Tag: statistics

J Orthop Surg Res. 2025 Nov 12;20(1):992. doi: 10.1186/s13018-025-06428-1.

ABSTRACT

BACKGROUND: Osteochondral lesions of the talus (OLTs) are common ankle injuries that can cause chronic pain and reduced function when conservative treatment fails. For larger lesions, autologous osteochondral transplantation (AOT) restores the joint surface with hyaline cartilage while offering reliable outcomes. While factors such as lesion size and age affect outcomes, the impact of cigarette smoking remains unclear. This study aimed to assess whether smoking adversely affects long-term outcomes after AOT for OLTs.

METHODS: This retrospective cohort study included 78 patients who underwent AOT between 2015 and 2019, with a minimum follow-up of five years (mean: 100.4 ± 14.7 months). Patients were categorized as smokers (n = 30) or non-smokers (n = 48). Clinical status was assessed using the visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Score (AOFAS), Tegner Activity Scale (pre- and post-op), and Foot and Ankle Outcome Score (FAOS). Statistical tests included the Mann-Whitney U test, Wilcoxon signed-rank test, chi-square test, and Spearman’s correlation analysis, with the significance level set at p < 0.05.

RESULTS: Both groups demonstrated significant improvement in VAS, AOFAS, and Tegner scores postoperatively (p < 0.001). Non-smokers had significantly better outcomes in VAS (p = 0.011), AOFAS (p = 0.008), and FAOS (p = 0.018). Postoperative Tegner scores did not differ significantly (p = 0.498). Baseline characteristics, lesion size, and complication rates were similar between groups. A moderate negative correlation was detected between pack-years and both FAOS (r = – 0.475, p = 0.008) and AOFAS (r = – 0.470, p = 0.009) scores.

CONCLUSIONS: Autologous osteochondral transplantation leads to statistically significant improvements in pain and functional scores in both smokers and non-smokers. However, smoking is associated with higher residual pain and poorer functional outcomes at midterm follow-up, despite no significant differences in activity levels based on Tegner scores. Preoperative smoking cessation should be encouraged in patients undergoing cartilage repair.

LEVEL OF EVIDENCE: Level III, retrospective comparative study.

PMID:41225542 | DOI:10.1186/s13018-025-06428-1

BMC Pediatr. 2025 Nov 12;25(1):927. doi: 10.1186/s12887-025-06115-4.

ABSTRACT

BACKGROUND: Childhood asthma is a prevalent chronic respiratory disease. While inhaled corticosteroids and β-agonists remain cornerstone treatments, growing evidence highlights the complementary role of non-pharmacological interventions in improving asthma outcomes. This study aimed to systematically evaluate the efficacy of diverse non-pharmacological approaches through a network meta-analysis (NMA).

METHODS: Seven English and Chinese databases were searched from their inception to April 1, 2025, for randomized controlled trials (RCTs) related to non-pharmacological intervention in childhood asthma. The risk of bias was assessed using the Cochrane risk of bias tool (ROB). Network meta-analysis was conducted using R 4.2.0 and Stata 14.0 software.

RESULTS: A total of 41 studies with 3164 participants were included. Involved structured exercise programs, controlled breathing techniques, traditional moxibustion therapy, psychological interventions, and traditional therapeutic massage adjuvant treatment measures. Five asthma outcome indicators were focused on: FEV1, FVC, PEF, PAQLQ, and FeNO. The ROB was low in the included studies. The NMA of two-by-two comparisons showed that all non-pharmacological adjunctive interventions were able to improve asthma symptoms better, with exercise training improving FEV1 (MD = 3.67, 95%CI [1.39, 5.95]), PEF (MD = 6.07, 95%CI [1.07, 11.07]), and PAQLQ (MD = 0.93, 95%CI [0.33, 1.52]) with statistical significance (p < 0.05).

CONCLUSION: Five non-pharmacological interventions for childhood asthma demonstrated consistent efficacy across all modalities in alleviating asthma symptoms. Psychological interventions emerged as the optimal adjunctive therapy for improving FEV1, while exercise training exhibited the most potent therapeutic effect on FVC. Furthermore, massage therapy demonstrated superior efficacy in enhancing PEF, PAQLQ scores, and FeNO levels.

PMID:41225527 | DOI:10.1186/s12887-025-06115-4

Syst Rev. 2025 Nov 12;14(1):222. doi: 10.1186/s13643-025-02979-w.

ABSTRACT

BACKGROUND: Sepsis remains a major global health issue, especially in low- and middle-income countries (LMICs) with limited diagnostic resources. This meta-analysis evaluates platelet index ratios (mean platelet volume-to-platelet count, MPV/PLT; platelet distribution width-to-platelet count, PDW/PLT; and platelet distribution width-to-plateletcrit, PDW/PCT) as cost-effective biomarkers for sepsis diagnosis and prognosis in resource-constrained settings.

