Tag: statistics

Interv Neuroradiol. 2025 Sep 23:15910199251380363. doi: 10.1177/15910199251380363. Online ahead of print.

ABSTRACT

PurposeThis study aims to evaluate the morphological features and branching patterns of the inferior alveolar artery (IAA) in living individuals using three-dimensional rotational angiography (3D-RA) and to propose a novel radiological classification based on its shape and branching pattern.MethodsA total of 101 hemifaces (53 right, 34 males/34 females) underwent 3D-RA imaging (slice thickness:0.10-0.20 mm). Morphological assessments of the maxillary artery (MA) and the IAA were performed on maximum intensity projection images. Statistical analysis used IBM SPSS Statistics 22.0 (p < 0.05).ResultsMean diameters of the internal carotid artery (ICA), external carotid artery (ECA), and MA were 4.62 ± 0.58 mm, 3.60 ± 0.87 mm, and 2.35 ± 0.41 mm, respectively. Females exhibited significantly smaller ICA, ECA, and MA diameters (p = 0.036, 0.001, 0.001), while IAA diameter (0.95 ± 0.19 mm) showed no sex difference. The IAA originated predominantly from the MA (96%), rarely from the ECA (4%), or was not observed (1%). Duplicated IAAs were detected in two cases. Branching patterns included a single vessel (71%) or a shared trunk with the posterior deep temporal artery (29%), showing significant correlation with MA course (superficial/deep) (p < 0.05). IAA shapes were categorized as straight, curved, or looped, addressing a literature gap.ConclusionsThis is the first in vivo study to radiologically classify variations of the IAA using 3D-RA. The technique enables high-resolution visualization of submillimeter vessels, offering valuable anatomical insights for maxillofacial surgeries. Further studies are warranted to validate these findings and explore clinical correlations.

PMID:40986317 | DOI:10.1177/15910199251380363

JAMA Netw Open. 2025 Sep 2;8(9):e2533193. doi: 10.1001/jamanetworkopen.2025.33193.

ABSTRACT

IMPORTANCE: Postprandial glycemic responses contribute to comorbidities and mortality risk, but the association between food and postprandial glucose responses in general population settings remains uncertain.

OBJECTIVE: To investigate the association of dietary glycemic load (GL), meal timing, age, sex, body mass index (BMI), and glycated hemoglobin (HbA1c) concentration with postprandial glycemic response to mixed meals.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from August 21, 2012, to March 26, 2015, at a primary health care center in A Estrada, northwestern Spain. A population-based sample of adults aged 18 to 85 years without diabetes who were randomly selected from National Health System records agreed to participate. Data analysis was performed between April 20, 2023, and March 26, 2024.

EXPOSURE: The main exposure was dietary GL. Additional exposures included age, sex, BMI, meal timing, and HbA1c concentration.

MAIN OUTCOME AND MEASURES: Postprandial glucose response over 3 hours after breakfast, lunch, and dinner was assessed using continuous glucose monitoring (CGM) for 7 days, with dietary assessments. Multilevel regression models evaluated the association between GL and glucose dynamics, accounting for age, sex, BMI, meal timing, and HbA1c concentration.

RESULTS: Of the 622 participants fitted with the CGM device, 514 (median age, 46 years [IQR, 36-58 years]; 64% females) met eligibility criteria and provided analyzable data. More than 1.3 million glucose measurements were analyzed across 2451 days. Dietary GL was associated with higher postprandial blood glucose levels, with maximum rises of up to 1.3 (95% CI, 0.8-1.8) mg/dL per 10 units of GL. Glucose responses were greater and more prolonged after lunches and dinners than after breakfasts, with peak values observed at 70 minutes after lunches and dinners and 50 minutes after breakfasts. Each 10-year increase in age was associated with an increase in postprandial glucose levels of 1.9 (95% CI, 0.6-3.3) mg/dL to 3.5 (95% CI, 2.2-4.8) mg/dL, while BMI was associated with glucose response after breakfast, with increases of up to 0.7 (95% CI, 0.4-1.1) mg/dL per BMI unit increase. Men had lower glucose levels than women during the late postprandial period after lunch and dinner, with differences of up to 4.6 (95% CI, 1.6-7.6) mg/dL. HbA1c concentrations and meal timing were also associated with postprandial glucose levels (eg, glucose levels increased up to 12.0 [95% CI, 6.5-17.5] mg/dL per 1% increase in HbA1c).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of adults without diabetes, higher-GL meals were associated with sustained postprandial glucose elevations, especially after lunch and dinner. Age, sex, BMI, meal timing, and HbA1c concentration were also associated with glucose responses. These findings support the validity of dietary GL as an explanatory factor for glycemic response to mixed meals under typical everyday conditions when meal timing, age, and BMI are considered.

