Category: Statistics

Contemp Oncol (Pozn). 2026;30(1):40-46. doi: 10.5114/wo.2026.159586. Epub 2026 Feb 27.

ABSTRACT

INTRODUCTION: The study was aimed to analyse the impact of the tumour type and other patient- and disease-related baseline parameters in a consecutive cohort managed with best supportive care (BSC) in northern Norway.

MATERIAL AND METHODS: This is a retrospective analysis of 149 patients managed with BSC without any systemic cancer-directed therapy or local brain-directed measures (2007-2024). Eleven patients were originally supposed to start active treatment and 12 had received prior prophylactic whole-brain irradiation (WBRT). Uni- and multivariate analyses of prognostic factors for survival were performed.

RESULTS: Median survival after radiological diagnosis was 1.3 months (95% CI: 1.08-1.52) for all 149 patients combined. The 3- and 6-month survival rates were 20% and 1%, respectively. Neither prior WBRT nor upfront intention to treat were associated with survival. Steroid responders survived significantly longer than non-responders. The multivariate Cox model suggested that survival mainly depends on Karnofsky performance status (< 70 vs. ≥ 70), extracranial metastases (present/absent), and primary tumour type (better in renal cell cancer/malignant melanoma vs. all others combined), p ≤ 0.01 for all three predictors of survival.

CONCLUSIONS: All prognostic strata in our study had median survival times < 2.5 months, indicating an inevitable poor outcome, despite presence of statistically significant differences, e.g. for the primary tumour type. The clinical impact of prognostic scores would thus be very limited. Median survival was similar in historical studies of BSC. Best supportive care is a reasonable choice in patients with brain metastases and very short life expectancy, as also evident from prospective research.

PMID:42089035 | PMC:PMC13137425 | DOI:10.5114/wo.2026.159586

Contemp Oncol (Pozn). 2026;30(1):68-76. doi: 10.5114/wo.2026.159587. Epub 2026 Feb 27.

ABSTRACT

INTRODUCTION: The aim of this study was to assess the inflammatory status of patients with pancreatic cancer (PC) prior to the initiation of the first course of chemotherapy and to ascertain the most precise systemic inflammation index for predicting overall survival (OS).

MATERIAL AND METHODS: A single-centre retrospective analysis involving 310 pa- tients with PC was conducted. Blood samples were collected from patients during chemotherapy qualification, either on the first day of chemotherapy or the day before the first chemotherapy dose. The following inflammatory indices were calculated: systemic immune-inflammation index, systemic inflammation response index, and inflammatory benchmark index (IBI). Statistical analyses were performed utilizing appropriate tests (e.g., the log-rank test).

RESULTS: All parameters were significant predictors of mortality; however, their area under the curve indicated only a moderate ability to differentiate mortality risk. Among the indices analysed, IBI was the sole metric that predicted OS in adjuvant (p < 0.05) and palliative (p < 0.001) cohorts, alongside disease-free survival (p < 0.04) and progression-free survival (p < 0.009). In the multivariate analysis, only IBI was proven to be statistically associated with OS (p < 0.043). Furthermore, IBI well stratified the tumour stage.

CONCLUSIONS: All analysed indices related to inflammation and immune response may function as prognostic markers; however, additional studies are required to determine their precise cut-off value. In our investigation, IBI exhibited a distinctive protective effect, culminating in a 65% reduction in mortality, thereby underscoring the importance of C-reactive protein in patient stratification.

PMID:42089034 | PMC:PMC13137428 | DOI:10.5114/wo.2026.159587

Contemp Oncol (Pozn). 2026;30(1):47-55. doi: 10.5114/wo.2026.159311. Epub 2026 Feb 13.

ABSTRACT

INTRODUCTION: Radiodensity of subcutaneous adipose tissue (SAT), measurable on routine computed tomography (CT), may reflect metabolic status and cachexia, both of which influence cancer outcomes. However, its prognostic role in metastatic non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICI) remains unclear. This study aimed to evaluate the prognostic value of SAT radiodensity in this patient population.

MATERIAL AND METHODS: The retrospective analysis included 92 patients with stage IV NSCLC receiving ICI. Subcutaneous adipose tissue radiodensity (Hounsfield units) was measured from pre-treatment CT at the L3 level and categorized into quartiles. Kaplan- Meier analysis, log-rank test, and Cox proportional hazards models were used. Nonlinear associations were assessed using restricted cubic splines. Cox models were? adjusted for demographic, clinical, and treatment factors. A p-value < 0.05 was considered statistically significant.

