Category: Statistics

ASAIO J. 2026 Jun 4. doi: 10.1097/MAT.0000000000002759. Online ahead of print.

ABSTRACT

Axillary percutaneous ventricular assist devices (pVADs) are increasingly utilized for refractory cardiogenic shock, yet standardized mobilization protocols are lacking. This study describes a structured mobilization protocol and evaluates its implementation in 196 patients supported with an axillary pVAD from December 2020 to June 2025. Of this cohort, 131 (67%) were mobilized per a progressive multidisciplinary exercise protocol. Mobilized patients achieved significantly higher functional status by intensive care unit (ICU) discharge via Johns-Hopkins Highest Level of Mobility (JH-HLM) scoring (p < 0.001) and hospital discharge (p = 0.002). Longitudinal analysis demonstrated significant stepwise improvement in JH-HLM scores across sessions (p < 0.001) with statistical gains appearing as early as the third session (p < 0.001). Stratified analysis confirmed feasibility across all clinical outcomes, including recovery (p = 0.002), durable left ventricular assist device (LVAD) (p < 0.001), and heart transplant (p = 0.023). Regarding clinical outcomes, the mobilized cohort had a lower mortality rate (12% vs. 58%), higher rates of myocardial recovery (46% vs. 25%), durable LVAD implantation (21% vs. 9%), and heart transplantation (20% vs. 8%) (p < 0.001). This technical report details a safe, reproducible framework for patients with axillary pVAD support, showing that a structured mobilization protocol is feasible and associated with progressive improvement in functional status.

PMID:42247139 | DOI:10.1097/MAT.0000000000002759

Surg Endosc. 2026 Jun 5. doi: 10.1007/s00464-026-12904-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Gastroesophageal Reflux Disease (GERD) is treated primarily with proton pump inhibitors (PPIs), with surgery reserved for patients refractory to PPIs or with symptomatic hiatal hernias. PPI efficacy depends on metabolism by cytochrome P450 2C19 (CYP2C19) in the liver, which varies with genetic polymorphisms. Rapid (RM) and ultra-rapid (UM) metabolizers may require higher PPI doses for efficacy, while poor (PM) and intermediate (IM) metabolizers respond to lower doses but have higher risk of side effects. This study assesses CYP2C19 phenotype prevalence in medically versus surgically managed GERD. We hypothesized a higher RM/UM rate among surgical patients, suggesting PPI resistance.

METHODS: This was a multi-site retrospective cohort study of adult patients with GERD and CYP2C19 genotyping from 2012 to 2023. Medical patients included those with Barrett’s esophagus, LA grade C/D esophagitis, or abnormal pH testing. Surgical patients included those who underwent anti-reflux surgery. CYP2C19 phenotypes were grouped as PM/IM, normal metabolizer (NM), and RM/UM based on the anticipated need for PPI dose adjustment. Descriptive statistics were used for analysis.

RESULTS: A total of 261 patients were included in this study: 187 medical (female: 59%, mean age: 57 (SD 15), 77% White) and 74 surgical (female: 69%, mean age: 58 (SD 13), 89% White). Medical patients included the following esophageal pathologies: 52% Barrett’s esophagus, 31% abnormal pH testing, and 17% LA grade C/D esophagitis. Surgical patients had a significantly higher proportion of RM/UM phenotypes compared to medical patients (p = 0.018). There was also a significant difference in hiatal hernia size between medical and surgical patients (p < 0.001).

CONCLUSION: Surgical patients have a higher prevalence of hypermetabolizing (RM/UM) CYP2C19 phenotypes compared to medical patients. Dose escalation of PPI should be considered in medical patients with these phenotypes, and if ineffective, a timely referral for anti-reflux surgery should be made.

PMID:42247133 | DOI:10.1007/s00464-026-12904-4

J Orthop Traumatol. 2026 Jun 5. doi: 10.1186/s10195-026-00937-3. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic-assisted total knee arthroplasty (RA-TKA) is increasingly being adopted for its ability to enhance bone-resection accuracy and component alignment. However, whether these technical gains influence the risk of periprosthetic joint infection (PJI) remains uncertain, especially in the context of prolonged operative duration. This study aimed to compare the 1-year rate of PJI following conventional total knee arthroplasty (cTKA) and RA-TKA in a propensity-score-matched cohort.

METHODS: We retrospectively reviewed 1284 consecutive patients who underwent primary TKAs at a single centre between 2021 and 2023. The patients were stratified according to surgical technique (cTKA versus RA-TKA) and subsequently matched 1:1 using propensity score analysis (age, sex, body mass index [BMI], American Society of Anesthesiologists [ASA] score, Charlson Comorbidity Index [CCI] score, CCI components and smoking), resulting in 522 pairs (1044 patients) for the final comparative analysis. Operative time and 1-year PJI were assessed using multivariable logistic regression. Infections were stratified according to timing: ≤ 90 days and from 90 days to 1 year after surgery.