PMID:40986304 | DOI:10.1001/jamanetworkopen.2025.33193

JAMA Netw Open. 2025 Sep 2;8(9):e2533204. doi: 10.1001/jamanetworkopen.2025.33204.

ABSTRACT

IMPORTANCE: Trauma care, with its inherent complexity and unpredictability, substantially contributes to health care costs in the US. Understanding temporal trends and associated factors may inform targeted cost-mitigation strategies.

OBJECTIVE: To examine trends in trauma-related inpatient costs from 2012 to 2021 and identify patient and hospital factors associated with contemporary costs.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the 2012-2021 National Inpatient Sample, which captures 97% of US hospitalizations. Hospitalization for traumatic injuries were identified using International Classification of Diseases, Ninth Revision and International Statistical Classification of Disease, Tenth Revision codes for external causes of injury. The data analysis was performed between September 2 and October 28, 2024.

EXPOSURE: External causes of traumatic injury.

MAIN OUTCOMES AND MEASURES: The primary outcome was temporal trends in annual and per-patient hospitalization costs. Additionally, risk-adjusted associations of patient and hospital characteristics with inpatient costs in 2021 were assessed.

RESULTS: A total of 18 353 296 hospitalizations were identified during the study period (median [IQR] patient age ranging from 69 [47-83] years in 2012 to 70 [52-82] years in 2021; proportion of women ranging from 53.2% in 2012 to 50.7% in 2021). When stratifying by mechanism of injury, motor vehicle collisions incurred the highest median inpatient costs ($15 412; IQR, $8718-$29 376), followed by falls ($11 769; IQR, $6930-$19 052), other blunt trauma ($9818; IQR, $5567-$17 488), and penetrating injury ($9669; IQR, $4948-$19 545). In 2021, falls accounted for the largest share of costs (70.0%), while patients aged 75 years or older represented the most costly group (34.8%) and Medicare incurred the highest costs among all payers (52.6%). Annual inpatient trauma care costs increased from $27 billion in 2012 to $42 billion in 2021. Median per-patient costs rose from $10 662 (IQR, $6141-$17930) to $14 124 (IQR, $8249-$23 491). Following risk adjustment (2021), motor vehicle collisions (β = $4735.80; 95% CI, $4337.19-$5134.41 [reference, falls]), Black race (β = $1134.86; 95% CI, $628.07-$1641.67 [reference, White race]), and care in the Pacific region (β = $7763.20; 95% CI, $6176.90-$9350.31 [reference, New England]) were associated with greater hospitalization costs.

CONCLUSIONS AND RELEVANCE: This cohort study found that inpatient trauma costs nearly doubled between 2012 and 2021, with geriatric falls a major contributor. Geographic and demographic disparities underscore the need for targeted interventions. Addressing systemic inefficiencies and standardizing care practices are critical to curbing rising costs while ensuring equitable trauma care.

PMID:40986303 | DOI:10.1001/jamanetworkopen.2025.33204

JAMA Netw Open. 2025 Sep 2;8(9):e2533266. doi: 10.1001/jamanetworkopen.2025.33266.

ABSTRACT

IMPORTANCE: Management of blunt splenic injury is evolving toward wider use of nonoperative approaches for splenic salvage, and splenic angioembolization (SAE) is being considered even in patients with hypotension on admission. Research is needed to understand the outcomes of these evolving management strategies.

OBJECTIVE: To compare outcomes of the 3 major treatments approaches for splenic injury.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was performed using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database from January 1, 2017, to December 31, 2022. The database collects injury data from more than 815 trauma centers in the US. Adults with isolated, severe (Abbreviated Injury Scale score ≥3) blunt splenic injury were identified. Isolated splenic injury was defined by the absence of other intra-abdominal injury and any other major associated injuries with an Abbreviated Injury Scale score of 3 or higher. Data analysis was performed from September to December 2024.

