Category: Statistics

J Comput Assist Tomogr. 2026 Jul 9. doi: 10.1097/RCT.0000000000001907. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the frequency, anatomic distribution, and potential mechanisms of postmortem gas formation identified on postmortem computed tomography (PMCT) in infants and young children, with emphasis on the association between postmortem gas and perimortem cardiopulmonary resuscitation (CPR).

METHODS: This retrospective study included 63 pediatric decedents (age range: birth to 25 mo) who underwent PMCT as part of medicolegal investigations, followed by autopsy. Two radiologists independently reviewed PMCT images, reports, and autopsy findings to determine the presence, location, and likely cause of postmortem gas. The presence of CPR was established based on documented history, autopsy findings, and imaging indicators. Descriptive statistics were used to characterize the cohort, and Fisher exact and t tests were applied for group comparisons with statistical significance set at P<0.05.

RESULTS: Postmortem gas was detected in 56 of 63 cases (89%). Among 61 cases with known CPR status, 57 had received CPR, and 4 had not. Gas was significantly more frequent in those with CPR (89%, 51/57) than in those without (25%, 1/4; P=0.008). The most commonly affected regions were the heart (64%) and liver (61%). Gas in the heart, liver, or brain was associated with a longer mean interval between death and imaging (7.4 vs. 3.9 h), although this difference did not reach statistical significance (P=0.06). Gas formation was observed as early as 0.5 hours postmortem.

CONCLUSIONS: PMCT frequently demonstrates postmortem gas in pediatric deaths, most notably in cases with prior CPR. The distribution pattern-favoring the heart and liver-and early appearance within hours of death suggest a major contribution from resuscitation-related mechanisms rather than decomposition only. Recognition of these CPR-related imaging patterns is essential for distinguishing physiological postintervention findings from decomposition or pathologic processes and may improve the forensic interpretive value of PMCT in pediatric death investigations.

PMID:42423975 | DOI:10.1097/RCT.0000000000001907

Int Urol Nephrol. 2026 Jul 9. doi: 10.1007/s11255-026-05264-4. Online ahead of print.

ABSTRACT

BACKGROUND: Sclerostin, an osteocyte-derived Wnt/β-catenin inhibitor, increases with declining kidney function and is implicated in chronic kidney disease-mineral and bone disorder (CKD-MBD). Whether circulating sclerostin reflects disease-specific activity in biopsy-proven glomerulonephritis (GN), independent of renal function and demographic confounders, remains unclear.

METHODS: In a single-centre cross-sectional case-control study, 49 adults with biopsy-proven GN and 30 healthy controls were enrolled. Serum sclerostin was measured by enzyme-linked immunosorbent assay (ELISA). Its associations with kidney function (estimated glomerular filtration rate, eGFR), proteinuria and routine biochemical parameters were examined using non-parametric tests and multivariable linear regression adjusted for age, sex and eGFR. To address baseline differences between groups and to test whether kidney function explained the observed associations, we additionally performed a propensity-score-weighted sensitivity analysis and a mediation-style statistical decomposition, with correction for multiple comparisons.

RESULTS: GN patients were older, more often male and had lower eGFR than controls. Serum sclerostin was higher in GN patients than in controls in the unadjusted comparison (median 10.86 vs 7.14 ng/mL, p < 0.001). However, this difference progressively weakened after accounting for age and sex, and was no longer statistically significant once kidney function (eGFR) was taken into account. The propensity-score-weighted sensitivity analysis showed the same pattern. Within the GN group, higher sclerostin was strongly associated with lower kidney function, and this relationship persisted in adjusted models. The apparent link between sclerostin and proteinuria was likewise explained mainly by kidney function: about three-quarters of the crude association was accounted for by the eGFR pathway (indirect effect 0.71; 95% confidence interval [95% CI] 0.16 to 1.54). Sclerostin was not robustly associated with the inflammatory markers C-reactive protein or ferritin, and an isolated inverse association with fibrinogen was regarded as exploratory because fibrinogen was measured in only 13 patients.

CONCLUSIONS: In biopsy-proven GN, elevated circulating sclerostin primarily reflects differences in kidney function, age and sex rather than GN-specific activity; within the limits of a healthy-control rather than CKD-control comparison, the data do not support serum sclerostin as an independent biomarker of glomerular disease activity. Prospective studies with non-GN CKD comparators and a complete CKD-MBD panel are needed.

