Tag: statistics

Int J Comput Assist Radiol Surg. 2025 Nov 8. doi: 10.1007/s11548-025-03545-4. Online ahead of print.

ABSTRACT

PURPOSE: This article reports on the development and feasibility testing of an MR-safe robotic needle driver. The needle driver is pneumatically actuated and designed for automatic insertion and extraction of needles along a straight trajectory within the MRI scanner.

METHOD: All parts use plastic resins and composite materials to ensure MR-safe operation. A needle could be clamped in the needle carriage using a pneumatically operated clamp. The clamp is designed to be easily attached and detached from the needle driver. Clamps with different opening sizes could accommodate a range of needles from 18 to 22 gauge. To mimic the manual procedure of needle insertion, a pneumatically operated rack-and-pinion mechanism simultaneously translates and rotates the needle carriage along a helical slot. Signal-to-noise ratio (SNR) and 2-D geometric distortion were measured to evaluate the MRI compatibility. Targeting was measured with an electromagnetic tracker. We also evaluated the maximum force that could be generated at the tip of the needle with different clamping pressures using a force sensor.

RESULTS: We recorded the maximum percentage change in SNR for multiple configurations of needle drivers as 6.6% and the maximum geometric distortion at 0.24%. The needle driver’s mean positioning accuracy for 105 targets at 50 mm depth was 2.38 ± 1.00 mm in a composite tissue phantom. The angulation error for the straight trajectory was 0.51°, and the mean linear trajectory deviation was statistically negligible. The measured force at the needle tip was 1.17N, 1.6N, and 2.12N at 30, 40, and 50 psi, respectively.

CONCLUSION: This preliminary study showed that the prototype of our robotic needle driver works as intended for the insertion and extraction of the needle. The driver is MR-safe and serves as a suitable platform for MRI-guided interventions.

PMID:41205052 | DOI:10.1007/s11548-025-03545-4

Arch Gynecol Obstet. 2025 Nov 8. doi: 10.1007/s00404-025-08238-6. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the impact of repeated cesarean deliveries on isthmocele formation and to investigate the diagnostic value and clinical presentation of morphometric parameters, including niche depth, width, length, residual myometrial thickness (RMT), adjacent myometrial thickness (AMT), and the depth/AMT ratio.

METHODS: A cross-sectional study was conducted with 116 symptomatic and asymptomatic women aged 18-45 years who had undergone one or more cesarean sections. The presence and dimensions of the isthmocele were assessed via transvaginal ultrasonography using Delphi consensus criteria. Morphometric and obstetric data were analyzed using descriptive statistics, correlation analysis, and binary logistic regression.

RESULTS: Isthmocele was identified in 71.6% of participants, with prevalence rising from 42.9% after the first cesarean to 100% after the fourth. The isthmocele group had significantly higher gravidity, parity, and cesarean numbers (p < 0.001). Niche depth, length, and the depth/AMT ratio were significantly elevated, while RMT was reduced (p < 0.001). The number of cesareans showed a strong negative correlation with RMT (r = -0.499, p < 0.001) and a strong positive correlation with the depth/RMT ratio (r = 0.615, p < 0.001). Multivariate analysis identified having three or more cesareans as an independent predictor of isthmocele (OR = 15.6; 95% CI 3.27-74.4; p < 0.001). Niche length had the highest diagnostic accuracy for symptomatic isthmocele (AUC 0.700; 95% CI 0.589-0.796; cutoff 5 mm).

CONCLUSION: Repeated cesarean deliveries significantly increase both the risk and severity of isthmocele. In women with four cesareans, isthmocele was detected in 100% of cases. A niche length of ≥ 5 mm proved to be the most reliable morphometric marker in identifying symptomatic cases.

IMPLICATIONS FOR CLINICAL PRACTICE: These findings emphasize the importance of routine transvaginal ultrasound screening post-cesarean-especially in women with multiple cesarean sections-and the incorporation of morphometric assessment (including RMT and depth/RMT ratio) into clinical decision-making.

PMID:41205040 | DOI:10.1007/s00404-025-08238-6

Pharmacoecon Open. 2025 Nov 8. doi: 10.1007/s41669-025-00615-w. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify health utility decrements of injection treatment-related attributes among patients with type 2 diabetes mellitus (T2DM) in China.

