Category: Statistics

Zhongguo Dang Dai Er Ke Za Zhi. 2026 Aug 15;28(8):954-958. doi: 10.7499/j.issn.1008-8830.2601117.

ABSTRACT

OBJECTIVES: To increase the breastfeeding rate of very preterm infants in the neonatal intensive care unit (NICU).

METHODS: The baseline period was January to December 2023, during which the breastfeeding rate for very preterm infants in the NICU of Cangzhou People’s Hospital was 75%. The quality improvement period was January to December 2024, with a target to increase the rate by 10 percentage points. Effective improvement measures were identified using the plan-do-study-act (PDSA) cycle. Reasons for not receiving breast milk were analyzed, and a key driver diagram was constructed to guide targeted actions. A run chart was used to dynamically monitor monthly breastfeeding rates until the quality improvement goal was achieved.

RESULTS: Seventy very preterm infants were included in the baseline group and 72 in the intervention group. The run chart showed that breastfeeding rate increased to 89% after implementation of the improvement measures, an increase of 14 percentage points from baseline, showing a statistically significant difference (P=0.039). No severe adverse events related to kangaroo care or donor milk-associated infections were reported.

CONCLUSIONS: Multidimensional quality improvement strategies based on the PDSA cycle significantly increase the breastfeeding rate of very preterm infants in the NICU.

PMID:42608302 | DOI:10.7499/j.issn.1008-8830.2601117

Zhongguo Dang Dai Er Ke Za Zhi. 2026 Aug 15;28(8):928-934. doi: 10.7499/j.issn.1008-8830.2601077.

ABSTRACT

OBJECTIVES: To evaluate the necessity of routine fluconazole prophylaxis in very preterm infants/very low birth weight (VLBW) infants in neonatal intensive care units (NICUs) with a very low incidence of late-onset invasive fungal infection (IFI), and to inform clinical practice.

METHODS: A retrospective cohort study using propensity score matching was conducted including eligible very preterm infants/VLBW infants admitted to the NICUs of West China Second Hospital, Sichuan University and Sichuan Provincial Children’s Hospital from January 2018 to December 2023. Infants were categorized into fluconazole and non-fluconazole groups according whether they received fluconazole prophylaxis. The primary outcome was the incidence of late-onset IFI.

RESULTS: A total of 1 961 infants were enrolled, with an overall late-onset IFI incidence of 0.25% (5/1 961). After propensity score matching, 442 infants were included in each group. No statistically significant differences were observed between the fluconazole and non-fluconazole groups in the incidence of late-onset IFI (0.45% vs 0.23%), mortality (2.04% vs 0.90%), retinopathy of prematurity requiring surgery (6.11% vs 4.98%), intraventricular hemorrhage grade ≥2 (9.28% vs 6.56%), necrotizing enterocolitis stage ≥2 (10.18% vs 8.14%), or bronchopulmonary dysplasia (36.20% vs 36.88%), nor in length of hospital stay (48.5 days vs 50.5 days) (all P>0.05).

CONCLUSIONS: In NICUs with a very low incidence of late-onset IFI, routine fluconazole prophylaxis is not recommended for very preterm infants/VLBW infants.

PMID:42608298 | DOI:10.7499/j.issn.1008-8830.2601077

Zhongguo Dang Dai Er Ke Za Zhi. 2026 Aug 15;28(8):909-915. doi: 10.7499/j.issn.1008-8830.2604056.

ABSTRACT

The broad-spectrum diagnostic framework for autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) tends to obscure the specific medical and support needs of individuals with severe impairments. In response, the Lancet Commission on the future of care and clinical research in autism proposed the concept of “profound autism” in 2021, referring to individuals with ASD who are aged 8 years or older, have severe intellectual disabilities (IQ < 50) and/or minimal or completely absent verbal communication abilities, and require round-the-clock (24-hour) care. Patients with profound autism often present with occult somatic comorbidities and treatment-resistant psychiatric abnormalities, including life-threatening self-injurious behavior and catatonia, which frequently render traditional stepped-care interventions ineffective. This review systematically summarizes the conceptual definition and clinical phenotypes of profound autism and emphasizes the need to shift the intervention focus toward managing serious comorbidities and establishing augmentative and alternative communication systems. Additionally, the potential application of modified electroconvulsive therapy as a salvage treatment for refractory and life-threatening symptoms is discussed. The aim is to provide evidence-based guidance for multidisciplinary management and the construction of comprehensive lifespan support systems for individuals with profound autism.

