Category: Statistics

Inflamm Bowel Dis. 2026 Jan 11:izaf313. doi: 10.1093/ibd/izaf313. Online ahead of print.

NO ABSTRACT

PMID:41520196 | DOI:10.1093/ibd/izaf313

J Am Med Inform Assoc. 2026 Jan 11:ocaf230. doi: 10.1093/jamia/ocaf230. Online ahead of print.

ABSTRACT

BACKGROUND: Despite rapid integration into clinical decision-making, clinical large language models (LLMs) face substantial translational barriers due to insufficient structural characterization and limited external validation.

OBJECTIVE: We systematically map the clinical LLM research landscape to identify key structural patterns influencing their readiness for real-world clinical deployment.

METHODS: We identified 73 clinical LLM studies published between January 2020 and March 2025 using a structured evidence-mapping approach. To ensure transparency and reproducibility in study selection, we followed key principles from the PRISMA 2020 framework. Each study was categorized by clinical task, base architecture, alignment strategy, data type, language, study design, validation methods, and evaluation metrics.

RESULTS: Studies often addressed multiple early stage clinical tasks-question answering (56.2%), knowledge structuring (31.5%), and disease prediction (43.8%)-primarily using text data (52.1%) and English-language resources (80.8%). GPT models favored retrieval-augmented generation (43.8%), and LLaMA models consistently adopted multistage pretraining and fine-tuning strategies. Only 6.9% of studies included external validation, and prospective designs were observed in just 4.1% of cases, reflecting significant gaps in translational reliability. Evaluations were predominantly quantitative only (79.5%), though qualitative and mixed-method approaches are increasingly recognized for assessing clinical usability and trustworthiness.

CONCLUSION: Clinical LLM research remains exploratory, marked by limited generalizability across languages, data types, and clinical environments. To bridge this gap, future studies must prioritize multilingual and multimodal training, prospective study designs with rigorous external validation, and hybrid evaluation frameworks combining quantitative performance with qualitative clinical usability metrics.

PMID:41520192 | DOI:10.1093/jamia/ocaf230

Global Spine J. 2026 Jan 10:21925682251412809. doi: 10.1177/21925682251412809. Online ahead of print.

ABSTRACT

Study DesignRetrospective Database Study.ObjectivesAnterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are common procedures performed for cervical spondylosis. Sparse data exists comparing the utilization and reimbursement rates associated with these procedures. This study seeks to compare Medicare utilization of single- and multilevel ACDF to CDA between 2011 and 2021. Additionally, this study evaluates Medicare reimbursement rate changes for ACDF with structural allograft, ACDF with cage, and CDA between the years 2016 and 2021.MethodsThis study used the publicly available Medicare National Summary Data Files to aggregate annual utilization and reimbursement rates for ACDF procedures as well as CDA procedures based on Current Procedural Terminology codes. Reimbursement rates were adjusted for inflation through use of the U.S. Bureau of Labor Statistics’ 2021 Consumer Price Index. Changes in reimbursement rates and utilization were calculated and compared between procedures.ResultsIn 2011, 27 974 single-level ACDF procedures were performed on Medicare Part B patients compared to 34 683 performed in 2021. This represents a growth in procedure utilization of 24% over the study period. Over the course of the same study period CDA procedures grew by 1087.3%, from 118 in 2011 to 1401 in 2021. Throughout the reimbursement study period, Medicare reimbursements per case for single-level CDAs had an average annual percent change of 9.96%, rising from $1636 in 2016 to $2779 in 2021. Reimbursement per case for single-level ACDF with allograft had an average annual change of -1.25%, falling from $3408 in 2016 to $3206 in 2021. Medicare reimbursement per case for single-level ACDF with cage had an average annual change of 1.19%, from $3379 in 2017 to $3547 in 2021.ConclusionAll procedures saw an increase in utilization throughout the study period, with CDAs showing significant growth within the Medicare population. While the reimbursement for ACDFs remained relatively constant, the reimbursement for CDAs demonstrated a moderate increase.

