Tag: statistics

BMC Psychiatry. 2025 Oct 7;25(1):937. doi: 10.1186/s12888-025-07288-z.

ABSTRACT

AIMS: To investigate the impact of varying levels of chronic stress on the disease-free survival (DFS) and overall survival (OS) of patients with hepatocellular carcinoma (HCC) following curative treatment and establish a comprehensive evaluation index for chronic stress.

METHODS: Ninety HCC patients who underwent curative treatment were assessed for chronic stress using hair cortisol concentration, Stress Score, and the Perceived Stress Scale (PSS-10). The optimal cut-off values for these markers were statistically determined, and correlations among them were analyzed to create the Chronic Stress Index (CSI), which classified patients into high or low chronic stress groups. DFS and OS were compared between the groups. Additionally, a systematic review of literatures on the effects of chronic stress and cancer recurrence was conducted.

RESULTS: The optimal cut-off values of the Stress Score, PSS-10, and hair cortisol concentration were 15.30, 50.00 and 19.70 pg/mg, respectively. Patients with a CSI score of 3 to 4 were classified into the low chronic stress state (LCSS) group, whereas those scoring 5 to 6 were classified into the high chronic stress state (HCSS) group. Patients in the HCSS group had significantly reduced DFS (P < 0.001) and OS (P = 0.033) compared to the LCSS group. The systematic review identified only three clinical trials on chronic stress and cancer recurrence.

CONCLUSION: High chronic stress levels are associated with shorter DFS and OS in HCC patients. The CSI classification effectively categorized the chronic stress state, providing a novel tool for clinical evaluation.

PMID:41057786 | DOI:10.1186/s12888-025-07288-z

Can J Microbiol. 2025 Oct 7. doi: 10.1139/cjm-2025-0153. Online ahead of print.

ABSTRACT

Coinfection and secondary infection by fungi in patients with viral pulmonary infection, especially SARS-CoV-2, are important factors that worsen the prognosis and are associated to increased death rates. This work aims to report the prevalence of Candida isolates in bronchoalveolar and nasopharyngeal samples from suspected COVID-19 patients in the first-second pandemic waves and their antifungal resistance profile. From 2,321 patients, 29.04 % were diagnosed with SARS-CoV-2 infection. The yeast isolation rate of 6.97 % (47/674) from positive SARS-CoV-2 was statistically higher than 4.43% (73/1647) from negative SARS-CoV-2 patients (p=0.0177). Among yeasts, the most prevalent species was Candida albicans (63/120), with four being azole-resistant isolates (6.35%); however other emerging and less susceptible species were also isolated, such as Candida guilliermondii (11), Candida glabrata (5), Candida lusitaniae (4), Candida krusei (1), and Candida norvegensis (1). Here, we highlighted Candida prevalence in respiratory tract, emphasizing the relevance for surveillance in SARS-CoV-2/COVID patients for improvement of management as well as patient outcomes.

PMID:41056573 | DOI:10.1139/cjm-2025-0153

JMIR Form Res. 2025 Oct 7;9:e68710. doi: 10.2196/68710.

ABSTRACT

BACKGROUND: Heart valve surgery is associated with a high risk of perioperative complications. However, current approaches for predicting perioperative complications are all based on preoperative or intraoperative factors, without taking into account the fact that perioperative complications are multifactorial, dynamic, heterogeneous, and interdependent.

OBJECTIVE: We aimed to construct and quantify the association network among multiple perioperative complications to elucidate the possible evolution trajectories.

METHODS: This study used the data from China Cardiac Surgery Registry (CCSR), in which 37,285 patients were included in the analysis. A Bayesian network was used to analyze the associations among 12 complications. Score-based hill-climbing algorithms were used to build the structure and the association between them was quantified using conditional probabilities.

