Tag: statistics

J Back Musculoskelet Rehabil. 2025 Dec 15:10538127251406955. doi: 10.1177/10538127251406955. Online ahead of print.

ABSTRACT

BackgroundIndividuals with low back pain (LBP) exhibit altered diaphragm function and poor psychological health. Chronic maladaptation of diaphragm activity has been linked to impaired emotional and physical well-being; however, no study has directly examined whether self-reported disability contributes to diaphragm function in LBP.ObjectiveTo compare ultrasonographic measures of diaphragm function in the standing position between young male participants with and without LBP and examine the associations between patient-oriented measures of physical function and psychological status and diaphragm function in those with LBP.MethodsA cross-sectional comparative study was conducted involving 22 young males with LBP and 17 healthy controls. Six validated questionnaires assessed physical and psychological status. Ultrasonography quantified bilateral diaphragmatic contractility and right hemidiaphragm excursion in the standing position.ResultsParticipants with LBP exhibited significantly lower contractility in both hemidiaphragms than controls (p < 0.05). The strongest predictor of right hemidiaphragm contractility was the mental component summary of the Short Form-36 (R² = 0.356, p = 0.003). The combination of social life dysfunction and pain-related disorder domains in the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire explained 25.0% of the variance in left hemidiaphragm contractility (R² = 0.250, p = 0.065). While the regression model of the left hemidiaphragm contractility approached statistical significance (p = 0.065), it did not meet our criterion alpha (0.05).ConclusionReduced diaphragm contractility in standing posture may be associated with poorer psychological health in young males with LBP. These findings suggest diaphragm dysfunction as a potential contributor to the multidimensional burden of LBP. Larger, prospective studies including females are warranted to clarify these associations.

PMID:41396527 | DOI:10.1177/10538127251406955

World J Urol. 2025 Dec 15;44(1):43. doi: 10.1007/s00345-025-06135-w.

ABSTRACT

PURPOSE: Individuals with neurogenic lower urinary tract dysfunction after spinal cord injury should undergo regular scintigraphy to assess renal function. However, renal scintigraphy entails radiation exposure and is not widely available. Consequently, reliable alternative diagnostic parameters are needed. We have, thus, investigated whether renal sonography and cystatin-C measurements are consistent with renal scintigraphy results in this population.

METHODS: Adult individuals with chronic spinal cord injury (duration ≥ 5 years) underwent renal sonography and cystatin-C measurement during routine consultation, followed by renal scintigraphy within six weeks. The correlation between renal sonographic parameters (arterial resistive index, renal parenchymal thickness, and kidney dimensions), serum cystatin-C, and scintigraphy clearance values was assessed using Pearson and Spearman’s rank correlation coefficients. Furthermore, the classification accuracy (for scintigraphy clearance ≤ 150 ml/min) of variables with statistically significant correlation coefficients was investigated.

RESULTS: Data of 8 women and 42 men (54 ± 14 years old; duration spinal cord injury 24.4 ± 14.6 years) were analyzed. There was a fair correlation between scintigraphy clearance and cystatin-C levels (r = -0.37, p = 0.013) as well as left renal resistive index (r = -0.44, p = 0.002). However, there were no correlations between scintigraphy clearance and renal parenchymal thickness (p > 0.45) as well as kidney dimensions (p > 0.13). Cystatin-C and left renal resistive index showed good classification performance (area under curve = 0.74/0.84, p < 0.00001).

CONCLUSION: Individuals with reduced renal function can be identified reliably using cystatin-C serum concentration and renal arterial resistance. These parameters may serve as additional diagnostic parameters to assess renal function and to determine whether scintigraphy examination is required.

CLINICAL TRIAL REGISTRATION: NCT04241666.

PMID:41396487 | DOI:10.1007/s00345-025-06135-w

Childs Nerv Syst. 2025 Dec 15;41(1):417. doi: 10.1007/s00381-025-07061-3.

ABSTRACT

INTRODUCTION: Co-existence of Dandy Walker malformation (DWM) and occipital encephalocele (OE) is extremely unique, and only a limited number of cases have been documented in literature. Their rarity poses distinct diagnostic and therapeutic challenges across the prenatal-postnatal continuum.

