Category: Statistics

Interdiscip Cardiovasc Thorac Surg. 2026 Apr 3:ivag066. doi: 10.1093/icvts/ivag066. Online ahead of print.

ABSTRACT

Herein, we reported a new technique as the simultaneous ligation of vessels after bronchus section that could facilitate the achievement of Robotic-Assisted Thoracic Surgery (RATS) Right Upper Lobectomy (RUL). The clinical data of all consecutive patients undergoing RATS RUL for management of early-stage Non-Small Cell Lung Cancer (NSCLC) was included in the study. Patients were divided in two groups based on whether RUL was performed by simultaneous ligation of vessels (Simultaneous Ligation Group) or by traditional single isolation-ligation technique (Control group). The inter-group differences regarding operative and peri-operative outcomes were statistically compared to assess the feasibility and safety of the procedure. Simultaneous ligation (n = 7) compared to control group (n = 37) was associated with a significant reduction of operative time (127 ± 56 min vs 178 ± 78.5 min; p = 0.01) and with a lower number of staplers used (3.4 ± 1.1 vs 7.5 ± 2.4; p = 0.001) while no significant differences were found regarding the number of resected LN station (p = 0.76) and of resected LN (p = 0.75); blood loss (p = 0.69); daily chest drainage output (p = 0.73); and length of chest drainage (p = 0.81) and of hospital stay (p = 0.86). The median follow-up was 11 months (ranged from 2 to 18 months); no recurrence was observed. Simultaneous ligation of vessels represented a viable option for surgeons in challenging cases, when standard technique was difficult to perform.

PMID:41934113 | DOI:10.1093/icvts/ivag066

Interdiscip Cardiovasc Thorac Surg. 2026 Apr 3:ivag093. doi: 10.1093/icvts/ivag093. Online ahead of print.

ABSTRACT

OBJECTIVES: Most ascending aortic replacements for acute type A aortic dissection (ATAAD) are performed utilizing hypothermic circulatory arrest with an ‘open’ distal anastomosis (‘hemiarch’), whereas some are completed without ever removing the aortic cross-clamp. We sought to determine the impact of distal anastomotic technique in ascending aortic replacement for ATAAD repair.

METHODS: All patients in the IRAD Interventional Cohort database who underwent ATAAD repair between 2010 and 2020 were identified (n = 2559). Data for distal anastomotic technique was available in 2031 patients who underwent ascending aortic replacement, divided into 2 groups, based on whether they underwent hypothermic circulatory arrest (Clamp Off, n = 1900 {93.5%}) or not (Clamp On, n = 131, 6.5%}). We then propensity-matched 101 pairs of patients and analyzed operative data and short- and mid-term outcomes.

RESULTS: In-hospital mortality for the unmatched population was 13.1% (266 deaths), not statistically different between matched groups (Clamp Off, 11.0% vs Clamp On, 5.1% p = 0.22). There were no statistically significant differences observed in three-year post-discharge survival curves between matched cohorts (Clamp Off, 89.5% vs Clamp On, 90.4%; stratified log-rank p value = 0.46). Major perioperative complications (renal failure requiring dialysis, reoperation for bleeding, respiratory insufficiency) were not significantly different between groups, notably including stroke (Clamp Off, 10.2% vs Clamp On, 5.8%, p = 0.32).

CONCLUSIONS: In this propensity-matched cohort, postoperative mortality, major morbidity, and mid-term survival were comparable between open distal anastomosis and clamp-on strategies in selected patients undergoing ascending aortic replacement for ATAAD.

PMID:41934110 | DOI:10.1093/icvts/ivag093

Rheumatology (Oxford). 2026 Apr 3:keag161. doi: 10.1093/rheumatology/keag161. Online ahead of print.

ABSTRACT

OBJECTIVES: Previously, tumour necrosis factor inhibitors (TNFi)-exposed infants were recommended to withhold rotavirus vaccination until 6 months due to infection risk. Guidelines have recently supported earlier vaccination, although safety data remain limited. We aimed to compare diarrhea risk (during early [1.5-6 months] and later [6-24 months] infancy) in TNFi-exposed infants who received rotavirus vaccination before 6 months vs those unvaccinated by 6 months.

METHODS: We identified 3,167 TNFi-exposed offspring in MarketScan commercial claims born to mothers with chronic inflammatory diseases between 2011-2021. Early vaccination was defined as ≥ 1 rotavirus dose between 1.5-6 months and modelled as time-varying. Diarrhea events were identified using ICD-9/10 codes from hospitalizations, outpatient visits, or emergency department visits. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for diarrhea events in vaccinated vs unvaccinated infants.

