Category: Statistics

JACC Adv. 2026 Aug 6;5(9):103015. doi: 10.1016/j.jacadv.2026.103015. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic total occlusion (CTO) is associated with increased ischemic burden, heart failure, and mortality. Comparative clinical outcomes associated with medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) remain uncertain.

OBJECTIVES: To compare clinical outcomes associated with medical therapy, PCI, and CABG in patients with CTO.

METHODS: We analyzed 741 patients with angiographically confirmed CTO enrolled across 7 tertiary centers in 4 Gulf countries between 2021 and 2023. Patients were managed with an initial strategy of medical therapy (n = 151), PCI (n = 441), or CABG (n = 149). The primary in-hospital endpoint was major adverse cardiovascular events. The long-term endpoint was major adverse cardiac and cerebrovascular events-free survival.

RESULTS: Treatment allocation differed substantially by baseline clinical and angiographic risk. Medically managed patients had worse renal function, more severely reduced left ventricular ejection fraction, and more cardiogenic shock despite simpler CTO anatomy CABG patients had more extensive multivessel disease, whereas PCI patients had greater CTO lesion complexity. After adjustment, neither PCI nor CABG differed significantly from medical therapy for in-hospital major adverse cardiovascular events. At a median follow-up of 22 months, adjusted 36-month restricted mean survival time analyses showed no statistically significant difference in major adverse cardiac and cerebrovascular events-free survival between PCI, CABG, and medical therapy. Adjusted Canadian Cardiovascular Society class I at last follow-up was reached in 86.2% of medical therapy, 91.7% of PCI, and 98.0% of CABG patients; the adjusted difference vs medical therapy was significant for CABG (P < 0.001) but not for PCI P = 0.17).

CONCLUSIONS: After adjustment, no treatment strategy demonstrated superiority for hard cardiovascular outcomes; revascularization, particularly CABG, was associated with a lower angina burden at follow-up.

PMID:42561488 | DOI:10.1016/j.jacadv.2026.103015

Gynecol Oncol. 2026 Aug 6;212:57-63. doi: 10.1016/j.ygyno.2026.07.018. Online ahead of print.

ABSTRACT

BACKGROUND: Metastatic cancer patients receiving systemic chemotherapy face increased risks for venous thromboembolism (VTE). Benefit has been shown for prophylactic anticoagulants in risk-stratified populations. Ovarian cancer (OC) is commonly advanced at diagnosis and treated with chemotherapy. Despite high VTE rates among OC patients, predictors of risk in this population are not well studied, and information on the benefit of oral anticoagulants is lacking.

OBJECTIVE: A quality improvement (QI) intervention to improve appropriate anticoagulation in risk-selected OC patients receiving first-line chemotherapy was implemented, prospectively assessing VTE risk reduction.

METHODS: Patients receiving first-line chemotherapy for OC at Sheba Medical Center 2020-2025 were included. A QI program (launched 07/2023) included staff education, EMR-incorporated Khorana scoring, integrated apixaban prescriptions and targeted chemo-suite questionnaires. Data was extracted from the EMR using MDClone® software with Natural Language Processing to identify VTE events in imaging reports. Descriptive statistics were used to compare patients treated before and after program implementation. Predictors of VTE were evaluated with logistic regression.

RESULTS: Patient characteristics were comparable before and after program implementation. VTE rates were high at 16.9% before, and 12.5% following roll-out. No increase in bleeding events or blood products consumption was appreciated. Program implementation was found to be a significant protective factor on multivariable analysis, adjusting for other risk factors (aOR = 0.39 (0.17-0.81), p = 0.015).

CONCLUSION: The implementation of an oral anticoagulation QI program successfully decreased VTE events during first-line chemotherapy for OC with no appreciable increase in risk. Future work will focus on improved risk stratification and selection for thromboprophylaxis.

PMID:42561468 | DOI:10.1016/j.ygyno.2026.07.018

Otol Neurotol. 2026 Aug 6. doi: 10.1097/MAO.0000000000005009. Online ahead of print.

