Tag: statistics

Anesth Pain Med. 2025 May 13;15(3):e160771. doi: 10.5812/aapm-160771. eCollection 2025 Jun 30.

ABSTRACT

BACKGROUND: Millions of computer users experience chronic neck and shoulder pain (CNSP) and reduced health-related quality of life (HRQoL) due to upper cross syndrome (UCS). While strengthening exercises for the posterior trunk alleviate symptoms, it remains unclear whether isometric or isotonic exercises are more effective.

OBJECTIVES: This study aimed to compare the effects of isometric and isotonic exercises on CNSP and HRQoL in individuals with UCS, and to evaluate these outcomes against a non-intervention group.

METHODS: In this randomized clinical trial (RCT), 43 UCS patients with CNSP were divided into three groups: Isometric exercises (n = 15), isotonic exercises (n = 14), and a control group (n = 14). Over 8 weeks, exercise groups completed 3 sessions per week (40 – 60 minutes each). Pain was assessed using the Visual Analog Scale (VAS) and HRQoL was assessed using the 36-item short form health survey (SF-36) questionnaire, both pre- and post-intervention.

RESULTS: Both isometric and isotonic exercises significantly reduced CNSP and improved HRQoL compared to the control group. Isometric exercises yielded a 70.4% pain reduction (P < 0.001) and a 14.9% HRQoL improvement (P = 0.002), while isotonic training showed a 47.6% pain reduction (P = 0.001) and a 17.7% HRQoL improvement (P < 0.001). Between-group differences were not statistically significant (pain: P = 0.853; HRQoL: P = 0.999). Although isometric exercises slightly favored pain reduction and isotonic exercises showed marginal HRQoL gains, these differences should not be overstated.

CONCLUSIONS: Both isometric and isotonic exercises improved CNSP and HRQoL in UCS patients, with no significant difference between them. Slight trends favoring each should be interpreted cautiously. Longer-term studies are warranted.

PMID:40727637 | PMC:PMC12297035 | DOI:10.5812/aapm-160771

Anesth Pain Med. 2025 May 26;15(3):e158242. doi: 10.5812/aapm-158242. eCollection 2025 Jun 30.

ABSTRACT

BACKGROUND: Postoperative pain following laparoscopic surgeries, such as laparoscopic cholecystectomy, can be severe. Despite various analgesic methods, high doses of narcotics are often required, leading to complications such as dizziness, respiratory disorders, and postoperative nausea and vomiting (PONV).

OBJECTIVES: The present study aimed to evaluate the efficacy of two novel analgesic methods, the erector spinae plane block (ESPB) and the retrolaminar block (RLB), performed under ultrasound guidance, in managing pain after upper abdominal laparoscopic surgeries.

METHODS: In this clinical trial, candidates for elective upper abdominal laparoscopic surgeries were randomly assigned to two groups (40 patients in the ESPB group and 40 in the RLB group). To manage preoperative pain, one group received an ESPB block under ultrasound guidance on the surgical side, while the other group received a RLB. Both groups were equipped with a patient-controlled intravenous analgesia (PCIA) pump containing fentanyl. The analgesic used in both blocks was 0.1% ropivacaine (20 cc) on the surgical side. Patients’ pain intensity [based on the Numeric Rating Scale (NRS)], need for additional narcotics, satisfaction, and sedation scores were recorded and analyzed at various time points post-surgery.

RESULTS: There was no statistically significant difference in the demographic and baseline characteristics between the two groups. However, the average NRS score was significantly lower in the RLB group at all time points post-surgery, except immediately after surgery (P < 0.001). Patient satisfaction was higher in the RLB group at 20 minutes, 2 hours, 4 hours, and 6 hours post-surgery (P < 0.05). The RLB group also required fewer narcotics, indicating that the RLB is more effective in managing acute postoperative pain.

CONCLUSIONS: The RLB is more effective than the ESPB in reducing post-laparoscopic cholecystectomy pain. It also decreases narcotic consumption and associated complications. Therefore, it is recommended as a cost-effective method for managing acute pain after laparoscopic cholecystectomy.

PMID:40727635 | PMC:PMC12301681 | DOI:10.5812/aapm-158242

Anesth Pain Med. 2025 Jun 2;15(3):e161767. doi: 10.5812/aapm-161767. eCollection 2025 Jun 30.

ABSTRACT

BACKGROUND: Tissue injury resulting from surgical procedures leads to the release of various inflammatory agents, such as mitochondrial DNA (mt-DNA). This can trigger inflammatory mechanisms that may harm different organs.

