Category: Statistics

Jt Dis Relat Surg. 2026 May 1;37(2):344-350. doi: 10.52312/jdrs.2026.2642. Epub 2026 Mar 18.

ABSTRACT

OBJECTIVES: This study aims to compare the volume and impact of hidden blood loss (HBL) following total hip arthroplasty (THA) performed via the direct anterior approach (DAA) versus the posterolateral approach (PLA).

PATIENTS AND METHODS: Between January 2016 and January 2024, a total of 134 patients (63 males, 71 females; mean age: 69.7 ± 7.7 years; range, 48 to 79 years) who underwent primary THA were retrospectively analyzed. The patients were stratified into two cohorts according to surgical approach: DAA group (n = 63) and PLA group (n = 71). Preoperative blood volume and visible blood loss (VBL) were quantified for both cohorts. Total blood loss (TBL) was derived from hematocrit (Hct) levels measured preoperatively and on postoperative Day 3, which subsequently allowed calculation of HBL and its proportion relative to TBL. Intergroup comparisons were performed for these parameters.

RESULTS: The most common etiology for THA was hip osteoarthritis. The mean operative time was 120.4 ± 10.2 min in the DAA group and 117.7 ± 8.2 min in the PLA group, indicating no statistically significant difference between the two groups (p = 0.093). The mean TBL was 366.3 ± 54.3 mL in the DAA group and 477.0 ± 71.6 mL in the PLA group (p < 0.001), while the mean HBL was 206.3 ± 40.4 mL and 318.9 ± 44.9 mL, respectively (p < 0.001). The reductions in Hb and Hct were significantly lower in the DAA group compared to the PLA group (p < 0.001 for both).

CONCLUSION: During the perioperative period of THA, HBL represents a considerable clinical concern regardless of the surgical approach employed. Compared to the PLA, the DAA is associated with a significant reduction in both HBL and TBL.

PMID:41906829 | DOI:10.52312/jdrs.2026.2642

Jt Dis Relat Surg. 2026 May 1;37(2):325-343. doi: 10.52312/jdrs.2026.2523. Epub 2025 Dec 29.

ABSTRACT

OBJECTIVES: This study aims to systematically evaluate the efficacy and safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) in promoting bone regeneration.

MATERIALS AND METHODS: A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted from inception to May 2024. Fifteen randomized-controlled trials involving 2,137 cases were included. Traditional and network meta-analyses were performed, machine learning techniques were applied to explore heterogeneity, and subgroup analyses were carried out to assess efficacy across anatomical sites including alveolar sockets, palatal clefts, and spinal fusion.

RESULTS: No significant difference was found in the overall bone healing rate between the rhBMP-2 and control groups (relative risk [RR] = 1.02, 95% confidence interval [CI] 0.87-1.20). However, rhBMP-2 demonstrated a significant advantage in spinal fusion (RR = 1.09, 95% CI 1.01-1.17) and a positive, although not statistically significant, trend in small oral and jaw bone defects. The incidence of serious adverse events was comparable (RR = 0.97, 95% CI 0.66-1.42). Network meta-analysis indicated that the overall success rate of bone regeneration with rhBMP-2 (odds ratio [OR] = 1.53, 95% CI 0.54-4.33) and other bone substitutes (OR = 1.42, 95% CI 0.39-5.21) did not significantly exceed autograft treatment, although both showed a trend toward superiority. Direct pairwise comparison revealed that rhBMP-2 was significantly more effective than autograft (OR = 1.54, 95% CI 1.02-2.33, p < 0.05), with low heterogeneity (I² = 0%).

CONCLUSION: While the overall healing rate was comparable to controls, rhBMP-2 showed significant efficacy in spinal fusion and a favorable safety profile. Its effectiveness was context-specific, influenced by anatomical site and patient factors. These findings support the selective use of rhBMP-2 in specific clinical contexts such as spinal surgery, while further research is needed to optimize its application in other indications.

PMID:41906828 | DOI:10.52312/jdrs.2026.2523

Jt Dis Relat Surg. 2026 May 1;37(2):291-298. doi: 10.52312/jdrs.2026.2556. Epub 2025 Dec 15.

ABSTRACT

OBJECTIVES: This study aims to quantify hidden blood loss (HBL) associated with minimally invasive pedicle screw placement and to compare HBL between the Wiltse approach and percutaneous pedicle screw techniques.

PATIENTS AND METHODS: Between January 2020 and December 2022, a total of 126 neurologically intact patients (63 males, 63 females; mean age: 43.0 ± 11.5 years; range, 18 to 65 years) with single-segment traumatic thoracolumbar fractures who underwent surgery were retrospectively analyzed. The patients were categorized into two groups based on surgical technique: the study group (Wiltse approach) and control group (percutaneous pedicle screw). Demographic and clinical data were collected. Perioperative laboratory values were recorded, and HBL was calculated using a combination of the Nadler, Gross, and Sehat formulas.

