Category: Statistics

Eur Radiol. 2026 Mar 15. doi: 10.1007/s00330-026-12443-5. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to analyze the intraindividual development of lung perfusion in children with congenital diaphragmatic hernia (CDH) at the ages of 2 and 10 years, as well as to investigate prenatal and postnatal influencing factors.

MATERIALS AND METHODS: Fifty-nine children after CDH were examined as part of a monocentric follow-up program using dynamic contrast-enhanced MRI (DCE-MRI) at 2 years (hereafter referred to as Examination 1, E1) and again at 10 years of age (Examination 2, E2). Pulmonary blood flow (PBF) and pulmonary blood volume (PBV) were quantified separately for each lung. Additionally, prenatal parameters (observed-to-expected fetal lung volume, o/e FLV) and postnatal factors (extracorporeal membrane oxygenation (ECMO); fetoscopic tracheal occlusion (FETO); patch repair; recurrence; and reoperation for recurrence) were recorded.

RESULTS: Ipsilateral perfusion remained consistently reduced between E1 and E2 (63.4 ± 27.8 vs 62.0 ± 23.6 mL/100 mL/min; p = 0.8001), while PBV significantly decreased (p = 0.0213). Low prenatal o/e FLV values correlated with reduced ipsilateral PBF (E1: r = 0.51; p = 0.0082; E2: r = 0.03; p = 0.0342). Patients who underwent ECMO showed a decrease in contralateral PBF over time (p = 0.0435), and those with FETO tended to exhibit poorer perfusion courses.

CONCLUSION: Patients with prenatally more severe lung hypoplasia, particularly those with low o/e FLV, exhibit persistently reduced lung perfusion even in the long term. These ongoing impairments remain stable over time, indicating permanently compromised lung development. Early identification and detailed risk assessment are therefore essential to initiate targeted therapeutic interventions.

KEY POINTS: Question Lung perfusion development in children with CDH between ages 2 and 10, including prenatal and postnatal influencing factors. Findings Ipsilateral lung perfusion remained reduced, PBV decreased, and low prenatal o/e FLV correlated with persistently impaired perfusion. Clinical relevance Children with severe prenatal lung hypoplasia show lasting perfusion deficits into adolescence. Early risk assessment enables timely, targeted interventions to mitigate long-term pulmonary impairment.

PMID:41832930 | DOI:10.1007/s00330-026-12443-5

Eur Radiol. 2026 Mar 15. doi: 10.1007/s00330-026-12405-x. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess how disclosing artificial intelligence (AI) results, particularly discordant findings, affects patient trust, anxiety, follow-up intentions, and attitudes toward AI in mammography. The study also assessed whether adding an explanatory note mitigates adverse reactions.

MATERIALS AND METHODS: A cross-sectional randomised experimental survey was conducted among 600 women (mean age 55.4 ± 6.8 years) undergoing mammography in two academic centres in Milan, Italy, between January 2023 and January 2024. Participants were randomised into four hypothetical BI-RADS 1 scenarios: Radiologist Only (control), AI No-Flag (AI concordant with radiologist), AI Flagged (AI discordant false-positive), and AI Flagged + Explanation (discordant AI with contextual information). Primary outcomes included trust (0-100 scale), worry, second-opinion intent, legal action intent, and AI approval. Analyses involved ANOVA, chi-square tests, and logistic regression with Bonferroni correction.

RESULTS: Disclosure of a discordant AI result significantly reduced trust in the radiologist (73.0 vs 90.1; p < 0.001), and increased anxiety (58.0% vs 16.0%; OR = 15.4), second-opinion intent (50.0% vs 8.7%; OR = 10.2), and legal action consideration (60.7% vs 38.7%; OR = 2.49). Adding explanatory context significantly mitigated these effects (e.g., anxiety: 25.3%; OR = 0.26). Compared to the Radiologist Only scenario, the AI Flagged + explanation scenario showed only a modest increase in anxiety (p = 0.04) and no significant trust reduction (p = 0.42). AI approval remained high (> 85%) across all groups.