PMID:41520188 | DOI:10.1177/21925682251412809

HGG Adv. 2026 Jan 10:100566. doi: 10.1016/j.xhgg.2026.100566. Online ahead of print.

ABSTRACT

Gene-environment interactions may enhance our understanding of blood pressure (BP) biology. We conducted a meta-analysis of multi-population genome-wide association studies of BP traits accounting for gene-depressive symptomatology (DEPR) interactions. Our study included 564,680 adults from 67 cohorts and 4 population backgrounds (African (5%), Asian (7%), European (85%), and Hispanic (3%)). We discovered seven previously unreported BP loci showing gene-DEPR interaction. These loci mapped to genes implicated in neurogenesis (TGFA, CASP3), lipid metabolism (ACSL1), neuronal apoptosis (CASP3), and synaptic activity (CNTN6, DBI). We also showed evidence for gene-DEPR interaction at nine known BP loci, further suggesting links between mood disturbance and BP regulation. Of the 16 identified loci, 11 loci were derived from non-European populations. Post-GWAS analyses prioritized 36 genes, including genes involved in synaptic functions (DOCK4, MAGI2) and neuronal signaling (CCK, UGDH, SLC01A2). Integrative druggability analyses identified 11 druggable candidate gene targets linked to pathways involved in mood disorders as well as known antihypertensive drugs. Our findings emphasize the importance of considering gene-DEPR interactions on BP, particularly in non-European populations. Our prioritized genes and druggable targets highlight biological pathways connecting mood disorders and hypertension and suggest opportunities for BP drug repurposing and risk factor prevention, especially in individuals with DEPR.

PMID:41520179 | DOI:10.1016/j.xhgg.2026.100566

Rheumatology (Oxford). 2026 Jan 10:keag016. doi: 10.1093/rheumatology/keag016. Online ahead of print.

ABSTRACT

OBJECTIVES: Several studies reported an association between Sjögren’s disease (SjD) and inclusion body myositis (IBM). However, the potential specificities of IBM when associated with SjD have been poorly investigated. Here, we compared the muscular inflammatory infiltrates between IBM patients with or without associated SjD.

MATERIALS AND METHODS: Formalin-fixed and paraffin-embedded muscle biopsies of patients with IBM, associated with SjD (IBM-SjD) and sporadic (sIBM) forms, from 6 French expert centers, were collected. Imaging mass cytometry (IMC) multiplex immunostaining (34 markers) was used to quantify and analyze inflammatory infiltrate composition. Supervised and unsupervised descriptive and comparative analyses were performed.

RESULTS: Fourteen IBM-SjD and 7 sIBM muscle samples were analyzed. No statistically significant difference was encountered but some trends were pointed. IBM-SjD samples had a broader inflammatory infiltrate surface (median 4.8%, IQR: 1.4-8.6) than sIBM samples (median 1.6% IQR: 1.2-2.4). In both groups, the main inflammatory cells in muscle infiltrate were primarily macrophages and T cells. However, the proportion of plasma cells (14.7% IQR: 5.4-24.6 vs 8.5% IQR: 4.6-9.8) and B cells (3.1% IQR: 0.4-5.6 vs 0.5% IQR: 0.0-3.2) were higher in IBM-SjD patients.

CONCLUSION: Using IMC on muscle biopsies, IBM-SjD and sIBM patients share common histological features, but there are notable distinctions (more extensive infiltrate, high numbers of B cells and plasma cells in IBM-SjD). These observations were exploratory and based on a small number of patients. but may suggest IBM-SjD has distinct SjD-related pathophysiology compared with sIBM, and open to further research with potential diagnostic and therapeutic implications.

PMID:41520169 | DOI:10.1093/rheumatology/keag016

Oncologist. 2026 Jan 10:oyag003. doi: 10.1093/oncolo/oyag003. Online ahead of print.

ABSTRACT

PATIENTS AND METHODS: we retrospectively collected data of patients with HR+/HER2- advanced breast cancer (ABC) treated with endocrine therapy (ET) and a CDK4/6 inhibitor (CDK4/6i) aiming to describe the patterns of post-progression outcomes.

