Category: Statistics

Neurology. 2026 Jul 14;107(1):e218053. doi: 10.1212/WNL.0000000000218053. Epub 2026 Jun 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Rural residence is linked to poor access to neurologists and specialized epilepsy centers, yet its impact on clinical epilepsy outcomes remains unclear. To address this knowledge gap, we assessed the association between rurality and epilepsy outcomes in a nationally representative cohort in the United States.

METHODS: We conducted a retrospective cohort study using the National Inpatient Sample (2016-2021), including patients with a primary diagnosis of epilepsy and recurrent seizures. The primary exposure was patient rurality, defined using the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Logistic regression models were used to study the effect of rurality on in-hospital mortality, presenting in status epilepticus, prolonged length of stay, nonroutine discharge, and receipt of EEG. Models were adjusted for demographic, socioeconomic, and hospital-related characteristics and Elixhauser comorbidities. Subanalyses examined patients presenting in status epilepticus, those with private insurance, and those admitted to urban teaching hospitals.

RESULTS: A total of 841,445 epilepsy admissions were included (median age 56 years, 47.2% female). After adjusting for covariates, patients from the most rural counties experienced significantly higher odds of in-hospital mortality (odds ratio [OR] 1.93 [95% CI 1.56-2.39], p < 0.001), presenting in status epilepticus (OR 1.32 [95% CI 1.24-1.41], p < 0.001), and prolonged length of stay (OR 1.29 [95% CI 1.19-1.41], p < 0.001), relative to patients from the most urban counties. The most rural patients also experienced lower odds of receiving EEG (OR 0.88 [95% CI 0.77-1.00], p = 0.047) and nonroutine discharge (OR 0.90 [95% CI 0.85-0.96], p = 0.001). When subanalyzing only patients with private insurance, the associations between rurality and mortality, presenting in status epilepticus, and prolonged length of stay were no longer observed.

DISCUSSION: Increasing rurality was associated with markedly worse epilepsy outcomes, including nearly double the odds of in-hospital mortality. The attenuation of these disparities among privately insured patients suggests that modifiable structural barriers drive rural-urban disparities, rather than geography alone. Inherent to observational studies, residual confounding and limited clinical granularity remain important considerations. These findings underscore the urgent need for targeted public health interventions to improve outcomes for rural epilepsy populations.

PMID:42234954 | DOI:10.1212/WNL.0000000000218053

Blood Adv. 2026 Jun 3:bloodadvances.2026019765. doi: 10.1182/bloodadvances.2026019765. Online ahead of print.

ABSTRACT

Children and adolescents with early-stage nodular lymphocyte-predominant Hodgkin lymphoma (nLPHL) have a 5-year event-free survival (EFS) of about 77% after complete lymph node resection and around 89% with anthracycline-containing chemotherapy. We investigated whether patients with early-stage nLPHL can be successfully treated with surgical resection alone or with low-intensity, anthracycline-free CVP chemotherapy for those with unresectable nodal disease. EuroNet-PHL-LP1 was a prospective phase III trial enrolling patients under 18 years with stage IA/IIA nLPHL. Completely resected lymph nodes led to active surveillance. Patients with unresectable disease received three cycles of CVP (cyclophosphamide, vinblastine, prednisone). In CVP-cohort-1, treatment cessation required a negative 18F -FDG-PET. An amendment in 2014 omitted PET for end-of-treatment response; CT and/or MRI alone defined response in CVP-cohort-2. The primary endpoint was 5-year EFS, with death, relapse, second malignancy and PET-positivity counting as events; for CVP-cohort-2, progression-free survival (PFS) was primary. Among 267 registered patients (2009-2018), 247 were evaluable. Seventy-eight underwent resection only; their 5-year EFS/PFS was 79.5%. Six of 18 patients who relapsed after surgical resection re-entered the CVP arm. In CVP-cohort-1, 51/82 (62%) achieved a complete metabolic response (CMR). 5-year EFS was 56.4%, while 5-year PFS in the CMR group was 91.3%. In contrast, PFS in 84 CVP-cohort-2 patients was 64.7%. During CVP, 68.3% of patients experienced grade 3-4 neutropenia. No treatment-related deaths were reported. Excellent outcomes were achieved after complete resection and with low-intensive, anthracycline-free chemotherapy if 18F-FDG-PET showed CMR after chemotherapy. This strategy now constitutes the EuroNet-PHL standard of care for early-stage nLPHL. The trial was registered under EudraCT-No.: 2007-004092-19.

PMID:42234940 | DOI:10.1182/bloodadvances.2026019765

J Clin Oncol. 2026 Jun 3:JCO2501896. doi: 10.1200/JCO-25-01896. Online ahead of print.