CONCLUSION: Disclosing discordant AI results reduces trust and increases anxiety, second-opinion intent, and legal concerns. Contextualised disclosure of AI results mitigates adverse emotional and behavioural responses, supporting its use as a communication strategy in AI-integrated mammography.

KEY POINTS: Question Current guidelines lack clear recommendations on disclosing AI-generated mammography findings, creating uncertainty about patient trust, anxiety, and medicolegal implications of discordant results. Findings Disclosing discordant AI mammography findings reduced patient trust, increased anxiety, second-opinion seeking, and litigation intent; adding contextual explanations significantly mitigated these adverse effects. Clinical relevance Providing clear context about AI limitations in mammography reports mitigates patient anxiety, enhances trust in radiologists, and reduces unnecessary follow-up and potential medicolegal actions, supporting optimal patient communication during clinical implementation of AI.

PMID:41832929 | DOI:10.1007/s00330-026-12405-x

Eur Radiol. 2026 Mar 15. doi: 10.1007/s00330-026-12460-4. Online ahead of print.

ABSTRACT

In the last decade, advanced AI methods were applied to radiology, providing tools for clinical practice. Regulations across countries are a relevant topic, considering that AI tools must be regarded as medical devices. We describe the regulatory scenarios in the EU, USA, and China. For the EU, we considered the 2017 Medical Device Regulation, including AI tools as “active” medical devices, the 2018 General Data Protection Regulation, protecting data privacy, and the risk-based approach by the 2024 AI Act. For the USA, we considered the three FDA premarket pathways: the 510(k)-clearance demonstrating substantial equivalence, the De Novo classification for novel devices without predicates, and the Premarket Approval process for high-risk applications demanding rigorous clinical evidence; recent regulations regarded lifecycle management, post-marketing surveillance and adaptive algorithms, underscoring the importance of real-world evidence of AI tool performance. For China, the role of the 2022 Guidance for classification and definition of AI medical software by the National Medical Products Administration is illustrated, describing how to determine whether a tool is an AI-enabled medical device, categorizing the associated risk level. The NMPA published six premarket technical review guides related to AI-enabled medical devices in radiology and medical imaging; protection of patient privacy is enforced by the law and de-identification is mandatory for manufacturers. Regulations in these three scenarios show meaningful convergences about patient’s data protection, risk assessment and classification, ensuring equity and generalizability, transparency and explainability, and the need of human oversight. The radiology community will act in a world scenario more homogeneous than expected. KEY POINTS: Question Regulatory fragmentation across the EU, USA, and China creates uncertainty for radiology AI development, validation, and clinical adoption, requiring clearer international harmonization. Findings Despite differences, regulations in the EU, USA, and China converge on core requirements: patient data protection, risk classification, transparency, bias mitigation, and human oversight. Clinical relevance By highlighting convergences across major jurisdictions, this review informs radiologists and developers on safe integration of AI tools, ensuring patient safety, equity, and trustworthy adoption in clinical practice.

PMID:41832928 | DOI:10.1007/s00330-026-12460-4

Environ Monit Assess. 2026 Mar 15;198(4):317. doi: 10.1007/s10661-026-15077-8.

ABSTRACT

This study investigated the accumulation levels, ecological and health risks, and the impact of socio-economic development on potentially toxic elements (PTEs) present in road dust collected from the major roads of low latitude industrialized City, Dongguan, China. The concentrations of PTEs decreased in the order of zinc (Zn) > lead (Pb) > chromium (Cr) > arsenic (As) > cadmium (Cd) > mercury (Hg). Similarly high levels of Cd and Zn accumulation were observed, and other PTEs were generally moderately accumulated or enriched. The ecological risk was relatively high for Cd and Hg and low for other PTEs. Most of sampling sites were moderately to heavily polluted, and the ecological risk was generally moderate to very high. The non-carcinogenic risks to both adults and children were safe at internationally accepted levels. However, higher levels of carcinogenic risk were observed in males and females, mainly due to the contribution of Cr and As. Spatial distribution patterns revealed higher accumulation level, ecological and health risks in districts of Binhai, Central City with higher GDP. In the present study, a positive relationship was observed between PTEs concentrations and GDP of Dongguan’s six districts (R = 0.66, p = 0.15) and a similar significant pattern was revealed for the first time at the global level (R = 0.66, p = 0.0021). It is evident that socio-economic development had a significant impact on PTEs contamination and the resulting ecological and health risks. Therefore, industrial cities such as Dongguan need to adopt broader strategies that decouple the relationship between socio-economic development and the emission of PTEs concentration (e.g. Cd, Cr and As), to mitigate this emission during economic growth and transition towards a more sustainable development model.

