Category: Statistics

Eur J Orthop Surg Traumatol. 2026 May 6;36(1):186. doi: 10.1007/s00590-026-04765-3.

ABSTRACT

BACKGROUND: This study aims to describe a cohort of patients who underwent conversion to total hip arthroplasty (THA), comparing surgical approach and robotic assistance.

METHODS: Patients ≥ 18 years who underwent conversion to THA between January 1, 2015 and May 6, 2024, were retrospectively reviewed, and additionally contacted via telephone for updated patient reported outcome measures (PROMs), including the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) questionnaire. Surgical approach and robotic assistance were per surgeon preference, with consideration for the approach of the previous hip surgery. Descriptive statistics were calculated, and continuous variables analyzed using the Student’s T-Test, the Wilcoxon Ranked Sum Test. Categorical variables were compared using Chi-Squared Tests and Fisher’s Exact Tests, and outcomes analyzed with logistic regression in R statistical software.

RESULTS: 83 patients met inclusion (53% anterior approach; 26.5% robotic assistance). Conversion via anterior approach demonstrated shorter operative times than posterior (by 45.9 min; p < 0.001), in addition to fewer postoperative transfusions (22.7% vs. 53.8%; p = 0.006). Length of stay (LOS), and fluoroscopy time were not significant. When stratified by previous surgery 37 patients were converted from prior intramedullary nail, 16 via the anterior approach. Mean operative time remained shorter (p = 0.003) and transfusion remained less (p = 0.015) compared to posterior conversion in this subset. Robotic assistance was associated with shorter operative times (by 44.9 min p < 0.001), and shorter LOS (p < 0.001). Zero robotic-assisted patients required transfusion within 24 h postoperatively compared to 50.8% of non-robotic cases (p < 0.001), although transfusion risk was not significant considering approach or robotic assistance after multivariable regression controlling for preoperative hemoglobin. PROMs were equivocal between compared groups (mean HOOS Jr 11.0 ± 5.1, response rate 42.2%).

CONCLUSION: Conversion THA demonstrates acceptable outcomes, with documented overall improvements in postoperative function. The anterior approach and robotic assistance were associated with significantly shorter surgical times, and less risk of transfusion, potentially demonstrating some advantage in this conversion scenario, although patient selection may have also influenced outcomes.

PMID:42090018 | DOI:10.1007/s00590-026-04765-3

World J Urol. 2026 May 6;44(1):343. doi: 10.1007/s00345-026-06428-8.

ABSTRACT

INTRODUCTION: Laser enucleation of the prostate (LEP) has become a standard treatment for benign prostatic obstruction, yet its adoption is limited by a steep learning curve and a lack of validated training models. This study aimed to evaluate the face and content validity of a bench-top simulator specifically developed for LEP training within the framework of the European School of Urology (ESU) Lower Urinary Tract Endoscopy Working Group.

METHODS: Fourteen expert endourologists assessed the simulator during the European Urology Residents Education Programme (EUREP) 2025. Face and content validity were evaluated using 4-point Likert questionnaires, structured using the ESU validation framework. Descriptive statistics and content validity indices (I-CVI, S-CVI/Ave, S-CVI/UA) were calculated to assess agreement across anatomical, procedural, and educational domains.

RESULTS: Face validity scores were high across all items (mean 3.57-3.86; ≥90% agreement). The overall S-CVI/Ave was 0.85 and S-CVI/UA 0.47. Domain-specific analysis showed strong content validity for procedural steps (S-CVI/Ave = 0.89) and educational/global domains (0.95), moderate validity for essential anatomy (0.81), and lower ratings for intraoperative conditions (0.69), primarily due to the absence of bleeding simulation. When restricted to core domains (procedural + educational), S-CVI/Ave improved to 0.91.

CONCLUSION: The simulator demonstrated strong face and content validity. Expert ratings indicated favorable perceptions of its realism, procedural similarity, and educational utility. These findings suggest that the simulator may be a useful component of a structured transurethral procedural training curriculum, although further construct validation is needed.

PMID:42090017 | DOI:10.1007/s00345-026-06428-8

Int Ophthalmol. 2026 May 6;46(1):226. doi: 10.1007/s10792-026-04094-8.

ABSTRACT

PURPOSE: To compare the intraoperative complication rates and incidence of postoperative day 1 (POD1) intraocular pressure (IOP) elevation in primary phacoemulsification cataract surgery performed by residents and staff surgeons in a teaching hospital and determine the risk factors associated with posterior capsule tear (PCT) and POD1 IOP elevation.