NO ABSTRACT

PMID:42234933 | DOI:10.1200/JCO-25-01896

Blood Adv. 2026 Jun 3:bloodadvances.2025019356. doi: 10.1182/bloodadvances.2025019356. Online ahead of print.

ABSTRACT

We report outcomes of the phase 2 study combining carfilzomib (CFZ) plus vincristine, dexamethasone, asparaginase, and daunorubicin (CFZ-VXLD) in heavily pre-treated, pediatric patients with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL). We investigated whether post-induction complete remission (CR) rates after CFZ-VXLD induction are superior to an external real-world control (EC). Patients aged ≥1 month to <21 years with R/R ALL received CFZ-VXLD induction, followed by optional consolidation (experimental arm). EC arm included similar patients receiving real-world, curative-intent regimens at Therapeutic Advances in Childhood Leukemia sites between 2000-2023. Primary endpoint was CR after induction; overall response rate (ORR; CR/CR with partial/incomplete hematologic recovery/CR without platelet recovery) was a secondary endpoint. Comparative analyses used inverse probability of treatment weighting. Experimental and EC arms included 105 and 140 patients, respectively. CR rates after induction were 14.8% vs 7.8% (odds ratio [OR] 2.04; 95% CI, 0.54-7.66) in patients with B-ALL and 13.6% vs 9.1% (OR 1.58; 95% CI, 0.47-5.31) in patients with T-ALL. There was no statistically significant increase in post-induction CR for the CFZ-VXLD arm vs the EC arm and the study did not meet its primary endpoint. In patients with B-ALL, ORR was 42.6% vs 26.3% favoring the CFZ-VXLD arm vs the EC arm. Adverse event rates with CFZ were consistent with previous reports. Taken together, the CFZ-VXLD regimen may be an option for some selected pediatric patients with R/R ALL and this study highlights that novel treatments for R/R ALL remain an area of unmet medical need. NCT02303821.

PMID:42234929 | DOI:10.1182/bloodadvances.2025019356

JMIR Serious Games. 2026 Jun 3;14:e79784. doi: 10.2196/79784.

ABSTRACT

BACKGROUND: Cognitive impulsivity is a multifaceted construct associated with symptom severity, functional impairment, and poor quality of life in eating disorders (EDs) and mental ill-health. However, objective assessment of cognitive impulsivity is piecemeal and complex, with many assessment tools lacking psychometric evaluation and ecological validity. Furthermore, validated assessment tools are rarely perceived to be engaging or meaningful by individuals who complete them, limiting their utility in research and forming a barrier to clinical translation. Thus, although cognitive impulsivity predicts treatment engagement and outcomes, it is rarely assessed or addressed in a clinical context.

OBJECTIVE: We aimed to redesign and evaluate the Cognitive Impulsivity Suite (CIS), a validated gamified assessment battery of cognitive impulsivity, through user-centered co-design, agile game development, and user-centered evaluation. This collaborative study partnered researchers with individuals with lived experiences (LEs) of EDs and commonly co-occurring mental ill-health, and game development experts.

METHODS: In a sequential mixed methods design, we first defined user requirements through inductive thematic analysis of data from 2 focus groups incorporating 7 individuals with LE of EDs and commonly co-occurring mental health conditions (mean age 27.6, SD 7.03 y; 4 women, 2 men, 1 nonbinary), researchers, clinicians, and technology professionals. Agile game development was achieved through 6-week-long sprints, involving game developers and a play-testing team of researchers. During LE evaluation, we collected and analyzed data from an expanded sample (n=18; mean age 30.5, SD 6.56 y; 12 women, 3 men, 2 nonbinary), using a pragmatic blending of qualitative and quantitative research methods. This included inductive and deductive thematic analysis of “thinking aloud” data, descriptive statistics, and ANOVA tests of the Game User Experience Satisfaction Scale, short version (GUESS-18) surveys.

RESULTS: We co-designed guiding principles and ideas for aesthetics, story concepts, and gameplay features, which closely aligned with leading theories of psychological well-being, clinical evidence concerning ED recovery, and gamification frameworks. Qualitative evaluations of the new tool, CIS Papillon Park, showed user engagement and motivation were driven by opportunities for autonomy, personal accomplishment, and simulated interpersonal relationships, aligning with approaches to gamification based on self-determination theory. In quantitative evaluation, a mean GUESS-18 composite score of 45.9 (SD 9.85) showed CIS Papillon Park achieved sound overall user satisfaction, with subscale scores revealing strengths in usability, narrative, visual and audio aesthetics, and personal gratification.

CONCLUSIONS: The contributions of this study are grounded in its integration of user-centered co-design and evaluation, agile game development, and theory-driven approaches to cognitive assessment and gamification, to redesign and evaluate a validated online task battery. The resulting CIS Papillon Park combines appealing aesthetics, gamification elements that address cognitive, emotional, and social needs, and accessible playing experiences, which maximized user satisfaction and engagement while prioritizing psychological safety. Next steps involve psychometric evaluation and dissemination.