METHODS: A systematic search was conducted for studies evaluating platelet parameter ratios in sepsis. Inclusion criteria comprised the following: (1) cohort/case-control designs; (2) non-duplicated datasets; (3) available quantitative data for meta-analysis. Exclusion criteria included reviews, abstracts, letters to the editor, and studies with incomplete data. Synthesis methods employed random-effects models to calculate standardized mean differences (SMD) and diagnostic metrics (sensitivity, specificity, etc.), with heterogeneity assessed via I-squared statistics. Publication bias was evaluated through funnel plots and Egger’s test.

RESULTS: Fourteen studies were included. The results revealed that MPV/PLT ratios were significantly higher in neonatal (SMD = 1.48, P = 0.004) and adult sepsis patients (SMD = 0.35, P < 0.001) than in controls. Survivors had significantly lower MPV/PLT ratios than non-survivors in both children/neonate (SMD = 0.67, P < 0.01) and adult group (SMD = 0.41, P < 0.01), with similar trends observed in longitudinal assessments. PDW/PLT was also lower in pediatric survivors (P = 0.009), while no significant differences were found for MPV/PCT in neonates or PDW/PLT in adults. For diagnosing sepsis, MPV/PLT had a sensitivity of 0.55 and specificity of 0.71 in adults, and 0.58 and 0.87 in neonates. For predicting mortality, neonatal sepsis showed higher sensitivity (89%) and specificity (73%) than adult sepsis (63%, 58%). In LMICs, MPV/PLT was elevated at admission in both age groups but was linked to survival only in neonates.

CONCLUSION: The MPV/PLT ratio shows promise as a cost-effective biomarker for sepsis diagnosis and prognosis, particularly in neonatal patients, with important potential applications in LMICs.

SYSTEMATIC REVIEW REGISTRATION: This study has been registered on the international platform of registered systematic review and meta-analysis protocols (INPLASY) (Registration Number: INPLASY202540096). https://doi.org/10.37766/inplasy2025.4.0096 .

PMID:41225524 | DOI:10.1186/s13643-025-02979-w

Virol J. 2025 Nov 12;22(1):373. doi: 10.1186/s12985-025-02999-x.

ABSTRACT

PURPOSE: Present study aimed to compare the boiling and magnetic bead nucleic acid extraction method for HPV genotypes detection.

METHODS: By mixing hemoglobin with HPV positive quality control products, the anti-interference ability of two nucleic acid extraction methods on hemoglobin was simulated. Subsequently, on the basis of paired small sample and longitudinal large sample comparisons, the HPV detection rates between the boiling and magnetic bead-based method were evaluated. Finally, the cost-benefit comparisons of the two extraction methods were further evaluated. A two-sided P value of less than 0.05 was considered statistically significant.

RESULTS: As for boiling method, when the hemoglobin concentration exceeded 30 g/L, HPV positive control could not be detected, nevertheless, the HPV positive control can still be detected even when the hemoglobin concentration reached 60 g/L for magnetic bead method. In the paired small-scale (639 cases) experiment, results indicated that the positive detection rate of HPV using the magnetic bead method was significantly higher than that of the boiling method, with positive rates of 20.66% and 10.02% (P < 0.001), respectively. Additionally, in the longitudinal large-scale analysis (16540 cases) reached the same conclusion. Compared with boiling method, the cost of magnetic bead method increased by 13.14%, however, the detection rate of HPV increased by 106.19%.

CONCLUSION: Compared to the boiling method, the magnetic bead-based nucleic acid extraction technique exhibited superior anti-interference capabilities and a significant higher detection rate for HPV. Furthermore, it is highly cost-effective. It is anticipated that the magnetic bead method will be fully adopted for HPV detection in place of the boiling method in the future. Of course, more research is needed to verify this conclusion.

PMID:41225522 | DOI:10.1186/s12985-025-02999-x

BMC Endocr Disord. 2025 Nov 13;25(1):262. doi: 10.1186/s12902-025-02081-1.

ABSTRACT

BACKGROUND: The estimated glucose disposal rate (eGDR), a novel composite indicator for assessing insulin resistance (IR), remains underexplored for its ability to predict the risk of chronic kidney disease (CKD) in individuals with diabetes or prediabetes.

METHOD: A total of 17,595 patients with diabetes or prediabetes from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018 were included. CKD is defined based on the estimated glomerular filtration rate and the urine albumin-to-creatinine ratio. The calculation of eGDR is based on the waist circumference, hypertension status and glycated hemoglobin. Multivariable logistic regression was used to evaluate the association between eGDR and CKD. Restricted cubic spline (RCS) regression was used to assess dose-response relationships. Subgroup analysis explores the differences in effects among different populations. Mediating analysis was used to quantify the role of serum uric acid (SUA) in the eGDR-CKD association. Receiver operating characteristic curve (ROC) curves were used to compare the predictive performance of eGDR with that of other IR indices.