PMID:41832927 | DOI:10.1007/s10661-026-15077-8

Clin Drug Investig. 2026 Mar 15. doi: 10.1007/s40261-026-01537-z. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Vortioxetine is widely used in Switzerland for treating major depressive episodes, but systematically collected data from routine clinical practice are not available. We evaluated real-world effectiveness and tolerability of vortioxetine for treating major depressive episodes in Swiss clinical practice.

METHODS: A prospective non-interventional observational study was conducted with an observation period of approximately 8 weeks from vortioxetine initiation. Adults with a current major depressive episode for whom a decision to initiate vortioxetine had been made independent of the study were eligible for inclusion. Assessment of depressive symptoms, functioning, safety and tolerability were performed at four study visits. Pre-planned explorative descriptive statistics were applied.

RESULTS: Of 226 patients enrolled, 208 (92.0%) completed the study. At baseline, the mean (standard deviation) sum of the unanchored Montgomery-Åsberg Depression Rating Scale items was 34.3 (8.89), indicating severe depression. Depression severity tended to be underestimated when relying on clinical estimation without any scale alone. Significant reductions were observed from baseline to visit 4 in the sum of the unanchored Montgomery-Åsberg Depression Rating Scale items, in all individual items, and in the Clinical Global Impression-Severity scale (all p < 0.001). The severity of impairment of all assessed functioning domains also decreased. Adverse drug reactions were reported in 7.5% of patients. Effectiveness and tolerability of vortioxetine was rated good or very good by >88% of clinicians and patients.

CONCLUSIONS: Patients who initiated vortioxetine for treating a major depressive episode experienced improvements in depressive symptoms and functioning. Vortioxetine was well tolerated. Underestimation of depressive episode severity by clinicians reinforces the importance of using rating scales in clinical practice.

PMID:41832924 | DOI:10.1007/s40261-026-01537-z

Am J Prev Med. 2026 Mar 14:108282. doi: 10.1016/j.amepre.2026.108282. Online ahead of print.

ABSTRACT

INTRODUCTION: The U.S. Food and Drug Administration’s The Real Cost Youth E-Cigarette Prevention Campaign partnered with the National Cancer Institute to provide SmokefreeTeen cessation resources to the campaign audience. This study explored how traffic directed to the SmokefreeTeen website from campaign messages interacted with content and how engagement differed on the basis of traffic source.

METHODS: Using SmokefreeTeen web traffic data from April 2021 to December 2022 (and analyzed in 2024), the study descriptively and statistically compared page views and engagement with cessation tools (3-step Vaping Reality Check quiz; Quit Plan builder) for referrals to SmokefreeTeen from The Real Cost Youth E-Cigarette Prevention Campaign advertising, direct traffic (e.g., typed website into browser), or organic searches (e.g., search engines).

RESULTS: Campaign traffic generated higher proportions of page views for campaign-linking pages. Quit resources engagement was greater for campaign visits, with a higher proportion of Vaping Reality Check completions and Quit Plan completions and downloads than of other sources. Organic searches generated the highest proportion of overall traffic, followed by direct website and the campaign.

CONCLUSIONS: The Real Cost’s primary goal is youth tobacco prevention. Because many youth experience E-cigarette-related addiction, the campaign also shares evidence-based cessation resources. Linking to SmokefreeTeen resources from campaign assets resulted in substantial traffic to intended pages and engagement with cessation tools. The campaign’s ability to successfully link to SmokefreeTeen cessation resources demonstrates that digital media campaigns, such as The Real Cost tobacco prevention campaigns, can reach audiences at various stages of tobacco use and encourage engagement with online cessation resources.

