Tag: statistics

BMC Oral Health. 2025 Nov 12;25(1):1777. doi: 10.1186/s12903-025-07024-9.

ABSTRACT

BACKGROUND: Postoperative pain is a common occurrence following root canal treatment, with reported incidence ranging from 3% to 58%. Contributing factors include insufficient canal debridement, extrusion of debris, and limitations in irrigation. While mechanical instrumentation aids in reducing microbial load, effective irrigation is essential for cleaning anatomically complex areas. The XP-Endo Finisher (XPF) is an innovative instrument designed to enhance irrigation efficacy. This study aimed to compare postoperative pain outcomes following final irrigation with either the XP-Endo Finisher or conventional needle irrigation in patients diagnosed with symptomatic irreversible pulpitis.

METHODS: A double-blind randomized controlled trial was conducted on 80 systemically healthy patients aged 18 years and above, presenting with symptomatic irreversible pulpitis and preoperative pain scores ≤ 3 on the Numerical Rating Scale (NRS-11). Participants were randomly assigned to two equal groups: final irrigation using either the XP-Endo Finisher or traditional needle irrigation. Patients with recent analgesic use, non-restorable teeth, or known NSAID allergies were excluded. Root canal therapy was completed in two visits. Postoperative pain levels were recorded at 6 h, 12 h, 24 h, and daily up to 7 days using the NRS-11. Statistical analysis involved descriptive statistics, normality checks, and non-parametric tests for group comparisons.

RESULTS: At 6 h, the difference in pain scores between the groups was not statistically significant (XP-Endo Finisher: 2.40 ± 1.77; Needle: 1.73 ± 1.52; p = 0.090). However, significantly lower pain was reported in the XP-Endo Finisher group at 12 h (p = 0.044) and on day 2 (p = 0.027). No significant differences were observed from day 3 to day 7. Analgesic intake was comparable across both groups (p > 0.05).

CONCLUSIONS: The XP-Endo Finisher resulted in reduced early postoperative pain compared to needle irrigation at specific time points, although both methods showed similar outcomes in long-term pain resolution and analgesic consumption. Improved irrigant activation may influence short-term postoperative comfort.

TRIAL REGISTRATION: This trial was retrospectively registered with the Kasturba Hospital Institutional Ethics Committee (KH IEC) under registration number 860/2020, dated 19/03/2021. It was also registered in the Clinical Trials Registry – India (CTRI) under registration number CTRI/2021/04/032667, dated 08/04/2021.

PMID:41225492 | DOI:10.1186/s12903-025-07024-9

BMC Public Health. 2025 Nov 12;25(1):3916. doi: 10.1186/s12889-025-25228-0.

ABSTRACT

BACKGROUND: Cardiometabolic Kidney Syndrome (CKM) is a global chronic disease challenge. While links between socioeconomic status (SES) and individual CKM components exist, research often overlooks CKM’s multi-system interactions and the role of psychosocial factors. Depression, prevalent in low SES groups and linked to CKM risk, may mediate the SES-CKM relationship.

METHODS: Using 2005-2018 NHANES data with 11,367 participants, this study quantified SES via the family poverty-income ratio (PIR), assessed depressive symptoms with the PHQ-9 scale, and defined CKM per AHA criteria. Statistical analyses included multivariable logistic regression and structural equation modeling to examine associations and mediating effects.

RESULTS: High SES was associated with 81% lower odds of advanced CKM (OR = 0.19, 95% CI: 0.10-0.36). Each unit increase in PIR was associated with 33% lower odds of depression (OR = 0.67, 95% CI: 0.63-0.72). Depression mediated 27.64% of the SES-advanced CKM link. A nonlinear threshold effect between SES and depression was found at PIR = 3.28, with subgroup analyses highlighting stronger SES-CKM associations in non-Hispanic Blacks and Whites.

CONCLUSION: Socioeconomic disadvantage is significantly associated with depressive symptoms and advanced CKM in this cross-sectional study. Depressive symptoms may play a substantial mediating role based on structural equation modeling of observational data. These findings suggest that incorporating mental health interventions into CKM prevention strategies and implementing targeted policies to address health inequities could potentially enhance health equity. Future prospective studies are needed to validate these findings before refining the CKM prevention framework.

PMID:41225483 | DOI:10.1186/s12889-025-25228-0

BMC Musculoskelet Disord. 2025 Nov 12;26(1):1039. doi: 10.1186/s12891-025-09277-5.

