Category: Statistics

Surgery. 2026 Jun 22;198:110405. doi: 10.1016/j.surg.2026.110405. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital lung malformations encompass a variety of abnormal pulmonary lesions, including congenital pulmonary airway malformations and bronchopulmonary sequestrations. Congenital lung malformation margins can be difficult to detect for complete resection. Therefore, inhaled indocyanine green has been utilized to visualize lesion borders. We report a novel, intraoperative technique of indocyanine green administration in the pediatric population to establish feasibility in facilitating thoracoscopic segmental lung resections.

METHODS: We conducted a retrospective review from December 2024 to September 2025 of pediatric patients who underwent intraoperative inhaled indocyanine green during thoracoscopic resections. Indocyanine green solution (0.5 mg/kg) was administered after induction and intubation via nebulizer through the endotracheal tube prior to single lung ventilation. Patients were matched in a 1:1 ratio, and patient demographics, perioperative, and postoperative data were compared.

RESULTS: Eight children received inhaled indocyanine green intraoperatively during thoracoscopic lung resections. Inhaled indocyanine green guidance assisted in 4 lobe-sparing segmentectomies. The median age at surgery was 8.8 (interquartile range, 7.2-15.4) months. Median total time spent in the operating room was 309 (interquartile range, 188.5-409.5) minutes, with a median operating time of 199.5 (interquartile range, 92.8-252.8) minutes. The median length of chest tube duration was 2 (interquartile range, 1.8-2) days. The median length of stay was 2 (interquartile range, 2-2.3) days. When compared with the matched controls, there were no statistical differences in operative time, in-room time, chest tube duration, or length of stay.

CONCLUSION: Intraoperative administration of inhaled indocyanine green is feasible, with avidity correlating with preoperative imaging. Thoracoscopic segmentectomy was completed with similar perioperative outcomes to matched controls. Inhaled indocyanine green may facilitate lobe-sparing pulmonary resection in select patients.

PMID:42462357 | DOI:10.1016/j.surg.2026.110405

Int Dent J. 2026 Jul 16;76(5):109753. doi: 10.1016/j.identj.2026.109753. Online ahead of print.

ABSTRACT

INTRODUCTION AND AIMS: This study investigates the short-term remineralization effects of multi-ion-releasing cements on demineralized dentin under simulated deep caries conditions and clarifies material-dependent differences relevant to interim caries management.

METHODS: Fifty root dentin specimens were assigned to five groups (n = 10): control (CO), Caredyne Restore (CR), Fuji IX (FU), HY Bond Temporary Cement Hard (HY), and IP Temp Cement (IP). Samples were demineralized (pH 4.5, 3 days), treated with cements, and subjected to 7-day pH cycling (4 hours/d at pH 4.5, 20 hours/d at pH 7.0). Mineral changes were assessed using swept-source optical coherence tomography before demineralization (DEM), after DEM, and after pH cycling. Transverse microradiography and scanning electron microscopy/energy-dispersive X-ray spectroscopy were used for quantitative mineral analysis and ion detection. Statistical analyses were conducted using one-way ANOVA and repeated measures ANOVA (P < .05).

RESULTS: All cement groups showed significantly reduced DEM compared to the control after pH cycling (P < .05). IP exhibited the most favourable remineralization-related response, as indicated by a reduction in attenuation coefficients towards baseline levels. Transverse microradiography analysis demonstrated significantly lower mineral loss and lesion depth in the CR, HY, and IP groups compared with the control. Scanning electron microscopy/energy-dispersive X-ray spectroscopy revealed material-dependent elemental signals, with zinc detected in CR and HY, fluoride-related elements in FU, and a distinct strontium signal in the surface prereacted glass ionomer-containing IP group.

CONCLUSIONS: Ion-releasing cements demonstrated short-term protective effects and induced remineralization-related changes in demineralized dentin under the present in vitro pH-cycling conditions. Material-dependent differences were observed, with the surface prereacted glass ionomer filler-containing temporary cement showing the most favourable effects.

