics among the three groups.

RESULTS: There were statistically significant gender differences among the three groups, with a higher proportion of females in the AQP4-Ab + group compared to the other two groups (P < 0.05). Structurally, significant differences were observed in all parameters between the AQP4-Ab + group and healthy controls (HC), as well as between the double-seronegative group and HC (all P < 0.05). Direct comparison between AQP4-Ab + and double-seronegative NMOSD patients revealed significant differences in specific OCTA parameters, including optic disc central vessel density (P < 0.001), inner optic disc ring vessel density (P = 0.010), inner optic disc ring superior vessel density (P = 0.008), and outer macular ring nasal vessel density (P = 0.042). However, most other OCTA parameters showed no statistically significant differences between the antibody-positive and antibody-negative subgroups (P > 0.05). The optic disc vessel density demonstrated the highest diagnostic efficiency overall, with the nasal side vessel density of the optic disc achieving an AUC of 0.829.

CONCLUSION: OCTA exhibits significant clinical utility in diagnosing AQP4-Ab + NMOSD. Differences between AQP4-Ab + and double-seronegative patients were explored and may provide further insight, although further research is required.

TRIAL REGISTRATION: Not applicable.

PMID:41057808 | DOI:10.1186/s12886-025-04394-0

BMC Psychiatry. 2025 Oct 7;25(1):943. doi: 10.1186/s12888-025-07298-x.

ABSTRACT

BACKGROUND: Both suicidal and non-suicidal self-injuring behaviors (NSSI) are common during adolescence In Slovenia, adolescent suicide rates are high, making suicide the leading cause of death in the year 2022 in this age group. These behaviors are influenced by a complex interplay of environmental, psychological, and genetic factors. Previous research has identified risk and protective factors mainly for suicidal behavior in adults, a notable gap in understanding these factors in adolescents remains, especially for NSSI. Notably there is an important lack of effective clinical tools or psychometric assessment methods to reliably assess the risk for either suicidal or NSSI behaviors in acutely hospitalized adolescents.

METHODS AND ANALYSIS: The proposed study uses a mixed-method observational design consisting of a prospective longitudinal cohort component involving adolescents hospitalized for high risk of DSH, and a cross-sectional comparison with a control group of healthy adolescents recruited from primary care settings. It is aimed at identifying genetic, psychosocial, and clinical factors associated with suicidal behaviors and NSSI in adolescents. The study group is recruited from adolescents aged 12-19, admitted to the Intensive Child and Adolescent Psychiatry Unit in Ljubljana due to severe self-harm risk. Exclusion criteria include involuntary treatment, acute psychotic disorders, intellectual disability, severe physical or central nervous system illnesses and acute intoxication. The control group comprises adolescents of comparable age, recruited through regular scheduled health check-ups in Slovenia. Exclusion criteria include suicidality, severe mental disorder, a history of self-harm behavior in a first-degree relative, intellectual disability, severe physical or central nervous system illnesses and acute intoxication. Enrollment runs from February 1, 2023, to December 31, 2025. Participation is voluntary, requiring parental or guardian consent for those 14 or younger. Data collection involves psycho-diagnostic tools assessing demographic, psychopathology, personality traits, trauma and traumatic events, and attachment patterns. Genetic analysis of blood samples will be performed using long-read sequencing to detect DNA methylation and bioinformatic tools for further analyses. Various statistical methods will be used to identify factors potentially linked to suicidality and NSSI. Additionally, the utility of a newly developed tool for the assessment of inpatient self-harm risk (Adolescent Self-Harm Risk Scale; ASHRS) will be tested. The efficacy of the proposed scale will be assessed using data on inpatient self-harm episodes, as well as subsequent suicidal and NSSI behavior collected during follow-ups at 6 and 18 months after the initial inpatient assessment. The study has been approved by the National Medical Ethics Committee of the Republic of Slovenia (No: 0120-507/2022/3) and financed by Slovenian Research Agency grants J3-4534, J5-50176 and P3-0343.

DISCUSSION: This study represents the first longitudinal examination of psychosocial and genetic factors associated with severest suicidal and NSSI behavior in the Slovenian adolescent population. The development of the ASHRS will add to the gap in the quick assessment of inpatient self-harm risk and better inpatient safety for adolescents.

PMID:41057804 | DOI:10.1186/s12888-025-07298-x

BMC Palliat Care. 2025 Oct 7;24(1):243. doi: 10.1186/s12904-025-01892-2.

ABSTRACT

BACKGROUND: People with life-limiting diseases can benefit from early integration of palliative care, yet early identification of these patients is challenging. Emergency Departments (ED) often serve as the initial contact point for hospital admissions due to acute medical problems, providing an opportunity to recognize palliative care needs. This study aims to determine the prevalence of unmet palliative care needs among patients presenting to the ED of a German university hospital and to assess the proportion of these patients already receiving outpatient palliative care services.

METHODS: We conducted a cross-sectional study at the ED of Hannover Medical School over a 30-day period in April and May 2022. All patients aged 18 years or older who were seen by a specialist in either internal medicine or general medicine in the ED were eligible to participate and screened using the Palliative Care and Rapid Emergency Screening Tool (P-CaRES) to identify those with unmet palliative care needs. Data were collected by on-duty physicians. For analysis, we used standard descriptive statistics.

