Tag: statistics

Breast Cancer Res. 2025 Apr 15;27(1):55. doi: 10.1186/s13058-025-01995-x.

ABSTRACT

BACKGROUND: Among premenopausal women, higher body mass index (BMI) is associated with lower breast cancer risk, although the underlying mechanisms are unclear. Investigating adiposity distribution may help clarify impacts on breast cancer risk. This study was initiated to investigate associations of central and peripheral adiposity with premenopausal breast cancer risk overall and by other risk factors and breast cancer characteristics.

METHODS: We used individual-level data from 14 prospective cohort studies to estimate hazard ratios (HRs) for premenopausal breast cancer using Cox proportional hazards regression. Analyses included 440,179 women followed for a median of 7.5 years (interquartile range: 4.0-11.3) between 1976 and 2017, with 6,779 incident premenopausal breast cancers.

RESULTS: All central adiposity measures were inversely associated with breast cancer risk overall when not controlling for BMI (e.g. for waist circumference, HR per 10 cm increase: 0.92, 95% confidence interval (CI): 0.90-0.94) whereas in models adjusting for BMI, these measures were no longer associated with risk (e.g. for waist circumference: HR 0.99, 95% CI: 0.95-1.03). This finding was consistent across age categories, with some evidence that BMI-adjusted associations differed by breast cancer subtype. Inverse associations for in situ breast cancer were observed with waist-to-height and waist-to-hip ratios and a positive association was observed for oestrogen-receptor-positive breast cancer with hip circumference (HR per 10 cm increase: 1.08, 95% CI: 1.10-1.14). For luminal B, HER2-positive breast cancer, we observed an inverse association with hip circumference (HR per 10 cm: 0.84, 95% CI: 0.71-0.98), but positive associations with waist circumference (HR per 10 cm: 1.18, 95% CI: 1.03-1.36), waist-to-hip ratio (HR per 0.1 units: 1.29, 95% CI: 1.15-1.45) and waist-to height ratio (HR per 0.1 units: 1.46, 95% CI: 1.17-1.84).

CONCLUSIONS: Our analyses did not support an association between central adiposity and overall premenopausal breast cancer risk after adjustment for BMI. However, our findings suggest associations might differ by breast cancer hormone receptor and intrinsic subtypes.

PMID:40234955 | DOI:10.1186/s13058-025-01995-x

J Health Popul Nutr. 2025 Apr 15;44(1):119. doi: 10.1186/s41043-025-00858-7.

ABSTRACT

INTRODUCTION: Several epidemiological studies have reported inconsistent findings on the association between carotenoid intake and fracture risk. This study aimed to determine the association between individual carotenoid intake and fracture risk.

METHODS: A cross-sectional study based on data from the National Health and Nutrition Examination Survey (NHANES), 2013-2018. This study identified elderly individuals with valid and complete data on carotenoid intake and fracture risk. The average dietary intakes of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein + zeaxanthin was taken based on the two 24-hour recall interviews. Matching was done based on age, sex, and body mass index (BMI). Logistic regression models were used to test the associations between carotenoids and fracture risk. All analyses were performed by using R (version 3.4.3; R Foundation for Statistical Computing, Vienna, Austria).

RESULTS: A total of 5491 (1140 cases and 4351 control) subjects were included in this study. The average age of the subjects was 55.62 ± 14.84 years old. In the adjusted model, the risk of osteoporotic fracture was decreased by 6.2% (odd ratio (OR): 0.938; 95% confidence interval (CI): 0.699 to 0.989) and 1.4% (OR 0.986; 95% CI: 0.975 to 0.997) for dietary intake of beta-carotene and lycopene, respectively.

CONCLUSIONS: Dietary intakes of beta-carotene and lycopene have significantly reduced the risk of osteoporotic fracture among the elderly population in the United States of America.

PMID:40234943 | DOI:10.1186/s41043-025-00858-7

Lipids Health Dis. 2025 Apr 15;24(1):139. doi: 10.1186/s12944-025-02560-3.

ABSTRACT

IMPORTANCE: Visceral adiposity index (VAI) vividly reflects body fat distribution through comprehensively integrating body mass index, sex, waist circumference, triglycerides, and high-density lipoprotein cholesterol. While VAI is an established predictor of various clinical outcomes, its relationship with premature mortality and life expectancy remains unclear.