CLINICAL RELEVANCE: Multi-ion-releasing temporary cements may contribute to the preservation of demineralized dentin and limitation of lesion progression when definitive restoration must be delayed.

PMID:42462351 | DOI:10.1016/j.identj.2026.109753

Int Dent J. 2026 Jul 16;76(5):109755. doi: 10.1016/j.identj.2026.109755. Online ahead of print.

ABSTRACT

INTRODUCTION AND AIM: Insulin resistance and obesity are significant metabolic risk factors for periodontitis. This study aimed to systematically investigate the association between the novel metabolic obesity composite index, triglyceride glucose-a body shape index (TyG-ABSI), and the risk of periodontitis, further evaluating its clinical predictive performance.

METHODS: Data from 4545 participants were obtained from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. To investigate the relationship between TyG-ABSI and the risk of periodontitis, weighted multivariable logistic regression models and restricted cubic spline (RCS) analyses were used. Exploratory mediation analysis was conducted to assess the statistical contributions of potential related factors to the association between TyG-ABSI and periodontitis. Predictive models were constructed using various machine learning (ML) algorithms. Model performance was evaluated and compared using the receiver operating characteristic curve, calibration curve, decision curve analysis, net reclassification improvement and integrated discrimination improvement.

RESULTS: A significant positive association was observed between TyG-ABSI and periodontitis risk (OR = 1.193, 95% CI: 1.089-1.308), with the highest tertile conferring a 2.25-fold elevated risk relative to the lowest tertile (OR = 2.252, 95% CI: 1.428-3.550). Restricted cubic spline analysis suggested a linear dose-response relationship. Subgroup analysis revealed a significant interaction with age, with the highest risk observed in individuals aged 45 to 59 years (OR = 1.320, 95% CI: 1.110-1.560). Exploratory mediation analysis showed that HbA1c and WBC accounted for 38.8% and 12.2% of the total association between TyG-ABSI and periodontitis, respectively. Machine learning models further suggested that the TyG-ABSI index has potential value in periodontitis risk prediction.

CONCLUSION: The novel composite index TyG-ABSI exhibits a significant positive association with periodontitis risk. It can serve as a reference indicator for periodontitis risk prediction.

CLINICAL RELEVANCE: TyG-ABSI integrates information related to insulin resistance and abdominal obesity. The present findings suggest that individuals with this metabolic-body shape abnormality phenotype should pay greater attention to their periodontal health status.

PMID:42462349 | DOI:10.1016/j.identj.2026.109755

Int Dent J. 2026 Jul 16;76(5):109740. doi: 10.1016/j.identj.2026.109740. Online ahead of print.

ABSTRACT

AIMS: To evaluate stage-specific intermethod association among DIAGNOdent, quantitative light-induced fluorescence (QLF), scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDS), and colourimetry in white spot lesion (WSL) assessment, and to compare alternative explanatory model structures for QLF-derived lesion volume (ΔQ).

METHODS: This secondary in vitro matched-block analysis included 20 bovine incisors sectioned into four enamel surfaces (80 surfaces). Within each tooth, surfaces were allocated to one of four groups. Measurements were obtained at baseline (T0), postdemineralization (T1), day 7 (T2), and day 30 post-treatment (T3). DIAGNOdent, QLF metrics (ΔF, lesion area [LA], and ΔQ), colourimetry, and SEM-EDS values were recorded. Statistical analyses included Spearman correlation and mixed-effects models.

RESULTS: At T1, intermethod association was limited, with weak associations among QLF, SEM-EDS, and DIAGNOdent. At T3, stronger associations were observed, particularly between intensity-based QLF metrics and mineral-related parameters. Ca/P showed positive associations with ΔF and ΔQ, while LA was inversely associated with Ca/P. DIAGNOdent scores were inversely associated with Ca/P and ΔF and positively associated with LA. Mixed-effects analyses identified a limited number of significant predictors of ΔQ, and the combined model demonstrated better relative in-sample fit than the clinical and compositional models at both T1 and T3.