ABSTRACT

PURPOSE: Most of the previous meta-analyses examining the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on preventing heterotopic ossification (HO) following total hip arthroplasty (THA) have separately analyzed Brooker’s classification I, II, III, and IV which may misrepresent their ordinal nature. We therefore applied a Bayesian network meta-regression that incorporates the ordinal nature of Brooker’s classification to more robustly assess NSAID efficacy and determine the optimal regimen.

METHODS: We searched the Cochrane Library, Embase, and PubMed for randomized controlled trials (RCTs). Cumulative regressions were conducted for ordinal variants to generate Napierian Logarithm odds ratios (lnOR) and the standard error of lnOR (selnOR) for each study. Subsequently these data were used to conduct Bayesian network meta-analysis and further network meta-regression to generate pairwise ORs, showing pairwise effect sizes (ESs).

RESULTS: 17 studies (5436 patients,14 regimens) were eligible. In the raw data analysis, celecoxib 400 mg/d, etoricoxib 90 mg/d, ibuprofen 1200 mg/d, indomethacin 75 mg/d, indomethacin 100 mg/d, indomethacin 150 mg/d, meloxicam 7.5 mg/d, meloxicam 15 mg/d, and naproxen 750 mg/d were conspicuously effective (OR: 0.048 ~ 0.351) compared with placebo. The ESs were comparable among these regimens except for ibuprofen 1200 mg/d, which was inferior to indomethacin 100 mg/d (OR = 0.382, 95%CI: 0.171 to 0.887) and indomethacin 150 mg/d (OR = 0.136, 95%CI: 0.020 to 0.970). In the network meta-regression analysis, after adjusting for follow-up time, the significance of diclofenac 150 mg/d (OR = 0.102, 95%CI: 0.013 to 0.835) emerged compared with placebo. The results of effective regimens aforementioned resembled the initial findings (OR: 0.039 ~ 0.249). All the effective agents, including diclofenac 150 mg/d, were comparable in ESs.

CONCLUSIONS: Considering the efficacy of preventing HO following THA observed in our research, together with analgesic effect and gastrointestinal tract safety from previous literature, etoricoxib 90 mg/d is recommended as the optimal choice for patient undergoing THA. More head-to-head and long-term studies are needed.

PMID:41225475 | DOI:10.1186/s12891-025-09277-5

BMC Public Health. 2025 Nov 12;25(1):3910. doi: 10.1186/s12889-025-24543-w.

ABSTRACT

BACKGROUND: Mental health problems such as depression and anxiety were increasingly prevalent among students. Emerging evidence links adherence to 24-hour movement guidelines-including adequate physical activity, limited screen time, and sufficient sleep-with improved mental well-being. However, the mechanisms underlying these associations remained poorly understood.

OBJECTIVES: This study aimed to examine the association of adherence to 24-hour movement guidelines with symptoms of depression and anxiety among Chinese students, and to explore the mediating role of perceived fitness in these relationships.

METHODS: A cross-sectional survey was conducted among 1674 students (mean age = 11.4 ± 0.8 years; 47.6% boys) from Chinese elementary schools. 24-hour movement behaviours were assessed using validated self-report measures. Mental health outcomes were measured using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7). Perceived fitness was assessed using the International Fitness Scale. Structural equation modelling was used to evaluate direct and indirect pathways, adjusting for relevant covariates.

RESULTS: Only 1.4% of participants met all components of the 24-hour movement guidelines. Adherence to the guidelines was significantly associated with lower levels of depressive (β = -0.125) and anxiety symptoms (β = -0.107). Perceived fitness was also significantly associated with reduced symptoms of depression (β = -0.111) and anxiety (β = -0.049). However, the mediating effects of perceived fitness in both models were minimal or not statistically significant (depression symptoms: β = 0.002; anxiety symptoms: β = 0.001).

CONCLUSIONS: Better adherence to 24hour movement guidelines was associated with fewer symptoms of depression and anxiety in Chinese students. While perceived fitness was independently linked to improved mental health, its mediating role appears limited. Future studies should incorporate objective fitness assessments and explore additional mediating pathways to fully understand how movement behaviours impact students mental well-being.

PMID:41225473 | DOI:10.1186/s12889-025-24543-w

BMC Oral Health. 2025 Nov 12;25(1):1773. doi: 10.1186/s12903-025-07140-6.

ABSTRACT

BACKGROUND: The burden of head and neck cancers (HNC) is a significant global health challenge, necessitating a comprehensive analysis of incidence and mortality trends. This study aimed to estimate the lastest disease burden and change trends of HNC in 2021 and examine trends from 1990 to 2021 using the Global Burden of Disease (GBD) Study 2021.

