Tag: statistics

Arch Gynecol Obstet. 2025 Jul 26. doi: 10.1007/s00404-025-08136-x. Online ahead of print.

ABSTRACT

PURPOSE: In vitro fertilization and embryo transfer (IVF-ET) has become crucial for infertile couples. Previous studies have suggested that multiple ETs are associated with increased risks of preterm birth and low birth weight. The current study aims to investigate this association.

METHODS: PubMed, Cochrane Library, EMBASE, ScienceDirect, and China National Knowledge Infrastructure databases were systematically searched. Network meta-analysis was performed to compare the associations between different numbers of embryo transfers (≥ 2) and the incidence rates of preterm birth and low birth weight. Consistency and inconsistency models were applied to ensure reliability. Frequentist statistical methods used data integration. The surface under the cumulative ranking curve (SUCRA) value was used to rank the risks of preterm birth and low birth weight associated with varying numbers of ETs.

RESULTS: There was a significant difference in the incidence of low birth weight between the 2-ET and 4-ET groups. The 4-ET group had the highest risks for preterm birth and low birth weight.

CONCLUSION: Multiple ETs are associated with increased risks of preterm birth and low birth weight. This study highlights the need for tailored clinical strategies to optimize pregnancy outcomes and mitigate complications.

PMID:40715771 | DOI:10.1007/s00404-025-08136-x

Drugs Real World Outcomes. 2025 Jul 26. doi: 10.1007/s40801-025-00509-7. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Anticholinergic medications are known to affect the prognosis of older nursing home residents. Various anticholinergic scales were developed to measure the cumulative anticholinergic burden; among them, the CRIDECO Anticholinergic Load Scale (CALS) has recently emerged as a new tool to identify patients with cognitive impairment due to anticholinergic burden. This study aimed to externally validate the CALS and to evaluate the association of CALS and the anticholinergic cognitive burden (ACB) scales with baseline cognitive and functional impairment, as well as with 3-year mortality rates.

METHODS: A prospective cohort of 600 nursing home residents (mean age 80.4 ± 8.0 years; 69.8% women) underwent a comprehensive geriatric assessment. Anticholinergic burden was assessed at baseline using both CALS and ACB scales. Cognitive impairment (Mini-Mental State Examination < 24) and physical disability (one or more impaired activities of daily living) were evaluated cross-sectionally using a logistic regression model. Cox proportional hazards models were used to estimate the association between anticholinergic burden and 3-year mortality, adjusting for age, sex, multimorbidity, nutritional status, and cognitive and functional status.

RESULTS: Among 600 nursing home residents included in the study, 72.0% had cognitive impairment and 56.3% had at least one activity of daily living limitation. The CALS and ACB scores were significantly correlated ( $\rho$ = 0.76), but CALS identified a higher number of residents with moderate-to-high anticholinergic burden. Multivariate logistic regression showed that CALS ≥ 2 was independently associated with cognitive impairment (odds ratio 1.84, 95% confidence interval 1.02-3.34), whereas ACB ≥ 2 was not. Both scales were associated with activities of daily living disability, with a stronger gradient and better goodness of fit for CALS than ACB. During the 3-year follow-up, 25.3% of residents died. Cox regression analyses showed that residents with CALS or ACB ≥ 2 had significantly lower survival over 3 years. In fully adjusted Cox models, both CALS ≥ 2 (hazard ratio 1.93, 95% confidence interval 1.07-3.46) and ACB ≥ 2 (hazard ratio 1.69, 95% confidence interval 1.02-2.83) remained associated with increased mortality. Prognostic performance was similar (CALS C-index: 0.783; ACB: 0.781), but the model fit favored CALS.

CONCLUSIONS: In this cohort of nursing home residents, anticholinergic burden as measured by both CALS and ACB was associated with baseline physical impairment and 3-year mortality, but CALS showed a better goodness of fit. Between the two scales, CALS only was independently associated with baseline cognitive impairment. These findings support the clinical utility of CALS in assessing anticholinergic-related risk among frail older adults in institutional settings.

PMID:40715770 | DOI:10.1007/s40801-025-00509-7

Evid Based Dent. 2025 Jul 26. doi: 10.1038/s41432-025-01181-0. Online ahead of print.