ABSTRACT

BACKGROUND: Hearing restoration by cochlear implantation (CI) yields benefits beyond hearing. Short-term benefits on cognition are well-known, but long-term data are limited and inconsistent. Therefore, we analyzed a large sample of CI recipients with a focus on cognitive changes in the long-term follow-up.

METHODS: Seventy-five CI recipients aged older than or equal to 50 (mean age 65.4, SD 9.2) were tested in attention, immediate and delayed recall, working memory (OSPAN) and verbal fluency (VF) pre-implantation and 12, 24, 54 as well as 99 months post-CI. Three linear mixed-effects models (linear, quadratic, and time-indicator) were fitted and contrasted.

RESULTS: Despite different statistical assumptions, all 3 models converged on initial cognitive improvement after implantation. In the time-indicator model, significant improvements relative to baseline were observed across all 5 outcomes at 12 and 24 months (P<0.01), with effect sizes at 24 months ranging from d=0.26 (OSPAN) to d=0.93 (VF). Subsequent trajectories diverged across domains. At 99 months, only attention (M3) showed sustained improvement (P <0.001, d=0.60), with an effect size comparable to its 24-month peak. The remaining 4 outcomes did not significantly differ from baseline (P>0.05). The quadratic model confirmed inverted-U-shaped trajectories for all outcomes, with significant negative quadratic terms (all P≤0.001).

CONCLUSIONS: Cognitive benefits of cochlear implantation extend beyond the short-term, but long-term trajectories are domain-specific. Considering the multifactorial nature of cognitive aging, multicenter studies with larger sample sizes and extended follow-up visits are needed to clarify the mechanisms behind the impact of CI on cognition.

PMID:42561447 | DOI:10.1097/MAO.0000000000005009

Acta Orthop Belg. 2026 Aug 5;92(2). doi: 10.52628/92.2.15398.

ABSTRACT

INTRODUCTION: While knee kinematics are well-documented in primary TKA, less is understood regarding revision TKA (rTKA), where altered soft tissue conditions may influence kinematics. This study aimed to investigate the relationship between kinematic parameters, specifically anteroposterior (AP) translation and post-cam engagement, and patient-reported outcome measures (PROMs) in rTKA patients.

MATERIALS AND METHODS: Thirty patients who underwent rTKA between 2022 and 2024 were assessed at a minimum six-month follow-up. Tibiofemoral kinematics, measured as femoral AP translation relative to the tibia, were evaluated during open-chain flexion-extension (FE) and closed-chain exercises (sit-to-stand (STS) and a lunge) using fluoroscopy. Two clusters, categorized by higher and lower PROMs, were compared for AP translation and post-cam engagement.

RESULTS: In the medial compartment, the low-PROMs group exhibited a more anterior femoral position compared to the high-PROMs group, with statistical significance observed during mid-flexion of the STS (50.87% (SD, 4.04) vs. 47.57% (SD, 2.75); p = 0.043) and FE exercise (51.97% (SD, 3.83) vs. 48.55% (SD, 3.62); p = 0.037). No significant differences were found in the lateral compartment. Post-cam engagement did not differ between the groups in either open- or closed-chain exercises.

CONCLUSIONS: Poorer PROM scores were associated with a more anterior femoral position in the medial compartment during mid-flexion of STS and FE exercises. Further research is needed to explore the relationship between kinematic variations and PROMs in rTKA patients.

PMID:42561440 | DOI:10.52628/92.2.15398

Acta Orthop Belg. 2026 Aug 5;92(2). doi: 10.52628/92.2.13561.

ABSTRACT

BACKGROUND: Total hip arthroplasty is a common orthopedic procedure with significant hemorrhagic risks, often necessitating postoperative transfusions to treat anemia. Transfusions carry considerable costs and complications, including infection, necessitating judicious use. Identifying factors influencing transfusion rates in hip arthroplasty can improve perioperative management.

