Category: Statistics

Zhonghua Gan Zang Bing Za Zhi. 2026 Feb 20;34(2):161-169. doi: 10.3760/cma.j.cn501113-20251017-00440.

ABSTRACT

Objective: To investigate the effect of antinuclear antibodies on the clinicopathological characteristics, short-term treatment response, and long-term prognosis of primary biliary cholangitis. Methods: A retrospective analysis was performed on 690 cases with primary biliary cholangitis who were treated in eight medical centers, including Nanjing Second Hospital, from January 2017 to October 2023, and were divided into a negative group (96 cases) and a positive group (594 cases) according to antinuclear antibody status. Propensity score matching (1∶1) was used to balance age and gender factors. The laboratory indicators, liver histological characteristics, short-term biochemical responses, and the occurrence of decompensated event conditions were compared between the two groups. An independent sample t-test was used for comparison between groups of continuous variables that conformed to normal distribution. The Mann-Whitney U test was used for comparison between groups of continuous variables with non-normal distribution. The χ² test or Fisher’s exact test was used for comparison of categorical variables between the two groups. The Mann-Whitney U test was used for rank data.The log-rank test was employed to compare the differences between groups in the Kaplan-Meier survival analysis.The Cox proportional hazards model was used to analyze the risk factors affecting prognosis. The cut-off value of the numerical variable was determined by the receiver operating characteristic curve. Results: There were 96 cases following matching in each group. The levels of aspartate aminotransferase (88.10 U/L vs. 71.55 U/L), γ-glutamyl transferase (278.61 U/L vs. 144.00 U/L), alkaline phosphatase (229.98 U/L vs. 159.68 U/L), and immunoglobulin G (19.90 U/L vs. 17.73 U/L) were significantly increased (P <0.05). The proportion of patients with positive anti-gp210 antibodies and/or anti-SP100 antibodies was significantly higher than that of the anti-nuclear antibody-negative group (21.43% vs. 5.26%, P=0.005). Liver histology showed that the detection rate of epithelioid granuloma was higher in the anti-nuclear antibody positive group (37.50% vs. 22.92%, P=0.028), while the degree of interface inflammation (none/mild/moderate/severe:2.08%/8.33%/63.54%/26.04% vs. 18.75%/23.96%/36.46%/20.83%, P<0.001) and Nakanuma-hepatitis activity score (HA0/HA1/HA2/HA3: 2.08%/4.17%/58.33%/35.42% vs. 23.96%/18.75%/35.42%/21.88%, P<0.001) were significantly higher in the anti-nuclear antibody-negative group. There was no statistically significant difference in the 1-year biochemical response rate and the incidence rate of decompensation between the two groups (P>0.05). Multivariate Cox regression analysis showed that platelet count ≤0.3× upper limit of normal value, albumin count ≤0.6×upper limit of normal value, and fibrosis stage S≥S3 were independent risk factors for decompensation of cirrhosis in patients with primary biliary cholangitis. Conclusions: Patients with antinuclear antibody-positive primary biliary cholangitis exhibit a phenotype of “high inflammatory burden,” suggesting that antinuclear antibody status may serve as a potential serological marker of disease activity, and its value in long-term prognosis and treatment decision-making needs to be further verified by prospective studies.

PMID:41795975 | DOI:10.3760/cma.j.cn501113-20251017-00440

Zhonghua Gan Zang Bing Za Zhi. 2026 Feb 20;34(2):154-160. doi: 10.3760/cma.j.cn501113-20251029-00463.

