Category: Statistics

Rev Neurol. 2026 Apr 21;81(4):48908. doi: 10.31083/RN48908.

ABSTRACT

BACKGROUND: Anxiety symptoms in elderly patients with cognitive impairment (CI) often reflect shared neurobiological processes rather than distinct psychiatric disorders. Current diagnostic approaches lack objective biomarkers for early identification. This study investigated the association between serum biomarkers and anxiety disorder status in elderly men with CI and to evaluate the exploratory discriminative ability of cognitive domains and biomarker profiles in differentiating CI patients with and without comorbid anxiety.

METHODS: This cross-sectional retrospective study analyzed 86 elderly male CI patients (Group A: CI alone, n = 41; Group B: CI with anxiety, n = 45) at Jiangsu Rongjun Hospital (June-December, 2024). Anxiety disorder diagnosis was established through structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria conducted by two independent psychiatrists, with the Hamilton Anxiety Scale (HAMA) serving as an initial severity screening instrument. The Montreal Cognitive Assessment (MOCA) was used to evaluate cognitive function. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum Tau protein (Tau), β-amyloid (Aβ), visinin-like protein 1 (VILIP-1), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6); reverse transcription-polymerase chain reaction (RT-PCR) quantified microRNA-34c (MiR-34c). Patients with acute inflammation (C-reactive protein [CRP] >10 mg/L) were excluded. Bonferroni correction was used to address multiple comparisons across 25 simultaneous tests, and multivariate regression analysis was controlled for demographic and clinical confounders. Receiver operating characteristic (ROC) analysis was used to determine the discriminative ability.

RESULTS: Group B showed worse cognitive performance across the MOCA domains, with attention (area under the curve [AUC] = 0.738) and delayed recall (AUC = 0.742) demonstrating the strongest discriminative ability. Biomarker analysis revealed elevated Tau (AUC = 0.957), MDA (AUC = 0.941), and VILIP-1 (AUC = 0.914) in anxiety patients. Within-group analyses showed that anxiety severity correlated negatively with MiR-34c and positively with Tau, Aβ, MDA, IL-6, and VILIP-1. Under the Bonferroni-adjusted threshold (p < 0.002), only MDA in Group B (r = 0.478, p = 0.001) and MiR-34c in Group B (r = -0.523, p < 0.001) remained significant. Multivariate analysis identified these factors as independently associated with the outcome after controlling for demographics and comorbidities. However, given the substantial baseline imbalances between the groups, these associations should be interpreted with caution.

CONCLUSION: Combined cognitive assessment (attention, delayed recall) and serum biomarkers (Tau, MDA, VILIP-1, MiR-34c) demonstrate promising discriminative ability for identifying anxiety in elderly male patients with CI. These findings are exploratory and derived from a single-center cohort of retired male military veterans with pronounced baseline group imbalances, which substantially limits generalizability to the broader elderly CI population. The identified markers may reflect shared neuroinflammatory and oxidative stress pathways underlying both cognitive and emotional dysfunction, warranting further investigation as potential targets for integrated therapeutic approaches. Validation in prospective, multicenter, sex-inclusive cohorts with balanced comparison groups is essential before any clinical application can be considered.

PMID:42052788 | DOI:10.31083/RN48908

Eur J Oral Sci. 2026 Apr 29:e70097. doi: 10.1111/eos.70097. Online ahead of print.

