Tag: statistics

Ultrasonics. 2025 Jun 9;155:107725. doi: 10.1016/j.ultras.2025.107725. Online ahead of print.

ABSTRACT

The purpose of this study was to assess eye lesions by analyzing wave speed (WS) of lesions using ultrasound vibro-elastography (UVE) together with a parametric ultrasound imaging approach. Ten subjects with eye lesions (5 nevus (N) vs. 5 melanoma (M)) were recruited and tested using UVE. In addition, the sliding window method was used to reconstruct and analyze horizontal Normalized Shannon Entropy (hNSE) images and Nakagami-m/omega images. Two-way ANOVA statistical analysis was performed to compare mean values of the contrast to noise ratio (CNR), hNSE, and m/omega of these images between the two types of lesions. The results show that there were significant differences in CNR of the m map images (p = 0.0174) and omega map images (p = 0.0128) reconstructed from shear wave velocity (SWV) between the two types of lesions and significant differences in CNR of the m map images (p = 0.0209) and omega map images (p < 0.0001) reconstructed from two dimensional (2D) speed maps between the two lesions Furthermore, the m values of 2D speed maps shows significant differences between N vs. M of all three frequencies (i.e., 100 Hz (p = 0.0052), 150 Hz (p = 0.0100), 200 Hz (p = 0.0174)). The results suggest that CNR, m and omega of Nakagami method are useful biomarkers for assessing eye lesion with UVE technique. Nakagami imaging of SWV and 2D speed maps have better performance than hNSE imaging for analyzing characteristics of eye lesions. UVE based Nakagami imaging is a promising method for evaluating eye lesions.

PMID:40505172 | DOI:10.1016/j.ultras.2025.107725

JACC Heart Fail. 2025 Jun 11;13(8):102497. doi: 10.1016/j.jchf.2025.03.041. Online ahead of print.

ABSTRACT

BACKGROUND: Pooling data from participants with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) from all completed outcomes trials evaluating finerenone to date may enhance understanding of its safety and efficacy in this high-risk and heterogeneous population.

OBJECTIVES: In this prespecified participant-level pooled analysis of the FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF trials (FINE-HEART), we evaluated the safety and efficacy of finerenone in individuals with HFmrEF/HFpEF.

METHODS: The treatment effects of finerenone vs placebo on cardiovascular death or heart failure hospitalization were evaluated using Cox proportional hazards regression models stratified by trial. Additional endpoints included cardiovascular death, HF hospitalization, new-onset atrial fibrillation, and all-cause death.

RESULTS: Among 18,991 pooled trial participants, 7,008 (36.9%) had HFmrEF/HFpEF (mean age, 71 ± 10 years; 44% female). Over a median follow-up of 2.5 years, finerenone reduced cardiovascular death or heart failure hospitalization compared with placebo (HR: 0.87 [95% CI: 0.78-0.96]; P = 0.008). Consistent effects were observed across trials (P_interaction = 0.24), key subgroups, and baseline estimated glomerular filtration rate (P_interaction = 0.47), urine albumin-to-creatinine ratio (P_interaction = 0.62), and glycated hemoglobin (P_interaction = 0.93). Finerenone additionally appeared to reduce heart failure hospitalization (HR: 0.84 [95% CI: 0.74-0.94]; P = 0.003) and new-onset atrial fibrillation (HR: 0.75 [95% CI: 0.58-0.97]; P = 0.030), but did not statistically significantly decrease cardiovascular death or all-cause death. Hyperkalemia was more common, and hypokalemia was less common, with finerenone vs placebo. Serious adverse events were similar between the treatment arms.

CONCLUSIONS: This participant-level pooled analysis of 3 large-scale outcomes trials supports the use of finerenone in individuals with HFmrEF/HFpEF across a broad range of cardiovascular-kidney-metabolic risk. (PROSPERO registration: CRD42024570467).

PMID:40505158 | DOI:10.1016/j.jchf.2025.03.041

J Med Internet Res. 2025 Jun 12;27:e66055. doi: 10.2196/66055.

ABSTRACT

BACKGROUND: Although much progress has been made in artificial intelligence (AI), several challenges remain substantial obstacles to the development and translation of AI systems into clinical practice. Even large language models, which show excellent performance on various tasks, have progressed slowly in clinical practice tasks. Providing precise and explainable treatment plans with personalized details remains a big challenge for AI systems due to both the highly specialized medical knowledge required and patients’ complicated conditions.

