Category: Statistics

Anatol J Cardiol. 2026 May 22. doi: 10.14744/AnatolJCardiol.2026.6045. Online ahead of print.

ABSTRACT

BACKGROUND: To assess the midterm clinical and echocardiographic outcomes of the Ozaki (aortic valve neocuspidization (AVNeo)) procedure performed at a single center.

METHODS: A total of 258 patients who underwent the AVNeo procedure between February 2019 and February 2025 were retrospectively analyzed. Demographic, operative, and echocardiographic data were evaluated. Patients were followed up with clinical examinations and transthoracic echocardiography at discharge, 3 months, 6 months, and annually thereafter.

RESULTS: The mean follow-up duration was 36 ± 17.5 months. The average age was 56.4 ± 15.1 years, and 31.6% were female. The mean peak pressure gradient across the aortic valve was 17.0 (11.8-20.2) mm Hg immediately after surgery, then 14.0 (11.0-19.0) mm Hg at 1 year and 17.0 (12.0-23.0) mm Hg at 3 years. The Friedman analysis demonstrated a statistically significant change in peak pressure gradient over time (χ² = 68.103, P < .001). Preoperatively, ejection fraction was 58.0 (52.0-64.0) %, increasing to 60.0 (56.0-62.0) % at 1 year and 61.0 (59.0-62.0) % at 3 years. Mild aortic regurgitation was seen in 2.7% of patients, and the reoperation rate was 0.38%. There were 3 in-hospital deaths (1.1%). Minimally invasive approaches (5 patients via a right anterior thoracotomy, 7 patients via an upper J sternotomy) were successfully performed in selected patients without needing to convert to full sternotomy.

CONCLUSION: The AVNeo procedure provides excellent midterm outcomes with low complication and reoperation rates. Its compatibility with minimally invasive approaches and avoidance of anticoagulation make it a promising, durable alternative to conventional aortic valve replacement.

PMID:42170756 | DOI:10.14744/AnatolJCardiol.2026.6045

Anatol J Cardiol. 2026 May 20. doi: 10.14744/AnatolJCardiol.2026.6183. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to identify the optimal measurement location and technique for native T1 mapping to establish a standardized approach. We evaluated the diagnostic performance of various T1 mapping measurement approaches by comparing non-ischemic dilated cardiomyopathy (NIDCM) and hypertrophic cardiomyopathy (HCM) cohorts with a control group.

METHODS: We retrospectively reviewed patients who underwent 1.5T cardiac magnetic resonance (CMR) with standardized protocol functional sequences, T1 mapping, and late gadolinium enhancement (LGE) between November 2016 and January 2023. A total of 143 subjects (61 NIDCM, 60 HCM, and 22 controls) were grouped based on CMR findings. Native T1 mapping images were acquired in basal, midventricular, and apical short-axis slices. Regions of interest were drawn in both the whole left ventricular myocardium (SAX) and the interventricular septum. Diagnostic yield and optimal cut-off values for native T1 were investigated.

RESULTS: Native T1 values were significantly higher than the control group for six different measurement approaches (p<0.05). Basal SAX and basal septal measurements provided the highest diagnostic accuracy values for both groups. Statistical analysis revealed that T1 values could differentiate between healthy and diseased myocardium, with a diagnostic accuracy of 86% for NIDCM and 73.4% for HCM. Furthermore, T1 values correlated with measures of global systolic function and left ventricular remodeling.

CONCLUSION: Our study shows that native T1 mapping using a streamlined single-slice acquisition with a septal measurement technique achieves diagnostic performance comparable to multi-slice protocols while reducing measurement heterogeneity. This optimization facilitates a time-efficient workflow and improves patient comfort without compromising diagnostic accuracy.

PMID:42170755 | DOI:10.14744/AnatolJCardiol.2026.6183

J Sports Med Phys Fitness. 2026 Jun;66(6):787-794. doi: 10.23736/S0022-4707.26.17494-5.

ABSTRACT

BACKGROUND: Brugada Syndrome (BrS) is a hereditary channelopathy with a dynamic ECG pattern, often latent at rest. While several triggers can unmask the type 1 pattern, the influence of physical activity (PA) remains uncertain. This study investigated whether PA is associated with spontaneous type 1 ECG, its unmasking in induced cases, and the occurrence of arrhythmic events in Brugada athletes.