RESULTS: The 1-year rate of PJI was 0.77% (4/522) after RA-TKA and 0.96% (5/522) after cTKA (P = 1.000). All PJIs in patients who underwent RA-TKA occurred within 90 days, whereas PJIs in patients who underwent cTKA occurred in both time windows. Multivariable logistic regression analysis did not identify surgical modality as an independent predictor of PJI (adjusted odds ratio [OR] 0.75, 95% confidence interval [CI] 0.22-2.90; P = 0.57). The median operative time was longer in the RA-TKA group than in the cTKA group (115 (range, 90-145) versus 85 (range, 60-105) min; P < 0.001).

CONCLUSIONS: RA-TKA was associated with a longer operative time, while no statistically significant difference in 1-year PJI rates was detected compared with cTKA. Nevertheless, these findings should be interpreted cautiously given the limited number of infection events.

LEVEL OF EVIDENCE: Level 3, non-randomised observational study.

PMID:42247101 | DOI:10.1186/s10195-026-00937-3

Lifetime Data Anal. 2026 Jun 5;32(3):38. doi: 10.1007/s10985-026-09696-z.

ABSTRACT

Assessing causal treatment effect on a time-to-event outcome and identifying important risk factors that contribute to the outcome of interest are crucial in many scientific studies. Although existing instrumental variable (IV) methods can address the endogenous treatment selection and yield an unbiased causal treatment effect estimate in the presence of censoring, the corresponding variable selection technique has not been investigated. In this paper, we propose a variable selection method for a wide class of causal semiparametric transformation models with all-or-nothing treatment compliance and right-censored data. Specifically, the minimum information criterion is embedded in the optimization step of the proposed expectation-maximization algorithm, rendering sparse estimators of the complier causal treatment effect and other regression parameters. The asymptotic properties of our method are established, including consistency and oracle property. Extensive simulation studies are conducted to evaluate the finite sample performance of the proposed method. An application to a colorectal cancer screening dataset is provided.

PMID:42247097 | DOI:10.1007/s10985-026-09696-z

Ir J Med Sci. 2026 Jun 5. doi: 10.1007/s11845-026-04449-1. Online ahead of print.

ABSTRACT

BACKGROUND: Glioblastoma is the most common malignant brain tumour in adults and carries a poor prognosis despite advances in molecular characterisation and therapy. The 2021 World Health Organisation classification redefined glioblastoma as an IDH-wildtype diffuse astrocytic tumour with aggressive histological or molecular features. Standard of care therapy has changed little over the last two decades, and outcomes remain suboptimal, with considerable heterogeneity in survival influenced by clinical, molecular, and treatment-related factors.

AIMS: This study evaluates the clinical and molecular characteristics, treatment strategies, and survival outcomes for glioblastoma patients at Cork University Hospital from 2006-2023 to assess changes in management and outcomes.

METHODS: 494 patients were diagnosed with glioblastoma between 1st of January 2006 and 31st of December 2023. IDH mutant cases were excluded. Data was extracted from medical records, with survival analyses using the Kaplan-Meier method and COX proportional hazards model.

RESULTS: The median age was 63 years (range: 17-86). Increased availability of molecular markers was observed between the time periods. Median overall survival remained stable over time (2006-2010: 9.9 months; 2011-2014: 11.9 months; 2015-2019: 10.9 months; 2020-2023: 11.1 months), with no statistical significance between periods. On multivariate analysis, key prognostic factors included age at diagnosis, ECOG performance status, glucocorticoid use at baseline, MGMT methylation status, and completion of the adjuvant chemo-radiation.

CONCLUSIONS: Despite advances in our understanding of the pathogenesis of glioblastoma, the mOS median overall survival in our real-world patient cohort did not improve over time. The findings emphasise the need for ongoing research efforts to improve outcomes in this lethal disease.

PMID:42247092 | DOI:10.1007/s11845-026-04449-1

Intern Emerg Med. 2026 Jun 5. doi: 10.1007/s11739-026-04419-6. Online ahead of print.