PATIENTS AND METHODS: Records of 3,865 patients who underwent primary total hip arthroplasty at a university center from 2002 to 2020 were retrospectively reviewed. Factors analyzed included age, sex, BMI, ASA physical status classification, surgical indication, operation duration, surgical approach, additional procedures, hospital stay duration, intraoperative complications, postoperative infections, anticoagulation, tranexamic acid use, anti- inflammatory use, and pre- and postoperative hemoglobin levels. Data were analyzed using descriptive, univariate, and multivariate analyses.

RESULTS: The overall transfusion rate was 9.4%. Transfusion rates decreased from 28.5% (2002-2003) to 11.3% (2004-2012) and 4.3% (2013-2020). Multiple logistic regression showed that female sex, surgical indication, surgical approach, longer operative time, higher ASA scores, and greater postoperative hemoglobin drop significantly increased transfusion risk. Conversely, tranexamic acid and anti-inflammatory use, and higher body weight significantly decreased transfusion risk. Infection rates were higher among transfused patients (3%) compared to non-transfused patients (0.83%).

CONCLUSION: Reducing transfusion use is essential due to the scarcity of blood, associated costs, and complications, necessitating a standardized transfusion policy and perioperative care protocols. Optimizing preoperative hemoglobin, using controlled hypotension anesthesia, minimally invasive surgical approaches, consistent surgical techniques, perioperative tranexamic acid, and postoperative anti-inflammatory use are crucial to reducing.

PMID:42561430 | DOI:10.52628/92.2.13561

JMIR Med Inform. 2026 Aug 6;14:e86963. doi: 10.2196/86963.

ABSTRACT

BACKGROUND: Noninvasive brain stimulation may alleviate social media addiction, but its efficacy requires accurate individual targeting and real-time brain monitoring. The neural mechanisms underlying the effects of social media use (SMU) remain unclear, limiting the development of interventions. Understanding how different levels of SMU modulate brain activity could guide personalized neuromodulation strategies.

OBJECTIVE: This study investigated a cohort of young adults using a multistage design, with concurrent electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) to examine the effects of SMU on brain activity. It aimed to characterize static and dynamic neural changes at baseline and after a standardized SMU task in individuals with different daily SMU durations.

METHODS: Participants were all male and were divided into a heavy social media users (HSMU) group and a light social media users (LSMU) group based on self-reported daily SMU duration. All participants underwent baseline fMRI scanning, followed by an EEG-fMRI session immediately after a 2-hour controlled SMU task. Analyses were performed on the static and dynamic amplitudes of low-frequency fluctuations (sALFF and dALFF), static and dynamic functional connectivity (sFC and dFC), and EEG microstates.

RESULTS: At baseline, compared with the LSMU group, the HSMU group showed lower dALFF variability in the middle frontal gyrus. After the immediate-effect task, the LSMU group exhibited increased sALFF in the temporal lobe and decreased sALFF in the middle and superior frontal gyri. The HSMU group showed increased sALFF in the middle temporal gyrus and decreased sALFF in the inferior temporal gyrus, superior parietal gyrus, and prefrontal cortex. Regarding dALFF variability, the LSMU group showed a decrease in the superior medial frontal gyrus, whereas the HSMU group showed a decrease in the middle frontal gyrus and an increase in the calcarine cortex. sFC analysis revealed increased connectivity across nearly all networks in the LSMU group. Conversely, the HSMU group showed reduced sFC between the visual and default mode networks. The HSMU group showed significantly shorter duration of microstate A, shorter duration and lower coverage of microstate C, and longer duration and higher coverage of microstate D.

CONCLUSIONS: This study is the first to characterize the distinct neural patterns associated with different levels of daily SMU, using both EEG and fMRI to assess sALFF and dALFF alterations, widespread functional connectivity changes, and EEG microstate reorganizations. These findings demonstrate the unique value of multimodal assessment in identifying potential neural targets for personalized neuromodulation in social media addiction. Future studies should explore whether modulating these identified neural markers can effectively alleviate addictive behaviors and improve clinical outcomes across diverse populations.