ABSTRACT

A COMMENTARY ON: Rokhshad R, Banakar M, Shobeiri, P, Zhang P. Artificial intelligence in early childhood caries detection and prediction: a systematic review and meta-analysis. Pediatr Dent. 2024;46:385-394.

DATA SOURCES: A literature search was performed in May 2024 via PubMed, Scopus, Embase, Web of Science, Institute of Electrical and Electronics Engineer database sources, and across the grey literature. Further studies were identified after analysis of reference lists. The research question was defined using the population-intervention-comparison-outcome (PICO) framework.

STUDY SELECTION: Studies published between 2010 and 2024 were included, that used artificial intelligence (AI) algorithms including machine learning (ML), deep learning (DL) and neutral networks (NN) for detecting and predicting early childhood caries (ECC). Exclusion occurred where the full text was inaccessible and non-English papers. Two independent reviewers screened titles and abstracts, with the use of a third reviewer in the case of any disagreement. The process was then repeated with the full texts to assess eligibility, again with a third reviewer where necessary. A total of 21 studies were used in the final analysis following assessment, 7 of which described ECC detection, and 14 for ECC prediction.

DATA EXTRACTION AND SYNTHESIS: The extracted data included author, publication year, study objectives, data modalities, datasets, annotation procedures, follow ups, ML test, AI model architecture, outcome measures and evaluation metrics. The findings were summarised descriptively. Quantitative synthesis was performed on six studies that reported sensitivity and specificity. Summary receiver operator characteristic curves were used to assess discriminatory ability. Statistical analysis was completed.

RESULTS: A total of 21 studies were included in the final analysis. It revealed that AI based methods, especially DL algorithms showed promising results in detecting ECC, with accuracy range of 78-86%, sensitivity of 67-96%, and specificity from 81-99%. ECC prediction had accuracy range of 60-100%, sensitivity of 20-100%, and specificity of 54-94%. The pooled sensitivity and specificity of these studies was 80% and 81% respectively, with confidence intervals of 95%, indicating statistically significant effects.

CONCLUSIONS: AI has demonstrated substantial potential in the detection and prediction of ECC. Further research is required to refine the technology and establish its application in paediatric dentistry.

PMID:40715738 | DOI:10.1038/s41432-025-01181-0

Am J Clin Dermatol. 2025 Jul 26. doi: 10.1007/s40257-025-00967-3. Online ahead of print.

ABSTRACT

BACKGROUND: Cholinergic urticaria (CholU) is characterized by pruritic papular wheals induced by various temperature-elevating stimuli such as exercise, bathing, and emotional stress. Although it is considered important to classify CholU into subtype on the basis of the pathogenesis and clinical features for better management, few studies have evaluated the rash type as a clinical feature.

AIM: This study aimed to investigate the associations between different types of rashes in CholU and their clinical phenotypes, and to consider the mechanisms underlying each type of rash.

METHODS: We conducted a retrospective study of 64 patients diagnosed with CholU who visited the Dermatological Institute of Kobe University Hospital. Clinical and photographic data obtained after exercise provocation and/or thermoregulatory sweat tests were reviewed and used to classify patients into the red wheal/erythema group (n = 44) or the goosebumps group (n = 20). Intradermal tests, namely the autologous sweat skin test (ASwST) and autologous serum skin test (ASST), were performed to assess sweat and serum reactivity, respectively. The presence of atopic dermatitis and hypohidrosis was evaluated in accordance with established guidelines. Univariable logistic analyses were conducted to assess the associations between rash types and clinical features, namely age, sex, ASwST and ASST results, atopic dermatitis, hypohidrosis, pruritus, and pain. Multivariable logistic analysis was performed using only sex and age. Statistical analyses were performed using GraphPad Prism 10, with significance set at P < 0.05.

RESULTS: The red wheal/erythema group had typical punctate or coalescent erythematous wheals, while the goosebumps group had follicular, goosebump-like rashes with or without erythema. Compared with the red wheal/erythema group, the goosebumps group had a higher proportion of males (85% versus 38.6%) and higher prevalences of hypohidrosis (89.4% versus 35.7%) and pain (89.5% versus 37.8%). In contrast, the red wheal/erythema group had significantly higher prevalences of ASwST positivity (68.4% versus 20%), atopic dermatitis (58.1% versus 5.3%), and pruritus (78.4% versus 10.5%). Univariable analysis revealed that ASwST positivity, atopic dermatitis, and pruritus were significantly associated with the red wheal/erythema group, while hypohidrosis and pain were significantly associated with the goosebumps group. Multivariable logistic analysis showed that male sex was significantly associated with the goosebumps group.