METHODS: We comprehensively focused on all HNC in GBD, including lip and oral cavity cancer (LOC), nasopharynx cancer (NPC), other pharynx cancer (OPC), and larynx cancer (LC), estimating incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates, including age-standardized rates (ASR) and 95% uncertainty intervals (UIs) on global, regional, and national levels.

RESULTS: Our results revealed that, in 2021, there were approximately 0.91 million new cases of HNC globally, representing significant increases from 1990, with specific increases in LOC (142.18%), NPC (55.89%), OPC (163.17%), and LC (60.48%). Additionally, around 0.5 million deaths were attributed to HNC. Notably, age-standardized incidence of nasopharyngeal cancer is increasing from 1990 to 2019, but decreasing from 2019 to 2021. Age-standardized mortality for LOC have declined among men but are rising among women between 1990 and 2021 (male: -6.61%, female: 7.95%). The burden of these HNC predominantly affected middle-aged and older populations. As the socio-demographic index rises, the incidence of LOC and OPC displayed a J-shaped relationship, but nasopharyngeal cancer, revealed a downward trend.

CONCLUSIONS: The global burden of HNC grew steadily from 1990 to 2021, the variation in incidence and mortality rates across regions highlights the need for tailored prevention and treatment strategies to address the changing HNC landscape.

PMID:41225462 | DOI:10.1186/s12903-025-07140-6

J Med Microbiol. 2025 Nov;74(11). doi: 10.1099/jmm.0.002091.

ABSTRACT

Introduction. Peri-implantitis is a prevalent and challenging complication in implant dentistry, primarily induced by biofilm-associated pathogens. Among these, Porphyromonas gingivalis and Filifactor alocis have emerged as key contributors, with evidence suggesting their potential synergistic role in exacerbating peri-implant inflammation and tissue destruction.Hypothesis/Gap Statement. While P. gingivalis is a well-characterized periopathogen, the specific role of F. alocis, alone or in combination with P. gingivalis, in peri-implantitis remains underexplored. This study addresses the gap in quantifying their presence in diseased versus healthy peri-implant sites.Aim. To assess the prevalence and microbial load of P. gingivalis and F. alocis in peri-implantitis and healthy peri-implant sites using quantitative real-time PCR (qPCR) and to investigate their correlation with clinical parameters.Methodology. This cross-sectional study included 110 participants: 52 diagnosed with peri-implantitis and 58 with healthy peri-implant tissues. Clinical examination recorded probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP). Submucosal biofilm samples were collected and analysed using species-specific qPCR. Statistical analysis employed the Mann-Whitney U test for intergroup comparisons and Spearman’s rank correlation for associations between microbial levels and clinical indices.Results. Both P. gingivalis and F. alocis were significantly elevated in peri-implantitis sites compared to healthy controls. Mean P. gingivalis levels were 4.80×10⁶ ± 4.78×10⁶ copies µl^-1 in peri-implantitis and 2.09×10³ ± 1.26×10³ copies µl^-1 in healthy sites (P<0.001). F. alocis levels averaged 4.58×10⁵ ± 3.40×10⁵ copies µl^-1 in peri-implantitis and 2.45×10³ ± 1.64×10³ copies µl^-1 in healthy sites (P<0.001). P. gingivalis showed strong positive correlations with PD, CAL and BOP, while F. alocis correlated moderately with PD and CAL but not significantly with BOP.Conclusion. The significant elevation of P. gingivalis and F. alocis in peri-implantitis supports their potential synergistic involvement in disease pathogenesis. These findings underscore the need for antimicrobial strategies that target both organisms and disrupt their cooperative biofilm behaviour. Further research should clarify their pathogenic interplay and inform the development of precise therapeutic interventions.

PMID:41222987 | DOI:10.1099/jmm.0.002091

Microsc Microanal. 2025 Nov 12;31(6):ozaf114. doi: 10.1093/mam/ozaf114.

ABSTRACT

An approach to characterize dopant spatial inhomogeneity at the nanoscale along with its local chemical environment has been developed using atom probe tomography. We achieve this through the combination of a local composition analysis using the nearest-neighbor atoms combined with a nonparametric Kolmogorov-Smirnov or Anderson-Darling statistical test. Using an in situ highly boron-doped silicon germanium layer we demonstrate that all three elements have an inhomogeneous distribution. Moreover, by subdividing the local dopant composition distribution, a correlation between the boron doping level and variations in the surrounding matrix composition was determined. These atomic-scale measurements provide new experimental insights into the dopant incorporation behavior in technologically relevant semiconductors and its relationship to the epitaxial growth processes.