PMID:42234926 | DOI:10.2196/79784

Iran J Kidney Dis. 2026 May 31;20(3):138-148. doi: 10.61882/ijkd.3.03.9536.

ABSTRACT

INTRODUCTION: In studies involving hemodialysis patients, repeated laboratory measurements (longitudinal data) and survival outcomes are often analyzed separately, which can lead to biased results due to ignoring measurement errors and the intrinsic dependency between the two analyses. Joint modeling has emerged as a powerful approach to handle such data. This study aims to investigate the impact of six time-varying biochemical markers, along with baseline covariates, on the survival of hemodialysis patients using a multivariate joint model.

METHODS: A longitudinal cohort of 894 maintenance hemodialysis (MHD) patients, who had started dialysis between 2004 and 2023, were included. Baseline and follow-up clinical information and monthly laboratory measurements were analyzed. A multivariate linear mixed-effects model was jointly fitted with a Cox proportional hazards model to simultaneously assess the longitudinal biomarkers and time-to-event data. Analyses were performed using R software.

RESULTS: The model indicated that older age (Hazard Ratio, HR = 1.02, P < .001), male gender (HR = 1.72, P < .001), diabetes mellitus (HR = 1.61, P < .001), walking disability at admission (HR = 1.78, P < .001), and catheter-based vascular access (HR = 1.71, P < .001) were significantly associated with an increased risk of mortality. Higher square root of phosphate levels (HR = 13.97, P < .001) were linked to increased, and higher square root of creatinine (HR = 0.32, P < .001), hemoglobin (HR = 0.75, P = .009) and albumin (HR = 0.31, P < .001) levels were associated with decreased mortality.

CONCLUSION: Findings of the joint model confirm the importance of baseline clinical risk factors and modifiable biochemical markers on the survival outcomes of hemodialysis patients.

PMID:42234920 | DOI:10.61882/ijkd.3.03.9536

Iran J Kidney Dis. 2026 May 31;20(3):131-137. doi: 10.61882/ijkd.3.03.9421.

ABSTRACT

INTRODUCTION: Kidney transplantation significantly improves survival and quality of life in End-Stage Kidney Disease (ESKD). However, kidney transplant recipients (KTRs) are prone to complications leading to hospitalization. Data on hospitalization etiologies among Iranian KTRs remain limited.

METHODS: This cross-sectional study included all KTRs hospitalized in the two centers with kidney transplant department in Isfahan between March 2023 and March 2024. Demographic, clinical, and laboratory data were collected from medical records. Etiologies of admission were classified, and descriptive and analytical statistics were calculated using SPSS, version 22.

RESULTS: A total of 408 patients (60.7% male, mean age 45.6 ± 15.2 years) were included. The most frequent comorbidities were diabetes mellitus (DM) (27.2%) and hypertension (HTN) (22.2%). Most patients (42.5%) had undergone transplantation for more than 10 years. The leading causes of admission were constitutional symptoms including fever, myalgia, and fatigue in 165 (40.4%), azotemia in 55 (13.5%), dysuria in 23 (5.6%) and limb edema in 21 (5.1%) patients. The main final diagnosis in hospitalized KTRs were infections (42.5%) and acute kidney injury (AKI)/AKI superimposed on chronic kidney disease (CKD) (15.6%). Laboratory findings revealed a mean serum creatinine of 2.58 ± 2.16 mg/dL, with 50% above 1.7 mg/dL. Anemia (Hb < 10 g/dL) was present in 43.7% of cases. Urinalysis showed hematuria in 50.3% and pyuria in 64.2% of patients. Graft failure requiring dialysis occurred in 9 (2.2%) patients. Eighteen (4.4%) patients died during hospitalization period.

CONCLUSION: Infections and acute kidney injury (AKI) were the predominant causes of hospitalization among Isfahan KTR population.

PMID:42234919 | DOI:10.61882/ijkd.3.03.9421

Int J Prosthodont. 2026 Jun 3;0(0):1-19. doi: 10.11607/ijp.9838. Online ahead of print.

ABSTRACT

PURPOSE: To explore private practitioners’ perspectives on participation in clinical dental research, identify perceived research priorities, and assess current and anticipated future use of research information sources in reconstructive dentistry.

MATERIALS AND METHODS: This cross-sectional survey included dentists practicing in Switzerland in private practice or academic settings. An anonymous online questionnaire with 13 structured items was distributed between June and November 2024 via professional meetings and alumni networks. Survey domains included demographics, current research involvement, interest in future research participation, research priorities, and use of research information sources. Descriptive statistics were calculated. Paired comparisons between current and anticipated future research information sources were analyzed using McNemar’s exact test, with p-values adjusted for multiple testing using the Benjamini-Hochberg false discovery rate procedure. Ranking data were summarized using mean ranks. Analyses were exploratory and hypothesis-generating.

