Category: Statistics

Laryngoscope. 2026 Mar 19. doi: 10.1002/lary.70511. Online ahead of print.

ABSTRACT

OBJECTIVE: High volume centers are trialing delayed extubation (DE) as an alternative management strategy to tracheostomy in patients undergoing head and neck reconstruction to bypass the pharyngolaryngeal oedema and ensure unobstructed ventilation. There remains a paucity of synthesized evidence in this area.

DATA SOURCES: This study represents the largest systematic review on this topic from databases including PubMed, Embase, and Scopus.

REVIEW METHODS: Review is conducted through JBI’s methodology for systematic reviews of effectiveness with findings reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A meta-analysis was conducted using the Mantel-Haenszel statistical method with risk ratios and 95% confidence intervals calculated.

RESULTS: For tracheostomy patients, weighted mean hospital and intensive care stay was 13.3 and 1.83 days respectively. For DE, the results were 12.25 and 1.47 days respectively. Meta-analysis for airway complications was statistically significant with a risk ratio of 4.14 (95% CI, 2.67-6.40) favoring the DE group. Risk ratio for flap complications was significant at 8.19 (95% CI, 3.41-19.65) favoring the DE group. One study reported overall survival and disease-free survival at 88.2% and 68.3% for tracheostomy group respectively, compared to 95.7% and 89.1% in the DE cohort.

CONCLUSION: Tracheostomy can no longer be considered routine and poses risks which should be considered in a shared decision-making model with the patient and assessed within a multidisciplinary setting. This study also highlights the emergence of DE, which can be considered in select patient populations. Further RCTs are required in this area.

PMID:41856784 | DOI:10.1002/lary.70511

Acta Anaesthesiol Scand. 2026 Apr;70(4):e70227. doi: 10.1111/aas.70227.

ABSTRACT

INTRODUCTION: Survivors of critical illness commonly experience physical, cognitive, and psychological impairments. Early rehabilitation may mitigate these impairments; however, how rehabilitation practices are perceived and implemented by healthcare professionals in intensive care unit (ICU) remains insufficiently described. This study aimed to describe healthcare professionals’ perceptions of rehabilitation activities in the ICU and to explore their self-reported estimates of the time devoted to these activities in Scandinavian ICUs.

METHODS: A cross-sectional survey was conducted among healthcare professionals working in ICUs in Denmark, Norway, and Sweden. Using convenience sampling, data were collected on rehabilitation activities, time allocation, timing of initiation, and availability of post-ICU rehabilitative services.

RESULTS: In total, 518 healthcare professionals participated. Rehabilitation was described as a multidimensional practice encompassing cognitive, sensory stimulation, physical, and social rehabilitation activities, as well as patient participation in personal care. Activities were typically performed daily throughout the ICU stay. Respondents reported spending a median of 40% of their working time on rehabilitation, and most patients were considered eligible. Commonly reported activities included verbal interaction, sitting on the edge of the bed, family visits, and participation in personal care.

CONCLUSION: Rehabilitation is an established component of ICU care in Scandinavia and is integrated into routine clinical practice. Activities span multiple domains, with physical and social rehabilitation activities being most prominent. Further research is needed to clarify optimal timing and prioritisation of rehabilitation activities.

EDITORIAL COMMENT: This survey study presents perceptions from ICU personnel of how rehabilitation activities tend to be implemented in their workplace. Through different means, rehabilitation efforts are described as established in ICU practice in the three Scandinavian countries which were sampled.

PMID:41856774 | DOI:10.1111/aas.70227

Br J Ophthalmol. 2026 Mar 19:bjo-2025-328651. doi: 10.1136/bjo-2025-328651. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: To determine the proportion of progressive retinal nerve fibre layer thickness (RNFLT) change that can be attributed to normal ageing.

METHODS: This prospective, longitudinal, cohort study included one eye each of 200 patients treated for open-angle glaucoma and 73 healthy control subjects who were followed with optical coherence tomography (OCT) every 6 months. A linear mixed-effects (LME) model was used to estimate the mean RNFLT slope and the difference between the two groups to evaluate factors affecting the slope, while adjusting for other variables.

RESULTS: The median (IQR) age and follow-up of all participants was 68.3 (61.8 to 74.7) years and 10.1 (6.4 to 12.9) years, respectively. The median baseline mean deviation in patients with glaucoma was -3.79 (-6.84 to -1.57) dB. Among those classified within normal limits for baseline RNFLT (39 (19.5%) patients with glaucoma and 68 (93.2%) healthy subjects), the individual RNFLT slopes were significantly steeper in patients with glaucoma (median, -0.76 (-1.13 to -0.49) µm/year) compared with healthy subjects (-0.51 (-0.72 to -0.19) µm/year, p<0.01). The LME model showed a statistically significant negative RNFLT slope in healthy subjects (-0.54 µm/year, p<0.01). After adjusting for covariates, diagnosis of glaucoma contributed an additional -0.47 µm/year (p<0.01). Baseline global RNFLT had a slightly negative impact on RNFLT slope (-0.01/year, p<0.01), while baseline age had a significant positive effect (0.01 μm/year², p<0.01).