METHODS: This retrospective study included all cases of primary phacoemulsification in patients aged 18 years or older, performed by residents and staff surgeons from May 27, 2022, to May 31, 2023 in a tertiary eyecare center in Turkey. There were no exclusion criteria. Data collected included primary surgeon, level of experience, preoperative status of cases, intraoperative complications, other operative details and POD1 IOP measurements.

RESULTS: A total of 1500 surgeries were included; 68.8% were performed by residents. Overall intraoperative complication rates were similar in groups in simple and complex cases. There was no statistically significant difference in PCT rates between groups in simple (2.4% and 1.9%, p = 0.800) and complex cases (3.7% and 5.1%, p = 0.455). Rate of POD1 IOP elevation above 25 mm Hg was also similar in groups (22.7% and 22.6%, p = 0.903). Pseudoexfoliation + small pupil and special cataracts were significant risk factors for PCT among residents (p = 0.048 and p = 0.033, respectively). Pseudoexfoliation + small pupil, glaucoma or ocular hypertension and uveitis were significant risk factors for POD1 IOP elevation.

CONCLUSION: Overall intraoperative complication and PCT rates were comparable between residents and staff surgeons in both simple and complex cases. Resident involvement was not a risk factor for POD1 IOP elevation.

PMID:42090014 | DOI:10.1007/s10792-026-04094-8

Eur J Trauma Emerg Surg. 2026 May 6;52(1):159. doi: 10.1007/s00068-026-03207-3.

ABSTRACT

PURPOSE: Tibial plateau fractures (TPF) are often associated with non-bony injuries that may impair knee stability and long-term outcomes. However, it remains unclear in which patients preoperative MRI is indicated to detect these injuries, and clear recommendations for surgical decision making are lacking. This study aimed to develop a CT-based predictor of surgically relevant non-bony injuries.

METHODS: This retrospective single-center study included all intra-articular TPF treated between January 2022 and May 2025 at a Level I trauma center. Fractures were classified according to the 10-segment and three-column classifications. Operative reports were reviewed to identify non-bony injuries requiring surgical treatment. Descriptive statistics and multivariate logistic regression were performed to determine predictors of surgically relevant non-bony injuries.

RESULTS: Among 243 patients (mean age 49,3 ± 14,9 years), 34,6% had at least one surgically treated non-bony injury. Posterior column involvement was significantly associated with a higher injury rate (41,4%), particularly affecting meniscus (20,7%), Anterior cruciate ligament (ACL) (17,2%), and medial collateral ligament (MCL) (12,3%). The posterolateral-central (PLC) segment showed the highest segment-specific injury rate (37,6%) and was an independent predictor of ACL injury. Increasing fracture complexity was associated with a higher incidence of soft tissue injuries.

CONCLUSION: TPF should be regarded as complex intra-articular injuries rather than simple bone fractures. This study provides a CT-based tool to identify fracture patterns associated with surgically relevant non-bony injuries. These findings may support indications for preoperative MRI, guide treatment strategies, and help prevent poor outcomes and post-traumatic osteoarthritis.

PMID:42090008 | DOI:10.1007/s00068-026-03207-3

Child Neuropsychol. 2026 May 6:1-15. doi: 10.1080/09297049.2026.2659058. Online ahead of print.

ABSTRACT

This study aimed to provide a comprehensive comparison of inhibitory control performance among children with Attention-Deficit/Hyperactivity Disorder (ADHD), Specific Learning Disorder (SLD), and comorbid ADHD+SLD, relative to typically developing peers. It sought to clarify whether inhibitory control deficits are generalized across tasks or specific to distinct types of inhibition. A total of 120 children (30 per group; aged 9-11 years) participated. Three tasks assessed different facets of inhibitory control: the Stroop Color-Word Test (interference suppression), the Cued Go/No-Go Task (prepotent response inhibition), and the Stop-Signal Task (cancellation of ongoing responses). Analyses controlled for baseline processing speed. Findings revealed distinct inhibitory profiles. Children with ADHD showed broad deficits across all tasks, most pronounced in the Cued Go/No-Go Task, indicating a core weakness in prepotent response inhibition. The SLD group demonstrated slower reaction times, particularly in the Cued Go/No-Go Task in the initial analysis. Slower responses reflect both processing-speed deficits and potential differences in motor planning and execution. However, after statistically controlling for these general speed effects, the SLD group’s profile revealed a specific and significant deficit only in interference suppression, with no core impairment in prepotent response inhibition or action cancellation. The comorbid ADHD+SLD group exhibited the most severe and pervasive deficits across all measures, exceeding single-diagnosis groups, suggesting a synergistic impairment. These results support the multidimensional nature of inhibitory control and highlight disorder-specific neurocognitive signatures. The findings underscore the need for differentiated assessment and intervention approaches targeting distinct inhibitory processes and processing-speed deficits, particularly in children with comorbid conditions.

