Category: Statistics

Epilepsy Res. 2026 Jul 13;227:107871. doi: 10.1016/j.eplepsyres.2026.107871. Online ahead of print.

ABSTRACT

OBJECTIVES: Objectives: The ketogenic diet (KD) is a recognized non-pharmacological treatment option for children with drug-resistant epilepsy (DRE). However, concerns persist regarding metabolic and renal complications, including nephrolithiasis. This study aimed to describe the incidence, clinical characteristics, and factors associated with renal stones in pediatric patients treated with KD or modified Atkins diet (MAD), and to characterize stone management strategies and clinical outcomes.

METHODS: This retrospective cohort study was conducted at the Pediatric Neurology Clinic of King Fahad Specialist Hospital-Dammam (KFSHD). A total of 112 children initiated dietary therapy (KD or MAD) during the study period; 80 patients with adequate follow-up and complete clinical, laboratory, and imaging data were included in the final analysis. Extracted variables included diet type, ketogenic ratio, duration of therapy, antiseizure medications, carbonic anhydrase inhibitor (CAI) use, metabolic parameters, and serial renal ultrasonography findings. The primary outcome was the development of nephrolithiasis or nephrocalcinosis. Clinical and treatment characteristics were compared between patients with and without renal stones.

RESULTS: Renal stones or nephrocalcinosis were identified in 11 of 80 patients (13.8%), while 69 patients (86.2%) showed no evidence of renal stones during follow-up. Patients who developed renal stones were older at KD initiation (p = 0.025) and were more frequently treated with higher ketogenic ratios (≥3:1), although this difference did not reach statistical significance (p = 0.071). All patients who developed kidney stones were on KD and no children receiving MAD developed renal stones/nephrocalcinosis; however, this finding was interpreted descriptively only because of the small MAD sample size. Concomitant CAI use, etiology, mobility status, route of feeding, KD duration, and number of antiseizure medications were not significantly associated with stone development. Management was predominantly conservative, and four patients required interruption of KD, with no patients requiring surgical intervention. A clinically meaningful seizure reduction (>50%) was observed in 60% of the cohort.

CONCLUSION: In this single-center cohort of children with DRE, KD was generally well tolerated and associated with meaningful seizure reduction. Renal stones occurred in a subset of patients, were frequently asymptomatic, and were managed conservatively. Older age at diet initiation was associated with stone formation. Higher ketogenic ratios showed a non-significant trend toward increased risk of renal stones. Regular metabolic surveillance and routine renal imaging may facilitate early detection and allow continued dietary therapy in most patients. These findings suggest that KD can be implemented with acceptable renal safety when appropriately monitored.

PMID:42468066 | DOI:10.1016/j.eplepsyres.2026.107871

Cancer Treat Res Commun. 2026 Jul 17;48:101316. doi: 10.1016/j.ctarc.2026.101316. Online ahead of print.

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE) is a common complication in cancer patients and negatively affects prognosis. Colorectal cancer (CRC) has the second highest incidence of VTE among the four most common cancers. In locally advanced rectal cancer (LARC), circulating tumor DNA (ctDNA) has emerged as a biomarker of residual disease and tumor burden, but its association with thrombotic risk remains unclear. We aimed to explore the association between baseline ctDNA levels and VTE occurrence in LARC.

METHODS: We conducted a prospective study of patients with LARC treated with chemoradiation at IEO. Plasma ctDNA was analyzed by droplet digital PCR for tumor-specific mutations identified in tissue samples, including KRAS, NRAS, BRAF, and PIK3CA. Baseline ctDNA, defined as variant allele frequency (VAF), was correlated with VTE occurrence using univariable and exploratory adjusted analyses.

RESULTS: Sixty-one patients underwent ctDNA assessment and were classified as VAF-low (n = 33) or VAF-high (n = 28) according to the median baseline value. Twenty-three patients (38%) were VAF-negative. After a median follow-up of 58 months, 9 VTE events (15%) were observed. Higher VTE cumulative incidence was observed in VAF-high versus VAF-low patients [HR 2.42, 95% CI 0.61-9.59; p = 0.21] and in ctDNA-positive versus ctDNA-negative patients [HR 5.70, 95% CI 0.70-46.1; p = 0.10]. In the KRAS-mutant subgroup, all VTE events occurred in patients with high baseline VAF (p = 0.001).

CONCLUSIONS: Higher baseline ctDNA levels may be associated with increased VTE occurrence in KRAS-mutant LARC. These exploratory findings require validation in larger prospective studies.

PMID:42468056 | DOI:10.1016/j.ctarc.2026.101316

Environ Sci Technol. 2026 Jul 17. doi: 10.1021/acs.est.6c02449. Online ahead of print.