ABSTRACT

Objective: To investigate the efficacy and safety profile of transjugular intrahepatic portosystemic shunt received by elderly patients with cirrhosis (age >75 years). Methods: A retrospective analysis was conducted on the data of patients who underwent TIPS for cirrhosis at Nanjing Drum Tower Hospital, affiliated with Nanjing University School of Medicine, from January 2019 to December 2021. Patients were divided into an elderly group (> 75 years) and a younger group (≤ 75 years) according to age. Propensity score matching was performed in a 1∶1 ratio. Statistical analysis was performed using the independent samples t-test, the Mann-Whitney U test, and the χ² test. Postoperative survival rate, rebleeding rate, and incidence rate of hepatic encephalopathy were analyzed using the Kaplan-Meier method between the two patient groups. Results: A total of 37 elderly and 478 younger cases were screened. Propensity score matching was performed in line with a 1∶1 ratio. Finally, 32 cases were included in each group. The elderly and younger patient groups had no statistically significant differences in the 1-year postoperative rebleeding rate [9.4% (3/32) vs. 6.3% (2/32), P=0.562], the incidence rate of hepatic encephalopathy [37.5% (12/32) vs. 18.8% (6/32), P=0.060], and the survival rate [25% (8/32) vs. 15.6% (5/32), P=0.371]. The incidence rate of hepatic encephalopathy according to the Child-Pugh class A stratification at 1 year following surgery had no statistically significant difference between the two patient groups’ liver function [12.5% (1/8) vs. 11.1% (1/9), P=0.896]. However, the incidence rate of hepatic encephalopathy at 1 year following surgery with Child-Pugh class B and C had a statistically significant difference between the two patient groups’ liver function [45.8% (11/24) vs. 21.7% (5/23), P=0.037]. Conclusion: Transjugular intrahepatic portosystemic shunt (TIPS) is equally safe and effective in elderly compared to younger patients. However, the incidence rate of postoperative hepatic encephalopathy is significantly higher in patients with Child-Pugh class B and C.

PMID:41795974 | DOI:10.3760/cma.j.cn501113-20251029-00463

Zhonghua Gan Zang Bing Za Zhi. 2026 Feb 20;34(2):147-153. doi: 10.3760/cma.j.cn501113-20250120-00031.

ABSTRACT

Objective: To analyze the incidence rate, compare the differences, and assess the risk factors for portal vein thrombosis (PVT) formation after different endoscopic treatment methods in patients with esophagogastric varices in cirrhosis. Methods: The laboratory, imaging, and endoscopic treatment methods data for 289 patients with esophagogastric varices in liver cirrhosis who initially received endoscopic treatment at the Endoscopy Center of You’an Hospital, affiliated with Capital Medical University, from January 2020 to December 2022, were retrospectively included. The incidence rate of PVT within 1 year after systematic standardized endoscopic treatment was statistically analyzed. Univariate and multivariate logistic regression analyses were used to screen the risk factors for PVT formation after endoscopic treatment. The t-test or rank-sum test was used to compare continuous data between the two groups. The χ² test was used for categorical data. Results: The incidence rate of portal vein thrombosis (PVT) within 1 year was 20.76% (60/289) among 289 patients with esophagogastric varices in cirrhosis who underwent standard endoscopic treatment. The PVT incidence rate was 22.81% (13/57) in patients who used sclerotherapy alone and 15.22% (7/46) in patients who used ligation rings alone, with no statistically significant difference in the PVT incidence among different endoscopic treatment methods (χ²=2.354, P>0.05). Univariate analysis showed statistically significant differences in preoperative platelet count, spleen thickness, spleen long diameter, model for end-stage liver disease score, ascites, and smoking between the PVT group and the non-PVT group (P<0.05). Multivariate logistic regression analysis showed that preoperative platelet count [odds ratio (OR) = 0.988, 95% (confidence interval, CI): 0.979-0.998, P = 0.018], splenic ultrasound thickness (OR = 1.051, 95%CI: 1.003-1.101, P = 0.038), massive ascites (OR = 14.153, 95%CI: 2.517-79.577, P = 0.003), and smoking (OR = 2.537, 95%CI: 1.267-5.076, P = 0.009) were independent risk factors for PVT formation. Conclusion: The incidence rate of PVT is similar to the current known annual incidence rate of PVT following endoscopic treatment in patients with esophagogastric varices in liver cirrhosis, and different endoscopic treatment methods have no significant effect on PVT formation. Preoperative platelet count, spleen thickness, massive ascites, and smoking are risk factors for PVT formation.

PMID:41795973 | DOI:10.3760/cma.j.cn501113-20250120-00031

Zhonghua Gan Zang Bing Za Zhi. 2026 Feb 20;34(2):134-146. doi: 10.3760/cma.j.cn501113-20241024-00556.

