Tag: statistics

BMC Gastroenterol. 2025 Sep 19;25(1):642. doi: 10.1186/s12876-025-04235-w.

ABSTRACT

BACKGROUND: Pakistan has one of the highest rates of chronic liver disease (CLD) burden in the world. Poor and underserved patients of CLD in the country may suffer from limited health-seeking behaviors, but there is not much research in this area. The aim of this study is to better plan support for CLD patients by identifying: (i) Health-seeking behaviors (HSB) according to patient-type; and (ii) the relationship of HSB with patient socio-demographic variables and independent study domains.

METHODS: We conducted a cross-sectional study. Data was collected over a four-month period from May 2022 to August 2022. A total of 850 patients visiting the Pakistan Kidney and Liver Institute and Research Centre were part of the study. We used correlation tests and multivariate logistic regression to investigate the relationship between the health-seeking behavior and the independent study domains (economic stability, health literacy, social support, experiencing grief, mental health, healthcare service quality, and coping strategies).

RESULTS: Main results suggest that patients with hepatocellular carcinoma, non-viral liver disease, and cirrhosis have less HSB, compared to patient with chronic viral hepatitis. Multivariate logistic regression results reveal that the following groups have lower odds for health-seeking behavior: (i) illiterate people; (ii) those living in rented homes; (iii) those belonging to nuclear families; and (iv) those with low monthly household income. The following study domains also show lower odds for HSB: (i) health illiteracy; (ii) low health service quality; (iii) low ability to use coping strategies; (iv) grief; (v) lack of social support; (vi) mental health challenges; and (vii) economic instability.

CONCLUSIONS: Our study highlights that the majority of CLD patients are poor, illiterate, or semi-literate and in urgent need of holistic care with respect to health literacy, mental health counseling, financial help, and improved support from provider and families. This is only possible through the integration of social policy officers and social workers in the tertiary health sector of the country.

PMID:40973962 | DOI:10.1186/s12876-025-04235-w

Oral Maxillofac Surg. 2025 Sep 20;29(1):158. doi: 10.1007/s10006-025-01459-8.

ABSTRACT

PURPOSE: This study aimed to assess the clinical and radiographic outcomes of transcrestal maxillary sinus lifting using Densah burs in combination with activated plasma albumin gel (APAG) during simultaneous implant placement in cases with severely limited residual bone height (3-5 mm).

METHODS: A total of six patients with missing posterior maxillary teeth and insufficient alveolar bone height were treated using the osseodensification technique with Densah burs and APAG. CBCT scans were obtained preoperatively and six months postoperatively to evaluate changes in bone height and peri-implant bone density. Bone density was estimated using CBCT gray values derived from OnDemand 3D software, recognizing that these values provide relative rather than absolute measurements and are subject to inherent limitations.

RESULTS: No post-operative complications were recorded, and the sinus membrane remained intact in all cases. After six months, a statistically significant bone height gain was observed (mean 5.28 ± 0.70 mm; p < 0.001), along with a significant increase in bone density (mean difference 255.15 ± 95.69 HU; p < 0.001). Implant stability showed no statistically significant difference between primary and secondary ISQ values (mean difference 1.17 ± 4.31; p = 0.54).

CONCLUSION: The combined use of Densah burs and activated plasma albumin gel for transcrestal sinus lifting appears to be a safe and minimally invasive technique, promoting substantial bone height gain and improved peri-implant bone density. The bioactive plasma gel played a key role in effective sinus membrane elevation and vertical bone augmentation.

TRIAL REGISTRATION NUMBER: This trial was retrospectively registered on ClinicalTrials.gov (ID: NCT06360263) in July 2023.

PMID:40973834 | DOI:10.1007/s10006-025-01459-8

Nat Metab. 2025 Sep 19. doi: 10.1038/s42255-025-01371-1. Online ahead of print.

ABSTRACT

A systematic characterization of metabolic profiles in human health and disease enhances precision medicine. Here we present a comprehensive human metabolome-phenome atlas, using data from 274,241 UK Biobank participants with nuclear magnetic resonance metabolic measures. This atlas links 313 plasma metabolites to 1,386 diseases and 3,142 traits, with participants being prospectively followed for a median of 14.9 years. This atlas uncovered 52,836 metabolite-disease and 73,639 metabolite-trait associations, where the ratio of cholesterol to total lipids in large low-density lipoprotein percentage was found as the metabolite associated with the highest number (n = 526) of diseases. In addition, we found that more than half (57.5%) of metabolites showed statistical variations from healthy individuals over a decade before disease onset. Combined with demographics, the machine-learning-based metabolic risk score signified the top 30 (around 10%) metabolites as biomarkers, yielding favourable classification performance (area under the curve > 0.8) for 94 prevalent and 81 incident diseases. Finally, Mendelian randomization analyses provided support for causal relationships of 454 metabolite-disease pairs, among which 402 exhibited shared genetic determinants. Additional insights can be gleaned via an accessible interactive resource ( https://metabolome-phenome-atlas.com/ ).