CONCLUSIONS: WSL assessment methods provided complementary rather than interchangeable information. Cross-method associations were limited after lesion induction, whereas stronger associations were observed after treatment, particularly between intensity-based QLF parameters and mineral-related measures. No single metric fully characterized WSL change, and the combined model showed modest explanatory performance.

CLINICAL RELEVANCE: No single chairside measure appears sufficient for all aspects of WSL assessment. Within the limits of this in vitro study, intensity-based QLF measures were more closely aligned with mineral-related changes after treatment, whereas LA and colour-based indices provided complementary information on lesion extent and visible appearance.

PMID:42462347 | DOI:10.1016/j.identj.2026.109740

Geriatr Nurs. 2026 Jul 16;72:104179. doi: 10.1016/j.gerinurse.2026.104179. Online ahead of print.

ABSTRACT

BACKGROUND: Multimorbidity is rising and comorbid hypertension and type 2 diabetes is the most common among older adults. Although pharmacological therapy is the mainstay, non-pharmaceutical interventions are essential for disease control. We conducted a systematic review to synthesize evidence from randomized controlled trials in older adults on non-pharmacological approaches by intervention strategy and delivery setting.

METHODS: Following PRISMA 2020, we searched PubMed, Embase, and Cochrane CENTRAL (until October 2024) for randomized controlled trials enrolling adults ≥60 years with both conditions. Risk of bias was assessed with RoB 2; heterogeneity precluded meta-analysis and findings were synthesized narratively.

RESULTS: A total of 3449 studies were screened, and 16 trials were included in final analyses. Interventions were classified as exercise (n = 3), diet (n = 2), self-monitoring (n = 1), multi-strategy (n = 3), or comprehensive lifestyle modification (n = 7), delivered via hospital (n = 6), community (n = 6), or telehealth (n = 4) models. Most trials (∼75%) reported a statistically significant effect on their prespecified primary outcomes, mainly blood pressure or HbA1c. Effects were most consistent for comprehensive lifestyle modification, especially those combining individualized planning with technology-assisted support. By setting, hospital interventions tended to yield short-term physiological gains, whereas community and telehealth models emphasized adherence and sustained engagement. Only two trials included post-intervention follow-up.

CONCLUSION: Comprehensive behaviorally informed interventions combining individualized planning with technology-assisted support were the most effective for older adults with hypertension and diabetes multimorbidity. Studies targeting this population remain limited with no long-term follow-up. Innovations in strategy optimization and adaptation to contexts and assessment of sustained effects are needed in multimorbidity management.

PMID:42462335 | DOI:10.1016/j.gerinurse.2026.104179

Diabetes Metab Syndr. 2026 Jul 15;20(6):103454. doi: 10.1016/j.dsx.2026.103454. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic disorders may progress sequentially from fatty liver to hypertension and diabetes, but this cascade has not been well characterised in lean Asian populations. We aimed to quantify this progression and develop practical risk prediction tools in a large longitudinal Japanese cohort.

METHODS: We analysed 75,781 health examination records from 24,718 Japanese adults between 2009 and 2019. Continuous-time multistate modelling quantified transitions across four states: no fatty liver, hypertension, or diabetes; fatty liver alone; fatty liver with hypertension; and fatty liver with hypertension and diabetes. Individual risk prediction tools were developed and internally validated.

FINDINGS: Among 38,858 observed transitions, 2880 were prespecified forward cascade-transition events. Annual transition intensities were 0.699 for state 0 to 1, 0.809 for state 1 to 2, and 0.769 for state 2 to 3, corresponding to a summed mean progression time of 3.97 years. Normal-range body mass index accounted for 1394 cascade events (48.4%), whereas obesity accounted for 238 events (8.3%). The simplified clinical score showed moderate discrimination (C-statistic, 0.63; 95% confidence interval, 0.58-0.68) and good calibration.

INTERPRETATION AND FUNDING: Metabolic disease progressed rapidly and sequentially in this Asian cohort, frequently among adults without obesity. These findings support earlier body mass index-independent metabolic screening and prospective evaluation of shorter surveillance intervals in Asian populations.