OBJECTIVES: In this study, we investigated the effects of isoflurane and propofol on mt-DNA levels during posterior spinal fusion (PSF) surgery.

METHODS: After meeting the inclusion criteria, 40 patients scheduled for PSF surgery were enrolled in a prospective randomized controlled clinical trial and randomly divided into groups receiving propofol or isoflurane for maintenance of anesthesia. Mitochondrial DNA levels were measured before surgery, one hour after induction of anesthesia, in the recovery unit, and 24 hours post-surgery.

RESULTS: There was no statistically significant difference between groups regarding age, gender, and mt-DNA levels prior to surgery (P-value > 0.05). However, mt-DNA levels were significantly higher in the isoflurane group one hour after induction of anesthesia (P-value = 0.001), in the recovery unit (P-value = 0.042), and 24 hours after surgery (P-value = 0.018).

CONCLUSIONS: Propofol was superior to isoflurane, as demonstrated by a lesser elevation in plasma levels of mt-DNA in PSF patients.

PMID:40727634 | PMC:PMC12297033 | DOI:10.5812/aapm-161767

Anesth Pain Med. 2025 May 26;15(3):e161542. doi: 10.5812/aapm-161542. eCollection 2025 Jun 30.

ABSTRACT

BACKGROUND: Spinal anesthesia (SA) is preferred over general anesthesia for lower extremity surgeries, but the optimal method of needle placement is debated. Although the paramedian approach reduces the risks of dural puncture, it presents technical difficulties. The modified paramedian technique may increase safety and patient satisfaction by facilitating subarachnoid access and overcoming anatomical challenges, particularly in obese or elderly patients.

OBJECTIVES: This study aimed to compare the paramedian and modified paramedian techniques from the perspective of anesthesiologists and their impact on postoperative patient satisfaction.

METHODS: This triple-blind randomized clinical trial investigated the effects of two SA techniques – paramedian and modified paramedian – on patient satisfaction and procedural ease. A total of 112 patients meeting inclusion and exclusion criteria were enrolled. Data were collected using the Iowa Satisfaction with Anesthesia Care Questionnaire. Demographic information was recorded in coded form, and data analysis was performed using SPSS version 19. Statistical methods included the independent t-test for comparing continuous means between groups, the chi-square test for categorical variables, and logistic regression analysis to assess the impact of individual characteristics (age, gender, weight) on the ease of performing spinal anesthesia.

RESULTS: The results indicated that the modified paramedian group demonstrated superior performance in terms of success on the first attempt (P = 0.006), reduced need for repositioning (P = 0.038), and fewer repeated attempts (P = 0.017). Additionally, patient satisfaction scores were significantly higher in the modified paramedian group (P = 0.001). Multivariate regression confirmed age and Body Mass Index (BMI) as independent predictors of procedural difficulty (P < 0.05).

CONCLUSIONS: The modified paramedian technique significantly enhanced the ease of SA administration and patient satisfaction compared to the traditional approach. These findings indicate its potential to improve the anesthesia process, reduce side effects, and elevate patient experience. This study supports broader adoption of the technique in surgical and healthcare settings, advancing anesthesia care quality.

PMID:40727633 | PMC:PMC12296660 | DOI:10.5812/aapm-161542

Anesth Pain Med. 2025 May 12;15(3):e160776. doi: 10.5812/aapm-160776. eCollection 2025 Jun 30.

ABSTRACT

BACKGROUND: The erector spinae plane block (ESPB) has traditionally been performed under ultrasound guidance, while fluoroscopic guidance has emerged as an alternative approach.

OBJECTIVES: This study aims to compare the efficacy of ESPB using ultrasound and fluoroscopic guidance in patients with cervical pain.

METHODS: This case series study includes fourteen patients with axial neck pain scheduled for cervical ESPB. According to the approach of ESPB (ultrasound or fluoroscopic guidance), patients were divided into two groups: Eight underwent ultrasound-guided ESPB, and six received fluoroscopy-guided ESPB. Pain and disability were assessed using the Numerical Rating Scale (NRS) and the Neck Disability Index (NDI) at baseline (pre-procedure), two weeks post-procedure, and three months post-procedure.

RESULTS: Both groups demonstrated significant improvements in NRS and NDI scores over time (P = 0.005). However, no statistically significant differences were observed in pain scores or disability indices at any of the evaluation points.

CONCLUSIONS: This study suggests that fluoroscopy-guided ESPB is as effective as ultrasound-guided ESPB for managing cervical radicular pain, providing a viable alternative for clinicians.