PMID:42608295 | DOI:10.7499/j.issn.1008-8830.2604056

Neuroradiol J. 2026 Aug 17:19714009261478304. doi: 10.1177/19714009261478304. Online ahead of print.

ABSTRACT

IntroductionThe Lattice flow diverter is a novel mechanical balloon-based device designed to enhance wall apposition and optimize aneurysm neck coverage. Yet, its safety, efficacy, and angiographic outcomes have not been systematically evaluated.MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines. Primary outcomes were complete aneurysm occlusion, satisfactory occlusion, and favorable functional outcome (mRS 0-2). Secondary outcomes included near-complete and incomplete occlusion, in-stent stenosis, morbidity (mRS 3-5), and mortality (mRS 6). Pooled proportions with 95% confidence intervals (CIs) were calculated using a random-effects model.ResultsSeven studies comprising 460 patients with 472 aneurysms were included (Table 1).The pooled rates of complete occlusion, satisfactory occlusion, and favorable functional outcome (mRS 0-2) were 80%, 89%, and 98%, respectively. Near-complete and incomplete occlusion occurred in 11% and 10% of cases, while in-stent stenosis was observed in 3%. The pooled rates of morbidity (mRS 3-5) and mortality (mRS 6) were 2% and 1%, respectively (Figure 2). Comparative data demonstrated no statistically significant differences in angiographic and clinical outcomes between the LFD and the PED Flex within the studied cohorts. These findings suggest the LFD as a promising alternative that warrants further long-term validation.ConclusionCurrent very-low-certainty evidence suggests that the Lattice flow diverter exhibits preliminary feasibility and acceptable short-term occlusion rates, with a low incidence of in-stent stenosis compared to established devices. These hypothesis-generating findings warrant confirmation through larger prospective, randomized trials.

PMID:42608291 | DOI:10.1177/19714009261478304

Br J Oral Maxillofac Surg. 2026 Aug 17:S0266-4356(26)00181-6. doi: 10.1016/j.bjoms.2026.06.005. Online ahead of print.

ABSTRACT

Orbital fractures represent a common and complex challenge in maxillofacial surgery, with functional and aesthetic sequelae. Advances in computer-aided design and manufacturing, virtual planning, and three-dimensional printing have enabledpatient-specific implants (PSIs). Polyetheretherketone (PEEK), a bioinert polymer with properties similar to cortical bone, has emerged as a suitable material for orbital reconstruction. Surgical navigation has also been advocated to enhance accuracy in challenging regions. This retrospective service evaluation analysed ten patients with unilateral orbital fractures reconstructed using customised PEEK PSIs, placed either with navigation (n = 5) or freehand (n = 5). Orbital volumes were measured preoperatively, after virtual planning, and postoperatively; implant positioning was assessed by translational and rotational deviations; and clinical outcomes were evaluated using standardised ophthalmic and maxillofacial criteria. Fractured orbits were larger than contralateral orbits preoperatively, with postoperative volumes close to those of the intact side in both groups. Planned-treated volume discrepancies were small (navigation median 1.50 cm³, IQR 0.30-1.60; freehand 0.20 cm³, IQR 0.20-0.50; median difference 1.00 cm³, 95% CI -0.30 to 1.60; p = 0.151). Translational deviations remained below 2 mm, while rotational discrepancies were greater without navigation, though not statistically significant. Clinical success was achieved in six of the nine evaluable patients, with persistent diplopia in three cases attributed to traumatic muscle injury rather than implant malposition. PEEK PSIs provided a reliable orbital reconstruction, accurate volume restoration, and favourable clinical outcomes. Customised PEEK PSIs were typically designed and manufactured within 4 weeks after clinical assessment and imaging, consistent with a delayed reconstruction pathway in complex cases. Navigation may enhance intraoperative confidence and refine rotational control; however, no statistically demonstrable advantage over freehand placement was shown in this small exploratory cohort, in which satisfactory outcomes were achieved with both approaches, consistent with the inherent ‘one-fit’ characteristic of PSI.