PMID:42089258 | DOI:10.1080/09297049.2026.2659058

J Prosthodont. 2026 May 6. doi: 10.1111/jopr.70154. Online ahead of print.

ABSTRACT

PURPOSE: To assess current utilization of the Prosthodontic Diagnostic Index (PDI), identify perceived benefits and limitations, and evaluate support for future updates.

MATERIALS AND METHODS: A survey regarding the use of the PDI was made available through email invitations to 68 US dental school prosthodontic/restorative department chairs (PD), 48 graduate prosthodontic program directors (GP), and 1834 private practice prosthodontists (PP) from the American College of Prosthodontists (ACP) member database. The results of this initial survey were inconclusive due to low response rates. The survey was also administered during the 2024 ACP Annual Session with an improved response rate for educators. Descriptive statistics were used to analyze responses from predoctoral education programs and graduate prosthodontic programs.

RESULTS: Responses were received from 43.8% (n = 21) graduate prosthodontic programs (GP) and 35.3% (n = 24) predoctoral programs (PD). The PDI was taught to graduate prosthodontic residents at 100% (n = 21) of the responding programs and at 58% (n = 14) of responding predoctoral programs. In contrast, the response rate for private practice prosthodontists, 2% (n = 43), was too low for statistical analysis. The PDI was used for new patient screening in 76.2% (n = 16) of GP and 41.7% (n = 10) of PD programs. The PDI was valued for enhancing diagnostic consistency (81.0%, n = 17 GP and 83.3%, n = 21 PD) and objective patient screening (90.5%, n = 19 GP and 87.5%, n = 21 PD). Common themes were observed in open-ended questions regarding the limitations of the PDI, including that the system was cumbersome, complicated, time-consuming to use, issues with calibration across all cohorts, and lacked recognition by general dentists and other dental specialists. The majority of respondents agreed that the PDI needs an update (76.2%, n = 16 GP and 66.7%, n = 16 PD), including the development of an ACP-endorsed classification system for implant-based treatment (81.0%, n = 17 GP and 91.7%, n = 22 PD).

CONCLUSIONS: The PDI is viewed as a beneficial diagnostic and educational tool in academic settings. However, it is complex and has limited alignment with contemporary prosthodontic practice. A revision of the classification system could address current limitations and better support clinical decision-making.

PMID:42089246 | DOI:10.1111/jopr.70154

J Am Heart Assoc. 2026 May 6:e047074. doi: 10.1161/JAHA.125.047074. Online ahead of print.

ABSTRACT

BACKGROUND: Stroke remains a leading cause of mortality and disability worldwide, requiring modifiable risk factors for prevention. Oral health, particularly posterior occlusal contact that supports mastication, may influence systemic vascular outcomes; however, its role in stroke remains unclear. This study investigated whether reduced posterior occlusal contact independently predicts stroke in Japanese adults.

METHODS: We conducted a retrospective cohort study using data collected from April 2016 to March 2022 from a nationwide health insurance database in Japan. Adults aged 40 to 74 years without a history of stroke were included. Posterior occlusal status was categorized as Eichner A (full posterior occlusal contact), B (partial contact), or C (no contact). The primary outcome was stroke incidence, identified using validated insurance claims. Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for demographics, health behaviors, comorbidities, and tooth counts.

RESULTS: Among 981 543 participants (mean age 49.6±7.0 years; 57.5% male) followed for 2 712 815 person-years, 7086 strokes occurred. In adjusted Cox models, Eichner B was significantly associated with higher stroke risk than Eichner A (HR, 1.26 [95% CI, 1.10-1.44], P<0.001). Eichner C showed elevated risk, although not statistically significant (HR, 1.17 [95% CI, 0.91-1.50], P=0.229). Associations were observed in both sexes and across age groups.

CONCLUSIONS: Reduced posterior occlusal support was associated with higher stroke risk independent of tooth count and conventional vascular risk. These findings highlight that posterior occlusal support may represent a potential marker of cerebrovascular risk and warrant further investigation into its clinical relevance.