CONCLUSIONS: Normal ageing contributed around one half of RNFLT thinning observed in patients treated for glaucoma.

PMID:41856770 | DOI:10.1136/bjo-2025-328651

BMJ Open Respir Res. 2026 Mar 19;13(1):e004065. doi: 10.1136/bmjresp-2025-004065.

ABSTRACT

INTRODUCTION: Sarcoidosis frequently involves intrathoracic lymph nodes and lung parenchyma and requires histological confirmation for diagnosis. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is recommended for obtaining mediastinal samples, its diagnostic yield frequently necessitates additional transbronchial lung biopsy (TBLB) and/or endobronchial biopsy (EBB). EBUS transbronchial mediastinal cryobiopsy (EBUS-TBMC) can yield larger, well-preserved tissue samples than EBUS-TBNA alone. However, whether EBUS-TBMC alone is equivalent to conventional multimodal sampling (EBUS-TBNA combined with TBLB and/or EBB), and whether TBLB and EBB provide incremental diagnostic value when added to EBUS-TBMC, is still unclear.

METHODS AND ANALYSIS: In this study, 410 patients with suspected stage I/II sarcoidosis will be randomly assigned in a 1:1 ratio to either the EBUS-TBMC or EBUS-TBNA group. All participants will then undergo TBLB and EBB. The primary outcome will be the granuloma detection rate. The diagnostic sensitivity, negative predictive value and procedure-related complications will be selected for secondary outcomes. Statistical analysis will be performed using SPSS V.24.0, with non-inferior testing for the primary comparison.

ETHICS AND DISSEMINATION: Approval for this DETECTION-SAR-II trial was obtained by the China-Japan Friendship Hospital Ethics Committee (Ethics number: 2025-KY-075). Participants will be fully informed of objectives, protocol and potential risks of the study before enrolment and will provide written informed consent.

TRIAL REGISTRATION NUMBER: NCT07246876.

PMID:41856756 | DOI:10.1136/bmjresp-2025-004065

Fam Med. 2026 Jan;58(1):20-26. doi: 10.22454/FamMed.2026.956887.

ABSTRACT

BACKGROUND AND OBJECTIVES: Family medicine residency faculty occupy multiple roles with residents, including teacher, adviser, evaluator, and supervisor. Faculty also might fill noncurricular roles in social settings and in providing health care services to residents. These overlapping responsibilities create potential for dual relationships that may blur boundaries and cause ethical concerns. While national guidelines prohibit overtly inappropriate relationships, little guidance exists for common noncurricular interactions. This study examined the prevalence, types, and consequences of faculty-resident dual relationships and assessed faculty awareness of related policies.

METHODS: We conducted a convergent mixed-methods survey of US family medicine faculty that included demographic items, questions about specific dual relationships and policy awareness, and an open-ended prompt concerning boundary crossings. Quantitative data were analyzed using descriptive statistics and χ2 tests; qualitative responses underwent thematic analysis.

RESULTS: We received 213 responses. Frequently reported dual relationships included social comingling (68%), provision of minor medical or behavioral services (54%), and personal relationships (36%); financial or contractual ties were rare (≤3%). We observed significant differences by faculty type: Behavioral health faculty were more likely to provide minor services (P = 0.004), while physician faculty more often provided intensive services (P = 0.011). Awareness of residency policies was low. Qualitative responses highlighted boundary crossings with negative impacts on residents, faculty, and programs.

CONCLUSIONS: Dual relationships are common in family medicine residencies, yet policy guidance is limited. Stronger institutional and professional guidelines would support resident wellness, faculty objectivity, and professional boundaries.

PMID:41854849 | DOI:10.22454/FamMed.2026.956887

Fam Med. 2026 Jan;58(1):12-19. doi: 10.22454/FamMed.2026.646169.

ABSTRACT

BACKGROUND AND OBJECTIVES: Maternal care in the United States is in crisis due to obstetrics workforce shortages. Family physicians, with whole-person training and geographical practice distribution, are well-positioned to address this crisis. Family physicians completing a family medicine obstetrics (FMOB) fellowship are trained in surgical skills and high-risk pregnancy management, and often practice in health care shortage areas. This study aimed to update and expand knowledge on FMOB fellowships, focusing on program characteristics and financial sustainability.