OBJECTIVE: To explore the association between VAI and premature mortality or life expectancy in a nationally representative cohort of US adults.

METHODS: This study included adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, linked to the National Death Index through December 31, 2019. Data were analyzed from August to October, 2024. VAI was categorized into quartiles from the lowest Q1 to the highest Q4. Primary endpoints were premature mortality (death before 80 years of age) and life expectancy.

RESULTS: A total of 43,672 participants (women: 22,164; men: 21,508) aged > 20 years were included. Over a median follow-up of 9.2 years (IQR: 4.9-13.8), 3,187 premature deaths were documented. Higher VAI quartiles were significantly associated with increased multi-adjusted premature mortality risk compared to Q1 (Q3 vs. Q1: hazard ratio [HR], 95% confidence interval [CI]: 1.30, 1.05 to 1.61; Q4 vs. Q1: 1.68, 1.34 to 2.11). This association was particularly pronounced in women (Q3 vs. Q1: 1.53, 1.01 to 2.30; Q4 vs. Q1: 2.36, 1.52 to 3.68), with significant linear trends (P < 0.001). Estimated life expectancy at age 40 years was 41.45 (95% CI: 41.24 to 41.66), 41.32 (41.11 to 41.53), 40.55 (40.35 to 40.75), and 39.26 (39.08 to 39.45) years in Q1, Q2, Q3, and Q4 of VAI, respectively. By sex, estimated life expectancy at age 40 in Q4 was reduced by 3.33 years in women and 1.24 years in men, compared to Q1. By race and ethnicity, it was shortened by 3.90 years in Black participants and 1.68 years in White participants in Q4 group, compared to Q1.

CONCLUSIONS: In this nationwide cohort study, higher VAI was significantly associated with an increased risk of premature mortality and reduced life expectancy at age 40 among US adults. These associations we heterogeneous by sex, race and ethnicity, more pronounced in women and Black participants.

PMID:40234930 | DOI:10.1186/s12944-025-02560-3

J Orthop Surg Res. 2025 Apr 16;20(1):381. doi: 10.1186/s13018-025-05791-3.

ABSTRACT

INTRODUCTION: Systemic lupus erythematosus (SLE) can lead to avascular necrosis (AVN) of the femoral head, often requiring total hip arthroplasty (THA). However, outcomes and complications of THA in SLE patients remain unclear. This study aims to analyze the differences in clinical outcomes and complications between SLE and non-SLE patients undergoing THA.

METHODS: This study adhered to the PRISMA guidelines and was registered in PROSPERO (CRD42024564792). Literature was retrieved from the Cochrane Library, Web of Science, PubMed, and Embase databases, supplemented by manual searches of relevant references. Studies meeting specific diagnostic criteria were included, with eligible study types comprising case-control and cohort studies. The intervention of interest was THA surgery, and primary outcome measures included adverse events and clinical outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Statistical analyses were performed using RevMan 5.4 software. Dichotomous variables were analyzed using relative risk (RR), while continuous variables were assessed using the mean difference (MD) or standardized mean difference (SMD), both with 95% confidence intervals for effect size estimation. Heterogeneity was assessed via the X² test and I² statistic, with P ≤ 0.05 considered statistically significant.

RESULTS: No significant difference in Harris Hip Scores (HHS) (MD= -0.69, 95% CI: -2.11 to 0.73, I²=0%, P = 0.34) was observed between SLE and non-SLE patients. However, compared to non-SLE patients, SLE patients had higher risks of prosthesis dislocation (RR = 2.44, 95% CI: 1.74 to 3.42, I²=52%, P<0.01), wound infection (RR = 2.30, 95% CI: 1.87 to 2.83, I²=0%, P<0.01), and blood transfusion (RR = 2.50, 95% CI: 2.14 to 2.92, I²=0%, P<0.01), as well as longer hospital stays (MD = 1.64, 95% CI: 1.44 to 1.64, I²=100%, P<0.01).

DISCUSSION: In conclusion, although SLE patients show similar improvements in hip function postoperatively compared to non-SLE patients, they face a significantly higher risk of complications, including prosthetic dislocation, blood transfusion requirements, DVT, and wound infections. These patients also experience longer hospital stays and slower recovery, likely due to their underlying health conditions and preoperative treatments. Personalized management strategies and risk assessments are crucial to minimize complications and optimize recovery outcomes for SLE patients undergoing THA. However, the included studies exhibit significant heterogeneity, including variations in prosthesis types, fixation methods, sample sizes, and study designs, which may introduce potential bias and affect the generalizability of the findings. Further high-quality research is needed to address these issues.