PMID:42561423 | DOI:10.2196/86963

Obstet Gynecol. 2026 Aug 7. doi: 10.1097/AOG.0000000000006396. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe Pregnancy Mortality Surveillance System (PMSS)-identified underlying causes of pregnancy-related deaths and changes over time in the overall and cause-specific pregnancy-related mortality ratios in the United States, 2005-2024.

METHODS: For this descriptive study, all pregnancy-related deaths were identified in the Centers for Disease Control and Prevention’s PMSS from 2005 to 2024. The PMSS has nine mutually exclusive underlying cause-of-death categories: hemorrhage, infection or sepsis, amniotic fluid embolism, thrombotic pulmonary or other embolisms, hypertensive disorders of pregnancy, anesthesia complications, cerebrovascular accidents, cardiovascular conditions (including cardiomyopathy), and other noncardiovascular medical conditions. Beginning with 2020 data, a new cause-of-death code specific for coronavirus disease 2019 (COVID-19) was added to the infection or sepsis category. Cause-specific proportionate mortality was calculated overall and in 5-year intervals. In addition, trends in pregnancy-related mortality ratios, overall and by underlying cause of death, were assessed over time with Joinpoint regression. Joinpoint analysis identified statistically significant changes in trends (joinpoints) and in annual percent change (APC) across distinct time periods.

RESULTS: During 2005-2024, 14,310 pregnancy-related deaths were identified in PMSS. There was a significant increase in the overall pregnancy-related mortality ratio from 2018 to 2021 (APC 20.11, P<.001) and a significant decrease from 2021 to 2024 (APC -17.91, P<.001). Throughout the study period, the most prevalent causes of death were infection or sepsis, cardiovascular conditions (including cardiomyopathy), other noncardiovascular medical conditions, and hemorrhage. Cardiovascular conditions were the leading cause of death for 17 of the 20 years. Trends in cause-specific pregnancy-related mortality ratios differed by cause of death. Deaths resulting from infection or sepsis had the largest increase in 2018-2021 (APC 86.17, P<.001) and the largest decrease in 2021-2024 (APC -49.67, P<.001), which coincided with the timing of the COVID-19 pandemic. Hemorrhage deaths showed an increasing pregnancy-related mortality ratio from 2017 to 2024 (APC 6.84, P=.02). The pregnancy-related mortality ratio for other cardiovascular conditions decreased from 2020 to 2024 (APC -9.49, P=.04).

CONCLUSION: From 2005 to 2024, the most prevalent causes of pregnancy-related death were cardiovascular conditions, infection or sepsis, other noncardiovascular medical conditions, and hemorrhage. However, cause-specific trends in pregnancy-related mortality in the United States have changed over time. These differences underscore the importance of sustained surveillance to better inform clinical and public health efforts to address leading and emerging causes of pregnancy-related death.

PMID:42561415 | DOI:10.1097/AOG.0000000000006396

J Med Internet Res. 2026 Aug 6;28:e89963. doi: 10.2196/89963.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly applied in clinical decision support, yet their diagnostic performance in Chinese-language settings and under realistic clinical workflows remains unclear. In particular, how LLMs perform across diseases with different prevalence and under stepwise diagnostic processes has not been well characterized.

OBJECTIVE: This study aimed to evaluate the diagnostic capabilities of LLMs for common diseases and rare diseases using clinical vignettes within a hypothetico-deductive framework and to identify their potential and limitations for clinical diagnosis.