OBJECTIVE: This study aimed to develop an explainable and efficient decision support system named H-SYSTEM to assist neurosurgeons in diagnosing and treating patients with hypertensive intracerebral hemorrhage. The system was designed to address the limitations of existing AI systems by integrating a medical domain knowledge graph to enhance decision-making accuracy and explainability.

METHODS: The H-SYSTEM consists of 3 main modules: the key named entity recognition (NER) module, the semantic analysis and representation module, and the reasoning module. Furthermore, we constructed a medical domain knowledge graph for hypertensive intracerebral hemorrhage, named HKG, which served as an external knowledge brain of the H-SYSTEM to enhance its text recognition and automated decision-making capability. The HKG was exploited to guide the training of the semantic analysis and representation module and reasoning module, which makes the output of the H-SYSTEM more explainable., To assess the performance of the H-SYSTEM, we compared it with doctors and different large language models.

RESULTS: The outputs based on HKG showed reliable performance as compared with neurosurgical doctors, with an overall accuracy of 94.87%. The bidirectional encoder representations from transformers, inflated dilated convolutional neural network, bidirectional long short-term memory, and conditional random fields (BERT-IDCNN-BiLSTM-CRF) model was used as the key NER module of the H-SYSTEM due to its fast convergence and efficient extraction of key named entities, achieved the highest performance among 7 key NER models (precision=92.03, recall=90.22, and F1-score=91.11), significantly outperforming the others. The H-SYSTEM achieved an overall accuracy of 91.74% in treatment plans, showing significant consistency with the gold standard (P<.05), with diagnostic measures achieving 88.18% accuracy, 97.03% area under the curve (AUC), and a κ of 0.874; surgical therapy achieving 98.53% accuracy, 98.53% AUC, and a κ of 0.971; and rescue therapies achieving 89.50% accuracy, 94.67% AUC, and a κ of 0.923 (all P<.05). Furthermore, the H-SYSTEM showed high reliability and efficiency when compared to doctors and ChatGPT, achieving statistically higher accuracy (95.26% vs 91.48%, P<.05). Additionally, the H-SYSTEM achieved a total accuracy of 92.22% (ranging from 91.14% to 95.35%) in treatment plans for 605 additional patients from 6 different medical centers.

CONCLUSIONS: The H-SYSTEM showed significantly high efficiency and generalization capacity in processing electronic medical records, and it provided explainable and elaborate treatment plans. Therefore, it has the potential to provide neurosurgeons with rapid and reliable decision support, especially in emergency conditions. The knowledge graph-enhanced deep-learning model exhibited excellent performance in the clinical practice tasks.

PMID:40505141 | DOI:10.2196/66055

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-24-00287. eCollection 2025 Jun 1.

ABSTRACT

INTRODUCTION: Although increased treatment of pediatric anterior cruciate ligament (ACL) injury is well-documented, surrounding trends remain unknown. We evaluated national trends over 21 years using data from pediatric ACL reconstructions (ACLR) submitted to the American Board of Orthopaedic Surgeons (ABOS) Part II Oral Examination and compared fellowship training, geographic variation, and case volume trends.

METHODS: The ABOS SCRIBE database was queried for ACLR in pediatric (<19) patients between 2000 and 2021. Data included geographic region, fellowship training, and patient demographics. ACLRs per capita was estimated using census data. Data were stratified by age and sex. Multiple linear regression assessed whether year, sex, and age/sex category predicted surgery number.

RESULTS: From 2000 to 2021, ABOS Part II candidates reported 12,124 pediatric ACLR. Nearly 2/3 were in patients 16 years or older. Most were in the Midwest (22.8%) and South (22.2%). Each region decreased in ACLR. Overall, pediatric ACLR decreased 31.3% and contributing surgeons decreased 40.4%. Female ACLR increased 39.5% from 2009 to 2014, with 11.9% more than male patients in 2014. After 2014, sex differences and total ACLR decreased. 81.3% were reported by surgeons with sports medicine training and 6.0% with dual sports medicine and pediatric orthopaedics fellowships. Dual training increased in 2009 and declined after 2013. Surgeries in male patients compared with female patients (B = -6.777, 95% confidence interval, -9.534 to -4.279) and male patients 16 to 18 years compared with male patients younger than 16 years (B = -4.935, 95% confidence interval, -6.596 to -3.273) decreased.