OBJECTIVES: To describe the correlation of these two diverse congenital disorders, and to perform a systematic review of the existing literature.

METHODOLOGY: Retrospective review of prospectively maintained database identified 5/128 DWM + OE patients (3.9%) managed between 2012 and 2024. Several parameters were noted and appropriate analysis was performed. Systematic literature review following PRISMA guidelines identified 79 cases for pooled comparison.

RESULTS: Mean age was 5.6 ± 2.41 months; male-to-female ratio 4:1. Four were first-order children, requiring NICU admission with all having delayed milestones. Two had significant microcephaly while one had macrocephaly. Giant sized OE was seen in four cases. On follow-up, two cases (40%) subsequently developed age-appropriate milestones. Systematic review confirmed significant statistical correlation between patients who underwent only repair vs patient who were shunted ± repair; the cases that were shunted fared better (p-value0.03).

CONCLUSION: VP/CP shunt is essential in surgical management leading to better prognosis as compared to repair alone. Giant size of OE/OM and associated anomalies may also dictate long-term outcomes. We affirmed that the pathophysiology resulting in hydrocephalus and OE/OM in DWM to be co-dependent. Our experience adds to this limited pool of data and our analysis of the largest studied number of cases in literature to date provides comprehensive insights into the clinical implications of this association.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41396485 | DOI:10.1007/s00381-025-07061-3

World J Urol. 2025 Dec 15;44(1):41. doi: 10.1007/s00345-025-06137-8.

ABSTRACT

PURPOSE: Thiazide (THZ) and thiazide-like (TL) diuretics are routinely prescribed and considered to be the gold-standard prophylaxis for kidney stones (KS) recurrence in current guidelines despite having limited evidence. Thus, we aimed to investigate the efficacy and safety of different doses of THZ and TL diuretics in preventing KS recurrence.

METHODS: We searched for randomised controlled trials in PubMed, Web of Science, Embase, CENTRAL, and clinical trials registries from their inception through January 2025. The clinical or radiological KS recurrence was the primary endpoint, while the occurrence of adverse effects at any time was the secondary endpoint. We estimated odds ratio (OR) in a frequentist random-effects network meta-analysis with P < 0.05. This study was prospectively registered (CRD42025650062).

RESULTS: Nine trials (n = 999) were included. Chlorthalidone 50 mg/d (OR: 0.18, 95% confidence interval [CI] 0.04-0.88), hydrochlorothiazide 50 mg/d (OR: 0.52, CI 0.29-0.93), and trichlormethiazide 4 mg/d (OR: 0.26, CI 0.10-0.68) were different from placebo in terms of KS recurrence. There was no evidence of dose-dependent effect when comparing hydrochlorothiazide 50 mg/d to 12.5 mg/d (OR: 0.58, CI 0.25-1.34) or 25 mg/d (OR: 0.65, CI 0.28-1.48), nor comparing chlorthalidone 50 mg/d to 25 mg/d (OR: 0.80, CI 0.12-5.20). Only trichlormethiazide 4 mg/d (OR: 49.96, CI 1.78-1 402.80) provoked more adverse effects than placebo.

CONCLUSION: Although some therapies were statistically different from placebo, the current evidence does not support their use in preventing KS recurrence due to several limitations, indicating that THZ and/or TL diuretics should not be routinely prescribed. Further well-designed trials are urgently needed to address head-to-head comparisons and provide high-quality evidence.

PMID:41396435 | DOI:10.1007/s00345-025-06137-8

J Craniofac Surg. 2025 Nov-Dec 01;36(8):2805-2810. doi: 10.1097/SCS.0000000000011828. Epub 2025 Oct 28.

ABSTRACT

BACKGROUND: Cranial vault remodeling (CVR) for craniosynostosis is associated with high transfusion rates and related complications, yet factors contributing to transfusion risk remain incompletely defined. This study aimed to identify patient-level and procedure-level predictors of transfusion and assess their association with postoperative outcomes.