PMID:42462329 | DOI:10.1016/j.dsx.2026.103454

Food Chem. 2026 Jul 12;525(Pt 1):150382. doi: 10.1016/j.foodchem.2026.150382. Online ahead of print.

ABSTRACT

Apples are widely recognized for their potential health benefits, partly attributed to their phenolic compounds. However, their impact on human metabolism remains incompletely understood. This study investigated metabolic effects of apple-derived phenolic compounds using untargeted metabolomics approach across multiple biofluids. In a crossover intervention study, 30 healthy men consumed a phenolic-rich apple juice or a placebo for two weeks. Blood, urine and saliva samples were collected before and after each intervention and analyzed by direct infusion ultra-high resolution mass spectrometry. Consumption of apple phenolic compounds resulted in significant alterations of the human metabolome, including increased levels of phenolic-derived degradation products and microbial-associated metabolites across all biofluids. Pathway enrichment analysis revealed pronounced effects on phenylalanine and tyrosine metabolism, as well as linoleic and arachidonic acid metabolism, Overall, these findings demonstrate that apple phenolic compounds induce measurable, microbiota-associated and systemic metabolic changes, providing new insights into their metabolic fate and biological relevance.

PMID:42462304 | DOI:10.1016/j.foodchem.2026.150382

Gynecol Oncol. 2026 Jul 16;211:217-223. doi: 10.1016/j.ygyno.2026.06.027. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical impact of Sentinel Lymph Node (SLN) biopsy in women with preoperative diagnosis of Atypical Endometrial Hyperplasia/Endometrial Intraepithelial Neoplasia (AEH/EIN), focusing on surgical safety and feasibility and adjuvant treatment decisions.

METHODS: Multicenter retrospective study which included 411 patients with preoperative diagnosis of AEH/EIN who underwent total hysterectomy between 2014 and 2025. Demographic, preoperative, surgical, pathological and adjuvant treatment data were collected from prospectively maintained databases and outcomes were compared between patients who underwent SLN biopsy and those who did not. Descriptive statistics were used.

RESULTS: Occult endometrial cancer (EC) was diagnosed in 47% of overall patients at final pathology; of whom 16% was classified within the intermediate to high-risk cases. SLN mapping was associated with slightly longer operative time. SLN metastases were found in 4.7% of patients with EC. SLN assessment modified treatment decisions in 11 of 22 patients (50%) receiving adjuvant therapy within the SLN cohort. Positive SLN findings led to chemotherapy escalation in 5 patients, while negative SLN status supported chemotherapy omission in 6 high to intermediate risk cases. No patients in the non-SLN group received chemotherapy.

CONCLUSION: SLN biopsy in AEH/EIN is a feasible and safe procedure that provides staging information in the subgroup with occult EC. Regardless of metastasis frequency, SLN status provides actionable prognostic information. Whether positive or negative, SLN findings refine risk stratification and may guide the escalation or de-escalation of adjuvant therapy, supporting the consideration of SLN biopsy in AEH/EIN patients.

PMID:42462287 | DOI:10.1016/j.ygyno.2026.06.027

EBioMedicine. 2026 Jul 16;130:106387. doi: 10.1016/j.ebiom.2026.106387. Online ahead of print.

ABSTRACT

BACKGROUND: The determinants of the species barrier preventing human infections with avian influenza A viruses (IAV) are incompletely understood. We previously identified loss-of-function variants of the interferon-regulated antiviral factor MxA as a genetic factor for increased susceptibility to infections with the H7N9 subtype. Given the central role of type I IFNs (IFN-I) in antiviral defence, we hypothesised that IFN-I-neutralising autoantibodies may similarly predispose to zoonotic H7N9 infection.