RESULTS: Among TNFi-exposed offspring, no statistically significant association was found between early vaccination and diarrhea risk during early (101 events; HR 1.04; 95% CI 0.65, 1.68) or later infancy (283 events; HR 1.16; 95% CI 0.87, 1.55). Patterns remained consistent among infants exposed to TNFi in the third trimester (1.5-6 months: HR 1.07; 95% CI 0.62, 1.85; 6-24 months: HR 1.10; 95% CI 0.79, 1.52) and those exposed to high-placental transfer TNFi in the third trimester (1.5-6 months: HR 0.93; 95% CI 0.51, 1.70; 6-24 months: HR 1.09; 95% CI 0.77, 1.56).

CONCLUSION: Eaxsrly rotavirus vaccination in TNFi-exposed infants did not increase diarrhea risk, even for those exposed late in pregnancy. Findings support early vaccination and reinforce updated recommendations.

PMID:41934107 | DOI:10.1093/rheumatology/keag161

J AOAC Int. 2026 Apr 3:qsag015. doi: 10.1093/jaoacint/qsag015. Online ahead of print.

ABSTRACT

BACKGROUND: The SureFast® Listeria 3plex ONE Kit uses the real-time polymerase chain reaction (PCR) technique for multiplex detection of Listeria species and Listeria monocytogenes in foods and environmental samples. The SureFast® Listeria 3plex ONE Kit can also be used with the SureFast® PREP Bacteria Kit to provide a second DNA extraction option and can be analyzed on multiple thermocyclers.

OBJECTIVE: The kit was evaluated using 25 g test portions in an unpaired study design for a single matrix, ready-to-eat smoked deli turkey as part of a harmonized validation protocol with MicroVal Certification.

METHODS: The matrix was compared to the International Organization for Standardization Technical (ISO) 11290-1:21017 reference standard. 17 participants from 16 laboratories, located within Austria, Germany, Italy, Spain, and the United States were solicited for the multi-laboratory validation (MLV), with only 10 participants submitting data. Three levels of contamination were evaluated: an uninoculated control level (0 colony forming units (CFU)/test portion), a low inoculum level (0.2-2 CFU/test portion) and a high inoculum level (2-10 CFU/test portion). Statistical analysis was conducted according to the Probability of Detection (POD) statistical model.

RESULTS: Results obtained for the low inoculum level test portions produced a dLPOD value with 95% confidence interval of -0.01 (-0.04, 0.02). The dLPOD results indicate equivalence between the candidate method and reference method for the matrix evaluated and the method demonstrated acceptable multi-laboratory reproducibility as determined in the MLV. False positive and false negative rates were determined for the matrix and produced values of 0.0% and 0.8% respectively.

CONCLUSIONS: Based on the data generated, the method demonstrated equivalence to the ISO reference method in a MLV study.

HIGHLIGHTS: The SureFast ONE 3plex method is a rapid and reliable alternative for the multiplex detection of Listeria species and Listeria monocytogenes in a broad range of foods and environmental surfaces.

PMID:41934106 | DOI:10.1093/jaoacint/qsag015

Nurs Open. 2026 Apr;13(4):e70490. doi: 10.1002/nop2.70490.

ABSTRACT

AIM: To assess the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) and identify key risk factors among adult patients.

DESIGN: A descriptive cross-sectional design.

METHODS: A total of 326 adult patients undergoing chemotherapy were recruited using consecutive sampling from a nearly 4000-bed tertiary general hospital in Shanghai, China, between July 2023 and April 2024. Demographic and health status data were collected within 24 h of patient admission. Clinicopathologic information was retrieved from nursing documents and electronic medical records. Delayed CINV was measured on the third day post-chemotherapy via telephone interviews using the Common Terminology Criteria for Adverse Events (CTCAE 5.0). Statistical analyses included univariate analysis, random forest modelling, least absolute shrinkage and selection operator (LASSO) analysis and binary logistic regression.

RESULTS: Among 326 participants, 113 (34.7%) reported delayed nausea and/or vomiting, with 32.2% (n = 105) experiencing delayed nausea and 13.2% (n = 43) experiencing delayed vomiting. The step-by-step analysis identified anxiety, motion sickness and high emetogenicity of chemotherapy agents as key risk factors for delayed CINV. Post hoc analysis showed that body mass index (BMI) and history of delayed nausea or vomiting during previous chemotherapy cycles emerged as important predictors that should be considered when assessing the risk of delayed CINV.

CONCLUSIONS: Health care providers should be vigilant in recognising patients at high risk for delayed CINV. Early and targeted prophylactic interventions are recommended to mitigate the risk of delayed CINV.