ABSTRACT

Per- and polyfluoroalkyl substances (PFAS), particularly perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA), are persistent contaminants of global concern, yet their long-term and spatially resolved emissions in China remain poorly understood. Here we developed a life cycle emission inventory of PFOS and PFOA with high spatiotemporal resolution for mainland China from 1985 to 2023 using dynamic material flow analysis (DMFA). By integrating provincial activity data, trade statistics, and sector-specific emission factors, we quantified emissions from production, industrial applications, in-use products, and end-of-life management to multiple media. Cumulative emissions reached 2,289.6 tons for PFOS and 846.1 tons for PFOA. Early-2010s PFOS emissions were approximately double previous estimates, and our inventory filled gaps in emission hotspots that had been overlooked in earlier studies. Historical emissions exhibited an increase-peak-decline pattern, peaking around 2010 and then decreasing due to the Stockholm Convention and domestic regulations. High emissions were concentrated in eastern coastal and industrialized regions, with hotspots extending toward central and western China. With tightening controls on PFOS and PFOA, future emissions will increasingly be driven by legacy products and waste streams. This inventory provides a solid foundation for exposure assessment, hotspot identification, and PFAS emission management in China.

PMID:42468049 | DOI:10.1021/acs.est.6c02449

J Neurosurg Pediatr. 2026 Jul 17:1-7. doi: 10.3171/2026.2.PEDS25438. Online ahead of print.

ABSTRACT

OBJECTIVE: Intrathecal baclofen (ITB) pumps (ITBPs) are commonly used to provide symptomatic relief and facilitate patient care for children with spasticity. Unfortunately, patients are at long-term risk for device-related infections. Removal of infected pumps can require complicated, prolonged hospital stays for systematic reduction of preexisting high doses of ITB. The management strategy for ITBP infections has not been clearly defined. In this study, the authors sought to determine whether immediate reimplantation after wound washout is a viable strategy when managing ITBP infections rather than the more standard-of-care approach of removal and delayed reimplantation.

METHODS: A retrospective review was performed for patients who underwent ITBP placement at Children’s National Hospital from 1999 to 2023 (24 years) with subsequent infection requiring removal and reimplantation. Demographics, timing of reimplantation, and outcomes were collected. Statistical analysis was performed with unpaired t-tests.

RESULTS: Over 24 years, 356 baclofen pump implantation surgeries were performed with an overall infection rate of 9.8%. Seven patients underwent ITBP removal and delayed reimplantation, and 16 underwent washout with immediate reimplantation followed by extended intravenous antibiotic therapy. There was a statistically significant decrease/wean in ITB dose prior to surgery in the delayed group compared with the immediate reimplantation group (dose decreased by a mean of 209.1 vs 15.6 μg/day, p = 0.01) with a resultant increase in preoperative length of stay for baclofen weaning (2.57 vs 1.19 days), overall hospital stay (mean 13.14 vs 7.63 days), and postoperative baclofen withdrawal (42.9% vs 6.3%, p = 0.03). There was a significantly increased risk of reinfection in the immediate reimplantation cohort (63% vs 14%, p = 0.03). However, 33% of the patients with successful immediate reimplantation were able to maintain their current baclofen dose and did not require a prolonged ICU stay. Eighty percent of patients who experienced reinfection after immediate reimplantation chose final removal, while 86% of patients who underwent delayed reimplantation still have an existing ITBP.

CONCLUSIONS: There is a lower risk of reinfection with removal and delayed reimplantation of ITBPs, and more patients in this cohort ultimately maintained their device. However, for patients on high ITB doses, immediate reimplantation in select cases may help to shorten hospital stays and prevent dangerous baclofen withdrawals and is successful for long-term pump utilization (without infection) one-third of the time.

PMID:42468045 | DOI:10.3171/2026.2.PEDS25438

Am J Phys Med Rehabil. 2026 Aug 1;105(8):690-696. doi: 10.1097/PHM.0000000000002947. Epub 2026 Jul 17.

ABSTRACT

PURPOSE: This quality improvement study evaluated a novel, electronic medical record (EMR)-based order set designed to standardize interdisciplinary care coordination for patients undergoing lower extremity amputation at a large academic medical center. When activated, the order set automatically placed consultations for an interdisciplinary team consisting of physical therapy, occupational therapy, physical medicine and rehabilitation (PM&R), chaplaincy, and orthotics/prosthetics.

METHODS: Patients (n=637) who underwent lower extremity amputation were divided into 2 cohorts: those with and without use of the amputation order set. Interdisciplinary consultation patterns, length of stay (LOS), and discharge disposition were analyzed.

