Category: Statistics

J Cardiothorac Surg. 2026 Apr 24. doi: 10.1186/s13019-026-04170-1. Online ahead of print.

ABSTRACT

PURPOSE: Given the systemic nature of connective tissue diseases (CTD), open surgical intervention for aortic stenosis is often considered high risk, making transcatheter aortic valve replacement (TAVR) a potentially preferable alternative. However, data on the impact of CTD on TAVR outcomes remain limited. Therefore, we conducted a nationwide analysis using the National Inpatient Sample (NIS) to examine trends and in-hospital outcomes of TAVR in patients with CTD in the United States.

METHODS: A total of 90,298 patients undergoing TAVR between 2016 and 2022 were identified, representing over 451,000 weighted hospitalizations, including 3,821 (4.2%) with CTD. Multivariable regression was used to adjust for demographic, clinical, and hospital-level characteristics. CTD patients were more frequently female and had higher comorbidity indices, although many differences were small in absolute magnitude.

RESULTS: In-hospital mortality was comparable between CTD and non-CTD groups (1.0% vs. 1.2%, p = 0.345). Rates of permanent pacemaker implantation and major complications, including vascular events, were similar. CTD patients demonstrated modestly shorter length of stay and lower inflation-adjusted hospitalization costs. Lower rates of cardiogenic shock, cardiac arrest, and mechanical ventilation were observed in the CTD cohort. In-hospital mortality declined significantly over time in the overall cohort, with a similar directional trend in CTD patients that did not reach statistical significance, likely due to smaller sample size.

CONCLUSION: Overall, TAVR appears to be a safe and feasible therapeutic option in patients with CTD, with outcomes comparable to those without CTD.

PMID:42032618 | DOI:10.1186/s13019-026-04170-1

Trials. 2026 Apr 24. doi: 10.1186/s13063-026-09726-z. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: A Study Within A Trial (SWAT) is a research study embedded within a larger trial which aims to investigate different strategies for a particular trial process, such as trial recruitment. It is imperative such studies, which are often underpowered, employ efficient and informative analytical methods. The use of Bayesian methods and interpretation of SWAT results in this context requires exploration. Bayesian methods provide direct probability statements about intervention effects and readily enable ACceptability Curve Estimation using Probability above Threshold (ACCEPT) analyses, which consider the probability of the tested intervention being effective for different threshold values. Additionally, they provide an opportunity to incorporate the results of previous similar studies within the analysis using informative priors. This proof-of-concept study re-analysed two previous SWATs using Bayesian methods and ACCEPT analyses.

METHODS: A SWAT conducted by Du et al. in 2009 and a subsequent SWAT by Mattock et al. in 2020 compared a video intervention against standard patient information on trial recruitment. For each SWAT, a primary Bayesian analysis was performed using a logistic model with non-informative priors. Sensitivity analysis explored informative priors informed by meta-analysis of previous similar studies; this included an analysis of the Mattock et al. SWAT incorporating the result of the earlier Du et al. SWAT. ACCEPT curves were constructed. Results were compared with frequentist analyses.

RESULTS: For the Du et al. SWAT, the primary Bayesian analysis gave an OR for recruitment for the video relative to standard information of 2.12, 95% CrI: 0.38-4.65 and a posterior probability of the video being effective (OR > 1) of 0.86. When taking into account results of previous SWATs by using an informative prior there remained a moderately high probability of video benefit (0.82). For the latter Mattock et al. SWAT, the primary Bayesian analysis gave an OR for recruitment for the video relative to standard information of 0.26, 95% CrI: 0.07-0.51 and the posterior probability of the video being effective was 0.0005, indicating very little chance of effectiveness; ACCEPT plots facilitated interpretation by showing the probability that the video was better than standard information for OR > 0.8 was very small (0.0032). When taking into account the results of previous SWATs using an informative prior, including Du et al., the probability of the video being effective was still very small (0.12).

CONCLUSIONS: Bayesian methods and ACCEPT analyses offer solutions to challenges experienced in the analysis and interpretation of SWATs, which are often underpowered. Greater use of these analytical approaches within SWATs will lead to a more accessible, improved evidence base on how to effectively conduct trials.

PMID:42032615 | DOI:10.1186/s13063-026-09726-z

BMC Public Health. 2026 Apr 24. doi: 10.1186/s12889-026-27451-9. Online ahead of print.

