Category: Statistics

Zhonghua Fu Chan Ke Za Zhi. 2026 Mar 25;61(3):227-235. doi: 10.3760/cma.j.cn112141-20251126-00578.

ABSTRACT

Objective: To investigate the oncological outcomes of patients with malignant transformation of ovarian mature cystic teratoma (OMCT) and the reproductive outcomes of young patients undergoing fertility sparing surgery (FSS). Methods: Clinicopathological data of 39 patients with malignant transformation of OMCT enrolled at the First Affiliated Hospital of Zhengzhou University from August 2011 to December 2024 were retrospectively collected. Their oncological outcomes were analyzed. Univariate and multivariate Cox proportional hazards regression models were used to identify factors associated with disease free survival (DFS) and overall survival (OS). Reproductive outcomes were analyzed in patients under 45 years old who underwent FSS. Furthermore, the clinicopathological data and oncological outcomes of 8 concurrently enrolled patients of OMCT with carcinoid tumor were analyzed and compared. Results: (1) The mean age of patients with malignant transformation of OMCT was (52.7±14.0) years, and the mean maximum tumor diameter was (10.8±0.8) cm. Surgical treatment was performed in all patients, intraoperative tumor rupture occurred in 8 patients (21%, 8/39). The pathological types included squamous cell carcinoma in 29 cases (74%, 29/39), mucinous adenocarcinoma in 9 cases (23%, 9/39), and malignant melanoma in 1 case (3%, 1/39).27 patients (69%, 27/39) were classified as stage Ⅰ, 4 patients (10%, 4/39) as stage Ⅱ, and 8 patients (21%, 8/39) as stage Ⅲ. (2) The median follow-up duration for these patients was 86.0 months. During follow-up, recurrence was observed in 12 patients (31%, 12/39), all of whom died. In addition, one patient died of non-cancer causes. At the last follow-up, 13 patients (33%, 13/39) died; while the remaining patients were alive with no evidence of disease. The 5-year disease free survival (DFS) and overall survival (OS) rates were 67% and 65%, respectively. Cox regression analysis identified a maximum tumor diameter≥13 cm, stageⅡ-Ⅲ and intraoperative tumor rupture as independent risk factors for both DFS and OS (all P<0.05). (3) Among the 5 patients under 45 years old with malignant transformation of OMCT who underwent FSS, 4 were staged as Ⅰa and 1 as Ⅱ. Three of the patients with Ⅰa stage successfully conceived naturally and delivered at full term within 1-2 years after surgery. The patient with stage Ⅱ died due to disease progression, while the remaining 4 patients were alive with no evidence of disease.(4) The mean age of the 8 patients of OMCT with carcinoid tumor was (42.4±18.0) years, the mean maximum tumor diameter was (15.0±9.1) cm. No recurrence was observed during follow-up, and all patients were alive with no evidence of disease at the last follow-up date on May 30, 2025. Survival analysis indicated no statistically significant difference in OS between patients with malignant transformation of OMCT and those of OMCT with carcinoid tumors (P=0.102). Conclusions: The maximum tumor diameter≥13 cm, intraoperative tumor rupture and stage Ⅱ-Ⅲ are unfavorable prognostic factors for patients with malignant transformation of OMCT. FSS may be a viable option for young patients with stage Ⅰa malignant transformation of OMCT who wish to preserve their fertility, close postoperative follow-up is required.

PMID:41866202 | DOI:10.3760/cma.j.cn112141-20251126-00578

Zhonghua Fu Chan Ke Za Zhi. 2026 Mar 25;61(3):203-210. doi: 10.3760/cma.j.cn112141-20250822-00394.