RESULTS: Median overall survival for Q1, Q2, Q3, and Q4 was 13.4, 26.3, 18.4, and 14.2 months, respectively (log-rank p = 0.0226). Compared with Q1, Q2 showed a significantly reduced mortality risk across all models (fully adjusted hazard ratios = 0.32, 95% CI: 0.15-0.64, p = 0.002). Q3 and Q4 were not significantly different from Q1. Restricted cubic spline analysis revealed a mild U-shaped relationship (p for nonlinearity = 0.0094), with intermediate SAT density linked to best outcomes. Programmed death ligand 1 expression significantly modified the SAT-survival association (p for interaction < 0.0001).

CONCLUSIONS: Moderate SAT radiodensity was associated with improved survival in metastatic NSCLC patients on ICI, potentially reflecting an optimal metabolic-immune balance. Subcutaneous adipose tissue density, easily obtained from routine imaging, warrants further prospective validation as a scalable prognostic biomarker.

PMID:42089030 | PMC:PMC13137427 | DOI:10.5114/wo.2026.159311

Front Digit Health. 2026 Apr 20;8:1764371. doi: 10.3389/fdgth.2026.1764371. eCollection 2026.

ABSTRACT

Panic attacks (PAs) are acute anxiety episodes that are pervasive, with one in 10 individuals having experienced a PA in the past year. PAs impair daily functioning and are associated with an increase in emergency room visits and suicide attempts. Despite their impact, the unpredictable nature of PAs makes them challenging to manage. PAs are transdiagnostic, occurring in individuals across and without a mental health diagnosis. However, prior work has largely focused on PA indications within individuals with panic disorder. This study identifies PA risk factors from over 6 months of passive sensing data recorded by Oura Rings in 182 young adults with and without adverse childhood experiences and psychiatric diagnoses, beyond just panic disorder. Our findings reveal that changes in Oura Ring-derived measures are associated with next-day PAs, with distinct associations observed across different mental health diagnoses. For individuals with panic disorder, the likelihood of PA increases with time spent inactive. For those with depression, the likelihood of PA increases with decreased variation in nightly respiratory rate, decreased rapid eye movement sleep, and increased time spent in high-intensity activity. For those without a mental health diagnosis, the likelihood of PA increases with decreased heart rate variability. Data aggregation window sizes that capture the associations with PA risk vary by diagnosis and the type of feature, suggesting that cumulative physiological patterns from windows up to 7 days before a PA contribute to onset. These findings point to the possibility that continuous monitoring of panic attack risk could one day support preventive mental health intervention.

PMID:42089029 | PMC:PMC13136185 | DOI:10.3389/fdgth.2026.1764371

Br J Nutr. 2026 May 6:1-29. doi: 10.1017/S0007114526107375. Online ahead of print.

ABSTRACT

Elevated LDL-cholesterol concentration is a major risk factor for CVD. Regular consumption of marine fish and seafood is associated with a reduced risk of CVD, although the n-3 PUFAs EPA and DHA have no cholesterol-lowering effect when given in physiologically relevant doses. Recent studies have demonstrated a lower LDL-cholesterol concentration in rodents after intake of cetoleic acid (CA, C22:1n-11), found in pelagic fish species such as herring. The primary aim was to investigate the effect of consuming capsules containing CA on LDL-cholesterol concentration in adults with overweight or obesity. The study was designed as a randomised clinical trial with two arms. Eighty participants were enrolled, and data from 75 participants were included in the statistical analyses. Participants consumed capsules containing either a CA concentrate (CECO group; 1480 mg CA and 232 mg EPA per day) or soyabean oil mixed with a n-3 PUFA concentrate without CA as comparator arm (SOYO3 group; 258 mg EPA/day) for eight weeks. The within-group changes in LDL-cholesterol were compared using ANCOVA with changes in body fat percentage as covariate. The LDL-cholesterol concentration was decreased from baseline to 8 weeks in the CECO group (n 37, median -0.1 (quartiles -0.1, 0.0) mmol/L) in comparison to the SOYO3 group (n 38, median 0.2 (quartiles 0.1, 0.2) mmol/L), with F=19.35, P=0.033 and η_p² = 0.212, corresponding to approximately 7% reduction in the CECO group relative to the SOYO3 group. To conclude, 8 weeks of dietary supplementation with CECO decreased the LDL-cholesterol concentration in adults with overweight or obesity.