METHODS: Health states of four attributes (hypoglycemia, dose frequency, flexibility and injection site reaction) were generated using a vignette-based method. Patients with T2DM were recruited from eight cities in China. The sample was broadly consistent with Chinese T2DM population with regard to age and sex distribution. Respondents completed seven time trade-off (TTO) tasks during face-to-face interviews. The ordinary least square (OLS), fixed effects (FE) and random effects (RE) models were used for TTO data. In subgroup analysis, groups were categorized based on whether injection treatment was currently used, number of medications, needle phobia, duration of injectable treatment and travel frequency.

RESULTS: A total of 400 patients (52.75% male, mean [SD] age 50.30 [12.05] years) were included in this study. Severe hypoglycemia had the largest disutility value of all attributes (-0.023, P < 0.001). Three times daily, twice daily and once daily injection (needed to be carried with the patient on short trips) were associated with -0.023 (P < 0.001), -0.018 (P < 0.001) and -0.011 (P = 0.022) disutility values compared with once weekly injection (not required to be carried with the patient on short trips), respectively. The disutility value associated with injection site reaction attribute was -0.013 (P < 0.001). In subgroup analysis, the relative importance of treatment-related attributes was found to depend on patient characteristics.

CONCLUSIONS: This study provides disutility values associated with several injection treatment-related attributes for Chinese patients with T2DM. Hypoglycemia appears to be the most important attribute, followed by dose frequency, flexibility and injection site reaction.

PMID:41205032 | DOI:10.1007/s41669-025-00615-w

Clin Drug Investig. 2025 Nov 8. doi: 10.1007/s40261-025-01497-w. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Anemia is a serious heath concern due to its high prevalence in the global population. Its occurrence in surgical patients varies greatly and correlates with worse outcomes. Higher costs and severe complications could also result from insufficient iron status. An effective way to mitigate the burden of iron deficiency could be the adoption of national patient blood management (PBM) programs. This study aimed to quantify the potential health economic benefits of implementing preoperative anemia management (the first pillar of PBM) with ferric carboxymaltose (FCM) in Romanian hospitals.

METHODS: An already published decision-tree-based health economic model was adapted and populated with Romanian cost and epidemiological data from 2019. Cardiac (coronary artery bypass grafting) and non-cardiac (hip and knee arthroplasty) elective surgery cases were analyzed. Costs of complications per discharged case were assessed on the basis of data from ten local hospitals.

RESULTS: A total of 14,641 cases met the inclusion criteria. On the basis of our sample of ten hospitals, the complication costs per case ranged from €1067.43 (for stroke) to €2896.14 (for sepsis with pneumonia). The health economic model simulated two scenarios. In the first scenario, all cases with anemia received FCM treatment. The total savings at the national level total were at least €1,500,875. In the second scenario half of the cases with anemia received treatment, resulting in savings of €363,779.

CONCLUSIONS: Our results suggest that introducing iron deficiency anemia treatment with FCM in case of elective surgical interventions results in considerable cost reduction for the healthcare system.

PMID:41205029 | DOI:10.1007/s40261-025-01497-w

Odontology. 2025 Nov 8. doi: 10.1007/s10266-025-01249-4. Online ahead of print.

ABSTRACT

Monolithic zirconia has become increasingly popular in prosthodontics due to its favorable mechanical and esthetic properties. However, exposure to acidic conditions, such as simulated gastric acid, may compromise its optical and surface characteristics. This in vitro study aimed to evaluate the effects of three different surface modification technique mechanical polishing, polishing followed by glaze application, and polishing followed by zirconia-silica coating on the color stability and surface roughness of monolithic zirconia under acidic and neutral conditions. Forty-eight monolithic zirconia specimens were randomly assigned to six groups according to the surface modification technique and immersion medium (distilled water or simulated gastric acid). Color differences (ΔE₀₀) were calculated using the CIEDE2000 formula, and surface roughness was assessed using Atomic Force Microscopy (AFM). Data were analyzed using two-way ANOVA and Tukey’s HSD post hoc test (α = 0.05). Surface modification technique significantly affected ΔE₀₀ values (p = 0.00015), whereas neither the immersion medium nor the interaction between the two factors was statistically significant. The mechanically polished group exhibited the highest color change. Regarding surface roughness, exposure to acidic conditions resulted in smoother surfaces in the mechanically polished and polished + glaze groups, whereas an increase in roughness was observed in the zirconia-silica-coated group. Surface modification techniques play a critical role in the esthetic and structural integrity of monolithic zirconia restorations. Glazing and zirconia-silica coating improved color stability and maintained surface characteristics more effectively than mechanical polishing alone. The influence of solution pH was minimal. These findings support the use of appropriate finishing techniques to enhance the clinical longevity of zirconia restorations.