PMID:40234929 | DOI:10.1186/s13018-025-05791-3

Orphanet J Rare Dis. 2025 Apr 15;20(1):180. doi: 10.1186/s13023-025-03695-3.

ABSTRACT

BACKGROUND: Fibrosing mediastinitis is a rare benign disease frequently complicated by pulmonary hypertension. A definitive diagnosis for fibrosing mediastinitis-associated pulmonary hypertension (FM-PH) and its etiologies necessitates mediastinal biopsy and subsequent pathological assessment. Endobronchial ultrasound (EBUS)-guided transbronchial mediastinal cryobiopsy is a recently developed technique that provides diagnostic advantages over standard needle biopsy, particularly in benign mediastinal disorders. Nevertheless, their safety and efficacy in diagnosing FM-PH remain elusive.

METHODS: We retrospectively studied patients with mediastinal lesion and pulmonary vascular compression who underwent both transbronchial needle aspiration and mediastinal cryobiopsy with EBUS guidance. Diagnostic yields of FM-PH and its etiologies, along with procedure-related adverse events, were analyzed. Immunohistochemical study was conducted to identify immunological properties of FM-PH.

RESULTS: Of the 529 patients with mediastinal lesions, 80 exhibited pulmonary vessel compression, including 10 who were ultimately diagnosed with FM-PH following mediastinal biopsy and right heart catheterization. Cryobiopsy showed a higher diagnostic yield for FM-PH compared to needle aspiration (100% versus 40%, p = 0.011). Disease etiologies included pneumoconiosis in 5 cases, tuberculosis in 3, and idiopathic FM-PH in the remaining 2. Cryobiopsy appeared to be superior to needle biopsy for etiological diagnosis, although this difference was not statistically significant (80% versus 60%, p = 0.628). Immunohistochemical analyses of cryosamples revealed mixed inflammatory infiltrates of B and T lymphocytes, as well as macrophages, surrounding or within FM-PH lesions. There was no significant bleeding or other complications.

CONCLUSION: Transbronchial mediastinal cryobiopsy might be a safe and effective diagnostic tool for FM-PH, offering valuable information for personalized treatment.

PMID:40234923 | DOI:10.1186/s13023-025-03695-3

BMC Oral Health. 2025 Apr 15;25(1):570. doi: 10.1186/s12903-025-05748-2.

ABSTRACT

BACKGROUND: To assess the effect of indirect ultrasonic activation on the root canal obturation with a premixed calcium silicate cement (CSC).

METHODS: Twenty-six single-rooted premolars were sectioned to the length of 11 mm. All the roots were instrumented using ProTaper Next instruments and randomly assigned to either the control (n = 4) or experimental (n = 22) groups according to root canal obturation methods. Root specimens allocated to experimental groups were obturated with Endocem MTA, with (group EMU) or without (group EM) indirect ultrasonic activation (n = 11/group). Root specimens obturated with gutta-percha served as positive and negative (after nail varnish coating) controls. Intraoral radiograph images were used to assess the presence or absence of voids in the coronal, middle, and apical thirds of each specimen. The specimens were connected to a nanoscale fluid filtration device to measure quantitative leakage data. Data was statistically analyzed with a significance level of 0.05.

RESULTS: There was no significant difference in the voids formation between the two groups (p > 0.05), but specimens in group EMU presented significantly higher quantitative leakage than those in group EM (p < 0.05).

CONCLUSIONS: Within the limitation of this study, indirect ultrasonic activation of premixed CSC did not affect the void formation but presented higher quantitative leakage. Future research incorporating micro-CT imaging would enable a more precise and comprehensive analysis, providing valuable insights into the root canal obturation with premixed CSCs.

PMID:40234919 | DOI:10.1186/s12903-025-05748-2

Diabetol Metab Syndr. 2025 Apr 15;17(1):128. doi: 10.1186/s13098-025-01693-w.

ABSTRACT

OBJECTIVE: To explore the relationship between body fat mass/muscle mass ratio (F/M) and thyroid hormone sensitivity in the euthyroid population.