NO ABSTRACT

PMID:42032562 | DOI:10.1186/s12889-026-27451-9

BMC Oral Health. 2026 Apr 24. doi: 10.1186/s12903-026-08421-4. Online ahead of print.

NO ABSTRACT

PMID:42032553 | DOI:10.1186/s12903-026-08421-4

BMC Public Health. 2026 Apr 24. doi: 10.1186/s12889-026-27399-w. Online ahead of print.

NO ABSTRACT

PMID:42032535 | DOI:10.1186/s12889-026-27399-w

BMC Public Health. 2026 Apr 24. doi: 10.1186/s12889-026-27499-7. Online ahead of print.

NO ABSTRACT

PMID:42032509 | DOI:10.1186/s12889-026-27499-7

Health Policy. 2026 Apr 18;170:105638. doi: 10.1016/j.healthpol.2026.105638. Online ahead of print.

ABSTRACT

Violence against healthcare workers has prompted policy responses across health systems that often emphasise security measures, legal sanctions, and behavioural interventions. While these approaches are essential to protect healthcare workers, their effectiveness remains limited. This Policy Comment argues that such framing may underemphasise determinants of violence arising at multiple levels of health systems, including broader policy choices (e.g., workforce planning, financing, and service configuration), governance arrangements (e.g., performance monitoring, administrative control, and regulatory standards), and organisational conditions (e.g., staffing shortages, workload, and care pathway bottlenecks), within a context influenced by international policy frameworks and societal factors. Drawing on a multi-level conceptual framework and examples from different countries, we suggest that violence can also be understood as an indicator of systemic strain arising from the persistent gap between healthcare needs and available capacity, reflecting how healthcare systems are organised, governed, and resourced. Rebalancing prevention efforts to address these policy and governance drivers may offer more sustainable solutions.

PMID:42030594 | DOI:10.1016/j.healthpol.2026.105638

J Neurosurg Pediatr. 2026 Apr 24:1-12. doi: 10.3171/2025.12.PEDS25560. Online ahead of print.

ABSTRACT

OBJECTIVE: Several studies have reported that a shorter duration of epilepsy is associated with better surgical seizure outcomes; however, most of these findings have been based on adult populations. Data on children remain limited, and it is still unclear whether the duration of drug-resistant epilepsy (DRE) or the duration of overall epilepsy is more associated with seizure outcomes. The primary research question of this study focused on the association between total epilepsy duration and seizure outcome at the 2-year follow-up, whereas the secondary research question centered on the role of DRE duration.

METHODS: The authors conducted a retrospective analysis of pediatric patients with epilepsy who underwent resective surgery between 2002 and 2022 at a single institution. Seizure outcome data were obtained at the 2-year follow-up after the last surgery. A subgroup analysis of patients with a known time for DRE onset was performed. Predictors of seizure recurrence were assessed using multiple adjusted logistic regression models, accounting for multicollinearity.

RESULTS: A total of 239 patients underwent epilepsy surgery in the study period. Among them, 154 patients (71.0% of those with DRE) had an identifiable time of DRE onset. Compared to those with ongoing seizures, seizure-free patients had a significantly shorter median duration of epilepsy (4.25 vs 5.98 years, p < 0.001) and a shorter median duration of DRE (1.75 vs 3.13 years, p < 0.001). Due to the multicollinearity between time-related variables, epilepsy duration and DRE duration were entered into separate models for adjusted logistic regression. In the epilepsy duration-based models, a longer epilepsy duration was associated with seizure recurrence (OR 1.10, 95% CI 1.03-1.18, p = 0.008). In the DRE-based models, a longer DRE duration was associated with worse outcomes (OR 1.20, 95% CI 1.00-1.43, p = 0.045), while epilepsy duration was not statistically significant.

CONCLUSIONS: In this unselected population-based, pediatric, resective epilepsy surgery cohort, longer epilepsy duration is associated with worse seizure outcomes. Similarly, a prolonged duration of DRE was correlated with worse seizure outcomes. The findings emphasize the importance of early surgical referrals. Future multicenter studies are warranted to further clarify the relative prognostic value of DRE duration versus total epilepsy duration and to guide evidence-based criteria for surgical timing in children with epilepsy.