METHODS: We sent an email-based survey examining fellowship structure and financial information to 44 FMOB fellowships. Representatives of 22 fellowships (50%) anonymously completed the online survey. Authors used descriptive statistics, including frequency, mean, and standard deviation, to summarize the data.

RESULTS: Half the fellowships were housed in family medicine residency programs. Fellowships, mostly 1 year long, admitted on average 2.2 fellows annually. Financially, nearly half (45%) the fellowships operated at a budget deficit, with clinical revenue and federal funding being major funding sources. More than 50% of programs reported that fellows spent less than 20% of their time as an independent billing physician.

CONCLUSIONS: FMOB fellows are surgically trained and uniquely positioned to help address the current crisis, including filling obstetric care gaps in underserved and rural areas. Given funding challenges FMOB fellowships face, developing strategies for financial viability of FMOB fellowships going forward is crucial. Opportunities include increasing clinical revenue generation and attaining secure funding via pursuit of accreditation status for FMOB fellowship programs from the Accreditation Council for Graduate Medical Education.

PMID:41854848 | DOI:10.22454/FamMed.2026.646169

Biochem Genet. 2026 Mar 19. doi: 10.1007/s10528-026-11351-z. Online ahead of print.

ABSTRACT

This study aimed to investigate the effects of Lavandula angustifolia oil and medical ozone on the gene expressions of CYP1A1, CYP1A2, CYP2B1, and CYP3A1, as well as on the levels of Malondialdehyde (MDA), and the activities of Superoxide Dismutase (SOD) and Catalase (CAT) enzymes on acute liver toxicity. Experimental groups were established by separating 10-week-old 28 Wistar male rats, each weighing between 350 and 450 g, into four groups of seven rats each. Gene expression levels were determined using RT-qPCR. MDA measured in the tissue samples by the thiobarbituric acid method. SOD and CAT enzyme activities measured spectrophotometrically. CYP1A1 fold regulation significantly decreased in the Lavandula (p = 0.012), and medical ozone (p = 0.044) groups compared to the control group. However, changes in the combination group were not statistically significant compared to the control group (p = 0.133). There were no significant differences in the fold regulations of CYP1A2, CYP2B1, and CYP3A1 among any groups (p > 0.05). MDA levels were significantly lower in the Lavandula, and medical ozone groups compared to the control group (p = 0.001). CAT enzyme activity did not show significant differences in the Lavandula (p = 0.096) and medical ozone groups (p = 0.103) but decreased significantly in the combination group (p = 0.031). SOD enzyme activity did not show significant differences among the groups (p = 0.112). Lavandula and medical ozone treatments significantly reduced CYP1A1 gene expression and MDA levels, which may indicate their potential in reducing oxidative stress. These findings highlight the complexity of combined therapies and suggest possible interactions or suppressive effects between the agents, which have not been previously reported.

PMID:41854830 | DOI:10.1007/s10528-026-11351-z

Discov Oncol. 2026 Mar 19. doi: 10.1007/s12672-026-04841-4. Online ahead of print.

ABSTRACT

INTRODUCTION: The role of peripheral blood basophil (PBB) and their telomere length (TL) in the pathogenesis and prognosis of hepatocellular carcinoma (HCC) patients has not been fully studied. The correlation between PBB and TL is the risk of HCC.

METHODS: 30 healthy participants and 80 HCC patients from our hospital were included in this study, and their clinical baseline data and clinical characteristics were statistically analyzed. TL and telomerase in PBB were analyzed using quantitative real-time PCR. Univariate and multivariate Cox regression, Kaplan-Meier survival analysis, and natural splines were used.

RESULTS: Healthy participants 66.23 ± 11.20 years and 62.71 ± 13.27 HCC patients showed no significant difference in their gender, age, highest education level, and the distribution of PBB counts. There was a significant difference in their TL. A significant correlation between PBB count and recurrence in HCC patients was observed. Significant spline terms (PBB count: p < 0.01; BAS TL: p < 0.001) confirmed nonlinear associations, justifying avoiding dichotomy. Patients with higher PBB counts (>0.125⋅10⁹) having a higher risk of recurrence (HR reaching 182.49 [5.00-6664.20], p<0.01). HCC patients with PBB-TL levels greater than 1.5 have a higher risk of recurrence (HR peaking at 66.62 [8.27-536.51], p<0.001). Sensitivity analysis adjusted spline degrees of freedom (df) to 2, 3, 4. AIC values varied minimally (PBB count: 87.2-89.3; BAS TL: 106.1-110.1), indicating model robustness to df changes.

CONCLUSION: The preliminary results of this study support the use of PBB counting and TL for predicting HCC recurrence, supporting reliable nonlinear modeling.