PMID:41222977 | DOI:10.1093/mam/ozaf114

JMIR Res Protoc. 2025 Nov 12;14:e73766. doi: 10.2196/73766.

ABSTRACT

BACKGROUND: The incidence of chronic diseases associated with physical inactivity is on the rise, being one of the leading risk-increasing factors for early death rates throughout the world. Often, physical activity interventions fail to deliver sustained adherence over time due to limiting tailoring to individual baseline characteristics, leaving out contextual changes over time. One solution for this issue may be the use of adaptive interventions relying on contextual multiarmed bandits, a type of reinforcement learning algorithm, that can use baseline and contextual individual data to personalize aspects of the intervention, such as developing personalized workout plans.

OBJECTIVE: The main objectives of this study are (1) to determine the effectiveness of contextual bandits for automated goal setting in the context of a web-based physical activity intervention, (2) to understand the role of user characteristics impacting ideal workout schedules based on adherence to predetermined goals, and (3) to explore the influence of user autonomy on recommendation effectiveness.

METHODS: We developed a protocol for a web-based adaptive intervention trial to investigate the effectiveness of goal recommendation (task difficulty) based on reinforcement learning. The web application (named Apptivate) creates workout routines with 3 different difficulty levels, changing the total workout duration as well as rest times between exercises. Physical activity professionals validated the routine design, ensuring that workouts match recommended guidelines for healthy adults. An initial pilot was conducted, aiming for 800 university students to test the web application for 1 week, to provide initial data to calibrate the algorithm as well as overall feedback for the web application. For the main study, a total of 500 university students will be recruited to participate for 40 days during early 2026. Participants will be divided into 3 groups: user choice (no recommendation), user choice with automated recommendations (contextual bandits), and automated plans without choice.

RESULTS: The pilot was conducted in September 2025. Data analysis for the pilot is undergoing, and the main study is planned for early 2026. Our main statistical analysis includes a direct comparison (paired tests) between success rates across intervention arms, as well as by difficulty level and individual characteristics.

CONCLUSIONS: Physical activity maintenance is key to achieving long term health goals. Tailored digital interventions are promising strategies for physical activity adherence, but personalization often fails to consider dynamic contextual changes. The proposed protocol for a physical activity intervention using adaptive experimentation can provide robust causal inference on the role of choice versus autonomy when goal difficulty is tailored under an adaptive data-driven approach.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/73766.

PMID:41222972 | DOI:10.2196/73766

JAMA Netw Open. 2025 Nov 3;8(11):e2543107. doi: 10.1001/jamanetworkopen.2025.43107.

ABSTRACT

IMPORTANCE: Brain metastases reduce overall survival rates of patients with non-small cell lung cancer (NSCLC); patients with epidermal growth factor receptor 2 (ERBB2 [formerly HER2])-mutant NSCLC are more likely to have baseline brain metastases. Trastuzumab deruxtecan (T-DXd) is an approved ERBB2-directed treatment for previously treated unresectable or metastatic ERBB2-mutant NSCLC.

OBJECTIVE: To assess the clinical effectiveness and safety of T-DXd 5.4 mg/kg and 6.4 mg/kg doses in patients with previously treated ERBB2-mutant metastatic NSCLC with or without untreated or previously treated stable brain metastases.

DESIGN, SETTING, AND PARTICIPANTS: This post hoc secondary analysis pooled patients from the DESTINY-Lung01 (data cutoff date: December 3, 2021) and DESTINY-Lung02 (data cutoff date: December 23, 2022) clinical trials by T-DXd dose (5.4 mg/kg and 6.4 mg/kg). DESTINY-Lung01 was a multicenter, open-label, 2-cohort, nonrandomized phase 2 study, while DESTINY-Lung02 was a dose-blinded, multicenter, 2-cohort, randomized phase 2 study. Participants had a previously treated ERBB2-mutant metastatic NSCLC with or without untreated or previously treated stable brain metastases at baseline. All statistical analyses were performed from April 2023 to October 2024.

INTERVENTION: Patients received a T-DXd dose of either 5.4 mg/kg or 6.4 mg/kg intravenously every 3 weeks.

MAIN OUTCOME AND MEASURE: Systemic and intracranial effectiveness by blinded independent central review using RECIST (Response Evaluation Criteria in Solid Tumors) version 1.1, sites of progression, and safety.