PMID:42423954 | DOI:10.1007/s11255-026-05264-4

Adv Ther. 2026 Jul 9. doi: 10.1007/s12325-026-03679-0. Online ahead of print.

ABSTRACT

INTRODUCTION: This study evaluated the real-world utilization, effectiveness, occurrence of adverse events (AEs), and healthcare costs in patients treated with next-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKI), alectinib, brigatinib, and lorlatinib, among ALK TKI-naïve patients with ALK rearrangement-positive metastatic non-small cell lung cancer (ALK + mNSCLC) in the US.

METHODS: This retrospective, observational cohort study used Veradigm electronic health records linked with Komodo closed claims. Eligible patients were adults with ALK + mNSCLC diagnosis who received their first ALK TKI (alectinib, brigatinib, or lorlatinib) between 5/22/2020 (US FDA approval of first-line brigatinib) and 12/31/2024. Descriptive analyses included baseline patient demographics, clinical characteristics, occurrence of AEs, and treatment patterns. Unweighted Cox proportional hazards models and propensity score-weighted Cox proportional hazards models were conducted to compare real-world treatment effectiveness [real-world time to treatment discontinuation (rwTTD), real-world time to next treatment (rwTTNT), real-world progression-free survival (rwPFS), real-world overall survival (rwOS)], and all-cause healthcare utilization and costs across ALK TKIs.

RESULTS: A total of 481 patients (alectinib: 391; brigatinib: 32; lorlatinib: 58) were included. Mean age ranged from 58.5 to 63.7 years across the three treatment groups; more than half of the patients were female (less than half male), White, or covered by commercial insurance. In the unweighted and weighted analyses, there were no statistically significant differences in rwTTD, rwTTNT, rwPFS, or rwOS between treatment groups. Mean weighted all-cause healthcare costs per-patient-per-month during the index TKI treatment duration were not significantly different across cohorts (alectinib: US$20,873; brigatinib: $25,693; lorlatinib: $24,984).

CONCLUSION: This study found no statistically significant differences in real-world clinical effectiveness and total all-cause healthcare costs between alectinib, brigatinib, or lorlatinib for ALK TKI-naïve patients with ALK + mNSCLC. Future studies with larger sample sizes and longer follow-up time are needed to confirm these findings.

PMID:42423952 | DOI:10.1007/s12325-026-03679-0

Adv Ther. 2026 Jul 9. doi: 10.1007/s12325-026-03690-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Solriamfetol, a dopamine and norepinephrine reuptake inhibitor, is indicated for the treatment of excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA). This study aims to evaluate the efficacy and safety profiles of solriamfetol across different severity levels of OSA via the post hoc analysis of a randomized clinical trial in a Chinese population.

METHODS: Participants were assigned in a 1:1 ratio to either the placebo group or solriamfetol group (dose titrated up to 150 mg/day) for 12 consecutive weeks, with randomization stratified by adherence status to primary OSA therapy. The co-primary endpoints were defined as the changes of mean sleep latency measured by the Maintenance of Wakefulness Test (MWT) and Epworth Sleepiness Scale (ESS) scores from baseline to week 12 in the full analysis set. The efficacy and safety profiles of solriamfetol were analyzed across subgroups stratified by baseline apnea hypopnea index (AHI).

RESULTS: Among eligible patients for subgroup analysis, 42.5%, 34.5%, and 23% had baseline AHI < 5, 5 ≤ AHI < 30, and AHI ≥ 30, respectively. At week 12, solriamfetol treatment significantly prolonged MWT sleep latency relative to placebo across all AHI subgroups. The least squares (LS) mean differences (standard error) versus placebo were 12.133 (2.2239) min for the AHI < 5 subgroup (P < 0.0001), 12.676 (2.5363) min for the 5 ≤ AHI < 30 subgroup (P < 0.0001), and 10.935 (2.6023) min for the AHI ≥ 30 subgroup (P = 0.0001). In subgroups with baseline AHI < 5 and 5 ≤ AHI < 30, solriamfetol significantly reduced ESS scores vs. placebo (LS mean difference [SE] versus placebo, – 2.0 [0.95] and – 2.1 [1.01], P = 0.0404 and P = 0.0394, respectively). In the baseline AHI ≥ 30 subgroup, solriamfetol showed a tendency toward reduction in ESS scores compared with placebo, although the difference was not statistically significant (P = 0.2497). Meanwhile, solriamfetol was well tolerated, with the most common treatment-emergent adverse events (> 10% incidence in any treatment group) including upper respiratory tract infection, hyperuricemia, dizziness, and hypertension.