EXPOSURE: Open splenectomy (OS) vs SAE vs observation.

MAIN OUTCOMES AND MEASURES: The primary outcomes were mortality and any complication. Outcomes were compared using multivariable Cox proportional hazards regression analyses.

RESULTS: A total of 7567 patients (median [IQR] age, 36 [25-55] years; 4901 men [64.8%]) were studied, including 1499 (19.8%) in the OS group, 1547 (20.4%) in the SAE group, and 4521 (59.7%) in the observation group. In multivariable analysis, there was no difference in mortality in the overall cohort or in subgroups. Morbidity was significantly lower in the SAE (odds ratio [OR], 0.61; 95% CI, 0.45-0.81; P < .001) and observation (OR, 0.71; 95% CI, 0.55-0.92; P = .01) groups compared with the OS group. Among patients with hypotension, there was no mortality difference, but shorter hospital length of stay was found in the SAE (β = -1.44; 95% CI, -1.79 to -1.09; P < .001) and observation (β = -1.41; 95% CI, -1.73 to -1.09; P < .001) groups. Compared with initial OS, morbidity was higher for patients in whom SAE (OR, 5.39; 95% CI, 3.39-8.57; P < .001) and observation (OR, 1.95; 95% CI, 1.44-2.64; P < .001) failed, and hospital length of stay was longer for these groups as well (β = 2.50; 95% CI, 1.27-3.73; P < .001 and β = 0.71; 95% CI, 0.07-1.35; P = .03, respectively).

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study, nonoperative management (SAE or observation) was associated with favorable outcomes when compared with OS in isolated severe blunt splenic injury, even in patients with hypotension on admission. Failure of nonoperative management, however, risked higher morbidity without associated increase in mortality. With careful patient selection, splenic salvage may be possible and preferred even in severely injured patients.

PMID:40986302 | DOI:10.1001/jamanetworkopen.2025.33266

Br Med Bull. 2025 Sep 22;156(1):ldaf014. doi: 10.1093/bmb/ldaf014.

ABSTRACT

INTRODUCTION: Empirical evidence on migrant morbidity suggests that migrant populations have a higher burden of disease compared to non-migrants in high-income destination countries. Yet, empirical evidence on migrant mortality typically shows a lower risk of death compared to non-migrants. Migrants might be living longer lives in worse health-a ‘migrant “morbidity-mortality” paradox’.

SOURCES OF DATA: Peer-reviewed, English-language publications.

AREAS OF AGREEMENT: The paradox has been reported in different destinations, across different migrant groups, and across different health outcomes. It presents most consistently among migrants and women born in low and middle-income countries, and/or when morbidity is self-reported.

AREAS OF CONTROVERSY: The majority of the evidence is based upon unlinked, aggregated, cross-sectional prevalence data that has well-known limitations. Nearly all the studies to date have been descriptive, and there is a lack of understanding concerning what might explain this paradox among migrants.

GROWING POINTS: That migrants are living longer subject to a higher burden of diseases is a social and public health concern that needs to be further explored and understood through more research.

AREAS TIMELY FOR DEVELOPING RESEARCH: We need more evidence of the paradox based upon linked individual-level, incidence-based data that compares the morbidity and mortality risks of the same migrant and non-migrant populations using objective data on morbidity from primary care (general practitioners) or secondary care (hospitalizations). We need to know how widespread the paradox is, which migrant populations are most affected by it, and the potential mechanisms responsible for it.

PMID:40986280 | DOI:10.1093/bmb/ldaf014

Biometrics. 2025 Jul 3;81(3):ujaf125. doi: 10.1093/biomtc/ujaf125.