METHODS: We enrolled 202 BrS patients (18-55 years), collecting demographic data, PA levels, resting ECG, and 12-lead Holter. Subjects exercising ≥4 hours/week were defined as “recreational athletes” per ESC guidelines. Statistical analyses included Mann-Whitney U, Chi-squared Tests, and logistic regression (adjusted for age/sex) to explore the relationship between PA and Brugada ECG patterns.

RESULTS: Of 202 patients (155 males, median age 35.5), 48 were athletes. Athletes showed lower median heart rate at first Holter (71 vs. 75 bpm). No significant difference was found in Brugada pattern expression between groups. PA was not significantly associated with the presence of type 1 ECG (OR: 2.51, P=0.140). No arrhythmic events occurred during exercise or follow-up.

CONCLUSIONS: PA does not increase Brugada ECG expression in spontaneous or induced cases. No arrhythmic events were reported in athletes during sport or follow-up.

PMID:42170723 | DOI:10.23736/S0022-4707.26.17494-5

Vet Rec. 2026 May 22. doi: 10.1002/vetr.70804. Online ahead of print.

ABSTRACT

BACKGROUND: To our knowledge, the effect of sedation with romifidine on the grading of laryngeal function in horses has not been studied. Our objective was to examine the effects of romifidine on the grading of laryngeal function and the cross-sectional area of the rima glottis (CSARG).

METHODS: Ten horses underwent three endoscopic examinations of the larynx: once while unsedated (group R1), once after being sedated with romifidine (0.04 mg/kg intravenously; group R2) and once again, while still sedated, after receiving a repeat dose of romifidine (0.08 mg/kg intravenously, total dose; group R3). The recorded examinations were randomised and examined by three blinded reviewers who graded laryngeal function. The CSARG was measured from still images obtained during peak inspiration.

RESULTS: Sedation had no significant effect on the endoscopic laryngeal function grade assigned. There was no statistical difference in CSARG between Groups R1 and R2 (p = 0.164). Significant reduction in CSARG was noted between Groups R1 and R3 (p < 0.001) and Groups R2 and R3 (p = 0.045).

LIMITATIONS: The low number of horses examined may have resulted in the analyses being insufficiently powered. As such, the findings should be interpreted cautiously.

CONCLUSION: A dose of 0.04 mg/kg romifidine administered intravenously had no significant effect on horses’ laryngeal function grade and CSARG.

PMID:42170716 | DOI:10.1002/vetr.70804

Hum Vaccin Immunother. 2026 Dec;22(1):2661114. doi: 10.1080/21645515.2026.2661114. Epub 2026 May 22.

ABSTRACT

Limited education and healthcare access are major contributors to Human Papillomavirus (HPV) vaccination disparities among African American adolescents. The Immunization Neighborhood (IN) involves enhanced communication and collaboration among providers to address people’s needs by expanding access points and education to increase vaccination. Because needs of immunization providers and parents to effectively collaborate are unknown, this study explored the feasibility of and processes needed for IN utilization across key partners: pediatricians, pharmacists, school nurses, health department staff, and African American parent-child dyads. We conducted a semi-structured interviews in a qualitative, descriptive study with a purposive sample of 30 African American parent-child dyads and 37 immunization providers in Middle Tennessee. The Consolidated Framework for Implementation Research (CFIR) guided inductive-deductive thematic analysis. We identified facilitators and barriers to IN utilization for four CFIR domains: (1) Intervention characteristics; (2) Outer setting; (3) Inner setting; and (4) Individual characteristics. Across CFIR domains and partners, key perceived facilitators include convenience, accessibility, extended hours, partner coordination, and existing subsidized programs. Perceived barriers included fragmented vaccination tracking, limited vaccine registry interoperability, existing policies, and lack of knowledge and trust in immunization providers and settings. Our study highlights the need for multi-component, collaborative, and patient-centered strategies for IN implementation to improve adolescent HPV vaccination rates, especially among African American adolescents. Policy changes to reduce out-of-pocket expenses, increase insurance coverage, require reporting to state immunization registries, encourage collaborative practices, and allow HPV vaccine delivery in schools could potentially enhance IN impact.

PMID:42170715 | DOI:10.1080/21645515.2026.2661114

J Glob Health. 2026 May 22;16:04167. doi: 10.7189/jogh.16.04167.

ABSTRACT

BACKGROUND: Niger has one of the highest maternal mortality rates, and facility delivery can help prevent these deaths. While distance to health facilities predicts home delivery in other sub-Saharan African settings, few studies have examined this relationship in Niger.

