Tag: statistics

J Orthop Surg Res. 2025 Aug 30;20(1):807. doi: 10.1186/s13018-025-06241-w.

ABSTRACT

BACKGROUND: This study aimed to investigate the utility of shear wave elastography (SWE) as a noninvasive diagnostic tool for assessing anterior compartment intracompartmental pressure (ICP) in patients with tibial plateau fractures, facilitating early detection of high compartment pressure (HCP) to mitigate acute compartment syndrome (ACS) risks.

METHODS: In this cross-sectional study conducted from January 2024 to March 2025 at a tertiary hospital in China, 170 patients aged 18-65 years with tibial plateau fractures diagnosed within 48 h were enrolled. Demographic data, injury mechanisms, Schatzker classification, and laboratory parameters were collected. shear wave velocity (SWV) was measured via SWE on both injured and contralateral anterior compartment muscles, alongside invasive ICP monitoring. Statistical analyses encompassed Spearman’s correlations, stepwise logistic regression for a multivariate model incorporating SWV, age, and fracture type, and receiver operating characteristic (ROC) curves for diagnostic performance.

RESULTS: Among participants (57.1% male, median age 45 years), 44 exhibited HCP (ICP ≥ 30 mmHg). Injury-side SWV and SWV differential showed strong positive correlations with ICP (ρ = 0.704 and 0.535, respectively; both P < 0.001). Significant SWV disparities were observed between HCP and non-HCP groups (P < 0.001). The multivariate model yielded an AUC of 0.880, with 93.2% sensitivity and 71.4% specificity, demonstrating consistent performance across gender subgroups. Adjusted odds ratios highlighted injury-side SWV (aOR 5.99) and Schatzker Ⅳ-Ⅵ fractures (aOR 4.14) as key predictors.

CONCLUSION: Our study results indicate that SWE can reliably and noninvasively detect HCP in tibial plateau fractures, providing superior diagnostic accuracy and clinical applicability.

PMID:40886029 | DOI:10.1186/s13018-025-06241-w

J Orthop Surg Res. 2025 Aug 30;20(1):803. doi: 10.1186/s13018-025-06199-9.

ABSTRACT

BACKGROUND: The spine, pelvis, and joints maintain sagittal balance, which is often disrupted in lumbar degenerative diseases. While preoperative changes in sagittal alignment are well studied, postoperative adaptations, particularly following spinal fixation extending to the pelvis, are less understood. Therefore, the present study aimed to examine sagittal changes in the spine, pelvis, and joints in sitting and standing positions after short- or long-segment posterior spinal fixation extending to the pelvis.

METHODS: This cross-sectional study analyzed patients who underwent long- or short-segment instrumented fusion to the pelvis for lumbar degenerative disease at our hospital from June 2018 to October 2019. Patients were grouped based on the number of internal fixation segments, both short and long. Sagittal parameters were measured in standing and sitting positions and matched for sex, gender, height, weight, and other related parameters. Statistical analysis was performed using t-tests and Mann-Whitney U tests.

RESULTS: A total of 98 patients were included, of whom 55 were included in the long-segmengroup (31 men, 24 women; mean age of 63.1 ± 8.5 years). In the long-segment group, no significant changes were observed between standing and sitting positions (P > 0.05). In the short-segment group, significant changes were observed in the sacral vertical axis, pelvic tilt, sacral slope, thoracic kyphosis, lumbar lordosis, T1 pelvic angle, T1 spinopelvic inclination, acetabular tilt, and pelvic-femoral angle between the two positions (P < 0.05). The difference in pelvic femoral angle changes between the groups was also significant (P < 0.05).

CONCLUSIONS: In the short-segment group, transitioning from standing to sitting leads to greater sagittal changes, including decreased lumbar lordosis and forward trunk lean, with smaller hip joints than in the long-segment internal fixation group.

PMID:40886027 | DOI:10.1186/s13018-025-06199-9

J Orthop Surg Res. 2025 Aug 30;20(1):800. doi: 10.1186/s13018-025-06222-z.

ABSTRACT

BACKGROUND: In this study, we investigated the bidirectional causal relationship between spondyloarthritis (SpA)/ankylosing spondylitis (AS) and intervertebral disc degeneration (IVDD).

METHODS: Genome-wide association study (GWAS) statistics for SpA, AS, and IVDD were obtained exclusively from the FinnGen consortium. The instrumental variables (IVs) were identified under genome-wide significance thresholds (P < 5 × 10^-8) with linkage disequilibrium clumping removed. An F-value exceeding 10 was deemed a robust association between IVs and exposure. The inverse-variance weighted (IVW) method was prioritized to infer causal relationships between SpA/AS and IVDD. To robustly evaluate reverse causality, reverse MR analyses were systematically implemented. Heterogeneity across single-nucleotide polymorphisms (SNPs) was quantified by conducting Cochran’s Q test and Rucker’s Q test; horizontal pleiotropy was assessed via MR-Egger intercept analysis.