CONCLUSION: Solriamfetol showed good efficacy and tolerability regardless of OSA severity among Chinese OSA participants with EDS.

TRIAL REGISTRATION: The parent study was registered at www.chinadrugtrials.org.cn with the trial number CTR20231397 on May 15, 2023.

PMID:42423948 | DOI:10.1007/s12325-026-03690-5

Adv Ther. 2026 Jul 9. doi: 10.1007/s12325-026-03691-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Primary biliary cholangitis (PBC) is a rare cholestatic autoimmune liver disease. We aimed to generate evidence of the signs, symptoms, and impacts of PBC considered important by patients through interviews with clinicians and patients.

METHODS: This noninterventional, qualitative study involved a targeted literature review (TLR), clinician interviews, and patient interviews. The TLR identified relevant signs, symptoms, and impacts of PBC, as well as their reported prevalence data. This information was developed into a preliminary conceptual model (PCM) of PBC and refined via interviews with gastroenterology/hepatology clinicians, focusing on patients’ experiences. Next, PBC-related concepts were captured through patient interviews, and the PCM was finalized. A thematic approach was used to analyze data, and descriptive statistics were used to assess symptom and impact salience, ensuring a representative sample and achieving concept saturation.

RESULTS: Fatigue and pruritus were confirmed as the most prevalent symptoms. Clinician interviews (n = 4) provided insights into biochemical abnormalities used for diagnosis and common symptoms. Patient interviews (n = 20) revealed 41 unique PBC signs and symptoms. Patients reported mental and/or physical fatigue, with both impacting daily activities and overall health-related quality of life. They also reported that pruritus interfered with sleep and social engagements. The final conceptual model could distinguish between salient and non-salient signs, symptoms, and impacts, reflecting patients’ attributions to PBC and its treatment.

CONCLUSIONS: PBC imposes a significant burden on patients’ lives. This study highlights unmet patient needs, contributing valuable qualitative evidence to support clinical and observational studies in PBC.

PMID:42423947 | DOI:10.1007/s12325-026-03691-4

Updates Surg. 2026 Jul 9. doi: 10.1007/s13304-026-02766-9. Online ahead of print.

ABSTRACT

As AI models evolve, their application in specialized fields like colorectal cancer requires rigorous validation. This pilot study aimed to comparatively assess the knowledge retention, safety, and reasoning limitations of six advanced AI chatbots using a constrained zero-shot multiple-choice question format. 137 text-based MCQs covering 12 core colorectal cancer modules were adapted from the 2023 Chinese guidelines and administered to Gemini 3 Pro Preview, GPT-5.1, Kimi K2 Thinking, DeepSeek V3.2, Qwen3-Max, and Claude Opus 4.5 under zero-shot conditions with a prompt prohibiting reasoning steps. Both quantitative statistical analysis and qualitative error analysis were performed. Overall accuracy was low: Kimi K2 Thinking 27.74%, SD = 0.45, Claude Opus 4.5 26.28%, SD = 0.44, Gemini 3 Pro 16.06%, SD = 0.37, DeepSeek V3.2 15.33%, SD = 0.36, GPT-5.1 14.60%, SD = 0.35, and Qwen3-Max 13.87%, SD = 0.34. Significant module-wise disparities emerged, with Kimi K2 scoring 37.04% in Endoscopic Imaging versus Qwen3-Max at 7.41%. Qualitative analysis revealed four failure patterns: semantic association bias, hierarchical logic failure, fact retrieval error, and hallucinations. No correlation existed between item difficulty and accuracy. Under constrained prompts, next-generation AI chatbots demonstrate unsatisfactory colorectal cancer performance, often relying on keyword matching rather than physiological simulation. This leads to dangerous clinical errors, highlighting the critical need for chain-of-thought prompting, expert oversight, and domain-specific fine-tuning before unsupervised use.