CONCLUSIONS: Patients with CholU develop rashes with varying coloration and shapes. Goosebump-like rashes, which differ from typical wheals, were often accompanied by hypohidrosis. The type of rash may help to differentiate the clinical subtypes of CholU.

PMID:40715731 | DOI:10.1007/s40257-025-00967-3

World J Urol. 2025 Jul 26;43(1):459. doi: 10.1007/s00345-025-05756-5.

ABSTRACT

PURPOSE: Due to its physical properties, endoscopic enucleation of the prostate (EEP) with the pulsed solid-state Thulium: YAG laser (pulsed ThuLEP) presents a promising alternative to the widely used Holmium: YAG laser (HoLEP). This study aims to compare perioperative parameters of EEP performed using a novel 100 W pulsed Thulium: YAG laser with high peak power versus a standard 100 W Holmium: YAG laser in patients with benign prostatic hyperplasia (BPH).

METHODS: A retrospective analysis was conducted on 312 patients undergoing laser EEP, comprising 80 pulsed ThuLEP and 232 HoLEP procedures. Outcomes were adjusted for key perioperative variables (age, American Society of Anesthesiologists score, hemoglobin, preoperative prostate volume, prostate-specific antigen levels) through multivariable regression analysis. Comparisons between the two techniques utilized adjusted means and marginal contrast analysis.

RESULTS: Baseline characteristics were comparable across groups. Pulsed ThuLEP demonstrated significantly shorter operative times, with a reduction of 6.23 min in total surgery time (p = 0.006) and 4.36 min in enucleation time (p = 0.001) compared to HoLEP. Although pulsed ThuLEP showed faster enucleation speed, it did not reach statistical significance (p = 0.095). Laser energy consumption was comparable (p = 0.191). Additionally, pulsed ThuLEP was associated with reduced hospitalization time (4.19 vs. 4.65 days, p < 0.001) and lower maximum postoperative pain scores (0.78 vs. 4.23, p < 0.001).

CONCLUSION: The novel pulsed solid-state Thulium: YAG laser offers a viable and effective alternative to the established Holmium: YAG laser for EEP. Advantages of pulsed ThuLEP include shorter operative duration, reduced length of hospital stay, and significantly lower postoperative pain, making it a compelling option for surgical management of BPH.

TRIAL REGISTRATION: German Clinical Trials Register number: DRKS00031676.

PMID:40715722 | DOI:10.1007/s00345-025-05756-5

Epilepsy Behav. 2025 Jul 24;171:110618. doi: 10.1016/j.yebeh.2025.110618. Online ahead of print.

ABSTRACT

INTRODUCTION: An aneurysmal subarachnoid hemorrhage (aSAH) is a severe type of hemorrhagic stroke associated with substantial morbidity and long-term cognitive sequelae even when functional recovery appears to be satisfactory. Epilepsy-a common complication in aSAH survivors-is associated with worse outcomes, including increased mortality and disability and a diminished quality of life. This cross-sectional study investigates the long-term cognitive, functional, and quality-of-life outcomes for aSAH patients who develop epilepsy, comparing them to controls without epilepsy.

METHODS: This study involved 20 patients with epilepsy and 18 control subjects, recruited using the Kuopio Intracranial Aneurysm Database. The participants were evaluated 12 years after their aSAH at Kuopio University Hospital. Cognitive abilities, fatigue levels, depressive symptoms, and quality of life were measured using neuropsychological assessments and validated self-report instruments.

RESULTS: The analysis revealed no statistically significant differences in cognitive performance between the two groups, encompassing areas such as working memory, verbal and visual memory, processing speed, executive function, and verbal skills. Similarly, the assessments of fatigue, depression, and quality of life revealed no disparities.

CONCLUSIONS: Our study suggests that the neuropsychological outcomes in this population are primarily sequelae of the aSAH itself rather than additive cognitive effects of epilepsy. An important strength of this study is the relatively long median follow-up time of 12 years, allowing the evaluation of long-term outcomes after aSAH. However, the study’s limitations include a small sample size and a considerable number of patients being lost to follow-up. Future research with larger participant groups is needed to further clarify the intricate cognitive and psychological effects of epilepsy in survivors of aSAH and to develop targeted interventions intended to improve their long-term outcomes.