ABSTRACT

Objective: To evaluate the cumulative live birth rate (CLBR) based on oocyte retrieval cycles in patients with diminished ovarian reserve (DOR) after repeat in vitro fertilization (IVF) and to explore the related influencing factors. Methods: Data from 3 740 DOR patients (8 386 IVF cycles) treated at Reproductive Medicine Center, Henan Provincial People’s Hospital from January 2017 to December 2022 (follow-up until December 31, 2023) were collected. Kaplan-Meier curves analysis was used to assess the trend of CLBR, and Cox proportional hazards regression model was applied to identify factors influencing CLBR. Results: Among 3 740 patients with DOR, 981 cases achieved at least one live birth, CLBR was 26.23% (981/3 740). CLBR increased with the number of oocyte retrieval cycles, reaching 35.49% in the 3rd cycle and 50.40% in the 7th cycle. However, the CLBR growth rate declined after the 3rd cycle, with 92.35% (906/981) of live births occurring in the first 3 cycles. Factors associated with reduced CLBR included advanced maternal age, higher basal follicle stimulating hormone level, and a history of recurrent miscarriage (all P<0.01). Conversely, higher anti-Müllerian hormone (AMH) and antral follicle count were positively correlated with CLBR (all P<0.001). Notably, patients with AMH<0.68 μg/L had a significantly reduced CLBR (P<0.001). Conclusions: Adhering to three IVF cycles significantly improves CLBR in DOR patients, with younger individuals benefiting particularly significantly. Factors such as age≥40 years, AMH<0.68 μg/L, and a history of recurrent miscarriage are associated with poorer CLBR. Beyond three cycles, the incremental gain in CLBR generally declines. It is recommended that younger patients persist with IVF treatment, while older patients should seek individualized counseling and consider alternative options.

PMID:41866199 | DOI:10.3760/cma.j.cn112141-20250822-00394

J Epidemiol. 2026 Mar 21. doi: 10.2188/jea.JE20250559. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term trends in cancer incidence were reported until 2015 in Japan, but recent data have been limited since the launch of the National Cancer Registry (NCR) in 2016. We analyzed 30-year trends in cancer incidence and mortality, emphasizing the NCR’s establishment.

METHODS: Cancer incidence data were obtained from high-quality population-based cancer registries in three prefectures (Yamagata, Fukui, and Nagasaki) from 1985 to 2015, and the NCR extracted data from these prefectures between 2016 and 2021. National cancer mortality data from 1979 to 2023 were obtained from published vital statistics. Trends in age-standardized rates (ASR) calculated using the 1985 Japan Standard Population were examined using joinpoint regression analysis.

RESULTS: The ASR incidence in 2016 (the first year of the NCR) was the highest ever recorded. All-cancer incidence (for both sexes) increased between 1985 and 2021 (annual percentage change, 0.9%; 95% confidence interval [95% CI]: 0.8 to 1.0). For males, all-cancer incidence stabilized after increasing until 2017, whereas for females, it increased after 2002 (1.7%; 95% CI: 1.4 to 2.3). All-cancer mortality (for both sexes) declined between 1997 and 2023 (-1.5%; 95% CI: -1.5 to -1.4), mainly due to decreases in stomach, lung, and liver cancers.

CONCLUSIONS: The NCR’s launch and the sharp rise in incidence in 2016 may have influenced trend interpretation and should be considered with caution. A longer observation period is needed before clear secular trends can be established under the NCR data system.

PMID:41866192 | DOI:10.2188/jea.JE20250559

J Am Pharm Assoc (2003). 2026 Mar 20:103078. doi: 10.1016/j.japh.2026.103078. Online ahead of print.

ABSTRACT

BACKGROUND: HPV vaccination coverage among U.S. adolescents remains below national targets. Community pharmacies are highly accessible vaccination venues, but staff need to enhance practical skills to identify vaccine-eligible adolescents and communicate effectively with parents.

OBJECTIVES: To evaluate the acceptability and feasibility of a team-based HPV vaccine communication training for pharmacy staff.

METHODS: We used a single-group pre/post-test design in three community pharmacies in Washington state between December 2022-May 2023. The prerecorded online vaccine communication training integrated vaccine eligibility forecasting with 5A’s counseling and Announcement Approach recommendation language. Pharmacy staff involved in adolescent immunizations completed baseline (n=18) and follow-up (n=13) online surveys assessing behavioral outcomes related to adolescent HPV vaccination before and after completing the training. Adolescent vaccination counts were audited for pre- (February-May 2022) and post-implementation (February-May 2023) periods.

RESULTS: The proportion of staff reporting strong HPV vaccine recommendations increased from 22% pre-implementation to 67% post-implementation (p=0.016). The proportion of staff recommending HPV vaccination starting at ages 9-12 increased from 33% to 50% for both female and male adolescents, though this was not statistically significant (p=0.324). Self-efficacy improved for personal interactions (mean 2.8 to 3.4; p=0.004), goal setting (2.7 to 3.5; p=0.004), and addressing hesitancy (2.6 to 3.3; p=0.010). Post-implementation, staff rated the acceptability (mean 4.1/5), appropriateness (4.0/5), and feasibility (4.1/5) of pharmacy-based HPV vaccination favorably. Vaccination audits showed increased HPV doses at one pharmacy (2 doses to 20 doses) and no change at the other pharmacy (1 dose to 1 dose). The third pharmacy did not administer any adolescent vaccinations during the post-implementation period.