RESULTS: MR analyses demonstrated a significant causal effect of SpA on IVDD (IVW: OR = 1.04, 95% CI: 1.02-1.05, P_adjust = 2.76E-05). Similarly, AS exhibited a robust causal association with IVDD (OR = 1.03, 95% CI: 1.02-1.04, P_adjust = 2.08E-05). The reverse analyses revealed that IVDD significantly increased susceptibility to SpA (OR = 1.26, 95% CI: 1.14-1.40, P_adjust = 7.07E-05) and AS (OR = 1.32, 95% CI: 1.14-1.52, P_adjust = 8.10E-04). Neither significant heterogeneity nor horizontal pleiotropy was detected.

CONCLUSIONS: SpA/AS significantly increased the risk of IVDD, whereas reverse MR analyses revealed that IVDD increased susceptibility to SpA/AS. Further experimental studies are required to confirm the bidirectional causal relationship between SpA/AS and IVDD.

PMID:40886020 | DOI:10.1186/s13018-025-06222-z

J Orthop Surg Res. 2025 Aug 30;20(1):802. doi: 10.1186/s13018-025-06231-y.

ABSTRACT

BACKGROUND: Multi-limb amputations are extremely rare and devastating injuries, particularly in the context of civilian disasters. The 2023 Türkiye earthquake resulted in a significant number of complex traumatic injuries, including multiple limb amputations. This study aims to investigate early mortality, surgical complications, and functional outcomes at two-year follow-up in civilian patients who underwent two or more limb amputations following the disaster.

METHODS: A retrospective analysis was conducted on 22 patients who sustained multiple limb amputations after the earthquake. Demographic data, amputation levels, surgical interventions, complications, and outcomes at two-year follow-up were recorded. The primary outcomes were mortality, the number and type of reoperations, and functional recovery at two years.

RESULTS: Among the cohort, two-limb amputations were performed in 17 patients, three-limb amputations in 4 patients, and four-limb amputation in 1 patient. Twenty patients required at least one additional surgical procedure during hospitalization, most commonly surgical debridement for soft tissue infection. Eight patients died, of whom five had undergone amputation of three or more limbs. Sepsis was the leading cause of death. Follow-up data at two years were available for 14 survivors. Of these, only 3 patients were able to ambulate independently using prosthetic devices. Phantom limb pain was reported in 6 patients, and all received medical management. The average hospital stay exceeded 80 days in patients with bilateral amputations.

CONCLUSIONS: This study presents one of the largest case series of multi-limb amputees following a civilian earthquake. The findings highlight the high rate of reoperation, substantial mortality, and limited functional recovery at two-year follow-up in this population. Early multidisciplinary rehabilitation strategies should be prioritized to improve outcomes in future mass-casualty settings.

PMID:40886017 | DOI:10.1186/s13018-025-06231-y

AIDS Res Ther. 2025 Aug 30;22(1):86. doi: 10.1186/s12981-025-00776-y.

ABSTRACT

OBJECTIVES: The diversity of HIV-1 genotypes among Men who have sex with men (MSM) globally has changed considerably. The purpose of this study to assess the global prevalence of HIV-1 genotypes among MSM.

METHODS: PubMed, Embase, Scopus, and Web of Science were systematically searched to identify the articles. Pooled prevalence of HIV-1 genotypes was calculated and subgroup analyses were performed to examine the prevalence estimates across time and locations.

RESULTS: A total of 95 studies were included in the final analysis, including 84,622 successfully genotyped samples. The predominant strains were CRF01_AE (34.46%), subtype B (31.16%), and CRF07_BC (24.72%). In subgroup analyses, Subtype B and C showed a declining trend over the years. However, CRF07_BC exhibited a consistent year-on-year increase, while CRF01_AE experienced a slight reduction after 2018. Notably, both subtypes currently account for more than 35% of the total. In addition, the distribution of HIV-1 subtypes in this population shown a clear regional distribution. Regionally, subtype B predominated in Latin America and Europe, CRF01_AE and CRF07_BC in Asia and China, while subtype C and CRF02_AG were dominant in Africa and the Middle East.

CONCLUSIONS: Global and regions MSM HIV-1 subtypes are becoming more complex over time and the prevalence of recombinant viruses is increasing. Ongoing and effective surveillance of the global and regional molecular epidemiology of HIV-1 in MSM is critical for developing targeted preventive control measures against HIV.