RESULTS: We obtained the network of valve surgery complications. A total of 13 nodes represented complications or death, and 34 arcs with arrows represented the directly dependent relationship between them. We identified clusters of complications that were logically related and not related and quantified the associations. The correlation coefficient between complications increases with the severity of the complications, ranging from 0.01 to 0.41. Meanwhile, the probability of death when multiple complications occurred was calculated. Even mild complications, when progressing to multiple organ dysfunction syndrome, result in a mortality rate of over 90%.

CONCLUSIONS: Our network facilitates the identification of associations among specific complications, which help to develop targeted measures to halt the cascade of complications in patients undergoing the valve surgery.

PMID:41056564 | DOI:10.2196/68710

Hepatology. 2025 Oct 7. doi: 10.1097/HEP.0000000000001558. Online ahead of print.

NO ABSTRACT

PMID:41056560 | DOI:10.1097/HEP.0000000000001558

Ocul Immunol Inflamm. 2025 Oct 7:1-6. doi: 10.1080/09273948.2025.2563170. Online ahead of print.

ABSTRACT

PURPOSE: To assess the association between retinal vasculitis and cerebral stroke and mortality in patients with systemic lupus erythematosus (SLE).

METHODS: Patients with SLE with and without retinal vasculitis were identified in the TriNetX research network. Initially, there were 337,411 patients with SLE and no retinal vasculitis and 570 patients with SLE and retinal vasculitis. After matching to balance age, sex, race, and cardiac risk factors, 540 patients remained in each group. Outcomes evaluated included stroke risk and mortality over a 20-year follow-up. Statistical analysis included risk ratios (RR), Kaplan-Meieranalysis, and Cox proportional hazards modeling.

RESULTS: The 1-year stroke risk was 1.9% in patients without retinal vasculitis and 4.5% with retinal vasculitis. At 5 years, risks were 4.7% and 9.1%; at 10 years, 5.6% and 13.2%; and at 20 years, 7.5% and 17.1%, respectively (p < 0.001). The average weighted stroke risk in patients with and without retinal vasculitis was 8.3% and 3.8%, respectively (RR: 2.19, 95% CI: 1.31-3.68, p = 0.002). Cox regression analysis of stroke risk showed a hazard ratio for retinal vasculitis of 2.25 (95% CI: 1.72-2.94, p < 0.001). Mortality rates over 20 years were 6.9% without retinal vasculitis and 8.3% with retinal vasculitis (RR: 1.21, 95% CI: 0.8 – 1.84, p = 0.3626).

CONCLUSIONS: The presence of retinal vasculitis in patients with SLE significantly increases the risk of stroke over a 20-year period, highlighting the importance of early identification and timely referral of this group of patients.

PMID:41056537 | DOI:10.1080/09273948.2025.2563170

J Trauma Nurs. 2025 Sep 30. doi: 10.1097/JTN.0000000000000884. Online ahead of print.

ABSTRACT

BACKGROUND: The Glasgow Coma Scale has been a standard tool for assessing consciousness in trauma patients for five decades, but its utility is limited by the omission of brainstem reflexes such as pupillary response.

OBJECTIVE: This study aimed to compare the prognostic accuracy of the Pediatric Glasgow Coma Scale (pGCS) and the Pediatric Glasgow Coma Scale – Pupils Score (pGCS-P) in predicting mortality and functional outcomes among pediatric patients with traumatic brain injury (TBI).

METHODS: This single-center observational cohort study was conducted from May 2022 to May 2023 at Bursa Training and Research Hospital, Health Sciences University, Turkey. Pediatric patients (age <18 years) presenting with TBI were evaluated for level of consciousness and pupillary responses on admission. Both the pGCS and pGCS-P scores were calculated for each patient. For patients with anisocoria but preserved light reflexes in both pupils, scoring adjustments were made.