ABSTRACT

This study evaluated the impact of in-office bleaching on color stability of bulk-fill composites submitted to staining. Bulk-fill (Aura, Opus, and Filtek One) and nanofilled (Filtek Z350) composite specimens were submitted to the following: control (CT); bleaching and immersion in distilled water (BL); and bleaching with daily 15-min immersion in coffee (BL + CF), cola-based drink (BL + CO), or red wine (BL + RW) among sessions. A spectrophotometer determined ΔE₀₀, ΔWI_D, and coordinates. Degree of conversion (DC) and topography of the composites were assessed using Fourier-transform infrared spectroscopy in attenuated total reflectance (FTIR-ATR) and scanning electron microscopy (SEM), respectively. Quantitative data were submitted to statistical tests according to the factors (α = 5%). In BL, Opus and Aura displayed significantly higher ΔE₀₀ and ΔWI_D than One. Compared to BL, only BL + CF significantly decreased the ΔWI_D and ΔL for Aura, but all staining immersions decreased ΔWI_D and ΔL for Opus. One and Z350 were not impacted by treatments, except for BL + CF, which significantly decreased ΔWI_D and ΔL. SEM revealed influence of cycling on composites’ surface, but DC did not determine their staining resistance. In-office bleaching compromised bulk-fill composite color stability, with Aura and Opus showing unacceptable changes, whereas Filtek One and Z350XT remained acceptable. Staining challenges altered Opus stability, and coffee immersion affected colorimetric outcomes across all composites after bleaching.

PMID:42052780 | DOI:10.1111/eos.70097

J Dent Educ. 2026 Apr 29. doi: 10.1002/jdd.70253. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to compare the Objective Structured Clinical Examination (OSCE) preparation and performance of foreign-trained dentists enrolled in a 28-month international dental program (DMDAS) with the traditional, domestic dental students (DMD).

MATERIAL AND METHODS: This study was exempted by the Institutional Review Board at the University of Illinois, Chicago (#2024-1441). De-identified OSCE results of 337 DMD and 249 DMDAS predoctoral dental students from the graduating classes of 2021-2025 were gathered and analyzed. For the purpose of analysis, differences greater than 2 standard deviations for each discipline tested on the OSCE were considered “academically meaningful.” Student perceptions and preparation strategies for the exam were assessed by an anonymous electronic survey disseminated to the class of 2025 (N = 118), 4 months following the OSCE. Descriptive and statistical analyses were performed (α = 0.05).

RESULTS: Both cohorts performed similarly with respect to the number of station failures. DMD students performed statistically significantly better than their counterparts in several OSCE stations; academically meaningful difference in performance was noted in Medical Referral, Lifelong Learning, and Evidence-Based Dentistry. Both student cohorts perceived the exam to have been fair and objective, covered a wide range of clinical applications and the curriculum, and was realistic. The exam platform and English proficiency seemed to have played a minor role in student’s perception of the exam outcomes.

CONCLUSION: Although OSCE performance varied between DMD and DMDAS students across disciplines/stations, no notable differences were found in how the two groups perceived the exam, nor in the total number of station failures.

PMID:42052779 | DOI:10.1002/jdd.70253

Can J Gastroenterol Hepatol. 2026;2026(1):e5902236. doi: 10.1155/cjgh/5902236.

ABSTRACT

BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent, and smoking is associated with greater disease severity. We investigated whether documented smoking cessation attempts among adults with MASLD were associated with liver-related outcomes, cardiovascular outcomes, and all-cause mortality.

METHODS: We performed a retrospective cohort study using the TriNetX Research Network. Adults (≥ 18 years) with MASLD and documented smoking history were included. A smoking cessation attempt was defined by cessation counseling and/or cessation pharmacotherapy; comparators had no documented cessation attempt. Patients with depressive disorders and competing liver etiologies were excluded. Cohorts were matched 1:1 using propensity scores, and outcomes were analyzed using Cox proportional hazards models. Sensitivity analyses were performed at fixed follow-up horizons of 6 months, 1 year, and 2 years.

RESULTS: Among 418,784 eligible patients, 85,639 had a documented cessation attempt and 333,145 did not; after matching, 83,315 patients remained in each cohort. In the matched cohort, cessation attempt was associated with lower hazards of cirrhosis progression (1.7% vs. 2.1%; HR 0.87, 95% CI 0.81-0.93), hepatocellular carcinoma (0.2% vs. 0.3%; HR 0.58, 95% CI 0.48-0.70), portal hypertension (0.8% vs. 1.1%; HR 0.77, 95% CI 0.70-0.86), and MASH progression (2.2% vs. 2.9%; HR 0.76, 95% CI 0.71-0.81). The cessation attempt was also associated with higher hazards of MACE (13.6% vs. 11.4%; HR 1.24, 95% CI 1.20-1.28), peripheral artery disease (4.1% vs. 3.2%; HR 1.33, 95% CI 1.26-1.40), and all-cause mortality (8.5% vs. 7.3%; HR 1.23, 95% CI 1.18-1.27). Fixed-horizon analyses showed similar patterns over time.