METHODS: This retrospective cohort study used the 2012 to 2023 ACS NSQIP-Pediatric database to identify patients aged 2 and under who underwent cranial vault remodeling for craniosynostosis using CPT and ICD codes. The authors examined demographic, comorbidity, preoperative laboratory, intraoperative, and postoperative data. Perioperative blood transfusion was predicted using various supervised machine learning algorithms: logistic regression, naive Bayes, K-nearest neighbors, decision trees, random forests, and extreme gradient boosting. Model performance was assessed in training and testing phases for discrimination, calibration, and clinical utility.

RESULTS: A total of 10,732 patients were identified, of which 5781 (53.9%) received a perioperative blood transfusion. The mean age of the blood transfusion group was 8.53 months compared with 5.71 months for the no transfusion group (P<0.001). Multivariable logistic regression revealed that longer anesthesia duration (aOR: 2.07, 95% CI: 1.76-2.44) was significantly associated with increased odds of transfusion. Conversely, factors associated with lower odds of transfusion included higher preoperative hematocrit (aOR: 0.94, 95% CI: 0.89-0.99), along with minimally invasive surgery (aOR: 0.34, 95% CI: 0.13-0.87) and combination approaches (aOR: 0.34, 95% CI: 0.16-0.70) compared with open procedures. The logistic regression model demonstrated the highest discriminative performance (AUC=0.787), with comparable results observed for the random forest model (AUC=0.777). Key predictors identified included anesthesia duration, age, weight, preoperative albumin, platelet count, serum creatinine, hematocrit, and white blood cell count.

CONCLUSION: Patients undergoing craniosynostosis repair are at increased risk for transfusion based on age, comorbidities, surgical approach, and ethnicity. These findings highlight the need for early intervention and strategies to reduce transfusion risk in vulnerable populations.

PMID:41396426 | DOI:10.1097/SCS.0000000000011828

J Craniofac Surg. 2025 Nov-Dec 01;36(8):e1238-e1242. doi: 10.1097/SCS.0000000000012012. Epub 2025 Oct 28.

ABSTRACT

OBJECTIVE: This study aims to assess the effectiveness of combining cognitive behavioral therapy (CBT) and acupoint application for sleep disorders in patients with benign paroxysmal positional vertigo (BPPV), and to contribute evidence for multimodal strategies in managing sleep-vestibular comorbidities within an integrative medicine model.

METHODS: A total of 120 patients with BPPV and comorbid sleep disorders were randomly assigned, using a random number table, to 1 of 3 groups (n=40 per group): (1) control group, which received canalith repositioning maneuvers alone, (2) acupoint application group, which received canalith repositioning combined with acupoint therapy, and (3) the combined treatment group, which received acupoint therapy along with CBT. Primary outcomes included the Pittsburgh Sleep Quality Index (PSQI), dizziness handicap inventory (DHI), and total traditional Chinese medicine (TCM) syndrome score. Assessments were conducted at baseline, 1 week, 2 weeks, and 1 month post-intervention.

RESULTS: The combined treatment group demonstrated significantly greater overall clinical efficacy compared with both the acupoint application and the control group (P<0.05). No statistically significant differences were observed among the groups in baseline PSQI, DHI, and TCM syndrome scores (P>0.05). Post-treatment evaluations revealed significant reductions in PSQI, DHI, and TCM syndrome scores in the combined treatment group compared with the other 2 groups (P<0.05).

CONCLUSIONS: The integration of CBT with acupoint application significantly improved sleep quality, vestibular function, and overall quality of life of patients with BPPV, highlighting the synergistic benefits of this multimodal therapeutic approach.

PMID:41396422 | DOI:10.1097/SCS.0000000000012012

Ophthalmol Ther. 2025 Dec 15. doi: 10.1007/s40123-025-01290-0. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to analyze the influence of refractive status, residential climate, and exposure to adverse environmental factors in contact lens (CL) dropout.

METHODS: This cross-sectional study involved a face-to-face survey conducted by trained optometrists among former and current CL wearers (CLWs) at General Óptica centers throughout Spain. The survey included questions related to demographic characteristics, refractive status, residential climate, and adverse environmental factors. The chi-square test and a forward stepwise binary logistic regression analysis were performed.