PMID:42087284 | DOI:10.1017/S0007114526107375

Eur J Heart Fail. 2026 May 5:xuag150. doi: 10.1093/ejhf/xuag150. Online ahead of print.

ABSTRACT

AIMS: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has been shown to reduce cardiovascular (CV) and kidney events in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We aimed to quantify the robustness of its CV benefits in phase 3 randomized controlled trials (RCTs) using fragility metrics coupled with conventional clinical effect measures.

METHODS AND RESULTS: We systematically searched MEDLINE and Scopus (from inception to June 2025) for phase 3 or 4 placebo-controlled RCTs of finerenone in T2DM and CKD reporting dichotomous CV outcomes. Three trials were included: FIDELIO-DKD, FIGARO-DKD, and the pooled FIDELITY analysis. We extracted hazard ratios (HRs), absolute risk reduction (ARR), relative risk reduction (RRR), number needed to treat (NNT), fragility index (FI), reverse fragility index (RFI), fragility quotient (FQ), and reverse fragility quotient (RFQ) for the primary composite CV outcome (CV death, non-fatal myocardial infarction [MI], non-fatal stroke, heart failure hospitalization [HFH]) and individual components. The primary composite outcome was significantly reduced in FIDELIO-DKD (HR 0.86, NNT 56; FI 4, FQ 0.0007) and FIDELITY (HR 0.86, NNT 59; FI 38, FQ 0.002), but not FIGARO-DKD (HR 0.87; RFI 7, RFQ 0.0009). Among individual outcomes, HFH showed the most consistent and robust benefit (FIDELITY HR 0.78, NNT 91; FI 23, FQ 0.001). Effects on CV death, MI, and stroke were numerically favorable but statistically non-significant, with low RFIs (mostly 1-3, and up to 9).

CONCLUSIONS: Finerenone significantly reduces HF hospitalization and modestly improves composite CV outcomes in T2DM with CKD, but effects on CV death, MI, and stroke are fragile. Combining fragility metrics with standard efficacy measures offers a clearer view of the reliability of trial results.

PMID:42087276 | DOI:10.1093/ejhf/xuag150

Fundam Clin Pharmacol. 2026 May;40(3):e70092. doi: 10.1111/fcp.70092.

ABSTRACT

Psychotropic medicines are known to impair cognitive function acutely, but the specific effects of individual substances remain underexplored. This study investigates the effects of dexamphetamine and zolpidem on cognitive performance to quantify the potential risk of intake and their pharmacokinetic and pharmacodynamic relationship. This randomized, double-blind, placebo-controlled trial (EudraCT 2021-005381 – 17) included 60 healthy men aged 26 ± 5 (mean ± SD) years. Participants received a single oral dose of 30-mg dexamphetamine, 5-mg zolpidem, or placebo (n = 20 per group). Cognitive performance was assessed at baseline and 3 and 8 h after dosing using the computerized Psytest system. Dexamphetamine and zolpidem improved sustained attention, with significant reduction of omissions at 8 h. Reaction time improved in both groups, but zolpidem impaired phasic alertness. Working memory remained unchanged. Plasma concentration of dexamphetamine and zolpidem was 70.8 ± 10.4 ng/mL and 39.0 ± 20.7 ng/mL at 3 h and 45.9 ± 7.9 ng/mL and 8.7 ± 6.6 ng/mL at 8 h, respectively. No correlation between drug plasma concentration and cognitive performance measures was demonstrable. Dexamphetamine caused the strongest subjective effects and highest liking ratings, whereas zolpidem elicited greater subjective dislike. Tolerability was best with placebo, followed by zolpidem and dexamphetamine. Single therapeutic doses of dexamphetamine and zolpidem modestly affected cognitive function 3 h after intake, with no relationship between cognitive performance and the study medicines’ plasma concentration. Both medicines improve cognition after 8 h but differed in subjective emotional effects. Nevertheless, generalizability is limited by the inclusion of healthy men only. Trial Registration: EudraCT: Nr: 2021-005381-17.