PMID:42030572 | DOI:10.3171/2025.12.PEDS25560

J Neurosurg. 2026 Apr 24:1-14. doi: 10.3171/2025.12.JNS251883. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate associations between the corpus callosum angle (CCA), corpus callosum splenial angle (CCSA), and resistance to CSF outflow (Rout) with neuropsychological performance in patients who had suspected idiopathic normal pressure hydrocephalus (iNPH), and to assess their predictive value for diagnosis and postoperative cognitive outcomes following ventriculoperitoneal shunt placement.

METHODS: This prospective observational study included 74 patients (39 male, mean age 73.6 years) who were evaluated for iNPH between 2019 and 2022 at a single institution. All patients underwent MRI-based measurement of the CCA and CCSA, the Katzman test for Rout, and a comprehensive neuropsychological battery. Patients were grouped by CCA size (< 90°, 91°-109°, and > 110°), CCSA size (< 60°, 61°-79°, and > 80°), and Rout (≥ 12 mm Hg and < 12 mm Hg). Group comparisons were performed using nonparametric tests, and logistic regression was applied to identify neuropsychological predictors of elevated Rout.

RESULTS: Lower CCA values were associated with trends toward poorer performance in imitation apraxia, visual gnosis, and Mini-Mental State Examination (MMSE) scores, although none reached statistical significance after correction for multiple comparisons. Elevated Rout (≥ 12 mm Hg) was significantly associated with better MMSE scores (adjusted p = 0.029), while other domains, including symbolic apraxia, rhythm reproduction, and confrontation naming, showed consistent trends but without statistical significance after correction. A logistic regression model that incorporated MMSE and rhythm reproduction predicted elevated Rout with 93.5% sensitivity and an area under the curve of 0.86. Postoperative cognitive improvements were modest and variable; however, long-term follow-up revealed sustained functional gains in selected patients, particularly those with elevated Rout and preserved preoperative cognitive function.

CONCLUSIONS: CCA and Rout were independently associated with distinct cognitive profiles in patients with suspected iNPH. In particular, Rout demonstrated predictive value for preserved global cognition. Integrating anatomical, physiological, and neuropsychological markers might enhance diagnostic accuracy and improve patient selection for ventriculoperitoneal shunt placement.

PMID:42030562 | DOI:10.3171/2025.12.JNS251883

J Neurosurg. 2026 Apr 24:1-9. doi: 10.3171/2025.12.JNS251835. Online ahead of print.

ABSTRACT

OBJECTIVE: Rathke’s cleft cysts (RCCs) are benign cystic lesions of the sellar and suprasellar regions that may cause hypopituitarism and arginine vasopressin (AVP) deficiency when symptomatic. A recent study with Isl-1 knockout mice identified six molecular markers-KRT8, TUBA1A, SOX2, SOX9, FOXA1, and FOXJ1-as potential indicators of RCC pathogenesis. This study aimed to investigate the expression patterns of these markers in human RCCs and examine their association with clinical manifestations.

METHODS: A retrospective analysis was conducted on 108 histopathologically confirmed RCC cases resected between 2011 and 2023 at three medical centers. Immunofluorescence staining was performed for six markers, and expression profiles were correlated with clinical symptoms (hypopituitarism, AVP deficiency, visual disturbances, and headache), epithelial morphology, and MRI findings. Statistical analysis was conducted using chi-square or Fisher’s exact tests.

RESULTS: KRT8 was expressed in 100% of RCC samples, while the expression rates for TUBA1A, SOX2, SOX9, FOXA1, and FOXJ1 were 90.7%, 75.9%, 76.9%, 55.6%, and 84.3%, respectively. SOX9 expression was significantly associated with single-layered epithelial morphology (p = 0.001). The absence of TUBA1A expression was significantly associated with AVP deficiency (p = 0.042), and FOXJ1 positivity was significantly associated with hypopituitarism (p = 0.040). No other significant associations were found between marker expression and imaging findings or other clinical symptoms.

CONCLUSIONS: This study confirms that the six molecular markers identified in Isl-1 knockout mice are also expressed in human RCCs, with variable expression patterns. KRT8 and FOXA1 staining may aid in distinguishing RCCs from craniopharyngiomas. Moreover, FOXJ1 and TUBA1A expression profiles provide novel insights into the mechanisms underlying hypopituitarism and AVP deficiency, respectively. These findings highlight the potential diagnostic and prognostic utility of molecular markers in RCC management and underscore the need for further studies in asymptomatic and incidental cases.

PMID:42030560 | DOI:10.3171/2025.12.JNS251835