CONCLUSIONS: In adults with MASLD and smoking history, documented smoking cessation attempts were associated with lower hazards of several liver outcomes but higher cardiovascular event rates and mortality, findings likely influenced by residual confounding and clinical risk clustering in patients receiving cessation interventions.

PMID:42052778 | DOI:10.1155/cjgh/5902236

Aust J Rural Health. 2026 Jun;34(3):e70199. doi: 10.1111/ajr.70199.

ABSTRACT

OBJECTIVES: Older adults in rural communities often have difficulty accessing mental healthcare. Community paramedicine may offer a novel opportunity to address this need. This study aimed to explore whether a feasibility trial of a community paramedicine programme, CP@clinic, can influence mental health outcomes in rural adults.

SETTING: This study was conducted in a regional town in Victoria, Australia, across six clinic sites, offering a free, 3-h drop-in service with community paramedics for individuals seeking health assessments or advice.

PARTICIPANTS: 205 clients (mean age 70 years) attended a community paramedic clinic.

DESIGN: The mixed-methods feasibility trial ran from 2022 to 2024. Data was recorded on chronic disease, quality of life, loneliness and mental health. Fourteen participants were interviewed to explore experiences and perceived benefits.

RESULTS: 47% of clients attending CP@clinic reported anxiety or depression. These participants experienced higher rates of social isolation, poverty, and health lifestyle risks. Participants reported that CP@clinic helped to improve their mental health both directly, through onward referrals to healthcare providers, and indirectly through improvements in mental health determinants across physical and social domains.

CONCLUSION: This study found a clear overlap between mental, physical, and social health needs of CP@clinic consumers. There is a need for accessible community-based services that address the mental health needs of older rural adults. CP@clinic may provide an opportunity to improve mental wellbeing in this population and should be further evaluated for this purpose.

PMID:42052773 | DOI:10.1111/ajr.70199

J Integr Neurosci. 2026 Mar 31;25(4):49400. doi: 10.31083/JIN49400.

ABSTRACT

Accumulating evidence has demonstrated that bilingual experience shapes the intrinsic functional organization of the brain. However, the findings from different studies remain fragmented. This review synthesizes resting-state functional magnetic resonance imaging (fMRI) studies examining how distinct dimensions of bilingual experience, including the age of L2 acquisition (AoA-L2), L2 proficiency (PL-L2), and usage of L2 (Usage-L2), modulate the resting-state functional connectivity (RSFC) and the intrinsic organization of the functional network. Earlier AoA-L2 is associated with stronger RSFC involving the language, attentional, and subcortical systems, whereas later acquisition is linked to compensatory increases in control and cerebellar-subcortical circuits. The evidence for PL-L2 indicates that bilinguals with higher proficiency exhibit increased RSFC within attentional, subcortical, and cerebellar networks, along with a more efficient and integrated organization of the whole-brain functional network. The frequency and contextual diversity of real-world Usage-L2 dynamically reshape intrinsic connectivity, with socially diverse language engagement enhancing cross-network integration in control, subcortical, and cerebello-cortical circuits, whereas routine home use is linked to more reduced or localized connectivity patterns. The current evidence reveals meaningful but fragmented patterns linking bilingual experience to intrinsic functional connectivity, largely due to conceptual inconsistencies, limited linguistic diversity, small samples, methodological heterogeneity, and the scarcity of longitudinal or multimodal designs. This review identifies seven priorities for future research to address these constraints and move toward a more unified account of bilingual neuroplasticity: establishing standardized and multidimensional measures of bilingual experience; expanding linguistic and sociocultural diversity; increasing statistical power and reproducibility; implementing longitudinal, training-based, and experience-sampling designs; harmonizing resting-state preprocessing and analytical pipelines; modeling nonlinear and interactive brain-experience relationships; and integrating multimodal neuroimaging to elucidate mechanistic pathways. Advances in these directions will enable the field to move beyond descriptive findings toward explanatory models that illuminate how different dimensions of bilingual experience dynamically reorganize the intrinsic functional architecture of the brain.