RESULTS: The Wiltse approach group demonstrated a significantly shorter surgical time and fewer intraoperative fluoroscopy uses compared to the percutaneous group (p < 0.001 for both). Although intraoperative visible blood loss (VBL) was higher in the Wiltse group (p < 0.001), this group showed a smaller postoperative hemoglobin loss (p = 0.025) and significantly less HBL in absolute volume (p=0.031).

CONCLUSION: In minimally invasive surgery for single-segment thoracolumbar fractures, perioperative HBL considerably exceeds VBL. Compared to the Wiltse approach, percutaneous pedicle screw fixation is associated with longer operation time, greater radiation exposure, and higher HBL. Therefore, spine surgeons should emphasize close monitoring of postoperative hemoglobin and appropriate management of anemia in patients undergoing percutaneous instrumentation.

PMID:41906824 | DOI:10.52312/jdrs.2026.2556

Pacing Clin Electrophysiol. 2026 Mar 30. doi: 10.1111/pace.70217. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines recommend the use of combined oral anticoagulants and antiplatelet agents in patients with acute myocardial infarction (AMI) and atrial fibrillation (AF), especially for those at high risk. In real-world clinical practice, adherence to anticoagulant therapy is often suboptimal, and some patients do not routinely receive it.

METHODS: Patients diagnosed with AMI and AF who were prescribed dual antiplatelet drugs in Tianjin, China, from August 2016 to June 2023 were enrolled. The primary outcomes were stroke, ischemic stroke, and hemorrhagic stroke.

RESULTS: A total of 1,026 patients were identified (mean age: 73.7, standard deviation: 9.12; 39% female), which included 132 rivaroxaban users and 894 non-users. Over a median follow-up of 922 days, 298 patients died and 367 patients suffered from stroke. After adjusting for multiple variables, rivaroxaban users had a lower risk of any stroke (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43-0.90) and ischemic stroke (HR, 0.63; 95% CI, 0.43-0.92), compared to non-users. In the propensity matched cohort, rivaroxaban users had a lower risk of stroke and ischemic stroke with no significant difference in bleeding or major bleeding. Multivariable competing risk models were consistent with the above results. No statistically significant association was found for rivaroxaban use and bleeding, major bleeding, all-cause mortality, or cardiovascular mortality.

CONCLUSIONS: Concomitant rivaroxaban use is associated with lower risks of stroke, especially ischemic stroke, but with no significant increase in the risks of bleeding and major bleeding in patients with AMI and preexisting AF taking dual antiplatelet drugs.

TRIAL REGISTRATION: Registration number: ChiCTR2400094021.

PMID:41906822 | DOI:10.1111/pace.70217

Nat Prod Res. 2026 Mar 30:1-15. doi: 10.1080/14786419.2026.2645753. Online ahead of print.

ABSTRACT

Tetraclinis articulata (Vahl) Masters (Cupressaceae) is a coniferous species native to the Mediterranean and North African regions. Its resin, commonly known as sandarac, has a longstanding history of ethnomedicinal use for treating respiratory disorders, wound healing, and ritual practices. Despite its traditional significance, comprehensive pharmacological and toxicological evaluations of its chemical constituents and safety profile remain limited. This study aimed to assess the general toxicity of sandarac resin methanolic extract (SRME) using the Artemia salina L. lethality bioassay, alongside detailed phytochemical profiling through qualitative screening and LC-MS/MS analysis. The antioxidant activity of SRME was assessed using the DPPH• radical scavenging method, while its total antioxidant capacity (TAC) was determined using the phosphomolybdenum assay. The total phenolic content (TPC) of SRME was determined using a modified Folin-Ciocalteu colorimetric method. Phytochemical screening confirmed the presence of phenolics and flavonoids, whereas alkaloids, tannins, and saponins were absent. LC-MS/MS analysis identified key phenolic acids, including caffeic acid (1222 mg/kg) and gallic acid (26.44 mg/kg), as well as other constituents such as cinnamic acid, rutin, and myricetin. Although SRME contained diverse bioactive compounds, the DPPH• and TAC assays demonstrated very limited antioxidant activity, with statistically significant DPPH• radical scavenging observed only at 25 µg/mL (4.32%), while no total antioxidant capacity was detected at any concentration. In contrast, ascorbic acid exhibited strong antioxidant activity, reaching 67.28% and 52.10% in the DPPH• and TAC assays, respectively. Toxicity assays demonstrated a dose- and time-dependent increase in A. salina larval mortality, particularly at high concentrations, suggesting potential toxic effects at supra-traditional doses. These findings indicate that SRME is relatively safe at traditional usage levels, while higher concentrations may pose risks. Further studies isolating active constituents and elucidating toxicodynamic mechanisms are warranted to inform the safe pharmacological application of T. articulata resin.