PMID:42608239 | DOI:10.1016/j.bjoms.2026.06.005

Prim Care Diabetes. 2026 Aug 17:S1751-9918(26)00151-8. doi: 10.1016/j.pcd.2026.08.003. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis of 12 randomized controlled trials (1835 participants) evaluated whether digital health interventions (DHIs) improve glycemic control among underserved adults with type 2 diabetes (T2D), including racial/ethnic minority, low-income, Medicaid-insured, rural, and low-health-literacy populations. Searches of PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to December 20, 2025 identified eligible parallel-group randomized controlled trials reporting change in hemoglobin A1c (HbA1c). Two reviewers independently screened studies, extracted data, and assessed risk of bias using the revised Cochrane Risk of Bias 2 tool. Random-effects meta-analysis showed that DHIs produced a modest but statistically significant HbA1c reduction versus control (mean difference, -0.37 %age points; 95% CI, -0.44 to -0.30; P < .0001; equivalent to -4.0 mmol/mol). Heterogeneity was moderate-to-substantial (I² = 69.9%). Subgroup analyses suggested directionally similar effects by population group and intervention modality, but interpretation was limited by study-level data and the small number of trials. Funnel-plot inspection and Egger’s test (P = .31) did not suggest major small-study effects, although power was limited. Overall certainty for HbA1c was moderate. DHIs may support more equitable diabetes care when implemented with cultural tailoring, language access, digital-literacy support, and technology-access safeguards.

PMID:42608227 | DOI:10.1016/j.pcd.2026.08.003

Chin J Traumatol. 2026 Aug 17:S1008-1275(26)00149-5. doi: 10.1016/j.cjtee.2026.06.003. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the current status of monoclonal anti-tetanus toxin antibody used for passive immunization in the prevention and management of post-traumatic tetanus in China, and to provide evidence for the selection of passive immunization agents for tetanus prophylaxis.

METHODS: This retrospective, multicenter, real-world survey included patients who received a monoclonal anti-tetanus toxin antibody (siltartoxatug injection) for passive immunization following traumatic injury at participating hospitals across China between March 1 and August 20, 2025. Patients with incomplete registration data or at least 1 missing key variable were excluded. Demographic, clinical, wound-related, payment, and follow-up information was collected. According to the National Clinical Practice Guideline for Non-neonatal Tetanus Prevention and Treatment (2024 Edition), patients were classified into high- and low-risk tetanus exposure groups based on vaccination history, booster interval, wound characteristics, and immune status. Demographic, clinical, and wound-related characteristics were compared between the 2 groups. Statistical analyses were performed using IBM SPSS Statistics, version 26.0 (IBM Corp., Armonk, NY, USA). Categorical variables were presented as frequencies and percentages and compared using the chi-square test or Fisher’s exact test, as appropriate. All statistical tests were two-sided, and a p value < 0.05 was considered statistically significant.

RESULTS: A total of 423 hospitals from 28 provinces, autonomous regions, and municipalities participated in the survey and provided case data. Among 1474 patients who received monoclonal anti-tetanus toxin antibody for passive immunization following trauma, no tetanus cases were documented during the available observation period; however, follow-up duration was not standardized across centers, and the protective efficacy of the monoclonal antibody could not be definitively evaluated.

CONCLUSION: Standardized wound assessment and appropriate selection of passive immunization agents are crucial for tetanus prevention. Monoclonal anti-tetanus toxin antibody represents an effective and promising option for passive immunization against tetanus.

PMID:42608224 | DOI:10.1016/j.cjtee.2026.06.003

J Voice. 2026 Aug 17:S0892-1997(26)00394-2. doi: 10.1016/j.jvoice.2026.07.041. Online ahead of print.

ABSTRACT

Platelet-rich plasma (PRP) has emerged as a regenerative option for the management of vocal fold lamina propria disorders. Several studies have reported improvements in perceptual, acoustic, and stroboscopic parameters, although methodological limitations remain.

OBJECTIVE: To describe the clinical experience with a standardized protocol of serial PRP injections in patients with dysphonia due to structural abnormalities of the vocal folds.

METHODS: Prospective observational study including 24 patients (41 vocal folds) diagnosed with atrophy, sulcus, or scarring. All subjects received three serial PRP injections, 4-6 weeks apart. VHI-10, GRBAS scale, and stroboscopic examination were assessed before and after treatment.

RESULTS: Most patients showed clinically meaningful improvement in VHI-10 and perceptual voice quality. Subgroup analysis revealed statistically significant improvement in the atrophy subgroup (P = 0.012), while scar and sulcus groups demonstrated a trend toward improvement that did not reach statistical significance. No relevant complications were observed.