PMID:40886010 | DOI:10.1186/s12981-025-00776-y

J Orthop Surg Res. 2025 Aug 30;20(1):806. doi: 10.1186/s13018-025-06242-9.

ABSTRACT

BACKGROUND: Perioperative blood loss and the need for transfusion are significant concerns in total knee arthroplasty (TKA). Topical tranexamic acid (TXA) is commonly used to reduce bleeding and is administered either via intra-articular (IAI) or peri-articular injection (PAI). This study aimed to compare the efficacy of PAI and IAI of TXA in reducing the postoperative drainage volume and blood transfusion rates in patients undergoing TKA.

METHODS: One hundred patients who underwent simultaneous bilateral TKA were included in this retrospective cohort study. The patients were divided into two groups: Group A received 1 g TXA via PAI and 1 g TXA via IAI in one knee, with 2 g TXA via IAI in the other knee; and Group B received 2 g TXA via PAI in one knee and 2 g TXA via IAI in the other knee. Postoperative outcomes, including blood loss, hemoglobin (Hb) levels, transfusion rates, and surgical duration, were collected and analyzed.

RESULTS: Group A demonstrated a significantly greater decrease in postoperative Hb levels (-2.03 ± 0.15 mg/dL) than Group B (-1.29 ± 0.11 mg/dL). Knees treated with PAI (391.10 ± 25.45 mL) or PAI + IAI (412.80 ± 26.76 mL) had significantly lower drainage volumes than those treated with IAI alone (523.50 ± 17.47 mL, p < 0.001). No significant differences were observed between the PAI and PAI + IAI subgroups. No major complications such as deep vein thrombosis or wound infections were noted.

CONCLUSIONS: PAI of TXA, either alone or in combination with IAI, is more effective in reducing postoperative blood loss in TKA procedures than IAI alone. These findings support the use of PAI, particularly with a higher dose of 2 g TXA, as a safe and effective method for minimizing drainage output in patients undergoing TKA.

PMID:40886003 | DOI:10.1186/s13018-025-06242-9

J Orthop Surg Res. 2025 Aug 30;20(1):812. doi: 10.1186/s13018-025-06190-4.

ABSTRACT

BACKGROUND: Intra-articular injection of mesenchymal stem cells (MSCs) has emerged as a promising therapy for knee osteoarthritis (OA). However, uncertainty remains regarding the optimal cell dose for maximizing clinical benefit. This systematic review and meta-analysis aimed to evaluate the efficacy of MSC injections for knee OA and investigate the relationship between cell dose and treatment outcome.

METHODS: A comprehensive literature search was conducted in PubMed and Scopus for randomized controlled trials (RCTs) published between 2015 and 2025. Eligible studies were RCTs that used intra-articular MSC injections for knee OA, and WOMAC scores were reported at baseline and 12-month follow-up. Standardized mean differences (SMDs) were pooled using a random-effects model. Subgroup analysis and meta-regression were performed to evaluate the effect of MSC dose on treatment outcomes.

RESULTS: Eight treatment arms from six RCTs involving 300 patients were included. The pooled SMD in the WOMAC score at 12 months was -1.35 (95% CI: -1.97 to -0.74), indicating a moderate to large treatment effect. MSC doses of ≤ 25 million cells were associated with statistically significant improvement, while higher doses did not demonstrate additional benefit. Meta-regression confirmed no significant dose-response relationship. Heterogeneity was moderate (I2 = 49.8%).

CONCLUSION: Intra-articular MSC therapy significantly improves clinical outcomes in knee OA at 12 months, with lower doses (≤ 25 million cells) appearing to be both effective and potentially more efficient. These findings support dose optimization as a critical consideration in advancing MSC therapy.

PMID:40886001 | DOI:10.1186/s13018-025-06190-4

Int Breastfeed J. 2025 Aug 30;20(1):69. doi: 10.1186/s13006-025-00758-w.

ABSTRACT

BACKGROUND: The first primary care visit of the newborn aims to assess neonatal feeding, promote breastfeeding, and identify potential health issues. This study examines the relationship between the timing of the first visit and the prevalence of exclusive breastfeeding (EBF) at one month of life.

METHODS: This prospective, observational, analytical study was conducted in Spain through a paediatric research network. Data were collected from newborns at both the first visit and the one-month check-up. Selected variables were compared with those from a 2014 study by the same network to estimate EBF rates at the first visit. The primary outcome was EBF prevalence at one month, measured using 2024 data. EBF was defined as receiving only breast milk in the past 24 h. To analyse factors associated with EBF over time, generalised estimating equation models with binomial distribution and logit link function were used in univariate and multivariate analyses.