PMID:41906815 | DOI:10.1080/14786419.2026.2645753

Child Care Health Dev. 2026 May;52(3):e70266. doi: 10.1111/cch.70266.

ABSTRACT

OBJECTIVES: This study aimed to quantify associations between chronic conditions and mental illness; investigate potential moderating effects of child age, sex, health functioning, mental health service contact and household income on these associations; and explore the potential mediating effect of family functioning.

METHODS: This study conducted secondary data analyses on a sample of 6242 children aged 4-17 years from the 2014 Ontario Child Health Study (OCHS). Chronic conditions were assessed using a standard list of conditions developed by the Statistics Canada. Mental illness was assessed with the Emotional Behavioural Scales (EBS). The Health Utility Index Mark III measured health functioning. Logistic regression models quantified associations between chronic conditions and mental illness. Moderating effects were tested with product-term interactions in logit models and interpreted using average marginal effects. Mediating effects were explored using the product of coefficients method.

RESULTS: Having a chronic condition was associated with mood disorder (OR = 2.25 [95% CI: 1.36-3.74]). For children who have better health functioning, average marginal effects indicated that children with chronic conditions are 29% more likely to have any mental illness (p < 0.01), 21% more likely to have anxiety disorders (p < 0.05) and 21% more likely to have ADHD (p < 0.05) than children with no conditions. For children who have poorer health functioning, there was no association between chronic conditions and mental illnesses. Family functioning did not mediate any associations between chronic conditions and mental illness outcomes.

CONCLUSION: The association between chronic conditions and mental illness in children is nuanced, with health functioning moderating this association for any mental illness, anxiety disorders and attention-deficit hyperactivity disorder specifically. Mental health screening programs should ensure children with chronic conditions who have better health functioning are routinely assessed and upstream interventions initiated early to reduce the incidence of physical-mental multimorbidity.

PMID:41906801 | DOI:10.1111/cch.70266

Child Care Health Dev. 2026 May;52(3):e70264. doi: 10.1111/cch.70264.

ABSTRACT

BACKGROUND: Parents caring for children with neurodevelopmental disorders (NDD) face unique and ongoing challenges that impact family well-being. Peer support from individuals with shared lived experiences can offer recognition, shared understanding and empowerment. Despite its promise, peer support for parents of children with NDD remains largely informal, under-researched and poorly integrated within standard healthcare, limiting its potential accessibility and impact. Little is known about what parents seek in peer support, how they experience it, and which factors facilitate meaningful engagement. This study therefore aimed to explore parents’ perceptions of peer support, focusing on uptake, impact and conditions influencing its effectiveness.

METHODS: A survey co-created with parent-carers collected quantitative and qualitative data on perceptions, needs, concerns and barriers related to peer support. The online survey was distributed via parent organisations. Descriptive statistics summarised participant characteristics and peer support uptake, while thematic analysis identified key experiential themes from open-ended responses.

RESULTS: Among the 225 participating parents (89% mothers), 77.3% expressed a need for peer support, mostly because friends and family did not fully understand their situation. Of these parents, 65.6% reported finding peer support, mostly informal initiatives. Thematic analysis of participants’ comments revealed four key categories describing the experience with and need for peer support: (1) support, (2) mutual learning, (3) connection by recognition and (4) experiencing no judgement. Also included in the results are concerns reported by parents and factors facilitating or hindering successful peer support.

CONCLUSION: Parents of children with NDD valued peer support for emotional connection, practical advice and shared understanding. Preferences are highly individual, emphasising the need for tailored peer support. These findings may guide the design and implementation of peer support initiatives aligned with parents’ needs and preferences. Future research should focus on how the full potential of peer support for these parents can be unlocked.

PMID:41906793 | DOI:10.1111/cch.70264

Clin Oral Implants Res. 2026 Mar 29. doi: 10.1111/clr.70123. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effect of narrow (< 2 mm) and wide (≥ 2 mm) keratinized mucosa (KM) over 10 years on peri-implant diagnosis and brushing discomfort.

MATERIALS AND METHODS: Eighty patients were initially evaluated. Demographic data, modified plaque index (mPI)/plaque index (PI), probing depth (PD), clinical attachment level (CAL), mucosal recession (REC), bleeding on probing (BoP), marginal bone level (MBL), brushing discomfort (BD), and peri-implant diagnosis were assessed. Implants were then divided into two groups according to the width of KM (narrow group: NG < 2 mm and wide group: WG ≥ 2 mm). Patients who returned after 4 years (T4) were invited to participate in the 10-year reassessment (T10). The same parameters were reassessed, and statistical analysis was performed.