PMID:40973818 | DOI:10.1038/s42255-025-01371-1

Mol Psychiatry. 2025 Sep 19. doi: 10.1038/s41380-025-03235-2. Online ahead of print.

ABSTRACT

Posttraumatic stress disorder (PTSD) is persistent over time, thus identifying risk factors for chronic PTSD is crucial for clinical research. Trauma exposure severity and polygenic liability are two established predictors of PTSD onset and severity, but their contributions to the long-term course of PTSD remain largely unknown. In this prospective longitudinal cohort study, we tested whether severity of trauma exposure and polygenic risk for symptoms of PTSD independently predict long-term trajectories of PTSD symptoms. Data included 49,402 observations, spanning July 2002 to December 2022, from n = 5687 World Trade Center responders who had predominately European ancestry (baseline mean age = 37.74, SD = 8.19, range = 16-75; 92.89% male). First, the best-fitting model of 20-year PTSD trajectories was determined. Next, a polygenic risk score and a sum score of traumatic exposures were included as predictors of individual differences in intercepts (initial levels) and slopes (rates of change), adjusting for demographic covariates. The polygenic risk score significantly predicted rates of change in PTSD symptoms, independent of the intercept, such that higher polygenic risk was associated with more rapid increases in the years after trauma and a steeper arch-shaped trajectory. Exposure severity predicted initial levels and rates of change in symptoms, with more pronounced effects on initial levels. These findings indicate that polygenic liability and exposure severity predict the long-term prognosis of PTSD and have the potential to inform future clinical studies in trauma-exposed populations.

PMID:40973784 | DOI:10.1038/s41380-025-03235-2

Eye (Lond). 2025 Sep 19. doi: 10.1038/s41433-025-04025-4. Online ahead of print.

ABSTRACT

BACKGROUND: Monitoring neovascular age-related macular degeneration (nAMD) is a significant contributor to ophthalmology demands in the NHS, with clinical capacity struggling to meet the demand. This task depends upon interpreting retinal optical coherence tomography (OCT) imaging, where artificial intelligence (AI) could rebalance clinical demand and capacity. However, evidence of safety and effectiveness in nAMD monitoring is lacking.

METHODS: Using a published non-inferiority design protocol, 521 pairs of ipsilateral retinal OCTs from consecutive visits for nAMD treatment were collected from two NHS ophthalmology services. Real-world binary assessments of nAMD disease activity or stability were compared to an independent ophthalmic reading centre reference standard. An AI system capable of retinal OCT segmentation analysed the OCTs, applying thresholds for intraretinal and subretinal fluid to generate binary assessments. The relative negative predictive value (rNPV) of AI versus real-world assessments was calculated.

RESULTS: Real-world assessments of nAMD activity showed a NPV of 81.6% (57.3-81.6%) and a positive predictive value (PPV) of 41.5% (17.8-62.3%). Optimised thresholds for intraretinal fluid increase (>1,000,000 µm³) and subretinal fluid increase (>2,000,000 µm³) for the AI system assessments produced an NPV of 95.3% (85.5-97.9%) and PPV of 57.8% (29.4-76.0%). The rNPV of 1.17 (1.11-1.23) met predefined criteria for clinical and statistical superiority and accompanied an rPPV of 1.39 (1.10-1.76).

CONCLUSIONS: This study suggests that the same thresholds for interpreting OCT-based AI analysis could reduce undertreatment and overtreatment in nAMD monitoring at different centres. Interventional research is needed to test the potential of supportive or autonomous AI assessments of nAMD disease activity to improve the quality and efficiency of services.

PMID:40973777 | DOI:10.1038/s41433-025-04025-4

Leukemia. 2025 Sep 19. doi: 10.1038/s41375-025-02644-0. Online ahead of print.