ABSTRACT

Microbiome research has immense potential for unlocking insights into human health and disease. A common goal in human microbiome research is identifying subgroups of individuals with similar microbial composition that may be linked to specific health states or environmental exposures. However, existing clustering methods are often not equipped to accommodate the complex structure of microbiome data and typically make limiting assumptions regarding the number of clusters in the data which can bias inference. Designed for zero-inflated multivariate compositional count data collected in microbiome research, we propose a novel Bayesian semiparametric mixture modeling framework that simultaneously learns the number of clusters in the data while performing cluster allocation. In simulation, we demonstrate the clustering performance of our method compared to distance- and model-based alternatives and the importance of accommodating zero-inflation when present in the data. We then apply the model to identify clusters in microbiome data collected in a study designed to investigate the relation between gut microbial composition and enteric diarrheal disease.

PMID:40986279 | DOI:10.1093/biomtc/ujaf125

Pharmacoeconomics. 2025 Sep 23. doi: 10.1007/s40273-025-01528-6. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Aztreonam-avibactam (ATM-AVI) is a novel combination antibiotic approved in Europe for the treatment of complicated intra-abdominal infection, hospital-acquired pneumonia, including ventilator-associated pneumonia; complicated urinary tract infection, including pyelonephritis and for infections due to aerobic Gram-negative organisms with limited treatment options. This analysis assessed the cost effectiveness of ATM-AVI ± metronidazole versus colistin + meropenem (COL + MER) for the treatment of patients with complicated intra-abdominal infection and hospital-acquired pneumonia/ventilator-associated pneumonia, including infections with suspected metallo-β-lactamase-producing Enterobacterales from the public payer perspective in Italy using phase III trial data.

METHODS: The cost-effectiveness analysis adopted a decision tree model to simulate the clinical pathway of complicated intra-abdominal infection and hospital-acquired pneumonia/ventilator-associated pneumonia, followed by a Markov model to capture lifetime health outcomes on cured patients, with costs valued in 2024 Euros and discounted at 3%. The model captures the impact of resistant pathogens and side effects (i.e. nephrotoxicity). Model uncertainty was assessed using a probabilistic and deterministic sensitivity analysis.

RESULTS: The ATM-AVI treatment sequence (ATM-AVI ± metronidazole followed by cefiderocol after treatment failure) had improved clinical outcomes and higher cure rates, shorter hospital stays and higher quality-adjusted life-year gains compared with the COL + MER sequence (COL + MER followed by cefiderocol after treatment failure). The incremental cost-effectiveness ratio in the ATM-AVI sequence was dominant for complicated intra-abdominal infection and was €1552 per quality-adjusted life-year for hospital-acquired pneumonia/ventilator-associated pneumonia, well below the willingness-to-pay threshold of €30,000 in Italy.

CONCLUSIONS: Our analysis suggests that ATM-AVI is expected to be a cost-effective use of Italian healthcare resources for treating suspected metallo-β-lactamase-producing Enterobacterales, including complicated intra-abdominal infection and hospital-acquired pneumonia/ventilator-associated pneumonia.

PMID:40986278 | DOI:10.1007/s40273-025-01528-6

Clin Rheumatol. 2025 Sep 23. doi: 10.1007/s10067-025-07647-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Rheumatoid Arthritis (RA) is a chronic autoimmune disease that affects the oral cavity, contributing to the development of periodontal disease (PD), an inflammatory condition that has a bidirectional relationship with various systemic conditions and can lead to tooth loss (TL).This study aimed to evaluate whether the number of missing teeth could serve as an additional indicator for the medical team in assessing the association with systemic disease exacerbations.

METHODS: This pilot study assessed patients with rheumatoid arthritis (RA) using specific protocols, including medical record analysis and a systematic orofacial examination to calculate the Decayed, Missing, and Filled Teeth (DMFT) index. Validated questionnaires were applied, and the disease activity (DAS-28) and functional capacity (HAQ) indices were collected.

RESULTS: The study included 21 patients with a mean DAS28 of 3.12 and a mean HAQ of 1.077. Of these, 7 (33.4%) were in remission, while 14 (66.6%) had some level of disease activity. 10 (47%) had moderate to severe disability due to RA. Statistical analysis identified polypharmacy as a clinically relevant factor associated with tooth loss (p = 0.029; r = 0.48). Additionally, patients with disease activity had higher DMF-T scores. Correspondence analysis indicated that polypharmacy was associated with a higher prevalence of moderate to severe disability (HAQ) and higher DMF-T scores.