REPORTING METHOD: The study followed the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:41934104 | DOI:10.1002/nop2.70490

Int J Health Care Qual Assur. 2026 Apr 7:1-18. doi: 10.1108/IJHCQA-11-2025-0182. Online ahead of print.

ABSTRACT

PURPOSE: Stroke care requires coordination among medical professionals and hospital management staff in a collaboratively developed process that must be continuously improved, as care time significantly reduces the patient’s capabilities after the intervention. This article aims to quantify the efficiency improvement in the stroke care process based on a comprehensive Lean Healthcare approach.

DESIGN/METHODOLOGY/APPROACH: An ad-hoc, two-phase structured Lean intervention was validated by analysing nine years of data in a hospital as proof of concept.

FINDINGS: Mean reductions of between 2 and 4 min in key in-hospital time-based metrics were achieved for both types of strokes under study, resulting in improvements of up to 11.1%. These benefits demonstrated a statistically significant difference in mean pre- and post-Lean metrics.

PRACTICAL IMPLICATIONS: The group of patients analysed post-Lean was not only managed with tissue plasminogen activator or thrombectomy in less time but also had lower disability degrees at entry and after three months, with the jump from three levels pre-Lean to a single level according to the modified Rankin score decreasing.

SOCIAL IMPLICATIONS: It was concluded that a patient-centric continuous flow design significantly increases the likelihood of patient recovery.

ORIGINALITY/VALUE: This study offers new evidence that a patient-centric continuous flow design enhances recovery outcomes in hospital care. By applying Lean Healthcare principles to patient-centred process redesign, it links operational efficiency directly to clinical improvement. The findings provide a replicable framework for integrating process flow optimisation into quality assurance, positioning it as a driver of patient-centred excellence and overall performance.

PMID:41934094 | DOI:10.1108/IJHCQA-11-2025-0182

Ultrasound Med Biol. 2026 Apr 2:S0301-5629(26)00094-3. doi: 10.1016/j.ultrasmedbio.2026.03.003. Online ahead of print.

ABSTRACT

OBJECTIVE: Given the high hypoenhancement prevalence of hepatic hemangiomas (HHs) during the transitional phase and Kupffer phase (KP) of Sonazoid contrast-enhanced ultrasound (CEUS), this study aimed to investigate the hypoenhancement phenomenon pattern and its influencing factors.

METHODS: This was a prospective multicenter study. A total of 136 patients with HHs were enrolled from 26 medical centers, including 76 cases in the KP hypoenhancement group and 60 cases in the KP non-hypoenhancement group. Enhancement characteristics and patterns at different time points during the transitional phase were analyzed between the two groups. Statistical analyses included Mann-Whitney U test for two independent samples, chi-square test or Fisher’s exact test for categorical variables and Spearman’s rank correlation analysis for the relationship between hypoenhancement prevalence and time points. Survival analysis was used to compare differences in the start time of hypoenhancement among HHs with different characteristics. Multivariate Cox regression analysis was performed to identify the influencing factors of KP hypoenhancement.

RESULTS: The hypoenhancement prevalence of HHs in the KP was 55.9% (76/136). The proportions of hyperenhancement, isohyperenhancement, mild hypoenhancement and marked hypoenhancement were 5.9% (8/136), 38.2% (52/136), 41.9% (57/136) and 14.0% (19/136), respectively. There was a significant positive correlation between the hypoenhancement prevalence and time points (r_s = 0.993, p < 0.001). The main start time of hypoenhancement was 4 min (p < 0.001). The median hypoenhancement time in the KP hypoenhancement group was 5.5 min. Two-dimensional ultrasound (2-D-US) echo type and maximum diameter were independent influencing factors for Sonazoid KP hypoenhancement: hypoechoic lesions were more likely to present hypoenhancement compared with hyperechoic ones (HR = 1.80, 95% CI: 1.10-2.95, p = 0.020); both lesions ≥5 cm and those between 2 and 5 cm had a higher likelihood of hypoenhancement compared with lesions <2 cm, with HR = 2.58 (95% CI: 1.18-5.65, p = 0.018) and HR = 2.32 (95% CI: 1.35-3.97, p = 0.002), respectively.

CONCLUSION: More than half of HHs show hypoenhancement in the KP of Sonazoid CEUS, and mild hypoenhancement is the main enhancement pattern among hypoenhancement cases. Hypoenhancement mostly occurs after 4 min, and the hypoenhancement prevalence gradually increases over time. The independent influencing factor for KP hypoenhancement is 2-D-US hypoechogenicity and maximum diameter greater than 2 cm.

PMID:41934080 | DOI:10.1016/j.ultrasmedbio.2026.03.003

Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Feb 17:S2212-4403(26)00068-4. doi: 10.1016/j.oooo.2026.02.009. Online ahead of print.