PMID:42052771 | DOI:10.31083/JIN49400

J Integr Neurosci. 2026 Apr 21;25(4):47468. doi: 10.31083/JIN47468.

ABSTRACT

BACKGROUND: Depression affects 28.4% of middle-aged and older adults globally, exacerbating functional decline, mortality, and healthcare burdens. Physical activity mitigates depression through neurobiological and psychosocial pathways, although efficacy varies significantly by gender. Current evidence lacks clarity regarding optimal physical activity intensity and interventions. This study aimed to identify the physical activity patterns most strongly associated with depression and to derive potential intervention targets for middle-aged and older Chinese adults.

METHODS: The data from 3739 participants in the 2020 China Health and Retirement Longitudinal Study were analyzed. Gaussian graphical models were adopted to recognize core and bridge symptoms within physical activity-depression networks across genders. Subsequently, computer-simulated interventions were conducted to determine the optimal targets for reducing depressive symptoms by gender.

RESULTS: Both male and female networks identified “depressed” as the central symptom. However, the bridge symptoms differed: males exhibited a bridge role for “days with moderate physical activity per week”, whereas females showed this for “duration of moderate physical activity per day”. Network comparison test revealed significant gender differences in edge weights (p = 0.007), with 14 edges being statistically significant. Simulation interventions consistently pinpointed “depressed” and “stuck” as effective targets for intervention across genders.

CONCLUSIONS: Moderate physical activity most strongly correlated with depression. For men, interventions might prioritize increasing the regularity per week with moderate physical activity to prevent depression, whereas for women, focusing on the duration per day of such activity could be a promising target.

PMID:42052763 | DOI:10.31083/JIN47468

Water Environ Res. 2026 May;98(5):e70394. doi: 10.1002/wer.70394.

ABSTRACT

In this study, a total of 103 groundwater samples were collected from four subareas in the Xingtai Se-enriched area, central North China to explore controlling factors of hydrochemical components and suitability for drinking and irrigation purposes. The results indicate that the groundwater exhibits neutral to slightly alkaline properties. Piper diagram classifies the major groundwater types as SO₄-Ca and Cl-Ca·Mg. Integrated hydrochemical analyses (Gibbs and Gaillardet diagrams, ionic ratios, Chloro-Alkali Index, and Saturation Index) together with statistical approaches (Pearson’s correlation analysis and principal component analysis) reveal that hydrogeochemical evolution is governed by water-rock interactions (dissolution of calcite, dolomite, fluorite, gypsum, pyrite, and halite), cation exchange, and anthropogenic influences. Nonpoint sources (fertilizers, manure, and sewage) contribute to the elevations of NO₃ ^– and Cl^– concentrations. Water Quality Index (WQI) assessments indicate 80.58% of samples are suitable for drinking. SO₄ ^2- and NO₃ ^–are identified as key triggers of water quality deterioration, which are linked to carbonate rock dissolution, cation exchange, sulfur-containing minerals dissolution (gypsum and pyrite), and anthropogenic pollution (fertilizers and sewage). USSL classifications indicate 44.67% of samples are suitable for irrigation, contrasting with 1.94% deemed unsuitable, whereas Wilcox diagram categorizations show 43.68% as excellent-to-good and 2.91% as unsuitable. The findings can provide scientific guidance for rationally utilizing the valuable local Se-enriched groundwater resource on the premise of balancing exploitation with protection against hydrogeochemical and anthropogenic contamination.