RESULTS: Among 452 evaluable patients 325 were treated in the first-line setting. Median progression free-survival (mPFS) was 22.8 months overall and 29.7 months in patients treated in first-line setting. Factors associated with outcomes in multivariate analysis were the line of CDK4/6i therapy, de novo vs recurrent disease, visceral vs bone-only metastases, and primary endocrine resistance.A total of 300 patients progressed and 250 overall and 156 in the first-line cohort received a subsequent treatment. Visceral progression and CDK4/6i duration <12 months were associated with a higher likelihood of receiving anthracycline or taxanes (AT) as compared to ET ±everolimus (EET). Post-progression PFS (PPFS) and post-progression OS (PPOS) were statistically significantly better with EET and capecitabine (C) arms over AT overall and in patients with visceral progression. Multivariate analysis confirmed a significant advantage for EET and C, while visceral progression retained a significant impact only on PPOS. After progression to the 1st post-CDK4/6i treatment C obtained a significant better PPOS as compared to other treatments.

CONCLUSION: we showed in a large real-world series that most patients with HR+/HER2- ABC failing CDK4/6i and ET unselected for the occurrence of molecular mutations retain endocrine sensitivity and may benefit of a subsequent ET ± a targeted therapy delaying the need for chemotherapy regardless of site of progression and prior CDK4/6i therapy duration.

PMID:41520162 | DOI:10.1093/oncolo/oyag003

Interdiscip Cardiovasc Thorac Surg. 2026 Jan 10:ivag017. doi: 10.1093/icvts/ivag017. Online ahead of print.

ABSTRACT

OBJECTIVES: Extended arch replacement (EAR) and hemiarch replacement (HAR) are surgical options for type A acute aortic dissection (AAD). However, the effectiveness of EAR compared with HAR, particularly in elderly patients, remains unclear owing to its invasiveness and complications. This study aimed to compare the postoperative outcomes of EAR and HAR in elderly patients with type A AAD.

METHODS: This retrospective cohort study used data from the Shizuoka Kokuho Database, a prefecture-wide, multi-institutional administrative claims database managed by the Shizuoka Prefectural Government. We identified patients aged ≥60 years with type A AAD who underwent HAR or EAR between April 2012 and September 2022. Propensity score matching was employed to balance the baseline characteristics between the groups. The primary outcome was all-cause mortality. The secondary outcome included the incidence of reoperation for bleeding.

RESULTS: A total of 774 patients were included (174 undergoing EAR and 600 undergoing HAR). After propensity score matching, 167 matched pairs were analyzed. Kaplan-Meier curves revealed no significant differences in survival between both procedures (log-rank test, p = 0.739). Cox proportional hazards analysis also revealed no significant differences in all-cause mortality between the EAR and HAR groups (hazard ratio: 1.08, 95% confidence interval: 0.70-1.66). However, the incidence of reoperation for bleeding was higher in the EAR group than in the HAR group (20 [12.0%] vs 7 [4.2%], p = 0.012).

CONCLUSIONS: Although no statistically significant difference in postoperative mortality was observed between EAR and HAR, the incidence of reoperation for bleeding was higher in the EAR group. Therefore, the indication for EAR in elderly patients with type A AAD should be considered with caution.

PMID:41520161 | DOI:10.1093/icvts/ivag017

Disabil Rehabil. 2026 Jan 10:1-25. doi: 10.1080/09638288.2025.2611576. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on gait and brain alteration in cerebral palsy (CP) children.

MATERIALS AND METHODS: MEDLINE, Scopus, Google Scholar, Web of Science, and Cochrane were searched in February 2024 and updated in 9 October 2025. Randomized controlled trials (RCTs) with CP participants under 18, rTMS or tDCS intervention, and gait assessment were included. The risk of bias was assessed, and a meta-analysis was conducted using random-effect models.This review was registered in PROSPERO (ID: CRD42024555049).