RESULTS: A total of 1094 surveys were included, comprising 509 former CLWs and 585 current CLWs. Age (B = 0.03; OR 1.03, 95% CI 1.02-1.04) and exposure to chemical (B = 3.51; OR 41.67, 95% CI 12.06-143.95) or dusty environments (B = 1.05; OR 2.93, 95% CI 1.16-7.41) were significantly associated with CL dropout. However, residing in a continental climate was associated with a lower CL dropout compared with a Mediterranean climate (B = – 1.39; OR 0.25, 95% CI 0.15-0.42). Spherical refraction, cylindrical refraction, and near addition power did not show statistically significant associations with CL dropout. Furthermore, the model excluded sex, exposure to high-humidity or dry environments, and the interactions between adverse environmental factors and residential climate as predictive factors.

CONCLUSIONS: Older age, residence in the Mediterranean climate, and exposure to chemical or dusty environments increase the risk of contact lens dropout. However, climate-specific conditions do not appear to significantly influence dropout rates, suggesting that other factors may play a more important role.

PMID:41396411 | DOI:10.1007/s40123-025-01290-0

J Artif Organs. 2025 Dec 15;29(1):15. doi: 10.1007/s10047-025-01541-8.

ABSTRACT

BACKGROUND: To evaluate the feasibility and safety of anticoagulation-free peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during lung re-transplantation and to assess its impact on blood transfusion requirements and clinical outcomes.

METHODS: In this single-center retrospective cohort (January 2023-April 2025), we included adults undergoing bilateral re-do lung transplantation on peripheral VA-ECMO with an anticoagulation-avoidance protocol; primary lung transplants were not included. Data on patient demographics, intraoperative transfusion volumes, postoperative complications, and survival were collected. The primary outcomes were intraoperative packed red blood cell transfusion volume and overall survival; secondary outcomes included incidence of primary graft dysfunction, acute kidney injury, and hemorrhagic and thromboembolic events. Continuous variables are reported as medians with interquartile ranges, and survival was estimated using the Kaplan-Meier method.

RESULTS: Seven patients (median age, 42 years; range, 30-56 years) underwent re-transplantation for chronic lung allograft dysfunction. The median intraoperative transfusion requirement was 560 ml (interquartile range 280-1050 ml). One patient developed primary graft dysfunction of grade 3and two developed stage 3 acute kidney injury requiring renal replacement therapy. Two developed deep venous thrombosis nonrelated to ECMO cannulation; no pulmonary embolism occurred. At a median follow-up of 469 days, all patients survived without evidence of recurrence of chronic lung allograft dysfunction.

CONCLUSIONS: Full anticoagulation-free peripheral VA-ECMO during lung re-transplantation is feasible and safe, with acceptable complication rates and potential reduction in transfusion requirements. Larger, multicenter studies are warranted to confirm these findings.

PMID:41396406 | DOI:10.1007/s10047-025-01541-8

Mol Biotechnol. 2025 Dec 15. doi: 10.1007/s12033-025-01520-7. Online ahead of print.

ABSTRACT

Bacterial cellulose (BC) is one of the biodegradable materials that is produced by BC-producing bacteria and is widely used in various industries. In previous studies, we isolated high-yield BC-producing Komagataeibacter diospyri MI 2 and analyzed its genomes. In this study, we aimed to improve the BC production ability of K. diospyri MI 2 by UV light and to investigate BC-regulating genes by comparative genomics. Of the 17 surviving colonies after UV irradiation, most produced significantly more BC higher than the wild type, while K. diospyri mutants B, G, and O had the highest BC yield. The properties of BC were analyzed by SEM and X-ray diffraction. The results showed that the BC produced by the K. diospyri mutants was denser than that of the wild type but did not significantly change crystallinity. The whole-genome sequencing and comparative genomics were performed to explore the genes involved in the improvement of BC in the K. diospyri mutants. The result showed that the descriptive statistics of the assembled genomes of the K. diospyri mutants were similar to that of the wild type. When comparing their genomes, we found that genes, including galE, aes, and bfr, which were likely involved in BC biosynthesis, disappeared in the K. diospyri mutants. In addition, variant analysis was performed, and SNPs and InDels located on the CDS of genes, including the response regulator, efflux transporter outer membrane subunit, chloride channel protein, and ribonuclease E, could be potential biomarkers for higher BC production. Our study provided the K. diospyri mutants by UV mutagenesis and explored the set of genes possibly involved in BC production.