PMID:40712206 | DOI:10.1016/j.yebeh.2025.110618

Epilepsy Behav. 2025 Jul 24;171:110616. doi: 10.1016/j.yebeh.2025.110616. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The association of environmental noise with new-onset epilepsy has not yet been explored. Therefore, the study’s objective was to assess whether long-term road traffic noise exposure is associated with the risk of new-onset epilepsy among adult residents of Toronto, Canada.

METHODS: We conducted a nested case-control study using linked health administrative and environmental data. We included adult residents of Toronto as of January 1, 2010, with no history of seizures or epilepsy. Cases were those who developed epilepsy before December 31, 2016, and were each matched with up to five controls. We measured exposure to road traffic noise using three-year averages of the nighttime average (LA_{eq, 8 hr}), daytime average (LA_{eq, 16 hr}), and the 24-hour average (LA_{eq, 24 hr}) road traffic noise levels at participants’ postal code of residence. We estimated the associations of these three-year noise averages with the risk of new-onset epilepsy using conditional logistic regression models.

RESULTS: We included 4,608 cases and 20,765 controls; 46.3 % were female and the mean age was 48.3 (± 17.4) years. The incidence rate ratios associated with a 10-dB increase in LA_{eq, 8 hr} was 1.043 (95 % CI: 0.994, 1.095), 0.999 (95 % CI: 0.946, 1.054) for LA_{eq, 16 hr}, and 1.031 (95 % CI: 0.980, 1.086) for LA_{eq, 24 hr}.

DISCUSSION: Although not statistically significant, these results point to a potential association between long-term exposure to road traffic noise, particularly average levels at night, and the risk of new-onset epilepsy. Future research should continue to explore this potential association.

PMID:40712204 | DOI:10.1016/j.yebeh.2025.110616

Epilepsy Behav. 2025 Jul 24;171:110545. doi: 10.1016/j.yebeh.2025.110545. Online ahead of print.

ABSTRACT

BACKGROUND: Effective self-management is essential for patients with epilepsy to achieve optimal health outcomes. However, previous studies indicate that self-management performance remains suboptimal in this population. This study aimed to evaluate the relationships between patient empowerment, disease-related fear, self-regulatory fatigue, and self-management behaviors in patients with epilepsy in China, utilizing dual systems theory as a framework.

METHODS: A convenience sampling method was employed to collect data from 655 patients with epilepsy at a tertiary hospital in Hangzhou, China, between June and November 2023. Validated scales were used to assess patient empowerment, disease-related fear, self-regulatory fatigue, and self-management behaviors. A structural equation model (SEM) based on dual systems theory was used for data analysis.

RESULTS: Among the included patients, 377 (57.60 %) were male, 360 (55.00 %) were from urban areas, and 361 (55.11 %) were unmarried.The average score for self-management behavior was 122.91 ± 18.48, indicating a moderate level of performance. SEM analysis revealed that patient empowerment had a direct positive effect on self-management behaviors (β = 0.236), a direct negative effect on illness-related fear (β = -0.608) and self-regulatory fatigue (β = -0.561), and an indirect effect on self-management behaviors (β = 0.433). All path coefficients were statistically significant (p < 0.0001). The model demonstrated excellent fit indices: χ2/df = 1.422, RMSEA = 0.025, GFI = 0.954, AGFI = 0.954, CFI = 0.952, TLI = 0.959, NFI = 0.954, IFI = 0.925.

CONCLUSION: The results of structural equation modeling show that the impact of patient empowerment on self-management is mediated through disease-related fear and self-regulatory fatigue. Therefore, enhancing patient empowerment and reducing patients’ disease-related fear and self-regulatory fatigue may help promote effective self-management in patients with epilepsy.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40712202 | DOI:10.1016/j.yebeh.2025.110545

Clin Genitourin Cancer. 2025 Jun 30;23(5):102395. doi: 10.1016/j.clgc.2025.102395. Online ahead of print.

ABSTRACT

INTRODUCTION: Retrospective data suggest poorer survival for female, racial minority, and older advanced urothelial carcinoma (aUC) patients. However, data on survival disparities in the modern era remain limited.