PMID:41205026 | DOI:10.1007/s10266-025-01249-4

Odontology. 2025 Nov 8. doi: 10.1007/s10266-025-01255-6. Online ahead of print.

ABSTRACT

This study aimed to evaluate the influence of root fusion on internal root morphology in maxillary second molars by comparing teeth with fused and independent roots using micro-computed tomography (micro-CT), in terms of inter-orifice distances, lateral and accessory canal distribution, apical anatomy, isthmus prevalence, and type. Three hundred extracted maxillary second molars were classified as having fused or independent roots and scanned using micro-CT. Linear distances between canal orifices, vertical position of MB2, isthmus types, and canal ramifications were analyzed. ROC analysis was performed to determine the diagnostic utility of inter-orifice distances in predicting root fusion. Statistical comparisons between groups were made using independent samples t-tests and Chi-square tests with a significance threshold of 5%. Fused roots showed significantly shorter MB1-P and DB-P distances compared to independent roots (p < 0.05). Cutoff values of 3.87 mm (MB1-P) and 3.38 mm (DB-P) demonstrated high sensitivity and specificity, respectively, for predicting fusion. The MB1-MB2 distance was not diagnostically useful (AUC < 0.5). Fused roots exhibited more bifid apices and a significantly higher number of apical foramina in mesiobuccal roots (p < 0.05). Independent roots had a higher number of accessory canals, particularly in MB roots. Type IV (isthmus without boundaries) isthmuses were more prevalent in the fused roots (p < 0.05). Fused roots exhibit distinct anatomical features compared to independent roots. Inter-orifice distances involving the palatal orifice may assist in identifying root fusion and anticipating complex canal configurations during endodontic treatment. Inter-orifice distances involving the palatal orifice (MB1-P, DB-P) were shorter in fused maxillary second molars in this ex vivo sample. Fused molars also tend to have more intricate anatomy with more bifid apices, higher mesiobuccal apical foramina counts, fewer accessory canals, and a greater prevalence of Type IV isthmuses compared with independent-rooted counterparts in the examined population.

PMID:41205025 | DOI:10.1007/s10266-025-01255-6

Med Biol Eng Comput. 2025 Nov 8. doi: 10.1007/s11517-025-03473-0. Online ahead of print.

ABSTRACT

Monitoring maternal and fetal health during pregnancy is crucial for preventing adverse outcomes. While tests such as ultrasound scans offer high accuracy, they can be costly and inconvenient. Telehealth solutions and more accessible body shape information provide pregnant women with a convenient way to monitor their health. This study explores the potential of 3D body scan data, captured during the 18-24 gestational weeks, to predict adverse pregnancy outcomes and estimate clinical parameters. We developed a novel algorithm with two parallel streams which are used for extract body shape features: one for supervised learning to extract sequential abdominal level circumference information, and the other for unsupervised learning to extract global shape descriptors, alongside a branch incorporating shape-related demographic data. Our results demonstrated that 3D body shapes can support the prediction of preterm labor and gestational diabetes mellitus (GDM), as well as the estimation of fetal weight. Compared to other machine learning models, our algorithm achieved the best performance, with prediction accuracies exceeding 89% and fetal weight estimation accuracy of 72.22% within a 10% error margin, outperforming the conventional anthropometric measurements-based method by 18.18%.

PMID:41205023 | DOI:10.1007/s11517-025-03473-0

Graefes Arch Clin Exp Ophthalmol. 2025 Nov 8. doi: 10.1007/s00417-025-07019-w. Online ahead of print.

ABSTRACT

PURPOSE: To study intricate relationship between drusen volume and evolving dynamics of retinal and choroidal vasculature in dry age-related macular degeneration (AMD).

METHODS: Patients underwent swept-source optical coherence tomography angiography (SS-OCTA) using Plex Elite 9000 device. Retinal thickness, retinal vessel perfusion, drusen volume, choroidal thickness (ChT), choroidal vascularity index (CVI), choroidal vessel diameters (MChVD), and intervessel distance (IVD) were assessed. The Advanced Research and Innovation (ARI) Network, ResUNet model, and Phansalkar thresholding were utilized for image analysis. The linear mixing model was used for the statistical analysis.