METHODS: This cross-sectional survey, an ancillary study to the AVENIR trial, included women aged 12-59 years old with a child participating in a sub-trial of AVENIR. Trained workers collected survey data on potential predictors of a home-based delivery, and separately documented primary health care centre (Centre de Santé Integré, CSI) services through site visits. Distance from household to CSI was split into three categories: less than five km, 5-10 km, and over 10 km. Generalised estimating equations (GEE) evaluated the association between distance to CSI and likelihood of a home-based delivery, adjusting for clustering by community. As a secondary analysis, backwards stepwise model selection determined the best set of predictors for a home-based delivery.

RESULTS: 49.2% of women indicated their last birth occurred at home. Compared with women living <5 km from a CSI, those living 5-10 km away had 1.72 times the odds of home delivery (95% confidence interval (CI) = 1.00-2.96), and those >10 km away had 2.67 times the odds (95% CI = 1.44-4.95). Model selection identified three significant predictors: number of prenatal care visits, distance to CSI, and number of living children.

CONCLUSIONS: Home delivery remains highly prevalent in rural Niger. Access to prenatal consultations, the number of living children a mother has, and distance from the household to the local CSI are key predictors of delivery location. Interventions for women who prefer or must give birth at home along with those aimed to increase facility-based delivery may support efforts to decrease maternal mortality in rural Niger.

TRIAL REGISTRATION: This trial was registered at clinicaltrials.gov (NCT04224987) on 13 January 2020.

PMID:42170714 | DOI:10.7189/jogh.16.04167

J Glob Health. 2026 May 22;16:04163. doi: 10.7189/jogh.16.04163.

ABSTRACT

BACKGROUND: Early-onset gastrointestinal cancers (EOGIC) are increasingly recognised as an urgent global health concern. We aimed to describe the global incidence patterns of EOGIC in 2022 and evaluate country-level ecological associations with behavioural risk factors.

METHODS: The incident cases and age-standardised incidence rates (ASIRs) of overall EOGIC, early-onset colorectal cancer (EOCRC), early-onset oesophageal cancer, early-onset gallbladder and biliary tract cancer, early-onset liver cancer (EOLC), early-onset pancreatic cancer (EOPC), and early-onset stomach cancer (EOSC) were extracted from the GLOBOCAN 2022 database. We used machine learning and generalised linear regression to screen and quantify the associations of behavioural risk factors and computed the model-based attributable fraction estimates.

RESULTS: In 2022, an estimated 465 584 new EOGIC cases occurred globally (9.49% of all-age gastrointestinal cancers), with an ASIR = 11.50 per 100 000 persons. Early-onset colorectal cancer was the highest in both incident cases (n = 186 840), and ASIR = 4.60 per 100 000, followed by EOLC and EOSC. High Human Development Index countries (n = 205 168 incident cases, ASIR = 13.20 per 100 000) showed highest incidence of EOGIC. The highest number of EOGIC incident cases was in Eastern Asia (n = 147 677) and the highest ASIR occurred in Australia-New Zealand (ASIR = 18.70 per 100 000). In the ecological analyses, diet high in red meat and smoking showed the largest attributable fraction estimates for overall EOGIC incidence, at 12.78% and 8.17%, respectively. Smoking also showed comparatively larger estimates for EOCRC (11.29%) and EOPC (23.97%). High alcohol use was associated with nonzero attributable estimates for EOCRC (3.14%), early-onset oesophageal cancer (1.57%), EOLC (7.39%), EOPC (3.75%), and EOSC (6.88%), whereas diet high in sodium showed the largest estimate for EOSC (15.41%).

CONCLUSIONS: Early-onset gastrointestinal cancer was a significant global health challenge, particularly for EOCRC and in high Human Development Index countries. These findings may help inform surveillance priorities and hypothesis generation for future etiologic research.

PMID:42170690 | DOI:10.7189/jogh.16.04163

Vet Radiol Ultrasound. 2026 May;67(3):e70181. doi: 10.1111/vru.70181.