ABSTRACT

Gallstones are a common digestive disorder whose development is influenced by abnormal liver function, metabolic disorders, and inflammatory states. The albumin-bilirubin (ALBI) score is a comprehensive indicator for assessing liver function and has been widely applied in liver cancer and chronic liver diseases; however, its association with gallstones remains unclear. This study analyzed NHANES data from 2017 to 2020, including 6332 adult participants. Survey-weighted multivariable logistic regression was performed to assess the association between ALBI and gallstone prevalence. Furthermore, the dose-response relationship was examined using restricted cubic spline (RCS) modeling. Subgroup analyses were conducted to assess the robustness of this association across different demographic and clinical strata. In addition, an exploratory mediation analysis was performed to examine whether body mass index (BMI) statistically accounted for part of the observed association between ALBI and gallstone prevalence. Multivariable logistic regression indicated that higher ALBI was associated with higher odds of gallstone prevalence (OR = 2.670, 95% CI: 1.778 – 4.008, P = 0.001). RCS analysis indicated that the relationship between ALBI and gallstones is approximately linear (P-overall < 0.0001, P-nonlinearity = 0.7779). The results of the subgroup analyses were consistent and robust. Exploratory mediation analysis suggested that BMI statistically accounted for 23.95% of the observed association between ALBI and gallstone prevalence in the mediation model. Higher ALBI levels were associated with a higher prevalence of gallstones, showing an approximately linear dose-response pattern. BMI statistically accounted for part of this association in exploratory mediation models, but this finding should not be interpreted as evidence of causal mediation given the cross-sectional design. Because gallstone status was self-reported, these findings should be interpreted with caution. Prospective studies are warranted to clarify temporal relationships, validate these associations, and determine whether ALBI provides clinically meaningful information beyond established gallstone risk factors.

PMID:42247086 | DOI:10.1007/s11739-026-04419-6

Jpn J Radiol. 2026 Jun 5. doi: 10.1007/s11604-026-02024-3. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate alterations in white matter microstructure in children with Tourette syndrome (TS) and to explore its potential role in pathophysiology.

METHODS: Diffusion tensor imaging data were collected from 53 children with TS and 91 typically developing controls. White matter integrity was assessed and analyzed using fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Correlations with tic severity and quality of life (QOL) were examined, followed by mediation analysis to assess whether motor tic severity mediated the relationship between FA values in the right anterior corona radiata (ACR_R) and QOL.

RESULTS: Children with TS exhibited widespread white matter alterations, lower FA in ACR_R and left anterior limb of the internal capsule, lower MD in the inferior fronto-occipital fasciculus, and lower AD in ACR_R, alongside higher MD in the genu of the corpus callosum, higher AD in the inferior fronto-occipital fasciculus, and higher RD in ACR_R. The FA values in ACR_R showed a significant negative correlation with motor tic severity (r = – 0.302, P = 0.031) and a significant negative correlation with physical/activities of daily living (ADL) subscale of QOL (r = – 0.468, P < 0.001). Motor tic severity was positively correlated with physical/ADL subscale of QOL (r = 0.430, P = 0.008). Motor tic severity partially mediated the relationship between FA values in ACR_R and physical/ADL scores (β = – 0.091, 95% CI [- 0.208, – 0.016]).

CONCLUSIONS: These findings suggest that impaired white matter microstructure may be associated with the pathophysiology of TS, and that future interventions may benefit from simultaneously addressing neural circuit integrity and symptom management.

PMID:42247083 | DOI:10.1007/s11604-026-02024-3

Jpn J Radiol. 2026 Jun 5. doi: 10.1007/s11604-026-02021-6. Online ahead of print.

ABSTRACT

PURPOSE: Large language models (LLMs) are increasingly integrated into radiology workflows, but their demographic biases have not been evaluated in diagnostic radiology. This study aimed to investigate racial and sex biases in the diagnostic performance of LLMs (text-only and vision models) in radiology and to evaluate whether prompting strategies mitigate these biases.

MATERIALS AND METHODS: This retrospective study included consecutive Diagnosis Please cases published in Radiology from April 1998 to October 2024, excluding cases with sex-specific diseases. For each case, eight race-sex scenarios were generated by altering four race/ethnicity categories (Asian, Black, Hispanic, White) and two sex categories (male, female). Three LLMs (GPT-5, Claude Sonnet 4.5, Gemini 2.5 Flash) were evaluated as text-only models (medical history and imaging findings) and vision models (medical history and images) using three prompting strategies (basic, self-consistency, chain-of-thought prompting). Generalized estimating equations were used to compare diagnostic accuracy across race/ethnicity, sex, and prompting strategies.

RESULTS: A total of 286 cases were included. Across models and conditions, ten significant race-related and four significant sex-related differences in diagnostic accuracy were observed. Among the four race/ethnicity groups, Black patients were most likely to have significantly lower accuracy (four of the ten statistically significant race-related comparisons [40%]) and least likely to have significantly higher accuracy (1/10 [10%]). Vision models with female patients under basic prompting showed a higher number of significant race-related differences (6/10 [60%]) than vision models with male patients and all text-only models. Text-only and vision models showed no statistically significant differences in diagnostic accuracy across prompting strategies (p = 0.78 and 0.95, respectively); basic and self-consistency prompting produced ten and four significant race- or sex-related differences, respectively, whereas no significant differences were observed with chain-of-thought prompting.