CONCLUSION: It is concluded that there is a relationship between the DMF-T index, RA activity, the number of missing teeth, and the need for polypharmacy, making these data important to be assessed in the clinical routine of RA patients. Additional studies are necessary to explore this association in greater depth and strengthen the evidence base.

PMID:40986267 | DOI:10.1007/s10067-025-07647-x

Rheumatol Ther. 2025 Sep 23. doi: 10.1007/s40744-025-00792-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Sjögren’s disease (SjD) is often characterized by the presence of anti-SSA/Ro and anti-SSB/La autoantibodies. The Clinical European Alliance of Associations for Rheumatology (EULAR) Sjögren’s Syndrome Disease Activity Index (ClinESSDAI) and Patient-Reported Index (ESSPRI) assess disease activity and patient-reported symptomatology; however, their association with patient-reported outcome measures (PROMs) remains unclear. We aimed to describe systemic disease activity in seropositive and seronegative SjD patients and evaluate the association between proxy ClinESSDAI and ESSPRI scores with PROMs.

METHODS: Data were drawn from the Adelphi Real World SjD Disease Specific Programme™, a cross-sectional survey conducted in France, Germany, Italy, Spain and the United States between June and October 2018. Physicians reported patient demographics and clinical characteristics. Patients completed the EQ-5D-3L and Visual Analogue Scale (EQ-VAS), and the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F). Proxy ClinESSDAI and ESSPRI scores were calculated using physician-reported organ activity and averaged patient ratings of dryness, pain, and fatigue, respectively. Associations between ClinESSDAI, ESSPRI, physician-reported disease severity, and PROMs were determined using linear and logistic regression modeling. Statistical significance was p < 0.05 for all tests.

RESULTS: Overall, 319 rheumatologists provided data on 1879 patients with SjD. Mean (standard deviation) patient age was 53.2 (12.2) years, 89% were female, and 89% were White. Of patients who received serum antibody testing for both anti-SSA/Ro and anti-SSB/La antibodies (n = 1344), 69% were double seropositive and 6% were double seronegative. The most common symptoms experienced by double seropositive and double seronegative SjD patients, respectively, included dry eyes (94% and 74%), and physical fatigue (82% and 60%). ClinESSDAI and ESSPRI were significantly associated with EQ-5D-3L, EQ-VAS, and FACIT-F (all p < 0.001).

CONCLUSIONS: Systemic disease activity and patient-reported symptomatology were significantly associated with health-related quality of life measures, highlighting the need for disease management that considers both clinical outcomes and the patient experience.

PMID:40986255 | DOI:10.1007/s40744-025-00792-4

Dermatol Ther (Heidelb). 2025 Sep 23. doi: 10.1007/s13555-025-01547-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Atopic dermatitis (AD) is a common chronic inflammatory disease during adolescence, with severe forms having a particularly high impact on patients’ quality of life. Several therapeutic options are currently approved for the treatment of AD in individuals over 12 years of age. This study evaluated the efficacy and safety of tralokinumab in adolescent patients, with a particular focus on identifying which patient profiles may derive the greatest benefit from this therapy.

METHODS: A retrospective multicenter study was conducted across nine Spanish hospitals, including patients from 12 to 17 years old with moderate-to-severe AD treated with tralokinumab.

RESULTS: A total of 27 patients were included, with a mean age of 14.8 years. Nine had previously received treatment with dupilumab, five due to primary or secondary failure, and four due to adverse events. One patient had been treated with upadacitinib, which was discontinued because of primary failure and acne. A statistically significant reduction was achieved in Eczema Area and Severity Index (EASI), pruritus visual analog scale (VAS), and Investigator’s Global Assessment (IGA) scores. Palmoplantar involvement was observed in 44.4% of patients; after 24 weeks of treatment, 83.3% of those with palmoplantar involvement experienced complete resolution. Additionally, 37.0% of patients were overweight or obese, with no statistically significant differences in treatment efficacy.

CONCLUSION: Tralokinumab demonstrated efficacy and safety in the treatment of moderate-to-severe AD in patients aged 12-17 years. Notably, the treatment was effective in adolescent patients with palmoplantar involvement and/or obesity.

PMID:40986238 | DOI:10.1007/s13555-025-01547-3