RESULTS: After full adjustment, the eGDR showed a significant inverse association with CKD risk. The RCS curves confirmed a linear negative relationship between eGDR and CKD. Subgroup analysis revealed stronger associations in men. Mediation analysis indicated that SUA partially mediated the eGDR-CKD association, accounting for 6.2% of the total effect. ROC analysis revealed that the eGDR shad a moderate predictive ability for CKD in patients with diabetes or prediabetes.

CONCLUSION: This cross-sectional study confirmed that the eGDR is linearly negatively correlated with CKD in a population with diabetes or prediabetes and that its discriminative power is moderate but superior to that of traditional IR indicators. The statistical overlap of SUA on the total association was approximately 6.2%, but the mediating effect was fragile. This finding should be verified in prospective cohorts in the future.

PMID:41225507 | DOI:10.1186/s12902-025-02081-1

BMC Med Educ. 2025 Nov 12;25(1):1587. doi: 10.1186/s12909-025-07866-5.

ABSTRACT

OBJECTIVE: This study examines the relationship among medical students’ academic achievement, self-regulated learning, and critical thinking ability.

METHODS: This study employed a cross-sectional analytical design involving 120 medical students. The Critical Thinking Tools (CriTT) questionnaire, validated instrument for measuring critical thinking skills, was used. Academic achievement was assessed using Grade Point Average (GPA), and self-regulated learning was evaluated using the Motivated Strategies for Learning Questionnaire (MSLQ). Data analysis included Spearman’s rank correlation and multiple linear regression using SPSS version 24 to examine association between variables with statistical rigor.

RESULTS: This study shows that the respondents demonstrated an average critical thinking score of 198.13 ± 25.14. The average GPA of the respondents was 3.60 ± 0.16. The respondents exhibited an average self-regulated learning score of 184.12 ± 19.68. Bivariate analysis showed significant relationships between critical thinking ability and self-regulated learning (p = 0.000).

CONCLUSION: The findings highlight the significant role of self-regulated learning in fostering critical thinking, whereas academic achievement, as measured by GPA, was not a significant predictor. These insights advocate for pedagogical reforms in medical education to nurture reflective and analytical learning environments.

PMID:41225506 | DOI:10.1186/s12909-025-07866-5

Nutr J. 2025 Nov 12;24(1):171. doi: 10.1186/s12937-025-01241-2.

NO ABSTRACT

PMID:41225494 | DOI:10.1186/s12937-025-01241-2

BMC Oral Health. 2025 Nov 12;25(1):1777. doi: 10.1186/s12903-025-07024-9.

ABSTRACT

BACKGROUND: Postoperative pain is a common occurrence following root canal treatment, with reported incidence ranging from 3% to 58%. Contributing factors include insufficient canal debridement, extrusion of debris, and limitations in irrigation. While mechanical instrumentation aids in reducing microbial load, effective irrigation is essential for cleaning anatomically complex areas. The XP-Endo Finisher (XPF) is an innovative instrument designed to enhance irrigation efficacy. This study aimed to compare postoperative pain outcomes following final irrigation with either the XP-Endo Finisher or conventional needle irrigation in patients diagnosed with symptomatic irreversible pulpitis.

METHODS: A double-blind randomized controlled trial was conducted on 80 systemically healthy patients aged 18 years and above, presenting with symptomatic irreversible pulpitis and preoperative pain scores ≤ 3 on the Numerical Rating Scale (NRS-11). Participants were randomly assigned to two equal groups: final irrigation using either the XP-Endo Finisher or traditional needle irrigation. Patients with recent analgesic use, non-restorable teeth, or known NSAID allergies were excluded. Root canal therapy was completed in two visits. Postoperative pain levels were recorded at 6 h, 12 h, 24 h, and daily up to 7 days using the NRS-11. Statistical analysis involved descriptive statistics, normality checks, and non-parametric tests for group comparisons.

RESULTS: At 6 h, the difference in pain scores between the groups was not statistically significant (XP-Endo Finisher: 2.40 ± 1.77; Needle: 1.73 ± 1.52; p = 0.090). However, significantly lower pain was reported in the XP-Endo Finisher group at 12 h (p = 0.044) and on day 2 (p = 0.027). No significant differences were observed from day 3 to day 7. Analgesic intake was comparable across both groups (p > 0.05).