PMID:41396403 | DOI:10.1007/s12033-025-01520-7

Phys Eng Sci Med. 2025 Dec 15. doi: 10.1007/s13246-025-01686-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Deep learning (DL)-based auto-segmentation has rapidly become the state-of-the-art in radiotherapy planning, significantly reducing contouring time while achieving geometric accuracy comparable to expert-derived contours [1-3]. While AI contouring on CTp is now widely established, its application to cone-beam CT (CBCT) is less well explored, despite CBCT’s critical role in daily image guidance for prostate radiotherapy. Current adaptive workflows rely on manual contouring or deformable image registration (DIR), both of which are resource-intensive and subject to limitations in accuracy and consistency. Recent advances in AI-based CBCT segmentation have shown promise in reducing manual workload, improving contour consistency, and supporting adaptive radiotherapy (ART) workflows [4]. To assess the clinical implications of these developments, this study retrospectively analyzed CBCT images from 20 prostate cancer patients, comparing AI- and DIR-generated contours to evaluate systematic differences and their potential impact on dosimetry and ART decision-making.

METHODS: Twenty prostate radiotherapy patients were retrospectively selected, treated with either 42.7 Gy in 7 fractions or 60 Gy in 20 fractions, and imaged on Halcyon linear accelerators using Hypersight CBCT ([Formula: see text]). AI-generated contours were produced with Limbus AI v1.8.0, while deformable image registration (DIR) contours were propagated from planning CTs in Velocity v4.2. Contour accuracy was assessed by two senior medical officers using a four-point Likert scale across 140 CBCTs. Prostate, bladder, and rectum were analyzed using Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), mean surface distance (MSD), center-of-mass (COM) displacement, and volumetric change relative to the planning CT. Dosimetric evaluation included [Formula: see text], [Formula: see text], [Formula: see text], and clinically defined organ-at-risk metrics to assess potential implications for adaptive radiotherapy. Statistical significance was tested using paired Student’s t-tests and Wilcoxon signed-rank tests with a threshold of [Formula: see text].

RESULTS: AI-generated contours achieved acceptable clinical accuracy in >80% of cases, with fewer severe or medium errors compared to DIR-derived contours, which required minimal changes of 49%. Quantitative analysis demonstrated broadly comparable Dice Similarity Coefficients (DSC), Hausdorff Distance (HD), and mean surface distance (MSD) across prostate, bladder, and rectum. Organ variation on CBCT revealed larger mean centre of mass shifts and volume differences for AI, particularly in bladder contours, whereas DIR showed smaller systematic deviations. Dosimetric comparisons highlighted that prostate dose metrics were significantly different between methods, while bladder differences were mostly non-significant except at high-dose volumes, and rectum analysis revealed consistent statistically significant variations. Overall, although both methods captured daily anatomical changes, suggesting complementary strengths depending on adaptive radiotherapy application.

CONCLUSION: AI-generated contours for prostate radiotherapy on CBCT images demonstrate high geometric accuracy and clinical usability, requiring minimal expert correction, while DIR contours, although generally usable, show greater variability, particularly for organs subject to large anatomical changes such as the bladder and rectum. Despite similar geometric comparisons, statistically significant dosimetric differences highlight the importance of careful expert verification, especially for sensitive structures like the rectum. These findings support the integration of AI-based contouring into adaptive radiotherapy workflows to streamline clinical processes, reduce workload, and maintain treatment accuracy, while emphasizing that automated contours, whether AI- or DIR-derived, should always undergo expert review to ensure safe and effective patient care.

PMID:41396387 | DOI:10.1007/s13246-025-01686-z