RESULTS: Fifty-six dentists completed the survey (median years since graduation: 18 [Q1-Q3: 7-23]). One-third of respondents (33.9%) reported current involvement in research, while 46.4% expressed interest in future participation, particularly in clinical trials. Anticipated future use of colleagues, study clubs/alumni networks, PubMed, and continuing education as research information sources decreased significantly compared with current use (all adjusted p≤0.032), whereas reliance on journals and social media remained stable. Ranking analyses indicated that predictability was the highest priority in therapy-related decision-making, a trusting patient-clinician relationship was most important in everyday practice, and patient satisfaction was the primary determinant of treatment success.

CONCLUSIONS: Private practitioners showed moderate interest in clinical research participation and emphasized clinically relevant, practice-oriented research priorities. Integrating practitioners’ perspectives may help align prosthodontic research more closely with real-world clinical needs.

PMID:42234485 | DOI:10.11607/ijp.9838

Int J Prosthodont. 2026 Jun 3;0(0):1-16. doi: 10.11607/ijp.9798. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the influence of build platform location on the mechanical and optical properties of a PolyJet-printed temporary dental resin material.

MATERIALS AND METHODS: Disc-shaped specimens (10 mm diameter, 2 mm thickness) were additively manufactured from a temporary PolyJet resin on a circular build platform at four radial positions (n = 10 per position). Biaxial flexural strength (BFS) was determined using an ISO piston-on-three-ball test. Colour coordinates (L*, a*, b*), colour difference (ΔEpos, ΔErel) and mean transparency (MT) were obtained from reflection and total transmission spectra. Surface gloss was measured at 60°. Data were analysed using Levene tests, analysis of variance (ANOVA) with post-hoc comparisons, and Pearson correlation (α = 0.05).

RESULTS: Mean BFS differed by about 20% across positions, ranging from approximately 215 MPa at the innermost to the highest values at the outermost tray location; a significant difference was identified only between the extreme positions. BFS showed a positive correlation with radial distance (r ≈ 0.43, p = 0.006). L*, a*, b* and ΔEpos exhibited small but statistically significant positional differences (0.3-0.8) in individual positions. Relative colour differences ΔErel (vs. the inner position) ranged between 1.3 and 1.9 and were not significantly affected by location. MT showed minor but significant variations (<5%) between some positions. Gloss values varied numerically, but without statistically significant positional effects.

CONCLUSIONS: In a PolyJet system, the location of the printed object on the build platform has a measurable effect on biaxial flexural strength and induces subtle changes in colour and translucency, whereas gloss remains unaffected. Although most optical differences appear clinically negligible, positional effects on strength may be relevant for load-bearing temporary restorations and should be considered when arranging critical cases on the build platform.

PMID:42234482 | DOI:10.11607/ijp.9798

Int J Prosthodont. 2026 Jun 2;0(0):1-26. doi: 10.11607/ijp.9754. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to characterize the adhesion and biofilm formation of key denture-associated microbes-Candida albicans, Porphyromonas gingivalis, and Streptococcus mutans-on a 3D-printed photopolymer resin (FotoDent®).

MATERIALS AND METHODS: Discs were fabricated at three distinct printing orientations (0°, 45°, and 90°) to assess the impact of layer deposition on surface properties and microbial colonization. Conventionally polymerized ProBase® cold resin discs served as controls. All specimens underwent comprehensive surface characterization, including measurement of areal surface roughness, static contact angle with polar and apolar liquids, and surface free energy components. Adherent microbial cells were quantified using species-specific quantitative real-time PCR (qPCR) following standardized biofilm assays.

RESULTS: Microbial adhesion to the 3D-printed resin was highly dependent on print orientation, with cell counts for all three species decreasing significantly (p<0.05) from the 0° to the 90° orientation. This trend was paralleled by an increase in surface roughness (Ra) with higher print angles. A strong, statistically significant positive correlation was observed between the surface roughness of FotoDent® discs and biofilm cell numbers for C. albicans (r=0.815), P. gingivalis (r=0.883), and S. mutans (r=0.903). In contrast, adhesion to the control ProBase® material was consistently higher and showed no significant correlation with any measured surface characteristic-roughness, wettability, or surface energy.

CONCLUSION: These findings indicate that for 3D-printed dental resins, printing parameters, especially orientation, critically determine the final surface topography, which in turn is a affects microbial adhesion and biofilm formation.

PMID:42234481 | DOI:10.11607/ijp.9754