PMID:42052753 | DOI:10.1002/wer.70394

Neuropsychopharmacol Rep. 2026 Jun;46(2):e70127. doi: 10.1002/npr2.70127.

ABSTRACT

AIM: A history of suicide attempts is a well-established predictor of future suicidal behavior; however, longitudinal evidence from real-world emergency settings remains limited. Because age and self-poisoning/overdose are readily available at emergency presentation and may inform post-discharge care, we examined whether age and overdose at the index suicide attempt predict medically attended suicide reattempts after emergency admission.

METHODS: We conducted a multicenter retrospective cohort study of 1038 patients admitted to emergency departments after suicide attempts between 2020 and 2025 at three tertiary hospitals in Japan (Dokkyo Medical University Hospital, Jichi Medical University Hospital, and Hachinohe City Hospital). Patients were followed longitudinally to identify suicide reattempts requiring medical attention. Time-to-event analyses were performed using Kaplan-Meier methods and Cox proportional hazards models. Age (< 40 vs. ≥ 40 years) and sex were included as baseline covariates, and overdose at the index attempt was examined as an explanatory variable. Sensitivity analyses were performed using a stricter definition of overdose (overdose alone).

RESULTS: During follow-up, 58 medically attended suicide reattempts were identified. Kaplan-Meier analyses showed higher cumulative reattempt risk in females and in patients aged 39 years or younger. In Cox proportional hazards models, age ≥ 40 years was associated with a lower risk of suicide reattempt, whereas overdose at the index attempt was associated with a significantly increased risk of suicide reattempt. These findings were consistent in sensitivity analyses.

CONCLUSION: Younger age and overdose at the index suicide attempt were independently associated with an increased risk of medically attended suicide reattempt. Assessment of the initial suicide method may help identify patients requiring intensive post-discharge monitoring.

PMID:42052750 | DOI:10.1002/npr2.70127

J Comp Eff Res. 2026 Apr 29:e260006. doi: 10.57264/cer-2026-0006. Online ahead of print.

ABSTRACT

Aim: Single-arm trial data is frequently used during the reimbursement of new oncology interventions. Evaluating treatment effects relative to multiple relevant comparators via network meta-analysis (NMA) using data from single-arm trials; however, remains a challenge. This work introduces a two-stage approach to incorporate single-arm trial data into an NMA and applies this to the LIBRETTO-001 (NCT03157128) trial where selpercatinib (a selective rearranged during transfection [RET] inhibitor) was trialed as a treatment for RET-fusion positive, nonsquamous non-small-cell lung cancer in the first line setting. Materials & methods: Using data from KEYNOTE-189 (NCT02578680) and a real-world database, a pseudo comparator arm was constructed by propensity score matching and adjusted via an acceleration factor to account for the prognostic effect of RET status. NMAs were conducted using a Bayesian random-effects model. Results: The hazard ratios of selpercatinib relative to pemetrexed + platinum-based chemotherapy (the most common comparator in the network used) were found to be 0.304 (95% credible interval [CrI] 0.165, 0.553) and 0.368 (95% CrI 0.178, 0.757) for progression-free survival and overall survival, respectively. The validation of the NMA results could be assessed for progression-free survival of selpercatinib versus pembrolizumab + pemetrexed + platinum-based chemotherapy. A good agreement with published results from the Phase III LIBRETTO-431 trial (NCT04194944) was found (0.586 [95% CrI 0.302,1.123] from the NMA vs 0.46 [95% CI 0.31, 0.70] from LIBRETTO-431 the intention to treat [pembrolizumab] population). Conclusion: The two-stage approach to incorporate single-arm trial data within NMAs is readily applicable within health technology assessment. Enabling the earlier assessment of single-arm trials, via pseudo comparator arms, will provide payers with greater confidence in anticipated treatment effects. In light of the joint clinical assessment, incorporation of single-arm trials within NMA facilitates the reporting of predicted treatment effects relative to multiple relevant comparators, which is important when considering the use of interventions for the global market.

PMID:42052748 | DOI:10.57264/cer-2026-0006