METHODS: Body compositions of 845 check-up individuals were determined using bioelectrical impedance analysis (BIA). Biochemical indexes including blood glucose, blood lipids, liver and kidney functions and thyrotropic hormones (THs) were detected. Free triiodothyronine to free thyroxine ratio (FT3/FT4), Thyroid Feedback Quantile-based Index (TFQI), Thyrotropin Thyroxine Resistance Index (TT4RI) and TSH Index (TSHI) were calculated for analysis.

RESULTS: TT4RI and TSHI showed increased trends with statistical difference, while FT3/FT4 and TFQI showed no difference among F/M quartile groups. After adjusting for confounding factors, F/M exhibited no correlation with FT3/FT4, but positive correlations with TFQI, TT4RI and TSHI. Gender subgroup analysis showed that F/M exhibited positive relationship with TFQI in females; exhibited positive correlations with TFQI, TT4RI and TSHI before the inflection points, but no correlations thereafter in males. Age subgroup analysis showed that F/M exhibited positive correlations with TFQI, TT4RI and TSHI, but no correlation with FT3/FT4 in age < 65 years group; exhibited no relationship with thyroid hormone sensitivity in age ≥ 65 years group. BMI subgroup analysis showed that F/M exhibited no relationship with thyroid hormone sensitivity in BMI < 25 kg/m² group; exhibited positive correlations with TFQI, TT4RI and TSHI before the inflection points, but no correlations thereafter in BMI ≥ 25, < 30 kg/m² group; exhibited positive correlation with TFQI before the inflection point, but no correlation thereafter in BMI ≥ 30 kg/m² group; exhibited no correlations with TT4RI and TSHI before the inflection points, but negative correlations with them thereafter in BMI ≥ 30 kg/m² group.

CONCLUSION: Impaired central, but not peripheral sensitivity to thyroid hormones was associated with increased body fat mass/muscle mass ratio (F/M), this association was obvious in males, individuals with age < 65 years and BMI ≥ 25 kg/m², with different inflection points. Maybe F/M independently affects thyroid hormone sensitivity, we need more clinical and basic studies in the future.

PMID:40234912 | DOI:10.1186/s13098-025-01693-w

BMC Med Educ. 2025 Apr 15;25(1):541. doi: 10.1186/s12909-025-07081-2.

ABSTRACT

BACKGROUND: The faculty development programs associated with positive outcomes are the ones that are designed in accordance with organizational needs, are based on a theoretical framework, target inter-professional learning and use multiple teaching strategies to teach a single skill. Rather than being short, one-time events, these programs are long term with contextual engagement of participants. To meet this challenge, a six-month long certificate course in health professions education, based on constructivist theory, was designed. The objective of this study was to evaluate the impact of this focused training, at Kirkpatrick level II, on learning of item writing skills by the participants.

METHODS: This quasi-experimental study was conducted from January 2019 to June 2020 at National University of Medical Sciences, Pakistan. A total of 133 faculty members were enrolled in the program. Of these, data from 124 students (75 male and 49 female participants), who had passed our CHPE program, was included in the study. The longitudinal engagement comprised of three steps. In step 1(pre-intervention) participants submitted 5MCQs each, resulting in a total of 620 MCQs. For the step 2 (intervention), a six-hour workshop on writing single best MCQs with peer and faculty feedback during the five-day long face to face session was conducted for all the participants. Subsequently four courses including learning theories, curriculum planning, teaching and learning and assessment were delivered over the course of next six months with special focus on building participants’ capacity on blueprinting so as to highlight the linkages between various courses and their significance through a single snapshot document. An assignment on writing single best MCQs was given as part of course on assessment and faculty gave individual feedback to participants. Finally, for the step 3- post intervention, the skills were tested in the end of program exam. A validated checklist was used to score the items on quality parameters. A total of 1800 MCQ items (600 at each step) were analyzed at these three points of intervention; and the scores obtained were compared to assess if the item writing skills had improved.

RESULTS: The average scores across three steps showed an increasing trend. The Friedman ANOVA test results indicated that there was a statistically significant difference across the three time points with a value of test statistics χ² (2, n = 600 = 955.86, P < 0.05). The Wilcoxon signed rank test showed significant differences between each pair of steps, supporting the finding of an improvement trend in the scores across all steps. Step 3 had the highest value of mean ranks (20.24 ± 0.05) and a higher median score (Md = 21). Bonferroni correction showed that at the threshold level of 0.0167, all three comparisons are still statistically significant.