CONCLUSION: Pediatric ACLR performed by ABOS Part II candidates decreased overall, but a concern for increased ACLR in female patients persists. More surgeries were done in the Midwest and South.

STUDY DESIGN: Cross-sectional Study Level of Evidence: III.

PMID:40505137 | DOI:10.5435/JAAOSGlobal-D-24-00287

JMIR Hum Factors. 2025 Jun 12;12:e66658. doi: 10.2196/66658.

ABSTRACT

BACKGROUND: The perinatal period is one of the most vulnerable times a woman experiences. Multidimensional, interprofessional, and personalized support is needed to improve outcomes in women’s and children’s health while strengthening partner relationships at the same time. Although a vast amount of support services already exist in Germany for psychosocial counseling during the perinatal period, groups who are especially at risk do not take advantage of them.

OBJECTIVE: Family eNav is an app-based intervention developed by experts in the field of medical and psychosocial support to help young parents navigate through primary and secondary care services in Germany according to their needs. It also empowers patient and parenting perspectives through self-education and symptom monitoring for different settings, for example, mental health and preterm birth. While the intervention will be evaluated in a multicenter, randomized, controlled trial, the focus here lies on the conception of the app, demand among patients, and preuse acceptance.

METHODS: During the conception phase, we conducted an explorative study with prospective users and experts in the perinatal psychosocial field to understand the need and preuse acceptance of the intervention. We interviewed 20 participants with a semistructured guide, analyzing their responses using systematic text condensation. Additionally, we conducted a short survey on general questions concerning digitalization within the health care system among the participants.

RESULTS: We established two main themes: (1) access and barriers to health care and psychosocial services and (2) high preuse acceptance of app-based intervention. Health care and psychosocial providers indicated that there is a high demand for their services, which cannot always be met immediately, and at the same time, they are doubtful of reaching those individuals most in need. Prospective users and health and social care providers alike showed great interest in the perinatal navigator and suggested a variety of needs and content requirements to be included. Regionality, availability, and individualized content were underlined as success factors for high user acceptance. Barriers consisted of data protection concerns, as well as denial of their own needs.

CONCLUSIONS: Our findings show great acceptance for an app-based intervention on the part of both prospective users and service providers. Feedback on requirements and content, as well as possible barriers, was taken into consideration while developing the app.

PMID:40505134 | DOI:10.2196/66658

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-25-00143. eCollection 2025 Jun 1.

ABSTRACT

INTRODUCTION: Socioeconomic status has been correlated with clinical and functional outcomes in elective orthopaedic surgery; however, there has been limited application in orthopaedic trauma. The Area Deprivation Index (ADI) uses 17 different metrics to assess disadvantages at the neighborhood level by zip code. The purpose of this study was to examine the relationship between ADI and unplanned return to the operating room (UROR) in the orthopaedic trauma patient population.

METHODS: A retrospective review of adult orthopaedic trauma patients from 2014 to 2019 at a level 1 trauma center was done. Patient demographics, injury characteristics, and ADI were recorded. ADI was used to describe survival to UROR, and logistic regressions were used to identify factors that increased the odds of UROR.

RESULTS: In total, 1,031 patients were included in the study, with a UROR incidence of 14.3%. The average ADI score fell in the minimally deprived category (second quartile). Univariate analysis demonstrated a significant association between UROR and younger age (P < 0.001), higher Injury Severity Score (P < 0.001), ADI > 75 (P< 0.05), osteoporosis (P < 0.001), open fracture (P< 0.05), number of fractures (P < 0.05), and higher fracture complexity (P < 0.001). Multivariate analysis revealed that ADI > 75 (OR 3.486, P = 0.029), younger age (OR 0.982, P = 0.004), Injury Severity Score (OR 1.069, P < 0.001), and osteoporosis (OR 5.086, P < 0.001) was associated with UROR. Kaplan-Meier confirmed increased rates of UROR for the third and fourth ADI quartiles for all cases (P < 0.001) and when controlling for symptomatic implant (P < 0.001).

CONCLUSION: Defined by ADI, patients from severely deprived communities undergoing orthopaedic trauma interventions were found to have a 3.5-fold increased rate of UROR. This study shows outcome disparities in the orthopaedic trauma population when using a comprehensive measure for socioeconomic status even after controlling for other contributing factors. Understanding and addressing the unique challenges facing socioeconomically deprived patient populations has the potential to markedly improve outcomes for orthopaedic trauma patients.