CONCLUSIONS: The XP-Endo Finisher resulted in reduced early postoperative pain compared to needle irrigation at specific time points, although both methods showed similar outcomes in long-term pain resolution and analgesic consumption. Improved irrigant activation may influence short-term postoperative comfort.

TRIAL REGISTRATION: This trial was retrospectively registered with the Kasturba Hospital Institutional Ethics Committee (KH IEC) under registration number 860/2020, dated 19/03/2021. It was also registered in the Clinical Trials Registry – India (CTRI) under registration number CTRI/2021/04/032667, dated 08/04/2021.

PMID:41225492 | DOI:10.1186/s12903-025-07024-9

BMC Public Health. 2025 Nov 12;25(1):3916. doi: 10.1186/s12889-025-25228-0.

ABSTRACT

BACKGROUND: Cardiometabolic Kidney Syndrome (CKM) is a global chronic disease challenge. While links between socioeconomic status (SES) and individual CKM components exist, research often overlooks CKM’s multi-system interactions and the role of psychosocial factors. Depression, prevalent in low SES groups and linked to CKM risk, may mediate the SES-CKM relationship.

METHODS: Using 2005-2018 NHANES data with 11,367 participants, this study quantified SES via the family poverty-income ratio (PIR), assessed depressive symptoms with the PHQ-9 scale, and defined CKM per AHA criteria. Statistical analyses included multivariable logistic regression and structural equation modeling to examine associations and mediating effects.

RESULTS: High SES was associated with 81% lower odds of advanced CKM (OR = 0.19, 95% CI: 0.10-0.36). Each unit increase in PIR was associated with 33% lower odds of depression (OR = 0.67, 95% CI: 0.63-0.72). Depression mediated 27.64% of the SES-advanced CKM link. A nonlinear threshold effect between SES and depression was found at PIR = 3.28, with subgroup analyses highlighting stronger SES-CKM associations in non-Hispanic Blacks and Whites.

CONCLUSION: Socioeconomic disadvantage is significantly associated with depressive symptoms and advanced CKM in this cross-sectional study. Depressive symptoms may play a substantial mediating role based on structural equation modeling of observational data. These findings suggest that incorporating mental health interventions into CKM prevention strategies and implementing targeted policies to address health inequities could potentially enhance health equity. Future prospective studies are needed to validate these findings before refining the CKM prevention framework.

PMID:41225483 | DOI:10.1186/s12889-025-25228-0

BMC Musculoskelet Disord. 2025 Nov 12;26(1):1039. doi: 10.1186/s12891-025-09277-5.

ABSTRACT

PURPOSE: Most of the previous meta-analyses examining the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on preventing heterotopic ossification (HO) following total hip arthroplasty (THA) have separately analyzed Brooker’s classification I, II, III, and IV which may misrepresent their ordinal nature. We therefore applied a Bayesian network meta-regression that incorporates the ordinal nature of Brooker’s classification to more robustly assess NSAID efficacy and determine the optimal regimen.

METHODS: We searched the Cochrane Library, Embase, and PubMed for randomized controlled trials (RCTs). Cumulative regressions were conducted for ordinal variants to generate Napierian Logarithm odds ratios (lnOR) and the standard error of lnOR (selnOR) for each study. Subsequently these data were used to conduct Bayesian network meta-analysis and further network meta-regression to generate pairwise ORs, showing pairwise effect sizes (ESs).

RESULTS: 17 studies (5436 patients,14 regimens) were eligible. In the raw data analysis, celecoxib 400 mg/d, etoricoxib 90 mg/d, ibuprofen 1200 mg/d, indomethacin 75 mg/d, indomethacin 100 mg/d, indomethacin 150 mg/d, meloxicam 7.5 mg/d, meloxicam 15 mg/d, and naproxen 750 mg/d were conspicuously effective (OR: 0.048 ~ 0.351) compared with placebo. The ESs were comparable among these regimens except for ibuprofen 1200 mg/d, which was inferior to indomethacin 100 mg/d (OR = 0.382, 95%CI: 0.171 to 0.887) and indomethacin 150 mg/d (OR = 0.136, 95%CI: 0.020 to 0.970). In the network meta-regression analysis, after adjusting for follow-up time, the significance of diclofenac 150 mg/d (OR = 0.102, 95%CI: 0.013 to 0.835) emerged compared with placebo. The results of effective regimens aforementioned resembled the initial findings (OR: 0.039 ~ 0.249). All the effective agents, including diclofenac 150 mg/d, were comparable in ESs.

CONCLUSIONS: Considering the efficacy of preventing HO following THA observed in our research, together with analgesic effect and gastrointestinal tract safety from previous literature, etoricoxib 90 mg/d is recommended as the optimal choice for patient undergoing THA. More head-to-head and long-term studies are needed.

PMID:41225475 | DOI:10.1186/s12891-025-09277-5