METHODS: In this observational case-control study, serum samples collected between 2013 and 2017 from 199 Chinese patients with laboratory-confirmed H7N9 infection and 531 healthy, uninfected controls (269 poultry workers, 262 close contacts) were screened for IgG autoantibodies binding IFNα₂, IFNβ_1b, or IFNω using a multiplex bead-based assay. Positive samples were tested for IFN-neutralising activity in a luciferase-based reporter assay. To confirm their ability to block IFNα₂-mediated antiviral activity, selected samples (n = 19) were analysed in IAV infection experiments. Associations between age, sex, H7N9 case status, case fatality, and the presence of neutralising autoantibodies were evaluated by logistic regression. Available whole-genome sequencing data from 26 individuals with neutralising autoantibodies were screened for variants in genes linked to IFN-I autoimmunity.

FINDINGS: Neutralising autoantibodies against at least one IFN-I were detected in 19.1% (38/199) of patients but in only 1.1% (6/531) of controls, consistent with published general population data. Most patient sera targeted IFNα₂ and/or IFNω (35/199), and 18.1% (36/199) neutralised even high IFN-I concentrations of 1-10 ng/ml. The presence of neutralising autoantibodies was associated with 8.2- to 25.3-fold higher odds of H7N9 infection (p < 0.0001), depending on antibody specificity and reference group. Autoantibody prevalence increased significantly with age in patients (44.8% ≥70 years; OR = 1.05; 95% CI 1.02-1.07; p = 0.0001), but was not associated with sex (OR for males vs. females = 0.52; 95% CI 0.23-1.14; p = 0.106). All selected sera containing neutralising autoantibodies blocked IFNα₂-induced antiviral activity in cell culture. No known genetic predisposition for IFN-I autoimmunity was identified.

INTERPRETATION: Our findings suggest that IFN-I-targeting autoimmunity is associated with susceptibility to zoonotic IAV infection with the H7N9 subtype, and possibly also other subtypes, including panzootic H5N1. Given the ease of implementation, screening for anti-IFN-I autoantibodies could be readily integrated into surveillance or targeted testing. This could be relevant in environments with increased exposure to zoonotic IAVs.

FUNDING: Shenzhen Medical Research Fund, National Natural Science Foundation of China, Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, Guangdong Provincial Science and Technology Program, Program for Youzuzhikeyan of Shenzhen University, German Research Foundation, Swiss National Science Foundation.

PMID:42462284 | DOI:10.1016/j.ebiom.2026.106387

EBioMedicine. 2026 Jul 16;130:106391. doi: 10.1016/j.ebiom.2026.106391. Online ahead of print.

ABSTRACT

BACKGROUND: Alzheimer’s Disease (AD) is a complex neurodegenerative disorder, with women comprising nearly two-thirds of individuals with AD. However, sex-specific heterogeneity in AD progression remains insufficiently understood. A data-driven approach is needed to characterise such heterogeneity from longitudinal electronic health records (EHRs).

METHODS: We developed a deep learning-based framework to uncover sex-specific AD sub-phenotypes using longitudinal EHRs from OneFlorida+ Clinical Research Consortium. We constructed temporal representations of these EHRs and employed an autoencoder architecture to generate latent embeddings, followed by clustering to derive sex-specific sub-phenotypes with associated progression patterns. We also performed statistical and survival analyses to unravel the characteristics of our identified sub-phenotypes.

FINDINGS: From 1665 individuals with AD (961 females, 704 males), we identified five major sex-specific sub-phenotypes of AD with distinct progression pathways and comorbidity patterns. Female-dominant sub-phenotypes presented later AD onset, longer disease duration, and enrichment of respiratory and neurological disorders. Male-dominant sub-phenotypes exhibited earlier onset, shorter duration, and higher prevalence of endocrine and metabolic conditions. Survival analysis showed significant differences in time to AD onset across sub-phenotypes.

INTERPRETATION: Our findings revealed distinct disease trajectories and comorbidity patterns between male- and female-dominant subgroups with AD. This study provides insight into sex-specific AD progression and demonstrates a data-driven framework for characterising disease heterogeneity using longitudinal EHRs.

FUNDING: This study was supported by grants from the Florida Department of Health, the Centers for Disease Control and Prevention, the National Institute of Environmental Health Sciences, and the NIHNational Center for Advancing Translational Sciences.

PMID:42462283 | DOI:10.1016/j.ebiom.2026.106391