PMID:41832902 | DOI:10.1016/j.amepre.2026.108282

Eur J Surg Oncol. 2026 Mar 6;52(5):111740. doi: 10.1016/j.ejso.2026.111740. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to identify psychosocial subtypes among gastric cancer (GC) patients and examine their associations with quality of life (QoL) and survival outcomes.

METHODS: A prospective cohort design was adopted, including 455 newly diagnosed GC patients admitted to the Union Hospital of Fujian Medical University between January 2023 and August 2024. Depressive symptoms and sleep quality were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh Sleep Quality Index (PSQI), respectively. QoL was evaluated using the EORTC QLQ-C30 and QLQ-STO22 questionnaires. Latent class analysis (LCA) was performed based on social support, depressive symptoms, and sleep quality to identify distinct psychosocial subtypes. Between-group QoL differences at 6 months were examined with pairwise comparisons adjusted for baseline QoL (ANCOVA).

RESULTS: Three psychosocial subtypes were identified: low-risk (37.6%), moderate-risk (40.4%), and high-risk (22.0%). At 6 months postoperatively, the low-risk group showed higher physical functioning than the high-risk group (94.02 ± 8.16 vs. 89.83 ± 14.10; P = 0.011) and higher cognitive functioning than the moderate-risk group (98.56 ± 3.68 vs. 96.08 ± 8.96; P = 0.001) on the EORTC QLQ-C30. Global health status/QoL was also higher in the low-risk group than in the moderate- and high-risk groups (68.47 ± 21.39 vs. 62.57 ± 22.95 vs. 61.89 ± 21.05; P = 0.023 and 0.027, respectively). Dysphagia symptom burden on the EORTC QLQ-STO22 was greater in the moderate- and high-risk groups than in the low-risk group (10.90 ± 11.54 and 11.71 ± 11.49 vs. 6.83 ± 10.17; P = 0.001 and 0.002, respectively). In multivariable Cox regression, the high-risk group had a higher risk of death than the low-risk group (HR = 3.95, 95% CI: 1.20-13.00; P = 0.024).

CONCLUSIONS: Psychosocial subtypes identified by LCA were associated with 6-month postoperative QoL, and the high-risk subtype was an independent predictor of overall survival among GC patients. Early identification of high-risk patients may facilitate precision supportive care and inform multidimensional interventions to improve both QoL and survival.

PMID:41832888 | DOI:10.1016/j.ejso.2026.111740

Nutrition. 2026 Feb 10;147:113158. doi: 10.1016/j.nut.2026.113158. Online ahead of print.

ABSTRACT

OBJECTIVES: Metabolic syndrome (MetS) is a cluster of cardiometabolic-related conditions that occur together with obesity. Visceral adiposity specifically is an important risk factor for MetS. The visceral adiposity index (VAI) is a sex-specific estimate of visceral adiposity presence and dysfunction and while a reliable predictor of MetS, more research is needed to establish VAI cut-points across varying populations before it can be used as a clinical tool. The purpose of this secondary analysis was to assess the effectiveness of the VAI and other anthropometric indices to predict MetS and to create cut-points using a sample of older adults with obesity using data from the Calorie Restriction in Overweight SeniorS (CROSSROADS) Study.

METHODS: The CROSSROADS Study was a randomized controlled trial that investigated the effects of a 12-month diet and exercise intervention among older adults with obesity (ClinicalTrials.gov, #NCT00955903). For statistical analysis, Pearson’s chi-squared tests, Wilcoxon Signed-Rank Test, logistic regression, and receiver operative characteristic curve analyses were conducted.

RESULTS: VAI was significantly associated with MetS presence in this sample more than other anthropometric indices (P < 0.001). A previously established VAI cut-point of 2.261 had the highest Youden Index for all sub-samples except for the Black participants, where the newly established VAI cut-point of 1.58 determined in this study had the highest Youden Index.

CONCLUSIONS: Among a sample of older adults with obesity, VAI is significantly associated with MetS. However, further research is needed to evaluate population-specific VAI cut-points to assess for practical utility before being used in clinical settings.

