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Finding an adequate dose of the drug by revealing the dose-response relationship is very crucial and a challenging problem in the clinical development. The main concerns in dose-finding study are to identify a minimum effective dose (MED) in anesthesia studies and maximum tolerated dose (MTD) in oncology clinical trials. For the estimation of MED and MTD, we propose two modifications of Firth's logistic regression using reparametrization, called reparametrized Firth's logistic regression (rFLR) and ridge-penalized reparametrized Firth's logistic regression (RrFLR). The proposed methods are designed by directly reducing the small-sample bias of the maximum likelihood estimate for the parameter of interest. In addition, we develop a method on how to construct confidence intervals for rFLR and RrFLR using profile penalized likelihood. In the up-and-down biased-coin design, numerical studies confirm the superior performance of the proposed methods in terms of the mean squared error, bias, and coverage accuracy of confidence intervals.
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http://dx.doi.org/10.1002/pst.2423 | DOI Listing |
Br J Psychiatry
September 2025
Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Background: Although current prescribing guidelines suggest continuation of psychotropic drugs in pregnant women, population-based evidence supporting their safety is limited.
Aims: This study aims to clarify the plausible causal links between maternal psychotropic drug exposures and obstetric complications.
Method: This cohort study investigated all births by Hong Kong residents ≥18 years of age in public hospitals between 2004 and 2022.
Surgery
August 2025
General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China. Electronic address:
Background: Textbook outcome, a composite measure of optimal recovery, remains poorly defined for invasive intraductal papillary mucinous neoplasm after pancreaticoduodenectomy. This study aimed to develop and validate the first nomogram predicting textbook outcome in this distinct cohort, addressing gaps in tailored prognostic tools for patients meeting contemporary surgical criteria on the basis of high-risk features.
Methods: Using multicenter data from 327 US patients (training cohort) and 152 Chinese patients (external test cohort), we evaluated 43 preoperative and intraoperative variables.
Eur J Obstet Gynecol Reprod Biol
August 2025
Department of Gynaecology and Obstetrics, Hôpitaux Universitaires de Strasbourg 67091 Strasbourg, France.
Introduction: Spontaneous rupture of membranes before 37 weeks of amenorrhea (preterm premature rupture of membranes [pPROM]) is associated with two main complications: prematurity and fetal infection. Biological parameters, particularly C-reactive protein (CRP) levels, were monitored during a continued pregnancy. Group A represented our previous practice, that is, regular CRP monitoring with induced birth or cesarean section after two consecutive levels above 20 mg/L.
View Article and Find Full Text PDFBMC Neurol
August 2025
Neurology Unit, Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia.
Background: High on-treatment platelet reactivity (HOTPR) may undermine the efficacy of antiplatelet therapy in acute stroke. This study aimed to assess platelet reactivity and HOTPR status during the acute phase of ischaemic stroke following antiplatelet initiation, and to determine their associations with stroke outcomes in a Malaysian cohort.
Methods: This prospective, observational study enrolled patients with acute ischaemic stroke at Sarawak General Hospital.
Acta Chir Orthop Traumatol Cech
July 2025
Klinika detske a dospele ortopedie a traumatologie 2. lekarske fakulty Univerzity Karlovy a Fakultni nemocnice v Motole, Praha.
Purpose Of The Study: The study evaluates the functional outcomes of the treatment of pediatric trigger digits in two centers and compares them with data from the available literature. The secondary objective is to verify the possibilities of collecting data on patients' health status through questionnaire surveys using remote communication via a web interface.
Material And Methods: Patients operated on at the Hand and Plastic Surgery Institute in Vysoké nad Jizerou (ÚCHRaPCH) and the Motol University Hospital, Department of Orthopaedics (FNM) between 2018 and 2021 were evaluated.