RESULTS: 21 studies met the inclusion criteria. tDCS led to significant improvements in velocity (MD = 0.17, 95% CI = 0 to 0.35), gross motor function measure (GMFM), and functional independence. However, changes in other parameters such as step length, and cadence were not statistically significant and showed high heterogeneity. rTMS also improved overall motor function and walking performance in several studies, though data variability prevented meta-analysis. Both methods were safe and well-tolerated.

CONCLUSION: Both interventions showed promise for improving velocity and GMFM in children with CP. However, due to inconsistent findings across other gait parameters and substantial heterogeneity, further large-scale, standardized RCTs with neuroimaging assessments are needed.

PMID:41518074 | DOI:10.1080/09638288.2025.2611576

Colorectal Dis. 2026 Jan;28(1):e70358. doi: 10.1111/codi.70358.

ABSTRACT

AIM: Neoadjuvant treatment for rectal cancer has evolved markedly with the growing adoption of total neoadjuvant therapy (TNT), organ-preservation strategies and selective omission of radiotherapy. Recent trials support risk-based personalization, but its application in real-world settings remains poorly documented. The aim was to describe current neoadjuvant treatment practices for mid-low rectal cancer in French expert centres and identify tumour- and patient-related factors influencing decisions.

METHOD: This observational study included patients with non-metastatic rectal adenocarcinoma ≤10 cm from the anal verge, discussed in tumour boards (October 2022 to March 2023) across GRECCAR centres. Tumours were classified as early, intermediate-risk or locally advanced rectal cancer (LARC). Neoadjuvant treatments were analysed according to tumour extension, location and age.

RESULTS: Among 463 patients from 27 centres, the most frequent regimen was induction chemotherapy, mainly FOLFIRINOX, followed by long-course chemoradiotherapy (CRT) (65%). This approach was used in 51%, 66% and 71% of patients in the early, intermediate-risk and LARC groups, respectively (p = 0.0060). TNT was more frequently administered for low- than mid-rectal cancers, especially in LARC (86% vs. 71%, p = 0.016). In patients >75 years, CRT + consolidation chemotherapy and radiotherapy alone were proportionally more frequent. Among the early rectal cancers, those treated with induction chemotherapy + CRT had more advanced features than those treated with CRT alone (cT3: 80% vs. 43%, cN+: 62% vs. 10%, tumour size: 3.4 vs. 2.3 cm; all p < 0.001).

CONCLUSION: TNT with induction chemotherapy is the predominant neoadjuvant approach in French expert centres. Tumour classification, location and patient age significantly influence treatment choices, reflecting a shift towards personalized context-specific care.

PMID:41518072 | DOI:10.1111/codi.70358

Appl Neuropsychol Child. 2026 Jan 10:1-8. doi: 10.1080/21622965.2025.2611932. Online ahead of print.

ABSTRACT

Sensory processing plays a critical role in children’s ability to engage in social interactions and participate in daily activities. This study examines the associations between sensory processing skills, social skills, and participation in kindergarten children. A total of 88 children aged 4-7 years were included. The Sensory Processing Measure (SPM), Social Skills Scale (SSS), and Child and Adolescent Participation Scale (CASP) were completed by parents. The SPM total score was significantly negatively correlated with social cooperation (r = -.45, p < .001), self-regulation (r = -.51, p < .001), and assertion (r = -.42, p < .001). Similarly, significant negative correlations were observed between SPM and CASP in home (r = -.55, p < .001), community (r = -.43, p < .001), and school (r = -.44, p < .001) settings, as well as with home and community living activities (r = -.34, p = .001). Regression analysis showed that both sensory processing (β = -.37, p < .001) and social skills (β = .39, p < .001) were statistically significant predictors of participation, explaining 43.4% of the variance (R² = 0.434, F = 30.318, p < .001). These findings highlight the importance of early identification and intervention for addressing sensory processing issues, thereby enhancing participation and social development in early childhood.

PMID:41518063 | DOI:10.1080/21622965.2025.2611932