CONCLUSION: A team-based HPV vaccine communication training was acceptable and feasible and improved staff-reported HPV recommendation behaviors, with heterogeneous short-term changes in HPV vaccination delivery. Larger multisite studies with longer observation periods are needed to evaluate effects on vaccination uptake.

PMID:41866129 | DOI:10.1016/j.japh.2026.103078

J Am Pharm Assoc (2003). 2026 Mar 20:103081. doi: 10.1016/j.japh.2026.103081. Online ahead of print.

ABSTRACT

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death for patients with type 2 diabetes (T2D). Recent clinical guidelines recommend earlier initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with ASCVD, chronic kidney disease, and/or multiple risk factors. However, broader adoption among healthcare clinicians has been evolving, influenced by factors such as medication cost, clinical complexity, and established care pathways that may involve specialist management. While interruptive and non-interruptive clinical decision support (CDS) within electronic health records (EHRs) can help identify care gaps, their specific impact on prescribing these cardioprotective agents is not well defined.

OBJECTIVE: This pilot study evaluated the use of CDS during specialist visits to facilitate guideline-directed medical therapy (GDMT) for patients with T2D and ASCVD in primary care.

METHODS: We conducted a retrospective, single-center cohort study at a large academic medical center to assess an interruptive alert presented during interventional cardiology (IC) visits. When the IC clinician acknowledged the alert, an automated EHR message was sent to the patient’s primary care provider (PCP), recommending initiation of a GLP-1 RA or SGLT2i. The primary outcome was the percentage of patients identified by the alert who were prescribed one of these medications. Secondary outcomes included documented reasons for not initiating GDMT and the provider type responsible for prescribing. Descriptive statistics were utilized.

RESULTS: The alert was triggered for 134 eligible patients. PCPs addressed the alert in the EHR for 61 cases (45.5%), and 26 patients (19.4%) were started on a GLP-1 RA or SGLT2i. The most frequent reasons for not initiating therapy were medication cost (n = 7), 11.5%) and contraindications (n = 5), 8.2%).

CONCLUSION: An interactive CDS prompted initiation of GDMT by primary care clinicians in nearly 20% of eligible T2D and ASCVD patients.

PMID:41866125 | DOI:10.1016/j.japh.2026.103081

Kidney Int. 2026 Mar 20:S0085-2538(26)00217-6. doi: 10.1016/j.kint.2026.02.023. Online ahead of print.

ABSTRACT

INTRODUCTION: Diabetic kidney disease (DKD) is a significant complication of diabetes, and an unmet need remains for new therapeutic options. Here, we investigated the efficacy and safety of monlunabant, a second-generation cannabinoid receptor 1 inverse agonist, in individuals with DKD.

METHODS: This phase 2, randomized, double-blind, placebo-controlled, multicenter study, enrolled adults with DKD. Participants were randomized (1:1:1) to receive oral tablets of monlunabant 10 mg or 25 mg, or placebo once daily for 16 weeks. The primary endpoint was the change in urine albumin-to-creatinine ratio (UACR) from baseline to week 16. Secondary endpoints included changes in urine protein-to-creatinine ratio (UPCR) and estimated glomerular filtration rate (eGFR).

RESULTS: In total, 254 participants formed the full analysis set (85, 86, and 83 in the 10 mg, 25 mg, and placebo groups, respectively). At week 16, the estimated geometric least squares mean ratios to baseline for UACR were 0.58, 0.51, and 0.71 in the 10 mg, 25 mg, and placebo groups, respectively. Monlunabant 25 mg did not show statistically significant differences compared to placebo (estimated treatment ratio [ETR] 0.72, 95% confidence interval (0.46 to 1.14)). Therefore, formal testing was not performed for 10 mg compared to placebo (ETR 0.82 (0.53 to 1.27)). Secondary endpoints showed similar trends, with no differences in UPCR or eGFR, when compared to placebo. The most frequently reported adverse events were mild to moderate gastrointestinal disorders, driven by nausea, vomiting, and diarrhea. Participant withdrawals increased with monlunabant dose.

CONCLUSIONS: Our study failed to establish proof of concept of monlunabant in DKD, as the effect on UACR at week 16 was not significantly different from placebo. However, greater than anticipated variability and a large placebo response affect interpretation.

PMID:41866124 | DOI:10.1016/j.kint.2026.02.023

J Vasc Surg Venous Lymphat Disord. 2026 Mar 20:102490. doi: 10.1016/j.jvsv.2026.102490. Online ahead of print.