PMID:40505132 | DOI:10.5435/JAAOSGlobal-D-25-00143

JMIR Res Protoc. 2025 Jun 12;14:e63586. doi: 10.2196/63586.

ABSTRACT

BACKGROUND: French Guiana, an overseas territory located in the Guiana Shield in South America, faces unique social and demographic challenges, particularly in relation to migration. Haitians represent 1 of the 3 largest foreign communities in the region and face specific barriers to health care access and prevention. They are also a population exposed to HIV infection.

OBJECTIVE: This Parcours d’Haïti study aims to update knowledge on the health of the Haitian population residing in French Guiana. From a quantitative standpoint, the primary objective of this study was to assess the frequency of sexual behaviors that expose Haitian individuals to HIV risk after arriving in French Guiana and explore the association of this risk with their living conditions. This study adopts a transdisciplinary approach to understand the broader determinants of health and the processes underlying HIV transmission.

METHODS: This mixed methods study involves a quantitative epidemiological and biographical analysis of Haitian individuals aged 18 to 60 years who have lived in French Guiana for more than 3 months. The biographical component uses a detailed grid that tracks key life events since birth. The qualitative component includes 3 substudies based on semistructured interviews and focus groups with Haitian people and health care professionals. These aim to deepen understanding of health care access, use of traditional and biomedical care, and mental health among Haitians. A phylogenetic component describes the distribution of clades of the Pol gene in the viruses of people living with HIV. The study materials were cocreated with local stakeholders. Recruitment of this partially hidden population used an innovative method involving all local actors and targeting key locations frequented by the Haitian community. Data collection and recruitment were carried out by Haitian Creole-speaking peer investigators (community health mediators).

RESULTS: Over 20 months between 2021 and 2023, the Parcours d’Haïti study was implemented in French Guiana. Anticipated results suggest that the main reasons for migration include insecurity and fleeing violence. Upon arrival, Haitian people likely experience significant economic hardship and social isolation. Mental health deterioration is expected, with high rates of posttraumatic stress disorder. People living with HIV are expected to face heightened vulnerability compared to HIV-negative individuals even though they already struggle with precarious living conditions. The qualitative findings regarding health care use indicate that Haitian people encounter numerous barriers to accessing health care, such as administrative complexity, language, and financial and mobility issues. The anthropological results are expected to emphasize the magical-religious origins of HIV and the use of plants and traditional medicine for its treatment. Phylogenetic results are anticipated to show a high prevalence of Caribbean B HIV subtypes.

CONCLUSIONS: The Parcours d’Haïti study aims to provide valuable insights into the health determinants and HIV-related risks in the Haitian population in French Guiana. These findings should help refine health care policies and practices to better meet the specific needs of this population. Trial Registration: ClinicalTrials.gov NCT05174234; https://clinicaltrials.gov/study/NCT05174234.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63586.

PMID:40505127 | DOI:10.2196/63586

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-24-00059. eCollection 2025 Jun 1.

ABSTRACT

INTRODUCTION: Elderly patients are often dehydrated and are at risk of having prolonged recovery from surgery because of comorbidities and anesthesia. The aim of this study was to investigate the effects of perioperative fluid management on same-day discharge (SDS) rates, physical therapy performance, and complications in elective total joint arthroplasty (TJA).

METHODS: A retrospective review of 158 patients with primary TJA performed as first-start cases was conducted, consisting of 77 total knee and 81 total hip arthroplasty patients from 2021 to 2023. Intraoperative fluids and total perioperative fluids given on the date of surgery were compared between SDS and admitted patients.

RESULTS: Of the 158 TJA first-start cases, 13% of patients were discharged home on postoperative day 0, including 10% of TKA patients and 21% of THA patients. SDS patients were found to have a markedly higher total fluids/body mass index (BMI) ratio and mean intraoperative fluid administration by 400 mL compared with non-SDS patients. Patients who were hypotensive during therapy had a lower total fluids/BMI ratio.

CONCLUSION: The total fluids/BMI ratio may be a useful tool to help guide appropriate intraoperative fluid administration based on varying BMI ranges. Intraoperative fluids during surgical intervention may be more beneficial in postoperative recovery compared with relying on oral replenishment.

PMID:40505123 | DOI:10.5435/JAAOSGlobal-D-24-00059

JMIR Mhealth Uhealth. 2025 Jun 12;13:e71196. doi: 10.2196/71196.