RESULTS: A total of 1952 cases were collected in 2024, with the first visit at 9.3 ± 6.1 days after discharge, compared to 2047 cases in 2014 at 10.7 ± 6.3 days. EBF prevalence at the first visit was 63.1% in 2014 and 62.6% in 2024. In 2024, EBF prevalence at one month was 55.0% (95% CI 52.7, 57.3). Previous maternal breastfeeding experience was the strongest predictor of EBF at one month (AOR 14.61, 95% CI 5.04, 42.33). Having the first visit within 7 days of life was associated with higher EBF maintenance at one month in univariate analysis (OR 1.34, 95% CI 1.17, 1.53), but not in multivariate analysis (AOR 0.90, 95% CI 0.47, 1.74).

CONCLUSIONS: The first primary care visit of the newborn occurs late in Spain. Rates of EBF have declined over the past decade, highlighting the need for targeted interventions that address modifiable determinants. The strongest predictor for EBF at one month is having previous breastfeeding experience. Early postnatal follow-up of newborns in primary care appears to have a beneficial effect on EBF maintenance at one month, although other determinants may mediate or influence its impact.

PMID:40885997 | DOI:10.1186/s13006-025-00758-w

BMC Health Serv Res. 2025 Aug 30;25(1):1156. doi: 10.1186/s12913-025-13200-y.

ABSTRACT

BACKGROUND: Burnout affects the physical and mental health of residents. This study aims to investigate the association between burnout and health across biological, psychological, and social domains among Chinese residents.

METHOD: A cross-sectional study was conducted from July 2022 to June 2024 at Peking Union Medical College Hospital in China. A total of 274 resident physicians were recruited, with 207 providing valid responses. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), while general health was measured using the Union Physio-Psycho-Social Assessment Questionnaire (UPPSAQ-70). Self-efficacy and subjective incompetence were also evaluated. Network analysis was applied to identify the centrality of various health factors in relation to burnout.

RESULTS: The overall prevalence of burnout was 74.4% (95% CI: 68.5-79.9%). Emotional exhaustion and depersonalization were significantly higher in male physicians compared to females, while younger physicians (aged ≤ 30 years) reported higher burnout in personal achievement. Network analysis identified strong connections between burnout dimensions (emotional exhaustion and depersonalization) and mental health symptoms such as anxiety, fatigue, and depression. Sleep, anxiety, and self-efficacy were found to be central nodes in the network, indicating their crucial role in resident physicians’ well-being.

CONCLUSIONS: This study found a high prevalence of burnout among resident physicians, with significant links between burnout and mental health conditions. Anxiety and fatigue emerge as core symptoms in the burnout network, suggesting that interventions should address these factors. Additionally, self-efficacy plays a crucial role in burnout.

PMID:40885990 | DOI:10.1186/s12913-025-13200-y

BMC Health Serv Res. 2025 Aug 30;25(1):1155. doi: 10.1186/s12913-025-13278-4.

ABSTRACT

BACKGROUND: Long wait times at health facilities negatively affect contraceptive access and cause dissatisfaction with care. Conventional data collection methods, such as population-based surveys and exit interviews, may not accurately capture wait times due to methodological challenges including recall and social desirability bias.

METHODS: We compared mystery client observations conducted in all public facilities in Kisumu County, Kenya with data from a population-based sample of women of reproductive age (18-49, n = 744) in Kisumu County. We compared recalled wait times from women who used public facilities in the last year for their last contraceptive method with wait times recorded by mystery clients (n = 401) presenting as first-time family planning users, and analyzed quotes from mystery clients who mentioned long waits.

RESULTS: Most mystery clients reported wait times between 1-2 h (49%) or over 2 h (33%), whereas most women surveyed in their homes recalled being seen within 30 min at their most recent visit for family planning (74%). When stratified by facility type, mystery clients waited the longest at dispensaries and basic health centers (median wait time of 110 min) and the shortest wait times at primary and secondary care hospitals (median of 82.5 min). In the survey, women recalled waiting a median of 15 min at basic health centers, 20 min at dispensaries, and 30 min at hospitals. Common causes of long waits reported by mystery clients in qualitative data included late facility openings, late providers, or prioritization of other patients. More than half of mystery clients reported spending less than 5 min with providers (59%), compared to only 8% of women surveyed.

CONCLUSIONS: Triangulation of data between different sources can provide a more nuanced understanding of long wait times, their causes, and how they impact contraceptive seekers. We find that in comparison, these different methods of data collection answer distinct questions about wait times, time spent with provider, and their impacts on contraceptive seekers. Both forms of data are useful to policy makers and stakeholders. We recommend data collection efforts aimed at improving quality of services and adherence to national guidelines consider supplementing standard data collection methods with mystery clients.

PMID:40885988 | DOI:10.1186/s12913-025-13278-4