ABSTRACT

Ultrasonography is frequently utilized in patients with urinary incontinence to screen for structural abnormalities such as ectopic ureters (EUs). Furosemide can be administered during an ultrasound for a better assessment of the ureters and their insertions. Furosemide decreases urine specific gravity (USG), and differences in specific gravity allow a better visibility of ureteral jets on ultrasound; however, it is unknown whether furosemide has utility in patients with hyposthenuria or isosthenuria. The aims of this study were to determine if furosemide administration improves the diagnosis of EUs using ultrasound and if there is a USG below which furosemide will not increase ureteral jet visibility. Thirty-one dogs with clinical suspicion for EUs, and seven dogs with polyuria and polydipsia were included. Urinary tract ultrasonography was performed, and a diagnosis of the presence or absence of EUs was made. Urine collected by urocystocentesis was used to measure USG, furosemide was administered, and the exam was repeated. Ultrasound results were compared to cystoscopy or other means of negative diagnosis to determine accuracy. The accuracy of the EU diagnosis following furosemide was not statistically significant. There was a significant increase in the confidence of diagnosis post-furosemide; there was no association between increased confidence and improved accuracy. Ureteral jets were visible following furosemide in dogs with USGs as low as 1.006. On the basis of these findings, furosemide can be helpful to improve confidence of EU diagnosis and can be administered to increase ureteral jet visibility in dogs with hyposthenuria or isosthenuria.

PMID:42170689 | DOI:10.1111/vru.70181

J Adolesc. 2026 May 22. doi: 10.1002/jad.70175. Online ahead of print.

ABSTRACT

INTRODUCTION: Resting heart rate (HR) measures reflect autonomic processes that could predict health risk behavior (HRB) in emerging adulthood when risky behavior is prominent. However, prior studies and extant theories are inconsistent, such that the relationships between HR measures and HRB could be positive or negative in direction. To reconcile these inconsistencies, we predicted that positive and negative relations between HR measures and HRB propensity exist together in a quadratic function.

METHODS: The current study tested this nonlinear hypothesis in a sample of young adults (N = 89, Mean Age = 21 years, 66% Female) who completed three separate resting baseline periods. ECG was recorded throughout to compute mean HR and high-frequency heart rate variability (HF-HRV) as partial and pure indices of resting vagal activity, respectively. HRB propensity was self-reported on the health/safety and recreational subscales of the Domain-Specific Risk-Taking questionnaire.

RESULTS: Resting HR and HF-HRV each exhibited quadratic associations with HRB propensity that were statistically separate from one another. In all functions, moderate levels of mean HR or HF-HRV were related to a reduced propensity for risk-taking behavior.

CONCLUSIONS: Findings suggest two potential pathways by which heart rate measures might contribute to HRB in emerging adulthood: one through heightened vagal activity, which may signal under-arousal, and the other through reduced vagal activity, which may reflect deficient self-regulation.

PMID:42170687 | DOI:10.1002/jad.70175

Front Psychol. 2026 May 6;17:1689646. doi: 10.3389/fpsyg.2026.1689646. eCollection 2026.

ABSTRACT

INTRODUCTION: In the digital era, Generation Z employees are increasingly influenced by social media driven peer norms. While traditional turnover models focus largely on internal organizational factors, the impact of external digital psychosocial stressors on employee retention remains largely overlooked. Drawing on social comparison theory, this study investigates the relationship between social expectation pressure and turnover intention, with upward social comparison acting as a mediating mechanism.

METHODS: A cross-sectional survey was conducted among 542 Generation Z employees working in Chinese e-commerce firms. Validated scales were used to measure social expectation pressure, upward social comparison, and turnover intention. Hierarchical regression, confirmatory factor analysis, Bootstrapping via PROCESS macro, and robustness checks including propensity score matching and multi-group analysis were employed.

RESULTS: Social expectation pressure showed a significant positive association with turnover intention (β = 0.324, p < 0.001). Upward social comparison partially mediated this relationship (indirect effect = 0.178, 95% CI = [0.111, 0.247]), accounting for 55.6% of the total effect. These statistical relationships remained consistent across different organizational contexts.

DISCUSSION: The study broadens turnover research by introducing social expectation pressure as a relevant external psychosocial factor and confirms the mediating role of upward social comparison in the digital workplace. The findings offer theoretical and practical insights for understanding employee withdrawal behavior in social media saturated environments. Furthermore, they underscore the need for organizations to recognize and manage the social and psychological dynamics that shape the career decisions of Generation Z employees, conceptualizing turnover intention as a key manifestation of these broader career choices.

PMID:42170655 | PMC:PMC13188931 | DOI:10.3389/fpsyg.2026.1689646