PMID:41832848 | DOI:10.1016/j.nut.2026.113158

Nutrition. 2026 Feb 18;147:113168. doi: 10.1016/j.nut.2026.113168. Online ahead of print.

ABSTRACT

BACKGROUND: Bariatric surgery (BS), including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), effectively treats severe obesity through enhanced secretion of satiety hormones (glucagon-like peptide-1 [GLP-1], peptide-YY [PYY]). However, these hormonal elevations cannot be sustained long-term, resulting in diminished efficacy. Postoperative dietary fiber (DF) intake is critically low post-BS, yet DF may enhance short-chain fatty acid (SCFA)-producing microbiota and stimulate the secretion of GLP-1 and PYY, potentially sustaining metabolic benefits.

OBJECTIVES: The trial aimed to investigate the effect of DF supplementation (oat bran) on gut microbiota, hormones, and glycolipid metabolism in post-BS patients.

METHODS: In a 12-week RCT, 63 post-BS patients were randomized to control (standard care) or intervention (standard care+30 g/d oat bran, providing 9.0 g DF for 12 weeks). Outcomes included microbiota composition, the levels of GLP-1 and PYY, glycolipid parameters, and percentage of excess weight loss.

RESULTS: Sixty-three participants completed the trial (intervention: 30, control: 33). The intervention group achieved higher DF intake (15.28 ± 3.69 g/d vs. 7.45 ± 4.63 g/d, P < 0.05), with increased beneficial genera (Lachnospira, Parabacteroides) and reduced Streptococcus (P < 0.05). The intervention group showed significant improvements in fasting GLP-1 and PYY, FBG, and HDL-C (P < 0.05). Although the between-group difference in EWL% was not statistically significant (16.59 ± 5.87% vs 10.47 ± 3.29%, P > 0.05), both groups showed significant within-group improvements (P < 0.05). ITT analysis confirmed robustness.

CONCLUSION: DF supplementation significantly improved gut microbiota, enhanced enteroendocrine hormone secretion, and improved metabolic parameters in post-BS patients, supporting its use as an adjunctive therapy.

REGISTRATION NUMBER FOR CLINICAL TRIALS: The study protocol was registered with the Chinese Clinical Trial Registry (ChiCTR2400092481) at http://www.chictr.org.cn.

PMID:41832846 | DOI:10.1016/j.nut.2026.113168

J Hazard Mater. 2026 Mar 9;507:141727. doi: 10.1016/j.jhazmat.2026.141727. Online ahead of print.

ABSTRACT

Chronic exposure to organochlorine pesticides (OCPs) is associated with altered DNA methylation and metabolic diseases, but their specific methylation patterns and mediating role in metabolic dysfunction-associated steatotic liver disease (MASLD) remain unclear. We conducted an epigenome-wide association study among 2905 adults, measuring 19 serum OCPs and blood DNA methylation using the Illumina EPIC array. Differentially methylated probes (DMPs) were identified via linear regression, and mediation analyses assessed their mediating effects on MASLD. We also constructed an integrated adverse outcome pathway (AOP) network to illustrate the underlying mechanisms. Eighteen novel OCP-associated DMPs were identified, of which 11 DMPs were related to prevalent MASLD and four to incident MASLD, with three overlapping (cg17075888, cg27402362, and cg11024682). In the cross-sectional analysis, eight DMPs (e.g., ABCG1, CPT1A, SREBF1) statistically mediated 15.90% of the association between β-HCH and prevalent MASLD. Furthermore, the longitudinal analysis provided stronger evidence, suggesting that cg27402362 (RUNX3) mediated 5.22% of the β-HCH and incident MASLD association. The AOP network included six molecular initiating events and 19 key events, implicating lipid metabolism, oxidative stress, and immune and inflammatory pathways. This study provides novel population-based evidence that OCP exposure may be associated with MASLD development through DNA methylation mechanisms. The AOP framework further strengthens the mechanistic plausibility of OCP-induced hepatotoxicity and improves our understanding of OCP-associated MASLD.

PMID:41832812 | DOI:10.1016/j.jhazmat.2026.141727