ABSTRACT

BACKGROUND: Patients with cancer may experience physiological and psychological adverse reactions, such as fatigue, pain, anxiety, and depression, which seriously affect their quality of life. Research has shown that remote interventions based on apps or miniprograms may help improve the physiological and mental health of patients with cancer. However, due to the limited number of relevant studies, the impact of web-based interventions in cancer management remains unclear.

OBJECTIVE: We aimed to determine the efficacy of interventions based on apps, miniprograms, or other web-based tools on the physiological (body pain and fatigue) and psychological (anxiety and depression) states and the quality of life of patients with cancer.

METHODS: We conducted electronic literature searches in PubMed, Scopus, Web of Science, the Cochrane Library, CINAHL, and EMBASE databases. The search period spanned from the inception of each database to October 15, 2024. Two researchers independently conducted literature retrieval and data extraction. The risk of bias was assessed with the Cochrane risk-of-bias tool, and the quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). All statistical analyses were performed using Review Manager version 5.4.

RESULTS: A total of 36 randomized controlled trials were included. The remote web-based interventions significantly improved the pain intensity (n=14, 39% studies; standardized mean difference [SMD] -0.39, 95% CI -0.64 to -0.14; I²=82%; GRADE rating=low) and fatigue status (n=11, 31% studies; SMD -0.52, 95% CI -0.95 to -0.09; I²=95%; GRADE rating=low) in patients with cancer. Regarding psychology, the results indicated that the remote web-based interventions significantly improved the anxiety (n=14, 39% studies; SMD -0.60, 95% CI -0.90 to -0.30; I²=91%; GRADE rating=low) and depressive state (n=10, 28% studies; SMD -0.36, 95% CI -0.58 to -0.14; I²=81%; GRADE rating=low) of patients with cancer. For quality of life, the results showed that the remote web-based interventions had a significant positive impact on the quality of life of patients with cancer (n=26, 72% studies; SMD 0.63, 95% CI 0.39-0.87; I²=92%; GRADE rating=low).

CONCLUSIONS: The remote web-based interventions were effective in reducing the intensity of physiological pain, relieving fatigue, improving depression and anxiety, and improving the quality of life of patients with cancer. However, due to the low certainty of evidence, more rigorous randomized controlled trials are needed to validate these findings further.

TRIAL REGISTRATION: PROSPERO CRD42024611768; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024611768.

PMID:40505121 | DOI:10.2196/71196

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-25-00099. eCollection 2025 Jun 1.

ABSTRACT

BACKGROUND: Use of electric bikes (EBs) and electric scooters (ESs) has increased dramatically, and so are EB-related and ES-related orthopaedic injuries. There is limited research regarding the severity of EB injuries and whether they more closely resemble ES, motorcycle (MC), or pedal bicycle (PB) related injuries. The aim of this study was to characterize injury patterns associated with EB accidents and compare injury severity and details with those of PB, ES, and MC accidents.

METHODS: This was a retrospective review of trauma patients presenting to an academic, level one trauma center between 2019 and 2022 to compare EB, ES, PB, and MC trauma patients. Descriptive statistics were obtained to characterize demographic data. Two-sided Fisher exact tests were used to compare categorical data, and ANOVA was used to compare continuous variables between groups.

RESULTS: EB trauma patients were significantly more likely to experience traumatic brain injury (TBI), intracranial hemorrhage (ICH), or fractures of the head/face compared with MC (54.0% vs. 19.3%, P < 0.0001) and PB (54.0% vs. 33.5%, P = 0.0001) cohorts. EB trauma patients were more likely to lose consciousness than MC or PB trauma patients. Spine fractures (11.0%) were the most prevalent in the EB study population, followed by fractures of the acetabulum (6.0%) and clavicle/scapula/radius (5.0%). EB trauma patients were significantly more likely to be admitted to the intensive care unit (ICU) than MC trauma patients (25.0% vs. 16.0%, P = 0.0256) and were significantly more likely to present as critical trauma activations than PB trauma patients (14.0% vs. 6.0%, P = 0.0106).

CONCLUSIONS: While the overall injury severity scores are similar to the modes of transport, there are differences in injury severity and patterns. EB accidents have a higher prevalence of TBIs, ICH, and facial fractures. EB trauma patients can result in high utilization of resources because many are critical trauma activations and have a higher rate of ICU stays. These data can help providers better understand injury patterns of EB accidents.

PMID:40505114 | DOI:10.5435/JAAOSGlobal-D-25-00099