CONCLUSION: Large language models exhibited racial and sex biases in diagnostic radiology, and chain-of-thought prompting may help mitigate these biases.

PMID:42247082 | DOI:10.1007/s11604-026-02021-6

AIDS Behav. 2026 Jun 5. doi: 10.1007/s10461-026-05149-8. Online ahead of print.

ABSTRACT

Thoughts of death or self-injury and the clinical implications of such thoughts remain largely underassessed among people with HIV (PWH) in Africa. As strong predictors of suicidal ideation and death by suicide, it is paramount to understand these risk indicators, particularly in populations with heightened susceptibility to poor mental health. We aimed to characterize thoughts of death or self-injury (i.e., self-injurious thoughts) and their relationship with non-same-day (i.e., delayed) anti-retroviral treatment (ART) initiation and longitudinal disengagement from clinic in a cohort of PWH newly entering HIV care in Cameroon. We conducted structured interviews with PWH aged 21 + initiating clinical care between June 2019 and March 2020. Clinical records were used to ascertain ART initiation date and disengagement from the clinic across two years following care initiation. Log binomial regression was used to estimate the association between self-injurious thoughts at care initiation and delayed ART initiation. A Fine and Gray sub-distribution proportional hazards model was used to quantify the cumulative incidence of disengagement from the clinic (i.e., a gap in clinic visits > 183 days) and differences in these estimates across groups. Of 426 enrolled individuals, seventy-one (16.7%) endorsed self-injurious thoughts at entry into care, 24 (33.8%) of whom had active thoughts of self-injury. Self-injurious thoughts at entry into care were positively associated with delayed ART initiation (adjusted prevalence ratio = 1.8; 95% CI: 1.2, 2.9) and cumulative incidence of disengagement from clinic, though differences in disengagement were statistically non-significant. Interventions are urgently needed to support the mental health and well-being of PWH entering care and improve down-stream HIV treatment outcomes.

PMID:42247071 | DOI:10.1007/s10461-026-05149-8

Mol Biol Rep. 2026 Jun 5;53(1):893. doi: 10.1007/s11033-026-12056-7.

ABSTRACT

BACKGROUND: Lipopolysaccharide (LPS)-induced sepsis is one of the leading causes of acute kidney injury (AKI). Gallic acid (GAL), a natural polyphenolic compound, exhibits potent antioxidant, anti-inflammatory, and cytoprotective properties. This study aimed to investigate the renoprotective effects of GAL.

METHODS: Thirty-two adult male Wistar rats were randomly divided into four groups (n = 8): Control, LPS (5 mg/kg, i.p.), LPS + GAL (100 mg/kg i.p. administered immediately before LPS), representing a preventive treatment design and GAL-alone. Renal tissues were examined histologically using hematoxylin-eosin staining and toll-like receptor 4(TLR4), nuclear factor kappa B(NF-κB), and interleukin-1 beta (IL-1β) immunoexpression by immunohistochemical staining. mRNA expression levels of sirtuin 1(SIRT1), adenosine monophosphate-activated protein kinase(AMPK), forkhead box O3(FOXO3), phosphoinositide 3-kinase (PI3K), protein kinase B(AKT1), glutathione peroxidase 4(GPX4), aquaporin 4 (AQP4), glycogen synthase kinase-3 beta(GSK3β) were assessed. Serum creatinine (CRE) and urea levels were analyzed to determine renal functional status.

RESULTS: LPS administration caused marked renal injury, characterized by severe hyperemia, hemorrhage, tubular necrosis, and increased TLR4, NF-κB, and IL-1β expression. GAL treatment attenuated these changes, with a significant reduction only in hyperemia scores, while decreases in hemorrhage, neutrophil infiltration, and necrosis remained nonsignificant. GAL administration was associated with reversal of the LPS-related decrease in PI3K, AKT1, AMPK, FOXO3, SIRT1, GPX4 and AQP4 mRNA expression, along with reduced GSK3β mRNA expression. Serum CRE levels improved with GAL, whereas the urea reduction was not statistically significant.

CONCLUSION: GAL showed a renoprotective effect in this preventive model of LPS-induced AKI and was associated with reduced inflammatory marker expression together with favorable changes in PI3K/AKT1/FOXO3/SIRT1-related mRNA profiles. These findings suggest that GAL may have prophylactic against early endotoxin-associated renal injury.

PMID:42247065 | DOI:10.1007/s11033-026-12056-7