ABSTRACT

OBJECTIVE: This study tested how many patients receiving treatment for pericoronal radiolucencies were confirmed to have dentigerous cysts and also assessed factors associated with the prevalence of dentigerous cysts.

STUDY DESIGN: A retrospective chart review study of 62 patients was conducted, including panoramic radiographs, pathology reports, demographic variables, and clinical data.

RESULTS: In total, 53.2% of study patients were diagnosed with dentigerous cysts. A statistically significant correlation was found between gender and the presence of dentigerous cysts, but not between age and a diagnosis of dentigerous cysts. Unilocular/multilocular lesions and the number of involved teeth also presented statistically significant correlations to this diagnosis.

CONCLUSIONS: This study demonstrates that dentigerous cysts are the most common type of pericoronal radiolucencies and highlights the importance of radiographic and clinical data in diagnosis.

PMID:41934074 | DOI:10.1016/j.oooo.2026.02.009

Cardiovasc Revasc Med. 2026 Mar 25:S1553-8389(26)00108-9. doi: 10.1016/j.carrev.2026.03.017. Online ahead of print.

ABSTRACT

INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is frequently associated with conduction disturbances and arrhythmias, often requiring permanent pacemaker (PPM) implantation in an elderly, high-bleeding-risk population. Leadless pacemakers (LPMs) reduce pocket and lead-related complications and have demonstrated noninferior safety compared with transvenous pacemakers (TVP) in non-TAVR populations. However, comparative data in the post-TAVR setting are lacking.

METHODS: We systematically searched Pubmed, Cochrane, Embase, Web of Sciences and Scopus for studies comparing LPM vs. TVP following TAVR. Random effects models were used to calculate risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, device-related complications, re-hospitalization and vascular access site complications. Statistical analysis was performed with R software, version 4.2.3.

RESULTS: Six retrospective studies comprising 10,681 patients were included, of whom 874 (7.56%) underwent LPM implantation. Compared with TVP, LPM was associated with a significant reduction in device related complications (RR 0.46; 95% 0.25-0.83; p < 0.011) and vascular access site complications (RR 0.15; 95% CI 0.03-0.68; p = 0.011). There was no significant difference in re-hospitalization (RR 0.82; 95% CI 0.23-3.12; p = 0.76). LPM was associated with a higher risk of all-cause mortality (RR 1.61; 95% CI 1.01-2.57; p = 0.047).

CONCLUSIONS: Among these six retrospective studies, LPM use following TAVR was associated with fewer device-related and vascular access complications compared with TVP, albeit with a higher risk of all-cause mortality at 2 years. However, this finding likely reflects a selection bias in non-adjusted baseline characteristics rather than device inferiority. No significant differences were observed in re-hospitalization between the two strategies. Prospective studies are required to confirm or refute these findings.

PMID:41934056 | DOI:10.1016/j.carrev.2026.03.017

Nutr Metab Cardiovasc Dis. 2026 Feb 23:104639. doi: 10.1016/j.numecd.2026.104639. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Anthropometric measures and derived ratios effectively predict cardiovascular disease (CVD) mortality. In this study, we aimed to compare waist-to-thigh ratio (WTR) with more common measures for predicting CVD mortality.

METHODS AND RESULTS: This study included 5661 U.S. adults from the 1999-2002 National Health and Nutrition Examination Survey, linked with 2019 mortality status from the National Death Index (768 CVD deaths). Anthropometric measures, including waist circumference (WC), thigh circumference (TC), BMI, waist-to-BMI ratio (WBR), waist-to-height ratio (WHtR), and WTR, were assessed at baseline. Hazards ratios (HR) and 95th confidence intervals (CI) were calculated for each anthropometric measure across quartiles in relation to CVD mortality after adjusting for traditional CVD risk factors and accounting for multi-stage sampling design. Study results showed that, compared to the lowest quartile, successive quartiles of WTR were significantly associated with greater HRs for CVD mortality (1.34 (0.88-2.03), 1.26 (0.90-1.76), and 1.62 (1.21-2.16, respectively, p trend = 0.003). Stronger associations were observed among adults aged 75 and above, with HR (95% CI) for the highest versus lowest WTR quartile of 2.34 (1.70-3.22) (p trend <0.001). However, no significant associations were observed for other anthropometric measures and CVD mortality.

CONCLUSIONS: In this nationally representative U.S. cohort, WTR was a stronger predictor of CVD mortality than WC, TC, BMI, WBR, or WHtR, particularly among participants aged ≥75 years. Incorporating WTR into traditional CVD risk models may more sensitively identify individuals at risk of CVD death.

PMID:41934045 | DOI:10.1016/j.numecd.2026.104639