RESULTS: This analysis included 102 patients in the T-DXd 5.4-mg/kg dose group (65 females [64%]; median [range] age, 57.5 [37.0-83.0] years and 59.5 [30.0-79.0] years in patients with and without brain metastases, respectively) and 141 patients in the T-DXd 6.4-mg/kg dose group (94 females [67%]; median [range] age, 62.5 [29.0-88.0] years and 59.0 [27.0-83.0] years in patients with and without brain metastases, respectively). In each group, 31% (32 of 102) and 38% (54 of 141) of patients, respectively, had baseline brain metastases and 53% (17 of 32) and 44% (24 of 54), respectively, received prior brain metastasis treatment. In patients with and without brain metastases, systemic confirmed objective response rates (ORRs) were 47% (15 of 32; 95% CI, 29%-65%) and 50% (35 of 70; 95% CI, 38%-62%), respectively, with the T-DXd 5.4-mg/kg dose, and 50% (27 of 54; 95% CI, 36%-64%) and 59% (51 of 87; 95% CI, 48%-69%) with the T-DXd 6.4-mg/kg dose. Median progression-free survival was 7.1 (95% CI, 5.5-9.7) months in the T-DXd 5.4-mg/kg dose group and 7.1 (95% CI, 4.5-9.6) months in the T-DXd 6.4-mg/kg dose group of patients with baseline brain metastases. Among patients with measurable baseline brain metastases, intracranial confirmed ORRs were 50% (7 of 14; 95% CI, 23%-77%) with the T-DXd 5.4-mg/kg dose and 30% (9 of 30; 95% CI, 15%-49%) with the T-DXd 6.4-mg/kg dose. At both doses, the safety profile of T-DXd was generally manageable, regardless of baseline brain metastases, favoring the T-DXd 5.4 mg/kg dose.

CONCLUSIONS AND RELEVANCE: In this secondary analysis, T-DXd at the approved dose of 5.4 mg/kg showed antitumor activity in patients with previously treated ERBB2-mutant metastatic NSCLC with or without brain metastases. This finding supports T-DXd 5.4 mg/kg use in this population.

PMID:41222935 | DOI:10.1001/jamanetworkopen.2025.43107

JAMA Netw Open. 2025 Nov 3;8(11):e2543398. doi: 10.1001/jamanetworkopen.2025.43398.

ABSTRACT

IMPORTANCE: The COVID-19 pandemic disrupted long-standing trends in hospital quality and patient safety, prompting questions about whether risk-adjusted outcomes have resumed their prepandemic trajectories.

OBJECTIVE: To determine whether trends in risk-adjusted mortality and case mix index (CMI) among hospitalized patients in hospitals have returned to prepandemic trajectories.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was a multicenter analysis that used the Vizient Clinical Data Base, which contains encounter-level administrative and financial data from more than 1300 hospitals in the US. The study included continuously reporting hospitals and examined inpatient discharges between October 2019 and March 2024. Data were analyzed between January and May 2025.

MAIN OUTCOMES AND MEASURES: Quarterly estimates of CMI and standardized mortality ratio (SMR) (observed-to-expected ratio). Ordinary least squares (OLS) regression was used to evaluate overall linear trends, and joinpoint regression was used to identify inflection points. Statistical significance was defined as P < .05, with slope estimates reported alongside 95% CIs.

RESULTS: Among 715 hospitals and 7 802 606 million inpatient encounters, the mean CMI increased from 1.70 in the fourth quarter (Q4) of 2019 to 1.79 in the first quarter (Q1) of 2024 (difference, 0.09; 95% CI, 0.01 to 0.17; P = .02). In OLS regression, CMI showed no significant overall linear trend (R2 = 0.006; P = .77). The mean SMR decreased from 1.00 in Q4-2019 to 0.80 in Q1-2024 (difference, -0.20; 95% CI, -0.32 to -0.08; P = .001), with a significant linear decline across the study period (R2 = 0.735; P < .001). Joinpoint regression identified a CMI inflection point in Q4-2020 (slope, 1.85; 95% CI, 0.73 to 4.14; P < .001 before; slope, -0.30; 95% CI, -0.62 to -0.09; P = .006 after) and an SMR inflection point in Q3-2021, after which SMR declined significantly by -3.17% per quarter (P < .05).

CONCLUSIONS AND RELEVANCE: In this cohort study of 715 US hospitals from 2019 to 2024, risk-adjusted in-hospital mortality declined significantly following the COVID-19 pandemic, resuming its prepandemic trajectory of improvement, while patient acuity as measured by CMI remained elevated. These findings suggest a new postpandemic baseline for patient acuity, whereas hospital mortality outcomes have returned to prior improvement trends.

PMID:41222931 | DOI:10.1001/jamanetworkopen.2025.43398