PMID:42087266 | DOI:10.1111/fcp.70092

Implement Sci Commun. 2026 May 5. doi: 10.1186/s43058-026-00955-6. Online ahead of print.

ABSTRACT

BACKGROUND: Syringe services programs (SSPs) are an evidence-based intervention for preventing infectious diseases and reducing the risk of overdose. Florida passed legislation that authorizes the implementation of SSPs (via the Infectious Disease Elimination Act; IDEA) in 2019. However, little is known about how organizational contexts and interorganizational networks shape adoption, implementation, and sustainment of this intervention.

METHODS: We conducted a cross-sectional, statewide survey of organizations engaged in implementing SSPs and related services between March and May 2025, using a community-based participatory research approach with the Florida Harm Reduction Collective. The survey assessed SSP implementation, barriers and facilitators, implementation climate, organizational sustainability, and interorganizational networks. Data were analyzed using descriptive statistics, t-tests for group comparisons, and social network analysis to examine relational structures and organizational centrality.

RESULTS: A total of 29 organizations representing 18 counties responded to the survey. Eight counties reported operating a sanctioned SSP, while none of the remaining counties had ordinances or champions supporting SSP adoption. Stigma and political resistance, lack of funding, and restrictive laws and policies were cited as major barriers to SSP implementation. There was an overall weak implementation climate for SSPs (mean = 1.4 on a 0-4 scale), though it was significantly stronger in counties with operational SSPs (1.8 vs. 1.1, p = 0.01). Organizations reported relatively strong organizational sustainability (mean = 5.6 on a 1-7 scale), with high ratings for program adaptation and lower scores for funding stability. Social network analysis revealed that the Florida Harm Reduction Collective served as the most central and influential node connecting diverse organizations statewide.

CONCLUSIONS: Our findings highlight both structural barriers (e.g., funding, stigma, restrictive policies) and organizational strengths (e.g., adaptability, network connectivity) in Florida’s harm reduction landscape. Addressing policy barriers, expanding and stabilizing funding availability, and leveraging statewide networks will be critical for strengthening implementation of SSPs in Florida and expanding equitable access to harm reduction services for people who use drugs.

PMID:42087235 | DOI:10.1186/s43058-026-00955-6

J Cardiothorac Surg. 2026 May 5. doi: 10.1186/s13019-026-04246-y. Online ahead of print.

ABSTRACT

OBJECTIVES: Current evidence does not support superiority of one cardioplegia type over another, but stems from low-risk populations. Therefore, we compared outcomes of multimorbid, high-risk infective endocarditis (IE) patients receiving Custodiol^®crystalloid or Calafiore blood cardioplegia during cardiac surgery.

METHODS: We retrospectively analyzed 553 patients (mean EuroScore II 22.7 ± 21.1) who underwent surgery for IE between 2009 and 2023 and received either cold crystalloid (Custodiol^®, n = 335) or warm blood (Calafiore, n = 218) cardioplegia. The primary endpoint was 1-year mortality. Secondary endpoints included 30-day mortality, postoperative stroke, and new-onset dialysis. Propensity score matching (1:1, 14 covariates) resulted in 175 matched pairs. Statistical analysis included nonparametric and exact tests.

RESULTS: In the overall cohort, patients receiving Custodiol^® were higher risk and had higher mortality and morbidity. After matching, there was no significant difference in 1-year mortality between patients receiving Custodiol^® and Calafiore (37.1% vs. 28.6%, p = 0.09). 30-day mortality trended to be lower in the Calafiore group without reaching statistical significance (22.9% vs. 14.9%, p = 0.057). However, stroke was less frequent (4.6% vs. 10.9%, p = 0.029), ICU stay was shorter (3[1-8] vs. 6[3-12.5] days, p < 0.001) and postoperative dialysis was numerically less common (13.7 vs. 20.6%, p = 0.091). These differences were most evident in procedures with shorter cross-clamp times, such as isolated mitral or aortic valve surgery, where mortality and recovery parameters consistently favored Calafiore.

CONCLUSIONS: In high-risk endocarditis patients warm blood cardioplegia may be superior to cold crystalloid, although differences did not reach statistical significance. However, propensity matching may not have accounted for all differences, which warrants further discussion and investigation.

PMID:42087214 | DOI:10.1186/s13019-026-04246-y