RESULTS: Of the 134 patients studied, 59.7% were male, and the mean (SD) age was 6.3 (5.4) years. In-hospital mortality was 12.7%, and 5.1% had unfavorable functional outcomes (UFOs) at discharge. Both the pGCS-P and pGCS demonstrated excellent ability to predict mortality (AUC, 0.97, 95% CI: 0.94-0.99 and 0.97, 95% CI: 0.94-0.96, respectively). There was no statistically significant difference in prognostic performance between the two scores using either binomial (p = .165) or nonparametric (p = .445) analyses (p >.05).

CONCLUSIONS: In pediatric patients with TBI, the prognostic accuracy of the pGCS with pupil response (pGCS-P) was comparable to that of the pGCS alone for predicting mortality and UFOs. Incorporation of the pupil score did not significantly improve prognostic discrimination in this cohort.

PMID:41056536 | DOI:10.1097/JTN.0000000000000884

Hum Vaccin Immunother. 2025 Dec;21(1):2569738. doi: 10.1080/21645515.2025.2569738. Epub 2025 Oct 7.

ABSTRACT

Female nursing students show high intention yet low uptake of HPV vaccination, which undermines cervical cancer prevention efforts. To examine the mechanisms influencing their vaccination behavior, this study developed and validated an intention-behavior transition model based on Protection Motivation Theory, thereby providing a theoretical foundation for designing targeted interventions and improving vaccination coverage. A total of 631 female nursing students from universities in Wuhan were selected by the convenience sampling method and were surveyed using a General Information Questionnaire, Protection Motivation Questionnaire, and HPV Vaccination Willingness and Behavior Questionnaire, and a structural equation model was constructed using AMOS 24.0 software. 69.3% of the 631 female nursing students had HPV vaccination intention, and 13.3% had vaccination behavior. The results of structural equation model fitting showed that threat appraisal significantly affected female nursing students’ willingness to receive HPV vaccination (β = 0.209, P < .002) and behavior (β = -0.198, P = .002). Coping appraisal significantly influenced their willingness to vaccinate (β = -0.085, P < .008) and behavior (β = -0.170, P < .001). Willingness to vaccinate significantly influenced vaccination behavior (β = 0.627, P < .001). The Protection Motivation Theory is applicable for explaining the decision-making mechanism regarding HPV vaccination among female nursing students, as both threat appraisal and coping appraisal collectively influence the intention-behavior transition process. This study provides theoretical support for formulating immunization promotion policies targeted at this population; however, future research should expand sample diversity to enhance the generalizability of the findings.

PMID:41056529 | DOI:10.1080/21645515.2025.2569738

PLoS Genet. 2025 Oct 7;21(10):e1011848. doi: 10.1371/journal.pgen.1011848. Online ahead of print.

ABSTRACT

Investigation of the cellular and molecular mechanisms of disease progression from precursor plasma cell disorders to active disease increases our understanding of multiple myeloma (MM) pathogenesis and supports the development of novel therapeutic strategies. In this analysis, single-cell RNA sequencing, surface protein profiling, and B lymphocyte antigen receptor profiling of unsorted, whole bone marrow (BM) mononuclear cell samples was used to study molecular changes in tumor cells and the tumor microenvironment (TME). A cell atlas of the BM microenvironment was generated from 123 subjects including healthy volunteers and patients with monoclonal gammopathy of unknown significance (MGUS), smoldering MM (SMM), and MM. These analyses revealed commonalities in molecular pathways, including MYC signaling, E2F targets and interferon alpha response, that were altered during disease progression. Evidence of early dysregulation of the immune system in MGUS and SMM, which increases and impacts many cell types as the disease progresses, was found. In parallel with disease progression, population shifts in CD8 + T cells, macrophages, and classical dendritic cells were observed, and the resulting differences in CD8 + T cells and macrophages were associated with poor overall survival outcomes. Potential ligand-receptor interactions that may play a role during the transition from precursor stages to MM were identified, along with potential biomarkers of disease progression, some of which may represent novel therapeutic targets. MIF, IL15, CD320, HGF and FAM3C were detected as potential regulators of the TME by plasma cells, while SERPINA1 and BAFF (TNFSF13B) were found to have the highest potential to contribute to the downstream changes observed between precursor stage and MM cells. These findings demonstrate that myeloma tumorigenesis is associated with dysregulation of molecular pathways driven by gradually occurring immunophenotypic changes in the tumor and TME. Trial registration: This project has been registered at EudraCT (European Union Drug Regulating Authorities Clinical Trials Database) with protocol number NOPRODMMY0001 and EudraCT Number 2018-004443-23 on 12 December 2018.