PMID:40727631 | PMC:PMC12297020 | DOI:10.5812/aapm-160776

J Public Health Res. 2025 Jul 24;14(3):22799036251351156. doi: 10.1177/22799036251351156. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Health is vital for survival and societal well-being, with global goals focusing on improved access and achieving progress in public health. In Bangladesh, investigating health determinants and disparities is crucial for effective interventions.

OBJECTIVE: This study investigates spatial and temporal variations in the influence of socioeconomic and health-related factors on the health index at a detailed district level in Bangladesh, aiming to discern disparities in health indicators among districts. Based on 21 years of secondary data across 64 districts in Bangladesh, this research deploys four Bayesian spatial-temporal models to analyze the health index and relevant variables.

DESIGN AND METHODS: The study identifies the optimal model by evaluating linear, analysis of variance, and autoregressive models of orders one and two. Comparative analysis utilizing the WAIC and DIC aids model selection. The MCMC method enhances precision in determining health index determinants, providing valuable insights for policymakers and researchers.

RESULTS: Our findings reveal that the AR (2) model demonstrated superior performance among all the spatiotemporal models. The health index demonstrated a consistent upward trend overall, but regional variations in residents’ health indices were noted. Positive spatial autocorrelation was identified in the health index, emphasizing interconnected health outcomes. Spatiotemporal models underscored the significance of the income index, child mortality, life expectancy, and the proportion of the active population as crucial factors shaping the health index in Bangladesh.

CONCLUSIONS: This study provides actionable insights for targeted health interventions in districts with specific needs, emphasizing focused policies on poverty, education, and healthcare to enhance overall well-being in Bangladesh.

PMID:40727627 | PMC:PMC12301593 | DOI:10.1177/22799036251351156

J Stat Phys. 2025;192(8):109. doi: 10.1007/s10955-025-03493-y. Epub 2025 Jul 26.

ABSTRACT

We say of an isolated macroscopic quantum system in a pure state $\psi$ that it is in macroscopic thermal equilibrium (MATE) if $\psi$ lies in or close to a suitable subspace $H_{\text{eq}}$ of Hilbert space. It is known that every initial state ${\psi }_0$ will eventually reach and stay there most of the time (“thermalize”) if the Hamiltonian is non-degenerate and satisfies the appropriate version of the eigenstate thermalization hypothesis (ETH), i.e., that every eigenvector is in MATE. Tasaki recently proved the ETH for a certain perturbation $H_{\theta }^{\text{fF}}$ of the Hamiltonian $H_0^{\text{fF}}$ of $N\gg 1$ free fermions on a one-dimensional lattice. The perturbation is needed to remove the high degeneracies of $H_0^{\text{fF}}$ . Here, we first point out that also for degenerate Hamiltonians all ${\psi }_0$ thermalize if the ETH holds, i.e., if every eigenbasis lies in MATE, and we prove that this is the case for $H_0^{\text{fF}}$ . Inspired by the fact that there is one eigenbasis of $H_0^{\text{fF}}$ for which MATE can be proved more easily than for the others, with smaller error bounds, and also in higher spatial dimensions, we show for any given $H_0$ that the existence of one eigenbasis in MATE implies quite generally that most eigenbases of $H_0$ lie in MATE. We also show that, as a consequence, after adding a small generic perturbation, $H=H_0+\lambda V$ with $\lambda \ll 1$ , for most perturbations V the perturbed Hamiltonian H satisfies ETH and all states thermalize.

PMID:40727612 | PMC:PMC12296827 | DOI:10.1007/s10955-025-03493-y

Arch Acad Emerg Med. 2025 Jul 11;13(1):e56. doi: 10.22037/aaemj.v13i1.2678. eCollection 2025.

ABSTRACT

INTRODUCTION: Meta-analyses of diagnostic/prognostic studies for calculating the pooled sensitivity and specificity require true positive (TP), true negative (TN), false positive (FP), and false negative (FN) counts. However, few studies report these values directly. This study aimed to consolidate practical methods to reconstruct sensitivity and specificity from minimal data.

METHODS: Our framework addresses three main situations: (1) algebraic rearrangements to compute specificity given partial metrics; (2) digitization of receiver operating characteristic (ROC) curves to obtain threshold-specific sensitivity and specificity; and (3) application of the binormal model when only AUC and prevalence are available. We tested these methods on a dataset related to mortality prediction in myocardial infarction (MI) using machine learning models, assessing how well they reconstructed sensitivity and specificity.

RESULTS: Algebraic formulas and ROC digitization yielded reliable estimates when partial metrics or graphical curves were sufficiently detailed. However, the binormal model, which assumes equal variances, showed noticeable inaccuracies, especially for sensitivity. Linear regression analyses indicated that higher prevalence and higher AUC reduced estimation errors.