METHODS: This cohort study used Flatiron Health’s nationwide de-identified electronic health record (EHR)-derived database. Patients who initiated systemic therapy for aUC between January, 2017 and May, 2024 were included. Baseline characteristics, treatment history, and clinical outcomes were abstracted. PFS and OS were compared by sex (male vs. female), race (White, Black, vs. Asian/Pacific Islander [API]), and age at diagnosis (> 65 years [y] vs. ≤ 65 y), using Kaplan-Meier log-rank analysis and Cox proportional hazards models. Independent sample t-tests and chi-square analyses were used for univariate comparisons. P-values < .05 were considered statistically significant.

RESULTS: A total of 5142 patients with aUC were identified. 1419 were (28%) female and 575 (11%) were > 65 y. Of those with recorded race (n = 3492), 1% were API, 5% Black, 14% categorized as “other,” and 80% White. There was no difference in PFS (8.7 vs. 9.0 months [m], HR1.03; P = .82) or OS (13.2 vs. 13.5 m; HR1.05, P = .31) between women and men. Women had shorter PFS to men on immune checkpoint inhibitors (ICI) (P = .002) but not with other first-line (1L) therapy. API patients had comparable PFS (9.6 vs. 8.9 m; HR0.91; P = .45) but longer OS (28.5 vs. 14.1 m; HR0.56; P = .008) compared to White patients. Black patients had comparable PFS (7.9 vs. 8.5; HR1.06; P = .81) and OS (11.5 vs. 14.1 m; HR1.32; P = .73) vs White patients. Patients > 65 y had shorter PFS to ≤ 65 y (7.6 vs. 9.0 m; HR1.14, P = .019); however, OS was longer in older patients (16.5 vs. 12.8 m; HR0.80, P < .001). Only on 1L ICI, OS was longer in those > 65 y compared to those ≤ 65 y (HR0.71; P = .021) CONCLUSION: In this large real-world database, female aUC patients had comparable PFS and OS to males. API patients showed superior OS to White patients. Patients > 65 y had inferior PFS but superior OS to patients ≤ 65 y.

PMID:40712200 | DOI:10.1016/j.clgc.2025.102395

Child Abuse Negl. 2025 Jul 24;167:107600. doi: 10.1016/j.chiabu.2025.107600. Online ahead of print.

ABSTRACT

BACKGROUND: Nurse-Family Partnership’s (NFP’s) effectiveness at improving child outcomes is likely influenced by patterns of program provision and engagement, or ‘intensity’.

OBJECTIVE: To investigate program effectiveness by patterns of intensity.

PARTICIPANTS AND SETTING: We analyzed secondary data from the Canadian NFP randomized controlled trial (RCT) involving 739 maternal participants and their 737 children in British Columbia.

METHODS: Participants were randomly allocated 1:1 to NFP and existing services (n = 368) or existing services (n = 371). We collected data on child injuries, language, cognition and problem behavior (mental health) at age two years (by November 2019). We estimated principal causal effects (PCE) using propensity score (PS) methods.

RESULTS: We identified three NFP intensity patterns: Low (median [Mdn] 14 visits), Partial (Mdn 52) and Sustained (Mdn 83). For NFP participants, we found statistically-significant differences in group mean scores (mean M [SD]): for Sustained on observed language (NFP 94.55 [16.71] versus PS-matched controls 89.97 [16.76]; PCE = 5.8, 95 % CI 0.57, 11.03, p = 0.030) and problem behavior (NFP 51.33 [9.04] versus PS-matched controls 56.43 [9.38]; PCE = -5.10, 95 % CI -8.27, -1.93, p = 0.002); and for Partial on maternal-reported language (NFP 313.43 [200.36]) versus PS-matched controls (255.99 [183.56]; PCE = 65.05, 95 % CI 24.09, 106.00, p = 0.013).

CONCLUSIONS: Delivering NFP as intended, with sustained intensity, led to greater benefits regarding child language and problem behavior (mental health) but not cognition or injuries by age two years. These complementary analyses provide crucial information, beyond standard RCT analyses, on NFP’s effectiveness in this Canadian cohort. Our results highlight the importance of ensuring full NFP intensity to maximize program benefits for children.

PMID:40712198 | DOI:10.1016/j.chiabu.2025.107600