PMID:41056512 | DOI:10.1371/journal.pgen.1011848

Hepatol Commun. 2025 Oct 7;9(11):e0824. doi: 10.1097/HC9.0000000000000824. eCollection 2025 Nov 1.

ABSTRACT

BACKGROUND: Large epidemiologic studies of autoimmune hepatitis (AIH) in the United States are limited. None have reported prevalence trends over time. This contemporary study examines AIH prevalence and demographic trends over 10 years in a community-based integrated healthcare system in Northern California. We further assessed whether prevalence trends differed by AIH ascertainment approach.

METHODS: This retrospective study used data from adults aged ≥18 years in Kaiser Permanente Northern California (2010-2019). AIH was identified by coded diagnosis and confirmed with diagnostic testing (laboratory and/or liver biopsy) and treatment response. Annual AIH prevalence was estimated and stratified by age, sex, and race/ethnicity.

RESULTS: Among 1129 patients with confirmed AIH, 80% were female, 44% non-Hispanic White, 26% Hispanic, 16% Asian/Pacific Islander, and 9% Black. In all, 76% of patients on AIH treatment demonstrated treatment response at 6 months. AIH prevalence (per 100,000 adults) increased from 9.1 in 2010 to 18.8 in 2019 (p<0.0001). Prevalence among older adults (≥75 years) quadrupled from 10.1 to 43.7 per 100,000. Prevalence rose among all ethnicities and in 2019 was highest for Black (28.9) and Hispanic populations (25.2) per 100,000.

CONCLUSIONS: AIH prevalence doubled over 10 years in a large healthcare system, with pronounced increases among older populations. Prevalence was highest among Black and Hispanic adults. Further studies should examine demographic differences in the clinical course of AIH, including response to therapy, adverse events, and outcomes.

PMID:41056496 | DOI:10.1097/HC9.0000000000000824

Mol Biol Evol. 2025 Oct 7:msaf253. doi: 10.1093/molbev/msaf253. Online ahead of print.

ABSTRACT

Bayesian phylogeographic inference is widely used in molecular epidemiological studies to reconstruct the dispersal history of pathogens. Discrete phylogeographic analysis treats geographic locations as discrete traits and infers lineage transition events among them, and is typically followed by a Bayes factor (BF) test to assess the statistical support. In the standard BF (BFstd) test, the relative abundance of the involved trait states is not considered, which can be problematic in the case of unbalanced sampling. Existing methods to correct sampling bias in discrete phylogeographic analyses using continuous-time Markov chain (CTMC) model, often require additional epidemiological information to balance the sampling effort among locations. As such data is not necessarily available, alternative approaches that rely solely on available genomic data are needed. In this perspective, we assess the performance of a modification of the BFstd, the adjusted Bayes factor (BFadj), which incorporates information on the relative abundance of samples by location when inferring support for transition events and root location inference without requiring additional data. Using a simulation framework, we assess the statistical performance of BFstd and BFadj under varying levels of sampling bias, estimating their type I and type II error rates. Our results show that BFadj complements the BFstd by reducing type I errors at the cost increasing type II errors for inferred transition events, while improving type I and type II errors in root location inference. Our findings provide guidelines for implementing the complementary BFadj to detect and mitigate sampling bias in discrete phylogeographic inference using CTMC modelling.

PMID:41056469 | DOI:10.1093/molbev/msaf253