RESULTS: During the study period, 1,122 patients presented to the ED and were seen by a specialist in either internal medicine or general medicine. 1,090 could be included in the study (inclusion rate: 97.1%). At least one life-limiting disease was identified in 280 of the 1,090 patients (25.7%). Of these, 173 patients had two or more potentially unmet palliative care needs, as determined by the P-CaRES screening tool. At the time of assessment, 11.6% of these patients were already receiving outpatient palliative care.

CONCLUSION: A significant proportion of patients presenting to the ED of a university hospital appear to have unmet palliative care needs according to P-CaRES. However, only a small fraction of these patients were known to have pre-existing outpatient palliative care support which could indicate a considerable gap in palliative care provision. Promoting the integrating of palliative care into emergency medicine could substantially enhance patient care by promoting holistic, patient-centred approaches that extend beyond acute medical treatment and facilitate the early implementation of outpatient palliative care services.

PMID:41057801 | DOI:10.1186/s12904-025-01892-2

BMC Psychiatry. 2025 Oct 7;25(1):937. doi: 10.1186/s12888-025-07288-z.

ABSTRACT

AIMS: To investigate the impact of varying levels of chronic stress on the disease-free survival (DFS) and overall survival (OS) of patients with hepatocellular carcinoma (HCC) following curative treatment and establish a comprehensive evaluation index for chronic stress.

METHODS: Ninety HCC patients who underwent curative treatment were assessed for chronic stress using hair cortisol concentration, Stress Score, and the Perceived Stress Scale (PSS-10). The optimal cut-off values for these markers were statistically determined, and correlations among them were analyzed to create the Chronic Stress Index (CSI), which classified patients into high or low chronic stress groups. DFS and OS were compared between the groups. Additionally, a systematic review of literatures on the effects of chronic stress and cancer recurrence was conducted.

RESULTS: The optimal cut-off values of the Stress Score, PSS-10, and hair cortisol concentration were 15.30, 50.00 and 19.70 pg/mg, respectively. Patients with a CSI score of 3 to 4 were classified into the low chronic stress state (LCSS) group, whereas those scoring 5 to 6 were classified into the high chronic stress state (HCSS) group. Patients in the HCSS group had significantly reduced DFS (P < 0.001) and OS (P = 0.033) compared to the LCSS group. The systematic review identified only three clinical trials on chronic stress and cancer recurrence.

CONCLUSION: High chronic stress levels are associated with shorter DFS and OS in HCC patients. The CSI classification effectively categorized the chronic stress state, providing a novel tool for clinical evaluation.

PMID:41057786 | DOI:10.1186/s12888-025-07288-z

Can J Microbiol. 2025 Oct 7. doi: 10.1139/cjm-2025-0153. Online ahead of print.

ABSTRACT

Coinfection and secondary infection by fungi in patients with viral pulmonary infection, especially SARS-CoV-2, are important factors that worsen the prognosis and are associated to increased death rates. This work aims to report the prevalence of Candida isolates in bronchoalveolar and nasopharyngeal samples from suspected COVID-19 patients in the first-second pandemic waves and their antifungal resistance profile. From 2,321 patients, 29.04 % were diagnosed with SARS-CoV-2 infection. The yeast isolation rate of 6.97 % (47/674) from positive SARS-CoV-2 was statistically higher than 4.43% (73/1647) from negative SARS-CoV-2 patients (p=0.0177). Among yeasts, the most prevalent species was Candida albicans (63/120), with four being azole-resistant isolates (6.35%); however other emerging and less susceptible species were also isolated, such as Candida guilliermondii (11), Candida glabrata (5), Candida lusitaniae (4), Candida krusei (1), and Candida norvegensis (1). Here, we highlighted Candida prevalence in respiratory tract, emphasizing the relevance for surveillance in SARS-CoV-2/COVID patients for improvement of management as well as patient outcomes.

PMID:41056573 | DOI:10.1139/cjm-2025-0153

JMIR Form Res. 2025 Oct 7;9:e68710. doi: 10.2196/68710.

ABSTRACT

BACKGROUND: Heart valve surgery is associated with a high risk of perioperative complications. However, current approaches for predicting perioperative complications are all based on preoperative or intraoperative factors, without taking into account the fact that perioperative complications are multifactorial, dynamic, heterogeneous, and interdependent.

OBJECTIVE: We aimed to construct and quantify the association network among multiple perioperative complications to elucidate the possible evolution trajectories.

METHODS: This study used the data from China Cardiac Surgery Registry (CCSR), in which 37,285 patients were included in the analysis. A Bayesian network was used to analyze the associations among 12 complications. Score-based hill-climbing algorithms were used to build the structure and the association between them was quantified using conditional probabilities.

RESULTS: We obtained the network of valve surgery complications. A total of 13 nodes represented complications or death, and 34 arcs with arrows represented the directly dependent relationship between them. We identified clusters of complications that were logically related and not related and quantified the associations. The correlation coefficient between complications increases with the severity of the complications, ranging from 0.01 to 0.41. Meanwhile, the probability of death when multiple complications occurred was calculated. Even mild complications, when progressing to multiple organ dysfunction syndrome, result in a mortality rate of over 90%.

CONCLUSIONS: Our network facilitates the identification of associations among specific complications, which help to develop targeted measures to halt the cascade of complications in patients undergoing the valve surgery.

PMID:41056564 | DOI:10.2196/68710