CONCLUSION: Contextual engagement of participants through a longitudinal faculty development program, incorporating varied teaching techniques like individual and group work, practice and prompt feedback and peer review, improves participants’ MCQ writing skills, such that they construct MCQs that assess higher cognitive skills with fewer item writing flaws.

PMID:40234907 | DOI:10.1186/s12909-025-07081-2

Cardiovasc Diabetol. 2025 Apr 15;24(1):162. doi: 10.1186/s12933-025-02721-9.

ABSTRACT

BACKGROUND: The associations between systemic inflammation biomarkers and cardiovascular disease (CVD) remain not well explored. This study aimed to investigate associations between different systemic inflammation biomarkers and incident CVD and main CVD subtypes – ischaemic heart disease (IHD), stroke, and heart failure – explore dose-response relationships, and compare their predictive performance.

METHODS: This prospective cohort study included 423,701 UK Biobank participants free of CVD at baseline. Baseline neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and system inflammation response index (SIRI) were derived. Cox-proportional regression models were used to investigate the associations.

RESULTS: NLR, PLR, SII, and SIRI was positively and LMR was negatively associated with all four of the outcomes investigated. The relationships were non-linear for all biomarkers with CVD and were linear for NLR, SII, and SIRI and non-linear for LMR and PLR with IHD, stroke and heart failure. Compared with the more established biomarkers, all four of the novel biomarkers had statistically superior predictive performance for three of the outcomes investigated (CVD, IHD and heart failure) and three of them were superior at predicting stroke. Compared to a model of CVD prediction with classical risk factors (C-index = 0.702), discrimination was improved on the addition of inflammation markers for CVD (C-index change 0.0069, 95% CI 0.0033 to 0.0107), IHD (C-index change 0.0054, 95% CI 0.0013 to 0.0095), and heart failure (C-index change 0.0153, 95% CI 0.0089 to 0.0218).

CONCLUSIONS: There were independent and dose-response relationships between the novel systemic inflammation biomarkers and CVD outcomes. Addition of the inflammation biomarkers including novel inflammation biomarkers showed improved discrimination of the traditional risk prediction model. With accumulated evidence, these biomarkers should be considered for inclusion in risk tools and prevention.

PMID:40234895 | DOI:10.1186/s12933-025-02721-9

BMC Womens Health. 2025 Apr 16;25(1):184. doi: 10.1186/s12905-025-03708-0.

ABSTRACT

OBJECTIVE: To analyse the effect of pelvic position on ultrasonic measurement parameters of pelvic floor in postpartum women.

METHODS: This study included 132 postpartum participants who visited Fujian Maternity and Child Health Hospital from May 2020 to May 2024. All participants were assessed by medical professionals for general information and pelvic floor four dimensional ultrasound. Ultrasonic measurements were performed in three different positions of the pelvis (anterior pelvic tilt, posterior pelvic tilt, and neutral pelvic tilt) based on lithotomy position.

RESULTS: Our results indicated that the differences in the diagnosis of cystocele, uterine prolapse, perineal overactivity, and hiatal ballooning among the neutral position, anterior pelvic tilt, and posterior pelvic tilt were statistically significant (P<.001, P<.001, P<.001, and P<.001 respectively). The differences among neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt in hiatal area (during contraction), hiatal area (during rest), hiatal area (during valsalva), bladder neck descent, urethral rotation angle, cervical descent, rectal ampulla descent, hiatal area increase, and hiatal area decrease were statistically significant (P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, and P <.001 respectively), with almost all the values of those parameters in posterior pelvic tilt the highest among three groups. The differences in cervical position (at rest), rectal ampulla position (at rest), and bladder neck position (during valsalva), cervical position (during valsalva), and rectal ampulla position (during valsalva) among neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt were statistically significant (P <.001, P =.035, P <.001, P <.001, and P <.001 respectively), with almost all the values of those parameters in posterior pelvic tilt the lowest among three groups.

CONCLUSION: During the pelvic floor muscle contraction, the posterior pelvic tilt showed the most reduction of hiatal area compared to that in other positions. During Valsalva, not only the most increase of the hiatal area, but also the greatest bladder neck descent, cervical neck descent, and rectal ampulla descent were observed in the posterior pelvic tilt position.

PMID:40234893 | DOI:10.1186/s12905-025-03708-0