RESULTS: The order set significantly increased consultations with PM&R, chaplaincy, and orthotics/prosthetics services. While overall hospital LOS was longer in the order set group, patients who received preoperative order set placement had significantly shorter time from surgery to discharge. In addition, patients in the order set group were more likely to be discharged to inpatient rehabilitation facilities, as opposed to skilled nursing facilities or directly home.

CONCLUSIONS: Findings suggest that structured interdisciplinary coordination, particularly when initiated preoperatively, can enhance discharge planning and facilitate higher-quality rehabilitation pathways. The implementation of a standardized amputation consultation panel within the EMR supports provider adoption and may reduce disparities in care access.

PMID:42468006 | DOI:10.1097/PHM.0000000000002947

Brief Bioinform. 2026 Jul 3;27(4):bbag383. doi: 10.1093/bib/bbag383.

ABSTRACT

Modern bioinformatics faces escalating challenges stemming from both the inherent computational hardness of many fundamental problems and the rapidly growing scale and complexity of biological data, increasingly limiting the effectiveness of classical computational approaches. Quantum computing has emerged as a promising paradigm for addressing these challenges by enabling alternative problem representations and novel search strategies for exploring complex solution spaces. This systematic review provides a structured overview of the emerging field of quantum bioinformatics and aims to supplement recent reviews on this topic in the journal by providing an updated and structured synthesis of current research. We systematically collect and organize existing studies across 10 bioinformatics domains to identify research trends, dominant themes, and recurring methodological patterns. The review examines quantum and hybrid quantum-classical approaches, problem formulations, and encoding strategies, with particular attention to the constraints of noisy intermediate-scale quantum devices, including noise, limited scalability, and the need for error mitigation. We further synthesize reported limitations, open challenges, and prospective research directions.

PMID:42467988 | DOI:10.1093/bib/bbag383

Plast Reconstr Surg. 2026 Jul 3. doi: 10.1097/PRS.0000000000013310. Online ahead of print.

ABSTRACT

BACKGROUND: Plastic and reconstructive surgery is among the most socially engaged surgical fields, with widespread use of digital platforms to share research. As a result, assessing scholarly impact now extends beyond traditional metrics such as journal impact factor (IF). The Altmetric Attention Score (AAS) provides real-time insight into online engagement, but its ability to predict academic impact in plastic surgery literature remains unclear. This study aims to determine whether AAS can serve as a reliable predictor of citation impact within the field.

METHODS: A total of 5,418 original research articles published between January 2022 and December 2023 in ten leading plastic surgery journals were analyzed. A mixed linear model was used to evaluate how well AAS, 5-year journal IF, and time since publication (a key factor in citation accrual) predicted Dimensions citation counts. Journal identity was incorporated as a random effect. Predictor strength was assessed using permutation-based relative importance testing.

RESULTS: Time since publication was the strongest predictor of citation count, accounting for 82% of the model’s explanatory power (p < 0.001). AAS was the second most influential predictor, contributing 16% (p < 0.001). In contrast, the 5-year journal impact factor accounted for only 1.6% and was not a statistically significant predictor (p = 0.119).

CONCLUSION: AAS is a valuable early predictor of academic impact in plastic surgery literature and outperforms journal IF. Altmetrics provide timely insight into research visibility and should be used alongside established metrics to more effectively evaluate scholarly reach in the digital era.

PMID:42467981 | DOI:10.1097/PRS.0000000000013310

Comput Inform Nurs. 2026 Jul 17. doi: 10.1097/CIN.0000000000001594. Online ahead of print.

ABSTRACT

Social determinants of health (SDOH) may influence hospital readmissions. The purpose of this project was to apply provider-assigned International Classification of Diseases-10-CM codes to the Healthy People 2030 SDOH Framework for use in future research focused on hospital readmissions using the 2018 Nationwide Readmissions Database (NRD). We classified all subcodes codes ranging from Z55 to Z65 that were captured within the 2018 NRD. Three researchers independently categorized 80 unique codes into the 5 Healthy People 2030 domains. Inter-rater reliability was 0.664 and the Kappa statistic was 0.54 for initial classifications. The Kappa statistic shows moderate agreement between the raters. After robust discussion, we adjusted 33 classifications to reach classification consensus. Among the 80 codes classified, 8 (10%) were classified into Economic Stability, 6 (7.5%) into Education Access and Quality, 0 into Healthcare Access and Quality, and 13 (16.3%) into Neighborhood and Built Environment, and 53 (66.3%) into Social and Community Context. Classification challenges were due to overlapping and related features of the descriptions that could be applied to more than one domain. Clear coding practice will support researchers, case managers, social workers, and providers in partnering with patients and their family to negotiate a safe evidence-based discharge transition plan.

