Category: Statistics

Isr Med Assoc J. 2026 Jun;28(6):376-382.

ABSTRACT

BACKGROUND: Post-traumatic stress disorder (PTSD) remains a significant and often refractory mental health condition. Hyperbaric oxygen (HBO) therapy has demonstrated promise in alleviating symptoms of PTSD but optimal dosing and treatment duration remain unclear.

OBJECTIVES: To evaluate the clinical efficacy and dosing effects of two HBO protocols in patients with PTSD.

METHODS: We conducted a randomized controlled trial comparing two HBO protocols: 60 daily sessions of 90 minutes at either 2.0 atmospheres absolute (ATA) or 2.5 ATA (HBO15). Adults with severe PTSD (Clinician Administered PTSD Score [CAPS]-5 ≥ 33) were randomized to treatment arms. CAPS-5 scores were recorded every 2 weeks. Secondary outcomes include measures of depression, sleep, executive function, and safety. Preliminary results are presented for the first nine patients who completed therapy (HBO10: n=5; HBO15: n=4).

RESULTS: Participants in HBO15 were younger (mean age 39 vs. 59 years, P = 0.2). Baseline PTSD severity (CAPS-5) was higher in HBO15 (median 61.5 vs. 48.0, P = 0.4). Other baseline psychological scores were similar between groups. Mean CAPS-5 improvement (ΔCAPS) was greater in HBO15 (-14.0 ± 21.2) vs. HBO10 (-5.3 ± 19.6), although not statistically significant (P = 0.8). Both groups demonstrated the largest symptom reduction by weeks 6-8, with a plateau observed thereafter despite continued treatment through week 12.

CONCLUSIONS: Preliminary data suggest both HBO protocols are associated with symptomatic improvement in PTSD, with a trend toward greater effect in the higher-pressure group (2.5 ATA). Improvements appear to peak around 6-8 weeks, potentially indicating a shorter optimal treatment duration.

PMID:42345229

Isr Med Assoc J. 2026 Jun;28(6):363-368.

ABSTRACT

BACKGROUND: Asthma poses unique challenges in aviation medicine. While strict criteria typically dictate waiver approvals in military aviators with asthma, the Israeli Air Force (IAF) applies a more individualized approach. Still, evidence to guide correct management is scarce.

OBJECTIVES: To assess the characteristics and long-term outcomes of military aircrew diagnosed with asthma.

METHODS: This retrospective study included active and reserve aircrew who were diagnosed with asthma during annual assessments at the Israeli Aeromedical Unit between 1998 and 2024. Baseline characteristics, treatment regimes, pulmonary function tests (PFTs), and asthma exacerbations were analyzed.

RESULTS: Thirty-two aircrew personnel (median age 30 years at diagnosis) were included in the study, with 44% serving at high-performance platforms. Six participants (19%) were classified as Global Initiative for Asthma step 4 or 5. Over an average follow-up period of 18.5 years, seven exacerbations were documented (4.0 per 100 patient-years), with no safety incidents reported. Participants’ pulmonary function remained stable. Forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) declined around asthma diagnosis (median of 82% predicted and 0.73, respectively) but recovered remarkably while on treatment (median 91% predicted and 0.78, respectively). Aircrew who experienced exacerbations had no statistically significant differences in demographics, disease severity or baseline PFTs.

CONCLUSIONS: With individualized management and regular monitoring, a new diagnosis of asthma in military aircrew was not associated with a significant impact on service. Our study supports a flexible, individualized approach to aeromedical management of aircrew with asthma.

PMID:42345227

Ann Med. 2026 Dec;58(1):2692729. doi: 10.1080/07853890.2026.2692729. Epub 2026 Jun 25.

ABSTRACT

BACKGROUND: Parents of children with special health care needs (CSHCN) usually hesitate to vaccinate their children, yet limited data on factors influencing parents’ willingness to vaccinate their children are available. Our study aimed to reveal parents’ willingness to immunize their children with the Expanded Programme on Immunization Vaccines and identify determinants influencing parents’ willingness.

METHODS: We conducted a cross-sectional, questionnaire-based survey using a stratified sampling approach in Wuxi, China. Description methods were used to describe guardians’ willingness to vaccinate their children, and logistic regression analysis was employed to examine the influencing factors of parents’ willingness.