PMID:42423944 | DOI:10.1007/s13304-026-02766-9

Ann Surg Oncol. 2026 Jul 9. doi: 10.1245/s10434-026-20150-0. Online ahead of print.

ABSTRACT

BACKGROUND: Breast surgical oncology was the most competitive surgical fellowship match in 2025, with a record low of 61% of applicants successfully matched. Previous studies evaluated the attitudes of program directors on the selection and ranking criteria of candidates. This study evaluates the perspectives of both program directors and associate program directors on the selection and ranking process because of the increasing competitiveness of the field.

METHODS: An anonymous, web-based survey was sent to all breast surgical oncology fellowship program leadership. The survey consisted of 24 questions. Survey analysis was performed using descriptive statistics.

RESULTS: Of 65 programs, 76.9% responded; 50 program directors and 26 associate program directors participated. Over half of programs (57.9%) engaged in holistic review of applicants before offering an interview and did not have formal screening criteria. For most programs (84%), additional faculty members beyond program leadership contributed to the rank list. Interview performance was the most important factor (65.8%) in the formation of the rank list.

DISCUSSION: Compared with prior years, breast surgical oncology fellowship directors reported fewer screening metrics before extending an interview. In rank list formation, there continues to be a strong majority consensus with previous years and among other surgical subspecialties that interview performance has the largest impact. An improved understanding of the application and rank list process enables both applicants and program directors to better prepare for a successful match.

PMID:42423938 | DOI:10.1245/s10434-026-20150-0

Sports Med. 2026 Jul 9. doi: 10.1007/s40279-026-02475-8. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding biological and race strategy characteristics of endurance track runners competing at benchmark events provides high-performance athletics programmes and coaches with valuable insight into what is required to succeed.

OBJECTIVES: The aim of this systematic review was to identify biological and race strategy characteristics investigated in elite able-bodied endurance track runners (Aim 1) and, where examined, highlight whether these characteristics could differentiate performance success within this elite cohort (Aim 2).

METHODS: For this systematic review, searches across EBSCOhost (Academic Search Complete, CINAHL Complete, MEDLINE Complete and SPORTDiscus), Scopus, PubMed and Web of Science were completed until May 2023. Searches also involved World Athletics Research Centre, New Studies in Athletics, handsearching and scanning of reference lists of included studies. Eligible studies were required to be published in English and have investigated performance-related biological or race strategy characteristics among senior able-bodied endurance track runners (800-10,000 m) capable of competing at benchmark events. Risk of bias of included studies was evaluated based on Sarmento et al.’s 16-item checklist. The review separated middle-distance runners (MDR) and long-distance runners (LDR), to account for the differing performance demands of these event groups. Studies were considered to address Aim 2 if they assessed for statistical associations between athlete characteristics and overall performance (e.g. race time) or compared characteristics between athletes with different competitive results (e.g. medallists and non-medallists).

RESULTS: Thirty-nine articles were included in this review, with 23 and 21 of these articles relevant to MDR and LDR, respectively. The most commonly reported characteristics were related to anthropometry (7 studies for MDR and LDR), biomechanics (7 studies for LDR), pacing (9 and 10 studies for MDR and LDR, respectively), qualification pattern (6 studies for MDR) and benchmark performance relative to athlete history (9 and 7 studies for MDR and LDR, respectively). However, the diversity of biological characteristics investigated and the generally small sample sizes makes it difficult to define an optimal biological profile for elite endurance runners. In contrast, race strategy characteristics investigated often included larger sample sizes providing a better understanding, especially in relation to pacing and for middle-distance events qualification patterns. Further, studies investigating whether characteristics differentiate performance among elite endurance track runners indicate that the most successful runners consistently demonstrate superior finishing ability. This is reflected in faster speeds during at least one 100-m segment of the final 400 m of the race and the ability to complete the final segments of the race at a pace close to, or faster than, their season best or 32-month best performance. In long distance events, better performance was associated with faster personal best times across the previous 32 months, indicating that having a high-ranking recent best time may be a prerequisite for succeeding at benchmark events. Faster 10,000-m runners had lower body mass and smaller arm and calf circumferences, suggesting a potential advantage of having lower non-functional mass. In middle distance events, success was associated with achieving superior qualification positions in the heats and semi-final, highlighting the importance of tactical positioning and efficient progression through qualification rounds. Faster male 800-m runners had a technique characterised by longer contact times and more compliant spring mechanics which may allow athletes to maintain or elevate speed during the sprint finish.