ABSTRACT

OBJECTIVES: Endovenous radiofrequency ablation (RFA) and cyanoacrylate ablation (CA) are widely used for the treatment of chronic great saphenous vein (GSV) insufficiency. Compared with traditional surgery, both modalities have demonstrated well-recognized therapeutic benefits. However, controversy remains regarding the optimal choice between RFA and CA. The aim of this study was to conduct a systematic review and meta-analysis to compare the early and mid-term clinical outcomes of RFA versus CA.

METHODS: A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Comprehensive searches were conducted in PubMed, Embase, Cochrane Library, and Web of Science to identify relevant studies. Randomized controlled trials, cohort studies, and case-control studies evaluating RFA and CA for the treatment of GSV incompetence were included. The primary outcomes were GSV occlusion rate and venous clinical severity score (VCSS). Secondary outcomes included skin pigmentation, phlebitis, deep vein thrombosis (DVT), ecchymosis, and procedure-related phlebitis. Data extraction and quality assessment were independently performed by two reviewers. Statistical analyses were conducted using Review Manager 5.3.

RESULTS: A total of 21 studies were included, encompassing 7,844 patients and 9,677 limbs. In terms of efficacy, there were no significant differences between CA and RFA in GSV occlusion rate or VCSS. Regarding safety, pooled data showed that CA was associated with a lower incidence of ecchymosis (5.96% vs. 10.97%; P = 0.01) and paresthesia (1.24% vs. 2.97%; P = 0.04). No significant differences were observed between the two groups in the incidence of phlebitis, DVT, or pigmentation. In addition, the procedure time was significantly shorter in the CA group than in the RFA group (P < 0.001).

CONCLUSIONS: For the treatment of incompetent saphenous veins, CA provides comparable efficacy to RFA. However, CA is associated with lower rates of skin pigmentation and ecchymosis, as well as a shorter procedure time.

PMID:41866115 | DOI:10.1016/j.jvsv.2026.102490

J Vasc Surg. 2026 Mar 20:S0741-5214(26)00652-X. doi: 10.1016/j.jvs.2026.03.435. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate longitudinal changes in quality of life (QoL) and health status (HS) in patients with an abdominal aortic aneurysm (AAA) undergoing endovascular aneurysm repair (EVAR).

METHODS: This prospective international multicenter cohort study included patients undergoing elective infrarenal EVAR in 21 institutions. QoL (WHOQOL-BREF questionnaire) and HS (SF-12 questionnaire) were assessed preoperatively and postoperatively at 6 and 12 months. Preset minimal clinically important difference (MCID)-thresholds defined meaningful changes in QoL or HS for each patient. Linear mixed models evaluated longitudinal changes for whole cohort.

RESULTS: In total, 151 patients were included (mean age 74.4 ±6.6 years). At 12 months, MCID-based individual-patient analysis demonstrated that QoL domains were higher in 14-31% and lower in 21-45% and that HS summary scores were higher in 26-29% and lower in 38%. In linear mixed models, environmental QoL was significantly lower at 6 and 12 months (mean difference -0.45 [95%CI -0.05; -0.84, p=0.021] and -0.44 [95%CI -0.05; -0.84, p=0.024]) and social QoL at 12 months (mean difference -0.62 [95%CI -0.11; -1.12, p=0.010]) compared to baseline, whereas no significant differences were observed in HS.

CONCLUSIONS: QoL measures (WHOQOL-BREF) indicated significant differences in social and environmental QoL domains after EVAR when compared to baseline, while HS measures (SF-12) did not reflect statistically significant changes. This suggests that QoL and HS capture different concepts of patient wellbeing after EVAR and that HS measures alone may not reflect what patients value. MCID-based individual-analysis demonstrated substantial heterogeneity in QoL and HS trajectories. These findings may support shared decision-making by informing patients about expected postoperative trajectories. Long term evaluations that incorporate frailty and multimorbidity are warranted.

PMID:41866090 | DOI:10.1016/j.jvs.2026.03.435

Orthop Traumatol Surg Res. 2026 Mar 20:104687. doi: 10.1016/j.otsr.2026.104687. Online ahead of print.