RESULTS: A total of 904 parents/guardians were collected; 864 (95.58%) were willing to immunize their children. Univariate analysis revealed that parents’ knowledge of vaccines and their awareness of vaccination assessment clinics were factors that influenced vaccination willingness. The multivariate logistic regression results indicated that parental education level and awareness of vaccination assessment clinics were significant predictors of parents’ willingness to vaccinate their children.

CONCLUSION: Higher parental knowledge and use of vaccination consultation clinic services are associated with greater willingness to vaccinate among parents of children with special health care needs.

PMID:42345214 | DOI:10.1080/07853890.2026.2692729

Int Angiol. 2026 Jun;45(3):174-180. doi: 10.23736/S0392-9590.26.05523-9.

ABSTRACT

BACKGROUND: Accurate measurement of the residual sac after endovascular aortic repair (EVAR) is essential for effective surveillance, guiding detection of complications and decisions regarding reintervention. While two-dimensional ultrasound (2D-US) remains standard-of-care, it is limited by operator variability. Three-dimensional ultrasound (3D-US) with modeling software has demonstrated improved precision but remains resource-intensive. The introduction of three-dimensional Software-Assisted Ultrasound (3D-SAUS) offers an automated, on-cart alternative for more streamlined clinical use. This study compares 3D-SAUS with 2D-US in measuring maximum residual sac diameter in EVAR patients, focusing on variability and clinical applicability.

METHODS: Patients previously treated with EVAR and following US-based follow-up were scanned by three or four experienced ultrasound operators. The maximum anterior-posterior residual sac diameter was measured for all patients using 2D-US and 3D-SAUS. Outcomes were median and limits of agreement (LoA) with 95% confidence intervals for both modalities.

RESULTS: Fourteen EVAR-treated patients underwent 44 paired 2D-US and 3D-SAUS scans. Median maximum residual sac diameters were 50.0 mm with 2D-US and 50.3 mm with 3D-SAUS. LoA were 3.4 mm for 2D-US and 3.6 mm for 3D-SAUS, with overlapping 95% confidence intervals (2.2-4.6 mm and 2.5-4.7 mm, respectively). The difference in LoA was not statistically significant (P=0.61). Automatic technical success was achieved in 79% of the available 3D scans.

CONCLUSIONS: 3D-SAUS demonstrated comparable residual sac diameter measurement precision and variability to expert 2D-US in post-EVAR patients. These findings support the potential of 3D-SAUS to enhance reproducibility and standardize ultrasound-based follow-up.

PMID:42345186 | DOI:10.23736/S0392-9590.26.05523-9

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2335-2343. doi: 10.31557/APJCP.2026.27.6.2335.

ABSTRACT

OBJECTIVE: To develop and evaluate an automated deep learning-based lung cancer staging system using computed tomography (CT) scan images.

METHODS: CT scan images were obtained from publicly available datasets (LIDC-IDRI/TCIA) comprising 1,018 patient scans. The dataset consisted of three subsets, which were: training (70 percent of total), validation (15 percent), and testing (15 percent). Lung region segmentation, anisotropic filtering, and data augmentation were used as preprocessing. To classify lung cancer stages, a customized CNN network based on multi-scale feature extraction and softmax-enabled probabilistic output was trained. Statistical confidence intervals, F1-score, ROC-AUC, recall, accuracy, and precision were used to test the performance of the model.

RESULTS: Using an area under the curve (AUC) of 0.98 (Stage I), 0.96 (Stage II), 0.95 (Stage III) and 0.97 (Stage IV) the proposed model indicates a total classification of 93.0 (95% CI: 91.2-94.8). Statistical analysis revealed a significant improvement compared to baseline CNN models (p < 0.05). Compared with state-of-the-art techniques, quantitative comparisons showed either equivalent performance or slightly higher performance, particularly in separating between early-stage (I-II) and advanced-stage (III-IV) disease.

CONCLUSION: The findings demonstrate that the suggested CNN-based architecture can effectively and precisely classify the stage of lung cancer based on CT images, which assists in automated clinical decision-making and enhances the early detection process.

PMID:42345183 | DOI:10.31557/APJCP.2026.27.6.2335

Asian Pac J Cancer Prev. 2026 Jun 22;27(6):2323-2334. doi: 10.31557/APJCP.2026.27.6.2323.

ABSTRACT

OBJECTIVE: To identify the mutational landscape of oral cancers of unknown etiology by leveraging publicly available datasets.