METHODS: We evaluated 4 Chinese LLMs (Doubao 1.5, DeepSeek-V3, Kimi K1.5, and Leftdoctor GPT 3.5) using 56 clinical cases (28 chronic obstructive pulmonary disease [COPD], and 28 relapsing polychondritis [RP]) sourced from the China Clinical Case Results Database (March 31-April 14, 2025). Patient information was provided incrementally, starting with the initial medical history, followed by physical examination, and laboratory results. Evaluation metrics included top-3 accuracy (RTop3D), top-1 accuracy (RTopD), final diagnostic accuracy (RFA), and mean reciprocal rank (MRR). Statistical analysis was performed using generalized estimating equations (GEE), Friedman tests, and Wilcoxon signed-rank tests with Bonferroni correction. In addition, a qualitative analysis was conducted to characterize recurrent patterns of diagnostic errors.

RESULTS: LLMs demonstrated significantly higher diagnostic accuracy for COPD compared to RP across all metrics (P<.001). Diagnostic accuracy improved after additional clinical information was provided, with the improvement mainly observed in RP cases. In RP, diagnostic accuracy increased from 32.14% to 71.43% for DeepSeek and from 35.71% to 78.57% for Doubao, whereas COPD accuracy remained consistently high across all diagnostic stages (82.14%-92.86%). For COPD, ranking performance was high and comparable among all models (MRR range: 0.82-0.89; P=.71). In RP, diagnostic performance differed significantly among models (MRR range: 0.10-0.39; P<.001). Qualitative analysis showed that COPD errors were mainly related to a failure to recognize specific features, whereas RP errors involved more diverse patterns, particularly the neglect of negative evidence and the failure to recognize specific features.

CONCLUSIONS: Chinese LLMs demonstrated relatively strong diagnostic performance for common diseases such as COPD, but lower and less stable performance for rare diseases such as RP. Additional clinical information improved diagnostic accuracy primarily in RP cases, although differences between models remained evident under diagnostically complex conditions. Error patterns in RP cases suggest that current LLMs remain limited in their ability to integrate complex clinical information and exclusionary findings. Careful evaluation and appropriate clinical oversight remain important for their application in clinical practice.

PMID:42561411 | DOI:10.2196/89963

JMIR Form Res. 2026 Aug 6;10:e92879. doi: 10.2196/92879.

ABSTRACT

BACKGROUND: Older adults living with dementia often have limited tolerance for intraoral procedures, which can restrict access to even basic oral health assessment in clinical care. Procedural burden-characterized by sustained intraoral manipulation, sensory overload, and limited opportunities for interruption-may represent a key barrier to equitable oral care. Intraoral scanning (IOS) enables stepwise, interruptible acquisition of oral data and may reduce this burden, but feasibility and tolerability in people living with dementia have not been systematically evaluated.

OBJECTIVE: This study aimed to assess the feasibility and tolerability of bedside maxillary IOS compared with a conventional impression procedure in people living with dementia.

METHODS: A single-center, nonrandomized, counterbalanced, crossover feasibility study was conducted in a geriatric ward. Nineteen hospitalized participants with dementia (mean age 83.5, SD 3.4 years; mean Mini-Mental State Examination score 18.2, SD 4.8) underwent both bedside maxillary IOS and a conventional alginate-based impression procedure during a single visit. The order of procedures was not randomized but assigned using an alternating allocation sequence based on chronological enrollment to counterbalance potential order effects. The primary outcome was feasibility, defined as procedure completion without premature termination due to gag reflex, defensive movements, participant refusal, or withdrawal of assent or cooperation. Secondary outcomes included participant-rated discomfort using a 0 to 10 visual analog scale (VAS); clinician-rated manageability using a 0 to 10 VAS, with higher scores indicating greater difficulty; adverse reactions, including gag reflex and defensive movements; and active bedside procedural time in minutes. Paired comparisons were performed using the Wilcoxon signed-rank tests for VAS outcomes, a sign test for active bedside procedural time, and McNemar tests for binary outcomes, with a 2-sided significance level of .05.