RESULTS: We assessed 53 eyes from 40 patients with dry AMD (22 eyes with early-stage, 31 eyes with intermediate-stage eyes). The mean age was 75.25 years and 62.5% were females. The mean LogMar visual acuity was 0.09 ± 0.17 standard deviation (SD) in early-stage and 0.19 ± 0.14 SD in intermediate-stage (p = 0.03). Mean drusen volume was 0.075 ± 0.125 SD mm³ in early-stage and 0.24 ± 0.26 SD mm³ in intermediate-stage (p = 0.005). Mean ChT was thicker, and mean CVI was higher in the early-stage compared to the intermediate-stage (p < 0.05). A decrease of 11.48 μm in MChVD for every 1 mm³ increase in drusen volume was noted.

CONCLUSION: With increase in drusen volume, a reduction in CVI and MChVD was noted, without any significant association with changes in retinal metrics, suggesting that choroidal vessels may exhibit early changes during disease progression.

PMID:41204997 | DOI:10.1007/s00417-025-07019-w

Environ Monit Assess. 2025 Nov 8;197(12):1311. doi: 10.1007/s10661-025-14703-1.

ABSTRACT

This study examines the presence and distribution of persistent organic pollutants (POPs) in the liver tissues of six Procellariiformes species collected from beach-cast individuals along the Rio Grande do Sul coast during their migration in the South Atlantic and the blood of brown booby (Sula leucogaster) sampled from a resident breeding population at the São Pedro and São Paulo Archipelago. POPs, including PCBs, DDTs, and Mirex, pose significant threats to marine ecosystems due to their persistence and bioaccumulative nature. Procellariiformes, such as albatrosses and petrels, and Suliformes, such as Sula leucogaster, are particularly vulnerable due to their high position in the food webs and high longevity. This study assesses the relative contributions of different POPs, identifies shifts in contamination profiles, and explores ecological factors driving variations in POP concentrations. Among Procellariiformes, no statistically significant differences were detected in POP concentrations between the taxonomic groups, suggesting shared exposure pathways in overlapping marine habitats. However, Shearwaters exhibited higher median PCB and Mirex levels compared to other groups. In contrast, S. leucogaster displayed a distinct contamination profile dominated by PCBs and DDTs, reflecting its specific foraging behaviors and tropical habitat. The predominance of highly chlorinated PCB congeners in S. leucogaster and Procellariiformes suggests long-range atmospheric transport as a significant source of contamination. These findings highlight the ecological role of multiple species of seabirds as sentinel species and underscore the need for ongoing monitoring of legacy POPs in tropical and subtropical ecosystems to inform conservation strategies.

PMID:41204991 | DOI:10.1007/s10661-025-14703-1

J Biopharm Stat. 2025 Nov 8:1-27. doi: 10.1080/10543406.2025.2575941. Online ahead of print.

ABSTRACT

This study presents a comprehensive evaluation of Bayesian meta-analysis methods for estimating odds ratios (ORs), with a focus on the impact of heterogeneity and prior distribution choices under varying conditions. Recognizing the limitations of frequentist approaches, especially in small-sample or rare-event scenarios, we implemented a Bayesian framework utilizing four different priors for heterogeneity: half-normal, exponential, half-Cauchy, and inverse-gamma. Simulation studies were conducted across 1,152 scenarios, varying the number of studies, event rarity, randomization ratios, and baseline risks. Results indicate that prior specification and study size substantially influence estimation accuracy, particularly for rare events. To further explore these interactions, CHAID (Chi-square Automatic Interaction Detection) analysis, which effectively identified key factors affecting model performance, is implemented. CHAID revealed that the number of studies included in the meta-analysis (NSMA) is the most significant determinant of estimation reliability, while other variables such as event type and randomization ratio exert notable influence under specific conditions. CHAID also facilitated the categorization of OR estimation quality and heterogeneity levels, offering a powerful visual and interpretive aid. Overall, this study underscores the importance of prior selection in Bayesian meta-analysis and highlights CHAID analysis as a valuable complementary tool for uncovering complex interactions and enhancing result interpretability.

PMID:41204818 | DOI:10.1080/10543406.2025.2575941