METHODS: Oral cancer mutation data in TCGA were accessed to identify never-smoking and never-alcohol-drinking subjects with genomic, epigenomic, and transcriptomic data. Habit-free participants within published individual whole-exome sequencing studies of oral cancer were examined as the replication dataset.

RESULTS: Somatic mutation analysis of 42 habit-free TCGA oral cancer subjects revealed MUC16 and MUC5B as recurrent mutational targets in 30% of all habit-free oral cancers; the highest after previously reported oral cancer genes such as TP53, CASP8, CDKN2A, NOTCH1. Comparison against other habit-free oral cancers not only confirmed these observations but also identified additional mucin genes as frequent mutational targets, supporting their potential causal role. Gene expression and immune fraction analysis of bulk transcriptomic data showed that habit-free oral cancers were enriched for the expression of mesenchymal genes and in T-regulatory cells.

CONCLUSION: Together, these data suggest that mucin genes, specifically MUC16 and MUC5B, are important for oral carcinogenesis in the absence of tobacco and alcohol. These results are relevant given the increasing clinical utility of mucins as druggable targets in cancer, particularly MUC16.

PMID:42345182 | DOI:10.31557/APJCP.2026.27.6.2323

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2269-2278. doi: 10.31557/APJCP.2026.27.6.2269.

ABSTRACT

BACKGROUND: Fluoropyrimidine-based chemotherapy is a fundamental treatment for colorectal cancer (CRC), yet its therapeutic efficacy is often limited by significant inter-individual variability. Enzymes involved in 5-fluorouracil (5-FU) metabolism thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), and methylenetetrahydrofolate reductase (MTHFR) are critical determinants of drug response. This study aimed to evaluate the molecular correlation between TS, DPD, and MTHFR mRNA expression in paired tumor tissue and peripheral blood samples, while simultaneously developing and validating a non-invasive predictive nomogram to forecast therapeutic response to neoadjuvant CAPEOX (capecitabine-oxaliplatin) chemotherapy in advanced CRC.

METHODS: A prospective cohort study was conducted on 36 patients with stage III-IV CRC receiving CAPEOX. mRNA expression of TS, DPD, and MTHFR was quantified using qRT-PCR from paired tumor and peripheral blood samples. Chemotherapy response was evaluated using RECIST 1.1 criteria. Statistical analyses included Spearman correlation, the Mann-Whitney U test, and multivariate logistic regression. A nomogram was constructed based on significant predictors.

RESULTS: DPD and MTHFR expression levels were significantly lower in responders than in non-responders (p < 0.001), while TS expression showed no significant difference. Gene expression in tissue and blood was strongly correlated (r = 0.820 for TS, r = 0.658 for DPD, and r = 0.623 for MTHFR; all p < 0.001). Multivariate analysis identified blood-based DPD and MTHFR expression as independent predictors of response. The predictive nomogram demonstrated excellent discrimination (AUC = 0.932).

CONCLUSION: Lower DPD and MTHFR expression predicts a favorable response to neoadjuvant CAPEOX in advanced CRC. These biomarkers offer a promising, non-invasive approach to personalizing treatment strategies potentially enhancing therapeutic efficacy while minimizing unnecessary toxicity.

PMID:42345176 | DOI:10.31557/APJCP.2026.27.6.2269

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2259-2268. doi: 10.31557/APJCP.2026.27.6.2259.

ABSTRACT

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the sixth most prevalent cancer globally and constitutes a major public health burden in Bangladesh, with approximately 7.5% of all cancer-related deaths. Although tobacco and betel-quid use are recognized risk factors, dietary patterns may also contribute to OSCC development.

OBJECTIVE: This study investigated the association of lifestyle and dietary factors with OSCC in Bangladeshi patients and explored the potential involvement of TERT promoter mutations and human papillomavirus (HPV) infection.

METHODS: A hospital-based, case-control study was conducted involving 47 histopathologically confirmed OSCC patients and 100 age- and sex-matched healthy controls without cancer or chronic illness. Sociodemographic, lifestyle, and dietary data were collected through a structured questionnaire. Tumor DNA was analyzed for TERT promoter mutations and HPV DNA using PCR and Sanger sequencing. Statistical analyses were performed using multivariable logistic regression to identify significant associations.