CONCLUSION: Biological and race strategy characteristics that profile elite endurance track runners and that, in several studies, showed association with performance success were discussed. These findings may assist high-performance athletics programmes and coaches in informing athlete development and investment. However, further research is required to establish a more holistic understanding of the biological profile of elite endurance track athletes and to determine which biological and race strategy characteristics may differentiate performance reliably among these elite runners.

PMID:42423935 | DOI:10.1007/s40279-026-02475-8

Cancer Causes Control. 2026 Jul 9;37(8):125. doi: 10.1007/s10552-026-02212-6.

ABSTRACT

BACKGROUND: Rural cancer survivors consistently experience poorer health outcomes than their urban counterparts, yet the interplay between rurality and area-level disadvantage remains understudied. This study examines how rural versus urban residence and neighborhood disadvantage relate to obesity, smoking, and psychological well-being among cancer survivors.

METHODS: Data from 1,062 HINTS-SEER participants across three registries were analyzed. Logistic regression models estimated associations between area-level factors (Social Deprivation Index (SDI) and Areas of Persistent Poverty) and health outcomes, adjusting for individual sociodemographic factors. Analyses accounted for complex survey design using Taylor series linearization.

RESULTS: Urban residents showed lower odds of obesity compared with their rural counterparts (OR: 0.69; 95% CI: 0.50-0.95). In stratified analyses, area-level social deprivation demonstrated smaller statistically significant associations. Higher deprivation was associated with increased odds of obesity among urban cancer survivors (OR: 1.01; 95% CI: 1.00-1.02) and increased depression/anxiety among rural survivors (OR: 1.02; 95% CI: 1.00-1.04). Across all models, individual-level socioeconomic factors (education, income) showed stronger, more consistent protective associations than area-level indicators.

CONCLUSIONS AND IMPLICATIONS: Area-level disadvantage was a contributor to rural cancer survivors’ psychological well-being. Individual socioeconomic status remains the dominant determinant of lifestyle and mental health outcomes. Cancer survivors residing in socioeconomically disadvantaged rural areas may benefit from targeted mental health intervention. Future longitudinal research incorporating census tract-level geographic measures and residential histories is needed to clarify the mechanisms linking the geographic and socioeconomic context to survivorship outcomes.

PMID:42423918 | DOI:10.1007/s10552-026-02212-6

Ir J Med Sci. 2026 Jul 9. doi: 10.1007/s11845-026-04547-0. Online ahead of print.

ABSTRACT

BACKGROUND: Standard postoperative care for major gynecologic and obstetric surgery traditionally involves a 48-hour observation period. However, extraordinary crises such as the COVID-19 pandemic and the 2023 Kahramanmaraş earthquake necessitated an accelerated 24-hour discharge protocol to preserve hospital capacity.

AIMS: This study aims to evaluate whether a 24-hour early discharge protocol is non-inferior to the conventional 48-hour standard regarding clinical complications.

METHODS: In this retrospective cohort study, data from 11,670 patients (2010-2024) were analyzed. Patients were categorized into Pandemic (n = 2,924) and Earthquake (n = 1,194) groups (24-hour discharge), and a Control group (n = 7,552; 48-hour discharge). Primary outcomes included surgical site infection (SSI), urinary tract infection (UTI), wound dehiscence, and hemorrhagic complications within 30 days.

RESULTS: Non-inferiority was established for SSI (4.3% and 4.4% vs. 4.1%), UTI (3.5% and 3.6% vs. 3.3%), and wound dehiscence (1.4% and 1.3% vs. 1.3%). Multivariable regression confirmed that hospitalization duration was not an independent predictor of SSI (p > 0.500), whereas obesity (OR: 1.91; p < 0.001) was the primary risk factor. Hemorrhagic complication results remained inconclusive due to insufficient statistical power.

CONCLUSIONS: A 24-hour postoperative discharge protocol is non-inferior to the 48-hour standard for most major complications following benign surgery. These findings suggest that patient-intrinsic factors, specifically BMI, drive infection risk more than the length of hospital stay.

PMID:42423912 | DOI:10.1007/s11845-026-04547-0