CONCLUSION: These methods offer practical alternatives for reconstructing diagnostic accuracy measures when data are incomplete. Relying solely on AUC-based estimations may introduce substantial bias, particularly in low-prevalence contexts. We recommend that primary studies report threshold-specific sensitivity and specificity to support more accurate meta-analytic estimations.

PMID:40727603 | PMC:PMC12303406 | DOI:10.22037/aaemj.v13i1.2678

Arch Acad Emerg Med. 2025 Jun 25;13(1):e57. doi: 10.22037/aaemj.v13i1.2693. eCollection 2025.

ABSTRACT

INTRODUCTION: By enabling direct consultation with neurologists, Real-Time Telemedical Oversight (ReTMO) can facilitate rapid stroke assessment and decision-making. This study aimed to assess the efficacy of prehospital stroke management before and after ReTMO implementation.

METHODS: A single-center retrospective before-and-after study was conducted at Ramathibodi Hospital, Bangkok, Thailand, from January 2020 to December 2024. In March 2022, a structured prehospital stroke protocol was integrated with the ReTMO system in this hospital. We evaluated its impact by comparing stroke patients transported by emergency medical services (EMS) before and after protocol implementation. Neurological outcomes at hospital discharge were analyzed using multivariable ordinal logistic regression. In contrast, door-to-treatment times in the emergency department (ED) and hospital length of stay were assessed using multivariable Gaussian regression.

RESULTS: The study included 91 prehospital stroke patients, with 36 in the pre-protocol group and 55 in the post-protocol group. Implementation of the structured prehospital stroke protocol was associated with a significant reduction in door-to-computed tomography (CT) scan time by 10.47 (95% confidence interval (CI): -17.62 to -3.3) minutes and door-to-laboratory result time by 15.90 (95% CI: -30.48 to -1.33) minutes. Additionally, adjusted ordinal logistic regression analysis demonstrated a significant improvement in neurological outcomes at hospital discharge (odds ratio (OR) = 0.14, 95% CI: 0.02-0.99, P = 0.049). However, reductions in ED stroke treatment time and hospital length of stay were not statistically significant.

CONCLUSIONS: Implementing ReTMO alongside a structured prehospital stroke protocol significantly reduced in-hospital delays in door-to-CT and door-to-laboratory result times while also improving neurological outcomes at hospital discharge.

PMID:40727597 | PMC:PMC12303409 | DOI:10.22037/aaemj.v13i1.2693

Int J Nanomedicine. 2025 Jul 22;20:9291-9300. doi: 10.2147/IJN.S503954. eCollection 2025.

ABSTRACT

INTRODUCTION: MicroRNAs (miRNAs) are small, non-coding RNA molecules critical for cellular function, growth, and development. Recent advances in remote diagnostic technologies have highlighted the potential of urinary miRNAs as non-invasive biomarkers for disease monitoring. This study introduces a simple, rapid, and cost-effective reagent for exosomal miRNA extraction, designed for urine-based exosome screening. We further identified hsa-miR-16-5p (miR-16) as a promising diagnostic biomarker for prostate cancer (PCa), with the goal of integrating this method with biosensors to enable rapid result acquisition and support early cancer detection and treatment planning.

MATERIALS AND METHODS: The extraction reagent was formulated using polyethylene glycol (PEG), sodium dodecyl sulfate (SDS), and diethyl pyrocarbonate (DEPC), differing from commercial kits. miRNAs were extracted and validated through RT-qPCR, focusing on miR-16 and the reference control miR-21. Results were compared against commercial kits. A cohort of 39 clinical samples-28 PCa patients, 1 benign prostatic hyperplasia (BPH) case, and 10 healthy controls (Ctr)-was analyzed. Statistical evaluations included T-tests and receiver operating characteristic (ROC) analysis to assess the diagnostic value of miR-16.

RESULTS: miR-16 expression significantly differed across PCa stages and between cancerous and non-cancerous individuals (Ctr vs Stage IV: p < 0.05; Stage II vs III: p < 0.05; Stage II vs IV: p < 0.005; Stage III vs IV: p < 0.05). ROC analysis confirmed miR-16’s diagnostic potential, particularly in detecting mid-stage PCa.

CONCLUSION: The proposed extraction method matches commercial kits in performance but offers notable advantages: a simplified five-step process, reduced extraction time (1.08 hours), and low cost ($0.13/test). These findings support the use of urinary miR-16 as a biomarker for PCa staging and highlight the practical value of the newly developed extraction reagent.

PMID:40727581 | PMC:PMC12301110 | DOI:10.2147/IJN.S503954