RESULTS: Excessive betel-quid chewing was strongly associated with OSCC (p < 0.01). Among 39 sequenced OSCC samples, 25 single-nucleotide polymorphisms (SNPs) at position -245 (A>G) and one hotspot mutation at position -124 (G>A) of the TERT promoter were identified substantially lower than frequencies reported in other populations. No HPV DNA was detected in any sample. Certain dietary patterns such as low fruit and vegetable intake and high consumption of betel quid were linked to increased OSCC risk.

CONCLUSION: Our findings suggest that, in Bangladeshi patients, specific dietary and lifestyle factors, rather than HPV infection or TERT promoter mutations, contribute significantly to OSCC development. Targeted public health strategies emphasizing nutritional awareness and cessation of betel-quid use are recommended.

PMID:42345175 | DOI:10.31557/APJCP.2026.27.6.2259

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2251-2258. doi: 10.31557/APJCP.2026.27.6.2251.

ABSTRACT

BACKGROUND: Breast cancer (BC) is a leading cause of mortality among Iraqi women, underscoring the need for accessible diagnostic tools. This study evaluates the combined utility of the tumor marker CA15-3 and routine hematological parameters as an adjunctive tool for distinguishing between treatment-naïve BC patients with a pre-existing diagnosis and healthy individuals.

METHODS: In this case-control study, 100 female BC patients (Group I) and 50 healthy controls (Group II) were recruited. Serum CA15-3 levels were measured using electrochemiluminescence immunoassay (ECLIA), and a complete blood count was performed. Statistical analyses included independent t-tests, ROC curve analysis, and logistic regression to develop a combined diagnostic model. All BC patients were treatment-naïve and were required to submit blood samples prior to undergoing any surgical procedure, although they had already been diagnosed.

RESULTS: CA15-3 levels were significantly higher in BC patients (26.1 ± 7.5 U/mL) than in controls (7.54 ± 2.6 U/mL; P < 0.001). Significant differences were also observed in white blood cell (WBC), red blood cell (RBC), lymphocyte, and platelet counts (all P < 0.05). ROC analysis showed excellent diagnostic performance for CA15-3 alone (AUC = 0.98). A combined model integrating CA15-3 with the four hematological parameters achieved a superior AUC of 0.99, with 96% sensitivity and specificity.

CONCLUSION: Elevated CA15-3 is confirmed as a key diagnostic marker for BC. Integrating CA15-3 with specific, routinely measured hematological indicators provides an improved, accessible, and cost-effective adjunctive tool for differentiating treatment-naïve BC patients from healthy individuals. This approach may be particularly useful for triaging patients with suspicious symptoms or monitoring those with established diagnoses.

PMID:42345174 | DOI:10.31557/APJCP.2026.27.6.2251

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2203-2210. doi: 10.31557/APJCP.2026.27.6.2203.

ABSTRACT

BACKGROUND: Uterine leiomyomas are the most common benign tumors in women of reproductive age, often causing significant symptoms such as abnormal bleeding, pain, and infertility. Melatonin, a hormone with anti-proliferative and oncostatic properties, has been studied; however, its effects on uterine leiomyomas remain unclear.

OBJECTIVE: This study aimed to evaluate the immunohistochemical expression of melatonin receptors MT1 and MT2 in uterine leiomyomas compared to normal myometrium, and to correlate their expression with clinical and histopathological features.

METHODS: A case-control study was conducted on ninety cases retrieved (60 leiomyoma cases, thirty normal myometrium controls). Immunohistochemical staining was performed to assess the expression of MT1 and MT2 receptors. Clinical data were collected, and statistical analyses were conducted to evaluate associations between receptor expression and demographic, clinical, and histological features.

RESULTS: MT1 and MT2 were significantly overexpressed in leiomyomas compared to controls (MT1: 70% vs. 30%, p < 0.0001; MT2: 60% vs. 16.7%, p < 0.0001). A strong positive correlation was observed between MT1 and MT2 expression (r = 0.6, p < 0.0001). MT1 score varied significantly with age (p = 0.03), tumor location (p = 0.04), and presenting symptoms (p = 0.03), while MT2 expression was positively associated with the number of lesions (p = 0.033).

CONCLUSION: Melatonin receptors MT1 and MT2 are significantly upregulated in uterine leiomyomas, suggesting a potential role in their pathogenesis. These findings support further investigation into melatonin-based therapies as adjunctive treatments for leiomyomas.

PMID:42345168 | DOI:10.31557/APJCP.2026.27.6.2203