ABSTRACT

INTRODUCTION: Knee arthroplasty is associated with a variable risk of blood transfusion depending on the surgical technique, with a higher risk for total knee arthroplasty (TKA) than for unicompartmental knee arthroplasty (UKA). Although the safety of single-stage bilateral procedures has now been established, the risk of transfusion for single-stage bilateral TKA is high at approximately 20% whereas the risk of transfusion for bilateral UKA is only 2%. Although this difference appears to be significant, to date there is no study comparing transfusion rates between the two procedures when performed as single stage surgeries. Reducing transfusion risk would support the use of unicompartmental knee arthroplasty, since transfusion is a known risk factor for postoperative complications, especially infections. The objective of this study was to compare blood loss and transfusion rate between these two techniques and to identify risk factors.

MATERIALS AND METHODS: A multicenter retrospective study was conducted in four French centers including 277 patients who underwent single-stage bilateral knee arthroplasty between January 2021 and December 2023: 149 bilateral TKA procedures and 128 bilateral UKA procedures. The parameters analyzed included preoperative hemoglobin, hemoglobin levels at postoperative day 1 (D1) and day 3 (D3), blood loss volume, number of transfused red blood cell units, use of a pneumatic tourniquet or suction drain, early complications, and patient satisfaction. Statistical comparisons were performed using Student’s t-test and the chi-square test, with a significance threshold set at p < 0.05.

RESULTS: Preoperative hemoglobin levels were slightly higher in the UKA group (14.5 g/dL vs 14.2 g/dL; p = 0.038). The mean hemoglobin decrease at D3 was significantly greater in the TKA group (4.8 g/dL vs 2.1 g/dL; p < 0.0001), as was blood loss volume (1.2 L vs 0.5 L; p < 0.0001). The transfusion rate was 20% in the TKA group versus 0% in the UKA group (p < 0.0001). The use of a suction drain was associated with significantly higher blood loss in both groups. No association was found between transfusion risk and age or ASA score. The rate of early complications was 6% in the TKA group and 1.6% in the UKA group, with no statistical difference. Patient satisfaction exceeded 94% in both groups. In multivariate analysis, lower preoperative hemoglobin level (OR ≈ 0.52, p = 0.011) and use of a suction drain (OR ≈ 11.3, p < 0.001) were independently associated with an increased risk of transfusion.

CONCLUSION: Single-stage bilateral total knee arthroplasty is associated with significantly greater blood loss and transfusion risk than bilateral unicompartmental knee arthroplasty. These results support the value of unicompartmental arthroplasty in reducing perioperative morbidity in the treatment of disabling knee osteoarthritis. However, patient-related factors appear to play a decisive role in bleeding risk, and additional studies will need to exclude these factors to clarify the influence of the surgical technique.

LEVEL OF EVIDENCE: III; Retrospective comparative study.

PMID:41866078 | DOI:10.1016/j.otsr.2026.104687

Hosp Pediatr. 2026 Mar 23:e2025008748. doi: 10.1542/hpeds.2025-008748. Online ahead of print.

ABSTRACT

OBJECTIVE: Prenatal substance exposure is associated with harm to newborns and their families. Clinicians must report in utero controlled substance exposure to Child Protective Services (CPS). Studies have found that clinicians disproportionately order toxicology tests for Black infants, particularly in the absence of standardized policies for drug testing, which may lead to disproportionate downstream harm for Black families. The aim of this single-center quality improvement (QI) study is to eliminate racial inequity in drug testing for potentially substance-exposed newborns.

METHODS: The QI team identified lack of standardized policy and clinician education as key drivers and implemented a QI change from December 2022 to July 2024, which included a policy to standardize indications for meconium drug testing linked to an order set and QI dashboard. Descriptive statistics regarding testing rates and indications for testing stratified by race and ethnicity were performed before and after QI interventions.

RESULTS: A total of 10 637 individuals were included in the study population. The rate of testing increased from 5.2% pre-policy to 9.9% post-policy for Black newborns (relative risk [RR] 1.89, 95% CI: 1.27-2.81, P = .002). The rate of testing for white newborns was stable (3.2% to 3.7%, RR 1.14, 95% CI: 0.90-1.45, P = .27). Reasons for testing varied by race; being late to prenatal care accounted for 19.4% of all tests performed for Black newborns compared with 7.1% of all tests for white newborns. Testing for isolated marijuana use increased from 4.5% to 7.2% for Black newborns and remained stable, from 2.6% for 2.7%, for white newborns.

CONCLUSIONS: Implementing a standardized policy and order set widened the inequity between Black and white newborns and increased testing rates for all newborns. Ongoing QI efforts include reevaluation of our approach to postnatal drug testing for prenatal cannabis exposure.

PMID:41866040 | DOI:10.1542/hpeds.2025-008748