ABSTRACT

The outcome of patients with acute myeloid leukemia (AML) worsens with increasing age. Dichotomization into “younger” and “older” patients is clinically routine and often dictates treatment options. We aimed to delineate whether molecular genetic features and/or outcome measures support assorting patient populations by age, including division into “younger” and “older” groups. We analyzed 2823 adult AML patients enrolled onto frontline chemotherapy-based clinical protocols of two cooperative study groups from USA and Germany who were profiled molecularly via targeted sequencing platforms. Frequencies of gene mutations and cytogenetic findings were depicted in 5-year age increments. Clinical outcomes of 2756 AML patients were analyzed with respect to molecular features, genetic-risk groups and age. Age-associated distributions of gene mutations and cytogenetic abnormalities were similar in both cohorts. There was almost linear shortening of overall survival with increasing age among all patients (P < 0.001) and within 2022 European LeukemiaNet-defined genetic-risk groups, with survival decreasing as age increased (favorable-risk, P < 0.001; intermediate-risk, P < 0.001; adverse-risk, P < 0.001). Although mutational profiles and outcomes of the youngest patients differed from those of older patients, there was no age cut-off identifying “younger” and “older” patients. These findings support more age-associated flexibility for drug approval and trial eligibility.

PMID:40973764 | DOI:10.1038/s41375-025-02644-0

Prostate Cancer Prostatic Dis. 2025 Sep 19. doi: 10.1038/s41391-025-01026-y. Online ahead of print.

ABSTRACT

BACKGROUND: Digital perioperative programs offer promising solutions to overcome organizational constraints of traditional prehabilitation, potentially improving recovery while reducing healthcare burden and costs. We aimed to assess the impact of adding a surgery-specific module to an optimized digital perioperative program on improving functional outcomes after radical prostatectomy (RP).

METHODS: This was a multicentre, prospective, comparative, non-randomized trial including consecutive robot-assisted RP. Intervention was the implementation of the Betty (Better Surgery) coaching program combined with the activation of a RP-specific pre- and rehabilitation module. The primary endpoint was continence recovery, defined as “0 or 1 safety pad per day” at 6 weeks after surgery. Secondary endpoints were mid-term continence, need for postoperative physiotherapy, erectile function, complications, and readmissions.

RESULTS: A total of 177 and 156 RP cases were included in the control and experimental groups. Baseline and pathological variables were statistically comparable between groups. The mean patient age and PSA were 65.3 years and 11 ng/ml, respectively. At 6 weeks after RP, 83.3% of patients following the digital program were continent, as compared with 68.4% in the control group (p = 0.002). The need for postoperative physiotherapy for persistent incontinence was significantly reduced in the digital program group (27.5%, versus 58.8%, p < 0.001). Patients who followed the digital program experienced lower complications although not statistically significant (p = 0.1), unplanned visits (p = 0.025), reoperation rates (p = 0.025), more same-day discharge surgery (p = 0.030), and higher satisfaction (9.4/10 versus 8.3/10, p < 0.001). The main limitation was the absence of randomization.

CONCLUSIONS: Besides the benefits provided by the perioperative digital program, the addition of a pre- and rehabilitation module, including surgery-specific content, significantly improved functional recovery after RP and perioperative outcomes.

PMID:40973738 | DOI:10.1038/s41391-025-01026-y

J Perinatol. 2025 Sep 19. doi: 10.1038/s41372-025-02432-9. Online ahead of print.

ABSTRACT

Preterm neonates frequently undergo a variety of painful and invasive procedures. Neonatal pain has been associated with changes in hormone levels, tissue damage, and brain development. Nonpharmacological approaches, such as the use of breast milk odor, have been investigated as a strategy to reduce those effects. However, its efficacy remains unclear, and further research is needed to establish its true therapeutic value.

PURPOSE: Evaluate the analgesic effects of breast milk odor in premature neonates.

METHODS: We systematically searched PubMed, EMBASE, and Cochrane for randomized controlled trials (RCTs) assessing the effects of human milk odor compared with no aromatherapy (control) or placebo (odorless diffuser/distilled water/saline) on pain relief, oxygen saturation (SaO₂), and heart rate in preterm neonates undergoing invasive procedures. Two independent reviewers screened studies and extracted data up to July 5, 2025. Statistical analyses were conducted using RevMan Web (version 8.0.0) for the primary meta-analyses, and R software was used to perform sensitivity analyses.

RESULTS: Among 460 references identified, eight randomized controlled trials met the inclusion criteria, totaling 451 preterm neonates, of whom 225 (49.9%) were exposed to human milk odor. The mean gestational age was 33.56 ± 2.58 weeks, and 226 (50.1%) were male. Two studies were conducted using venipuncture as a painful procedure, four used the heel prick test, one used peripheral catheterization, and one used vaccination. Compared with the control group and the placebo, the group exposed to the milk odor showed a reduction in pain scores during the painful procedure (SMD = -0.95; 95% CI: -1.45 to -0.45; p = 0.0002; I² = 84%). The subgroup analysis of the five RCTs that used the PIPP score for the pain assessment showed similar results; the human milk odor-exposed group showed a lower pain score compared with the control group (MD -2.66; 95% CI -4.25 to -1.06; p = 0.001). Secondary outcomes included physiological parameters such as heart rate and oxygen saturation (SaO₂). Neonates exposed to breast milk odor exhibited lower heart rates compared to control (MD = -9.26; 95% CI: -14.28 to -4.24; p = 0.0003; I² = 27%). Oxygen saturation was also higher in the intervention group (MD = 2.40; 95% CI: 0.68-4.12; p = 0.006; I² = 53%) CONCLUSION: Aromatherapy with human breast milk reduces pain in neonates. Larger studies are needed to validate our results.