RESULTS: Thirty patients and 116 implants were included in this 10-year follow-up study. Although at T10 the prevalence of peri-implant diseases was not influenced by the KM width, the implants in the WG had 84% lower odds of being diagnosed with peri-implant diseases compared to those in the NG. Furthermore, the NG had higher PI, mPI, BoP, and REC than the WG. In addition, significant MBL was observed in the NG over 10 years. Both groups reduced BD, with no significant difference between them.

CONCLUSION: A narrow KM favors plaque accumulation, mucosal recession, and peri-implant tissue inflammation in the long term, while a wider KM (≥ 2 mm) appears protective against peri-implant disease onset. Brushing discomfort declined over time irrespective of KM width.

PMID:41906210 | DOI:10.1111/clr.70123

J Forensic Sci. 2026 Mar 29. doi: 10.1111/1556-4029.70316. Online ahead of print.

ABSTRACT

Postmortem decomposition changes of bodies in aquatic environments may offer valuable insights into the postmortem submergence interval (PMSI) for medicolegal death investigators. However, the effects of immersion on the onset of such changes are poorly understood. The aims of this study were to augment what is known about the statistical relationship between PMSI and observable decomposition changes across three body regions (head, torso, and limbs) and to quantify the influence of extrinsic (e.g., clothing, immersion, location, and body position) and intrinsic (e.g., height, weight, BMI) moderating covariates for bodies in aqueous anthropogenically constructed environments. This study retrospectively examined 79 deceased adults recovered from pools, bathtubs, hot tubs, and spas between January 2010 and December 2019 in Victoria, Australia. Mean estimated PMSI was 18.33 h (SE = 3.83), and bivariate t-tests and ANOVA showed that PMSI was significantly related to gaseous distension of the face and torso, discoloration of the skin, marbling, skin sloughing, and discoloration of the torso and limbs. Univariate GLM (two-way factorial ANOVA) results showed that each moderating factor had a unique profile of influence on the various relationships between PMSI and the decomposition change being evaluated. Multiple linear regression modeling demonstrated the importance of including only specific moderators in estimations of PMSI. One model predicted nearly two-thirds of the variance in PMSI (adjusted R² = 0.656, SE of estimates = 18.150), but more cases involving lengthier submergence intervals are needed to understand with greater confidence the onset of advanced decomposition changes in such aqueous settings.

PMID:41906193 | DOI:10.1111/1556-4029.70316

Community Dent Oral Epidemiol. 2026 Mar 29. doi: 10.1111/cdoe.70065. Online ahead of print.

ABSTRACT

OBJECTIVES: Early Childhood Caries (ECC) is reported to be more common among immigrant children than their native counterparts. There are no community-based studies that assess the effectiveness of an intervention in reducing the risk of ECC among immigrant children in Norway. This study aimed to assess the effect of a culturally adapted intervention on ECC, plaque, feeding and oral hygiene habits in immigrant children, as well as on their parents’ oral health behaviours.

METHODS: Seven primary health centres in Bergen, Norway, were randomly assigned to either an intervention or a control group. Immigrant parents of newborns participated in the baseline study (n = 345). Self-reported data were collected via questionnaires at baseline (infants aged 0-6 months) and at follow-up (18-24 months following baseline). The intervention group received a culturally adapted intervention, which consisted of two one-to-one motivational interviews, MI-informed counselling (MI), toothbrushing demonstrations and pamphlets in the participants’ native languages at baseline and after 6 months. The control group received only the routine dental information provided at the primary health centres. Clinical oral examinations were performed to assess the presence or absence of ECC and plaque in the children at follow-up. Differences in outcomes were assessed and compared between intervention and control groups using generalised linear mixed models. Odds ratios with corresponding 95% confidence intervals were reported.

RESULTS: A lower prevalence of carious lesions was observed in the intervention group (7.7%) than in the control group (10.6%), while plaque accumulation was higher in the intervention group (19.2%) than in the control group (17.3%). The intervention group exhibited lower odds of night-time feeding, not brushing day and night, or not using fluoride. Conversely, the intervention group showed higher odds of sugar intake in feeding bottles. Parents in the intervention group had higher odds of irregular flossing, mouthwash use and frequent sweet intake. However, none of the findings were statistically significant, indicating no true effect of the intervention.

CONCLUSIONS: The present study suggests that the intervention had no impact on ECC, plaque, feeding or oral hygiene habits of the immigrant children or on the parents’ dietary and oral hygiene habits. These findings underscore the necessity for community-based, comprehensive interventions with extended follow-up periods to effectively address the needs of this diverse population.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05758454.

PMID:41906192 | DOI:10.1111/cdoe.70065