PMID:42467977 | DOI:10.1097/CIN.0000000000001594

Eur J Gastroenterol Hepatol. 2026 Jul 17. doi: 10.1097/MEG.0000000000003227. Online ahead of print.

ABSTRACT

OBJECTIVES: Gluten-free diet (GFD) is, to date, the only effective therapeutic intervention for coeliac disease (CeD). Evaluation of dietary adherence is of the utmost importance in the management of CeD. However, in the paediatric population, there is limited data concerning the adherence to the GFD in patients diagnosed via bioptic confirmation compared to those diagnosed through the biopsy-sparing method, according to the ESPGHAN 2012 guidelines. In this multicentric study, we investigated dietary adherence in a group of adolescents with CeD, comparing patients diagnosed with the two different diagnostic modalities, and we proposed the validation of an evaluation tool for the GFD compliance in this population.

METHODS: A total of 206 patients aged 14-18 years, diagnosed between 2012 and 2019, all with CeD and on a GFD for at least 2 years, were included. Adherence was assessed using the Leffler questionnaire [Celiac Dietary Adherence Test (CDAT)] and the Biagi score.

RESULTS: Among participants, 81.1% had been diagnosed through biopsy. No significant difference in Biagi scores was observed between the two groups (P = 0.057). Regarding the CDAT, poor or suboptimal adherence (score: ≥13) was identified in 66 patients diagnosed by biopsy and 12 patients diagnosed by the biopsy-sparing approach (P = 0.362). A multivariate analysis exploring the influence of diagnostic method, age at diagnosis, and education level on CDAT scores did not reach statistical significance (P = 0.1, R2 = 0.031).

CONCLUSION: Adherence to a GFD does not differ between adolescents diagnosed by biopsy and those diagnosed through the biopsy-sparing approach, irrespective of age at diagnosis or educational level.

PMID:42467974 | DOI:10.1097/MEG.0000000000003227

JMIR Hum Factors. 2026 Jul 17;13:e81439. doi: 10.2196/81439.

ABSTRACT

BACKGROUND: Web-based and mobile phone-based apps have become widely available for dietary self-monitoring; however, their use may increase the risk of disordered eating. College students frequently demonstrate poor nutrient intake despite consumption of sufficient calories. One way to improve diet quality may be via the use of a smartphone app that encourages intuitive eating.

OBJECTIVE: The purpose of this study was to improve diet quality among college students through the use of a novel smartphone app that promotes intuitive eating rather than calorie counting and weight loss.

METHODS: The In2Eat iOS mobile app was developed in SwiftUI and stored user data in a Firebase database. A total of 45 college students completed assessments of intuitive eating, diet quality, and disordered eating before and after 4 weeks of using the In2Eat app. Users evaluated the usability of the app with the System Usability Scale (SUS). Engagement with the app was recorded as the total number of days a meal was logged, the total number of meals logged, and the average number of meals logged per day.

RESULTS: After our 4-week intervention, dietary qualities that protect against chronic disease increased by 28%, fruit consumption increased by 63%, and skin antioxidant levels increased by 6.1% (Hedges g=0.16; mean difference 0.33, 95% bias corrected and accelerated [BCa] CI 0.04-0.61; P=.03). Global intuitive eating did not change during the user study; however, the unconditional permission to eat subscale increased (Hedges g=-0.28; mean difference 0.28, 95% BCa CI 0.07-0.49; P=.01, adjusted P=.07). Overall, disordered eating also did not change with app use, although dietary restraint decreased (Hedges g=-0.23; mean difference 0.30, 95% BCa CI -0.61 to -0.04; P=.04, adjusted P=.22). The average SUS score for the In2Eat app was 67.2 (SD 15.5). The number of days a meal was logged was positively correlated with SUS scores (r=0.28; P=.06), and the total number of meals logged had a monotonic association with app usability (ρ=0.31; P=.04). When divided according to the low (mean 10.2, SD 5.3), medium (mean 26.3, SD 2.8), and high (mean 33.6, SD 3.8) number of days logging meals, participants with higher days of logging reported the app as more usable (H=6.75; P=.03). A regression analysis showed that 8% of the variance in system usability (R²=0.080; P=.31) was explained by app use; however, none of the individual predictors contributed substantially to the variance.

CONCLUSIONS: An intuitive eating smartphone app can improve diet quality without increasing disordered eating. Results suggest that participants who logged more meals tended to rate the app as more usable. Further research is needed with a greater sample size after incorporating features to improve the app’s usability.

PMID:42467965 | DOI:10.2196/81439