PMID:40973724 | DOI:10.1038/s41372-025-02432-9

Int J Obes (Lond). 2025 Sep 19. doi: 10.1038/s41366-025-01895-2. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Tracking excess adiposity at population scale is essential for managing the obesity pandemic in human populations. New formulas based on weight, height, waist and hip measurements have been suggested as better alternatives to the classic body mass index and waist-hip ratio, but the lack of systematic benchmarking on how these formulas reflect adiposity, metabolic dysfunction and clinical sequelae causes confusion on how to best monitor the health of populations.

SUBJECTS/METHODS: Participants from the Northern Finland Birth Cohort 1966 were included based on data availability at the 46-year visit (2511 women and 1908 men). Cross-sectional sex-adjusted Spearman correlations with clinical biomarkers and serum and urine NMR metabolomics were calculated for body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHER), abdominal volume index, body adiposity index, body roundness index, body shape index, conicity index and impedance-based body fat. UK biobank participants were selected based on available data at initial visit (244,947 women and 205,949 men). Prevalent and incident cases of type 2 diabetes, hypertension, liver disease and heart disease were ascertained through register linkage. Prevalent cases were predicted from adiposity measures by age- and sex-adjusted logistic regression and incident cases by age- and sex-adjusted Cox regression.

RESULTS: Adiposity measures were highly collinear and exhibited low biomolecular specificity. BMI and WHR together captured almost all body shape information related to cardiometabolic diseases. For instance, the c-statistic of the BMI & WHR model for diabetes (0.8012; CI95: 0.7963, 0.8061) was near the theoretical maximum of 0.8047. Diabetes was also predicted by WHER (0.7951; CI95: 0.7903, 0.8000). Other adiposity measures showed equal or worse prediction accuracy. This pattern repeated across multiple disease diagnoses.

CONCLUSIONS: We did not observe sufficient benefits from the more recent body adiposity formulas over body mass index, waist-hip or waist-height ratio to warrant their widespread application in cardiometabolic epidemiology.

PMID:40973720 | DOI:10.1038/s41366-025-01895-2

Eur Heart J. 2025 Sep 19:ehaf702. doi: 10.1093/eurheartj/ehaf702. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Antiplatelet treatment is recommended to start 24 h after intravenous thrombolysis due to concerns about haemorrhagic transformation. This study aimed to investigate the potential benefit of early antiplatelet after intravenous thrombolysis in minor stroke.

METHODS: A multicentre, double-blind, randomized trial was conducted in China between 7 August 2022 and 1 August 2024, to evaluate the efficacy and safety of early antiplatelet in acute ischaemic stroke patients presenting with mild neurological deficits, as indicated by a National Institutes of Health Stroke Scale (NIHSS) score of 0-5, who received intravenous thrombolysis. Patients were randomly assigned to receive either clopidogrel and aspirin or placebo within 6 h after intravenous thrombolysis. The primary endpoint was an excellent functional outcome at 90 days, indicated by a modified Rankin Scale (mRS) score of 0-1. Statistical analysis was based on a modified intention-to-treat population. Symptomatic intracranial haemorrhage, any intracranial haemorrhage, and major systemic bleeding were safety endpoints.

RESULTS: The primary endpoint was not met in this study. Of the randomly assigned 1022 patients, 995 patients were included in the modified intention-to-treat analysis (503 with early antiplatelet treatment and 492 with placebo). The primary endpoint occurred in 89.7% (451/503) of patients receiving early antiplatelet vs 89.6% (441/492) of those receiving placebo with no significant difference (odds ratio 1.00, 95% confidence interval .67-1.51, P = .99). Similar safety profiles were found between the two groups.

CONCLUSIONS: Among Chinese patients with acute minor ischaemic stroke who received intravenous thrombolysis, early antiplatelet treatment with clopidogrel plus aspirin was safe but did not improve already excellent functional outcome (mRS 0-1) at 90 days.

PMID:40973702 | DOI:10.1093/eurheartj/ehaf702