PMID:41854795 | DOI:10.1007/s12672-026-04841-4

Breast Cancer Res Treat. 2026 Mar 19;216(3):31. doi: 10.1007/s10549-026-07917-5.

ABSTRACT

PURPOSE: To investigate long-term outcomes for triple‑negative breast cancer (TNBC) patients enrolled in JBCRG-22.

METHODS: TNBC (cT1c-T3, cN0-1, M0) patients were stratified by homologous recombination deficiency (HRD) and germline BRCA mutation (gBRCAm) status. Group A patients (aged < 65 years with HRD-positive tumors, or those with gBRCAm, if available) were randomized to receive 4 cycles of weekly paclitaxel (group A1) or eribulin (group A2), both with carboplatin, followed by 4 cycles of anthracycline. Group B patients (aged < 65 years with HRD-negative tumors or aged ≥ 65 years) were randomized to receive 6 cycles of eribulin plus cyclophosphamide (group B1) or eribulin plus capecitabine (group B2). Five-year invasive disease-free survival (IDFS), distant disease-free survival (DDFS), and overall survival (OS) were assessed. Additionally, data were analyzed by biomarker levels including lymphocyte count (LC) and neutrophil-to-lymphocyte ratio (NLR).

RESULTS: Ninety-nine patients were followed for a median of 5.6 years. In patients who received eribulin-based therapy (groups A2 + B1 + B2), 5-year IDFS and OS rates, respectively, were 95% and 100% in patients who achieved pCR after neoadjuvant therapy (n = 20) and 71.4% and 80.2% in those who did not (n = 56), showing significantly better prognosis in the pCR cohort (p < 0.05). OS tended to be better in patients with baseline LC ≥ 1500/mm³ and NLR < 3, particularly in eribulin-treated patients, although differences were non-significant.

CONCLUSIONS: These findings will help guide the development of eribulin-based neoadjuvant chemotherapy for selected TNBC patients. Our exploratory analysis of LC and NLR results may help inform clinical prediction models for eribulin-treated patients.

TRIAL REGISTRATION: The study has been registered with the University Hospital Medical Information Network Clinical Trials Registry ( https://www.umin.ac.jp/ctr/index-j.htm ) with unique trial number UMIN000023162. The Japan Breast Cancer Research Group trial number is JBCRG-22.

PMID:41854792 | DOI:10.1007/s10549-026-07917-5

Head Neck Pathol. 2026 Mar 19;20(1):34. doi: 10.1007/s12105-026-01908-0.

ABSTRACT

AIM: To characterize the expression of CD8 + T cells, CD68 + macrophages, and PDL1 in HPV-related multiphenotypic sinonasal carcinoma (HMSC) and evaluate their correlations with clinical outcomes.

MATERIALS AND METHODS: This retrospective cross-sectional study analyzed 27 HMSC cases. Clinical and histopathological data were obtained from medical records. Immunohistochemical expression of CD8 and CD68 was assessed quantitatively and qualitatively in stromal and intratumoral compartments. PDL1 expression was evaluated using the Combined Positive Score (CPS). HPV genotyping was performed using the Anyplex II HPV28 assay. Statistical analyses included descriptive statistics, Fisher’s exact test, Chi-square test, Spearman’s correlation, Student’s t-test, Mann-Whitney U test, Kaplan-Meier survival analysis with log-rank test, and Cox proportional hazards models.

RESULTS: The cohort included 15 (55.6%) males and 12 (44.4%) females, with a mean age of 59.5 years. Most patients presented without recurrence (n = 17, 63.0%), lymph node metastasis (n = 22, 81.5%), or distant metastasis (n = 23, 85.2%). HPV-33 was the predominant genotype, detected in 17 cases (63.0%). PDL1 positivity was observed in 12 tumors (44.4%) and correlated with increased CD8 + infiltration (ρ = 0.602, p < 0.01). Higher densities of CD8 + T cells and CD68 + macrophages were associated with reduced recurrence risk. Older age correlated with higher Ki67 index (ρ = 0.452, p < 0.05), lower PDL1 expression (ρ=-0.436, p < 0.05), and increased recurrence. Lymph node and distant metastases were associated with poorer disease-specific survival (p = 0.020 and p = 0.010, respectively).

CONCLUSIONS: The immune microenvironment, characterized by CD8 + and CD68 + cell density and PDL1 expression, together with patient age, appears to influence clinical outcomes in HMSC. These findings suggest that a subset of HMSC patients, particularly those with an inflamed tumor microenvironment, may be candidates for PDL1-targeted immunotherapy.

PMID:41854784 | DOI:10.1007/s12105-026-01908-0