PMID:42089190 | DOI:10.1161/JAHA.125.047074

J Am Heart Assoc. 2026 May 6:e049028. doi: 10.1161/JAHA.125.049028. Online ahead of print.

ABSTRACT

BACKGROUND: Inconsistent links between arterial stiffness and cognition may reflect limited cognitive tests and unaccounted diurnal pulse wave velocity variation. To bridge this knowledge gap, we investigated 24-hour ambulatory estimated pulse wave velocity (ePWV) and its association with dementia-related neuroimaging and cognitive function in hypertension.

METHODS: We assessed 893 patients with hypertension aged ≥50 years (mean age, 67.2 years; 52.3% women), including brain magnetic resonance imaging (n=545), global cognitive testing (n=623), and ambulatory ePWV measurements. White matter hyperintensity and hippocampus were quantified via Computational Anatomy Toolbox 12 and Statistical Parametric Maps 12. Cognition was assessed via the Mini-Mental State Examination and Montreal Cognitive Assessment.

RESULTS: Among 623 tested participants, the prevalence of mild cognitive impairment was 10% (Mini-Mental State Examination, n=62) and 18.5% (Montreal Cognitive Assessment, n=115). Cognitive scores decline with higher white matter hyperintensity burden and lower hippocampal volume (P≤0.024). Higher 24-hour ePWV quartiles showed graded associations with higher white matter hyperintensity volume and lower hippocampal volume (both P<0.001) and lower cognitive scores (P≤0.037). Multivariable models showed each 1-SD (+1.2 m/s) increment in 24-hour ePWV were associated with 2.00±1.74 mL greater white matter hyperintensity volume (P=0.004), and 0.54±0.14 mL smaller hippocampal volume (P<0.001), independent of age, systolic blood pressure, and other confounders. These associations persisted after further adjustment for carotid-femoral PWV, which itself showed no independent association (P≥0.18). Results were consistent for daytime and nighttime ePWV and across key subgroups.

CONCLUSIONS: Ambulatory ePWV is an independent risk factor for dementia-related brain pathology. Targeting arterial stiffness represents a promising strategy for dementia prevention.

PMID:42089188 | DOI:10.1161/JAHA.125.049028

Epidemiol Psychiatr Sci. 2026 May 6;35:e30. doi: 10.1017/S2045796026100663.

ABSTRACT

AIMS: Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels.

METHODS: Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990-2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute’s APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010-2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data.

RESULTS: In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17-78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58-23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015-2019 was approximately 60% lower than 2000-2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68-0.78) in the 1980 cohort to 0.90 (95% CI: 0.70-1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010-2019.

CONCLUSIONS: Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.

PMID:42089172 | DOI:10.1017/S2045796026100663

J Am Heart Assoc. 2026 May 6:e044747. doi: 10.1161/JAHA.125.044747. Online ahead of print.

ABSTRACT

BACKGROUND: Guideline-directed medical therapy during the transitional period is crucial for improving outcomes in heart failure with reduced ejection fraction. We investigated whether a simplified transitional care intervention could increase guideline-directed medical therapy adherence in patients with acute heart failure (HF).

METHODS: This multicenter, open-label randomized trial enrolled 982 patients with acute HF. The transitional care intervention included a discharge checklist, HF education, and telephone monitoring. The primary outcome was achievement of high guideline adherence indicator, defined as the prescription of all 3 guideline-directed medical therapy drugs (renin-angiotensin system blockades, beta blockers, and mineralocorticoid receptor antagonists) at 6 months. Both modified intention-to-treat and per-intervention analyses were conducted to evaluate the effectiveness of intervention components.

RESULTS: Among 982 participants (mean age, 62.4±15.5 years; 64.5% male), there was no statistical difference in the proportion achieving a high guideline adherence indicator between the intervention and control groups (49.6% versus 44.6%; OR, 1.12; 95% CI, 0.86-1.45; P=0.37). No significant differences were observed in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score or clinical outcomes. In the per-intervention analysis, patients who received all components showed significantly higher guideline adherence indicator achievement compared with those who received no components (adjusted odds ratio [OR], 1.56 [95% CI, 1.07-2.27], P=0.02).

CONCLUSIONS: In this randomized trial of patients with acute HF, although the simplified transitional care intervention did not increase high guideline adherence indicator achievement, implementation of all intervention components was associated with improved guideline adherence. Our findings emphasize that implementation fidelity is the key challenge in optimizing transitional care for HF management.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04900584.

PMID:42089166 | DOI:10.1161/JAHA.125.044747