CONCLUSIONS: Serial office-based PRP injection was associated with improvements in patient-reported, perceptual, stroboscopic, and selected acoustic outcomes in patients with structural vocal fold disorders. These preliminary findings support the feasibility of PRP as an adjunctive treatment option and warrant further controlled studies with standardized protocols and longer follow-up.

PMID:42608212 | DOI:10.1016/j.jvoice.2026.07.041

Nurs Health Sci. 2026 Sep;28(3):e70415. doi: 10.1111/nhs.70415.

ABSTRACT

Based on conservation of resources theory, this study investigated workplace violence prevalence and associated factors among nursing interns. A cross-sectional self-report design that followed STROBE guidelines. A cross-sectional study was conducted from April to July 2024. We recruited a convenience sample of 347 nursing interns from five tertiary hospitals in Chengdu, China. Data were collected using validated scales, including the Workplace Violence Scale, the Connor-Davidson Resilience Scale (CD-RISC-10), the Organizational Climate Scale, and the Social Support Rating Scale (SSRS). Binary logistic regression analysis was performed to identify factors associated with workplace violence. Workplace violence prevalence was 38.6%, with emotional abuse most common (61.9%). Significant associated factors included formal reporting systems (AOR = 0.443), higher education (Bachelor’s: AOR = 0.209; Master’s: AOR = 0.315), positive organizational climate (AOR = 0.916), greater resilience (AOR = 0.940), and stronger social support (AOR = 0.934). Workplace violence is prevalent among nursing interns. A multilevel resource protection system, incorporating institutional, environmental, and individual factors, may be associated with lower levels of violence and higher levels of professional well-being.

PMID:42608202 | DOI:10.1111/nhs.70415

AJNR Am J Neuroradiol. 2026 Aug 17:ajnr.A9595. doi: 10.3174/ajnr.A9595. Online ahead of print.

ABSTRACT

BACKGROUND: Extra-articular extension of temporomandibular joint (TMJ) lesions may mimic primary pathology of adjacent compartments, leading to misdiagnosis and inappropriate management.

PURPOSE: Building on our prior work describing intracranial extension of TMJ lesions, we sought to characterize the clinical presentation, imaging features, and pathologic distribution of extra-articular extracranial lesions across five anatomical compartments, and to evaluate the clinical impact of radiologic misclassification.

DATA SOURCES: A search of MEDLINE, SCOPUS, and Embase, in accordance with PRISMA guidelines, yielded 3,228 records.

STUDY SELECTION: After screening, 236 studies comprising 270 cases were included; studies without imaging descriptions or reporting exclusively intracranial extension were excluded.

DATA ANALYSIS: Extra-articular extracranial extension was categorized into five compartments: central skull base, temporal bone, deep neck spaces, facial bones, and paranasal sinuses; ≥2 compartments was classified as multicompartment extension. Descriptive statistics were performed using Excel and STATA.

DATA SYNTHESIS: TMJ lesions most commonly extended to deep neck spaces (n=52), temporal bone (n=44), and central skull base (n=42). Clinical presentation varied by compartment, including otologic symptoms with temporal bone extension and preauricular swelling mimicking parotid pathology in deep neck space involvement. Pigmented villonodular synovitis (PVNS)/tenosynovial giant cell tumor (T-GCT) predominated in temporal bone, deep neck, and multicompartment disease, while synovial chondromatosis was most common in skull base extension. Among cases with reported imaging differentials, imaging misclassification was highest in temporal bone (79%) and facial bone (75%) involvement. Radiologic misdiagnosis led to six cases of unnecessary parotidectomy and five cases of delayed diagnosis or avoidable patient morbidity.

LIMITATIONS: Inherent biases of case report and case series literature, including variability in reporting of imaging features, clinical presentation, management, and follow-up.

CONCLUSIONS: Extra-articular extracranial TMJ lesions demonstrate compartment-specific clinical presentations, imaging patterns and pathological distributions that, when recognized, can guide accurate diagnosis and prevent radiologic misclassification. Misdiagnosis rates across all compartments underscore the importance of systematic TMJ assessment on cross-sectional imaging and inclusion of TMJ pathology on the imaging differential in adjacent head and neck lesions.

PMID:42608195 | DOI:10.3174/ajnr.A9595