RESULTS: Participants reported significantly lower discomfort with IOS than with the conventional impression procedure (median 1.0, IQR 0.5-1.5 vs median 7.75, IQR 3.7-8.5; P<.001), and clinician-rated manageability was more favorable for IOS (median 2.0, IQR 1.0-3.0 vs median 5.0, IQR 3.0-6.5; P<.001). Active bedside procedural time was similar in the analysis of all initiated procedures, with a mean duration of 3.02 (SD 0.72) minutes for IOS and 2.92 (SD 0.78) minutes for the conventional impression procedure. Exploratory analyses showed no statistically detectable evidence of an order effect. Gag reflex occurred less frequently during IOS (1/19, 5.3% vs 9/19, 47.4%; P=.004).

CONCLUSIONS: Bedside IOS was feasible in hospitalized older adults living with dementia and was associated with lower immediate procedural burden than a conventional alginate-based impression procedure. These findings support further evaluation of IOS as a low-burden approach for oral data acquisition in dementia care, while downstream treatment effects and implementation in other settings require further study.

PMID:42561409 | DOI:10.2196/92879

JMIR Mhealth Uhealth. 2026 Aug 6;14:e83194. doi: 10.2196/83194.

ABSTRACT

BACKGROUND: Poststroke cognitive impairment (PSCI) is a common and disabling complication after stroke; however, early screening remains challenging due to limited access to neuropsychological testing and the high cost of neuroimaging. Portable, tablet-based eye-tracking technology may offer a scalable, low-cost solution for early PSCI detection.

OBJECTIVE: This study aimed to evaluate the clinical utility of a tablet-based, AI-driven eye-tracking system for early screening of PSCI at 3 months after acute ischemic stroke. We sought to quantify oculomotor-cognitive associations and develop a practical nomogram for individualized risk prediction.

METHODS: We prospectively enrolled 142 hospitalized patients with acute cerebral infarction between May 2023 and October 2024, of whom 122 completed the 3-month follow-up and were included in the final analysis, along with 20 healthy community-dwelling controls. All patients underwent tablet-based eye tracking (visual paired comparison and antisaccade tasks) during the acute phase, as well as baseline and 3-month neuropsychological assessments. PSCI was defined using validated cutoffs. Multivariable logistic regression was used to identify independent predictors, and a nomogram was constructed. Internal validation was performed using bootstrap resampling (1000 samples).

RESULTS: At 3 months, out of 122 patients, 47 (38.5%) met PSCI criteria. Compared with patients with non-PSCI (n=75), patients with PSCI showed significantly prolonged correct saccade latency (median 322.96, IQR 209.45-445.59 ms vs 194.55, IQR 141.50-299.75 ms; Z=-4.03, P<.001), increased uncorrected error rate (median 30.00%, IQR 15.00%-42.00% vs 5.00%, IQR 0.00%-28.00%; Z=-4.24, P<.001), and reduced novelty preference ratio (median 1.44, IQR 0.97-1.70 vs 2.12, IQR 1.27-4.56; Z=-3.44, P=.001). Multivariable analysis identified 4 independent predictors of 3-month PSCI: older age (odds ratio [OR] 1.067 per year, 95% CI 1.009-1.129; P=.02), lower education level (OR 0.841 per year, 95% CI 0.708-0.999; P=.049), higher NIHSS (National Institutes of Health Stroke Scale) scores (OR 1.557 per point, 95% CI 1.075-2.256; P=.02), and prolonged correct saccade latency (OR 1.004 per ms, 95% CI 1.000-1.007; P=.04). A nomogram incorporating these 4 factors achieved good discriminative performance (area under the receiver operating characteristic curve 0.86, 95% CI 0.793-0.927) with satisfactory calibration.

CONCLUSIONS: Age, education, admission NIHSS, and correct saccade latency were identified as possible independent predictors of 3-month PSCI in this cohort. The tablet-based eye-tracking system, when combined with clinical variables, may represent a feasible approach for early PSCI screening. A nomogram based on these variables demonstrated high accuracy and potential clinical utility for early PSCI identification. This approach may facilitate early identification of high-risk patients and enable timely, personalized interventions in resource-limited settings.

PMID:42561408 | DOI:10.2196/83194