ABSTRACT

Objective: To reveal the role of dietary composition in the onset and prognosis of patients with liver cirrhosis by analyzing, exploring, and observing the correlational features between dietary composition and clinical indicators and mortality. Methods: A cirrhosis population was obtained from the National Health and Nutrition Examination survey from 2001 to 2018. Patients with cirrhosis (155 cases) were matched with healthy controls (615 cases) in accordance with a 1:4 ratio. Data on 37 food patterns, clinical indicators such as personal medical history and laboratory tests, and the status and cause of death of patients were obtained from the database. Univariate and logistic regression analyses were used to identify influencing factors. Kaplan-Meier survival curves were used to examine the impact of specific dietary intake on patient mortality. Results: Multivariate analysis revealed that patients with cirrhosis had higher daily alcohol consumption than healthy controls (OR=1.11, 95%CI: 1.03-1.19, P<0.01), while there was no statistically significant difference in food intake (P>0.05). Total starchy vegetable intake was lower in patients with cirrhosis than in controls (OR=0.38, 95%CI: 0.17-0.88, P=0.02) among the subgroup of patients with cirrhosis who drank alcohol. Total starchy vegetable intake was higher in patients with cirrhosis than in controls (OR=1.55, 95%CI: 1.01-2.38, P=0.04) among the subgroup of patients with cirrhosis who did not drink alcohol. Subgroup analysis by gender revealed that male patients with cirrhosis consumed less dark green vegetables (OR=0.24, 95%CI: 0.06-0.96, P=0.04), while female patients consumed more meat (OR=1.28, 95%CI: 1.05-1.54, P=0.01). Spearman analysis revealed no statistically significant correlation between any dietary composition and the aspartate aminotransferase-to-platelet ratio index and mortality. Conclusion: Excessive intake of starchy vegetables and meat and insufficient intake of dark green vegetables may be associated with the onset of cirrhosis in non-drinking female and male populations, respectively, suggesting the potential significance of dietary factors in the course of cirrhotic diseases.

PMID:41795972 | DOI:10.3760/cma.j.cn501113-20241024-00556

Zhonghua Gan Zang Bing Za Zhi. 2026 Feb 20;34(2):115-123. doi: 10.3760/cma.j.cn501113-20241219-00627.

ABSTRACT

Objective: To explore the occurrence of risk factors, construct a nomogram, and evaluate its predictive value for progressive liver fibrosis (PLF) in patients with metabolic-associated fatty liver disease (MAFLD). Methods: The clinical data of 259 MAFLD cases who visited the Obesity Department of Hubei Provincial Hospital of Traditional Chinese Medicine from May 2022 to October 2023 was retrospectively analyzed. Patients were divided into the PLF and non-progressive liver fibrosis (NPLF) group based on whether their liver stiffness measurement (LSM) value detected by FibroTouch >12 kPa. Univariate analysis was used to screen influencing factors. The original dataset of influencing factors was reconstructed using the Synthetic Minority Over-sampling Technique (SMOTE) algorithm. LASSO-logistic regression was used to determine independent risk factors for progressive liver fibrosis in MAFLD patients based on the SMOTE algorithm. A nomogram was constructed. Receiver operating characteristic (ROC) curves, Hosmer-Lemeshow calibration curves, and decision curves were plotted to evaluate the nomogram performance. Results: Univariate analysis showed statistically significant differences in terms of gender, smoking history, body mass index, visceral fat area, skeletal muscle content, basal metabolic rate, waist circumference, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1, high-sensitivity C-reactive protein (hs-CRP), glycated hemoglobin, homeostatic model assessment for insulin resistance index (HOMA-IR), ultrasound attenuation parameter (UAP), and stages of liver fatty degeneration (P<0.05) between the PLF group and the NPLF group. LASSO-logistic regression showed that HDL-C, hs-CRP, HOMA-IR, and UAP were independent occurrence risk factors for progressive liver fibrosis in MAFLD (P<0.05). The nomogram model constructed based on logistic regression results showed areas under the ROC curves of 0.893 (95% CI: 0.848-0.938), 0.802 (95% CI: 0.711-0.892), and 0.863 (95% CI: 0.815-0.911) in the SMOTE training, validation, and original datasets, respectively. The Hosmer-Lemeshow tests showed all P>0.05. The calibration curves indicated substantial consistency between the model’s predictions and actual results. Decision curve analysis showed that the model had high clinical benefit when the threshold probabilities were 0.02-0.87, 0.03-0.96, and 0.02-0.79, respectively. Conclusion: HDL-C, hs-CRP, HOMA-IR, and UAP levels are independent risk factors for progressive liver fibrosis. The nomogram model established on these grounds has high accuracy and can be used for early-stage identification and risk prediction of progressive liver fibrosis in patients with MAFLD.

PMID:41795970 | DOI:10.3760/cma.j.cn501113-20241219-00627

Int J Neuropsychopharmacol. 2026 Mar 9:pyag009. doi: 10.1093/ijnp/pyag009. Online ahead of print.

ABSTRACT

IMPORTANCE: Seltorexant, a selective orexin-2 receptor (OX2R) antagonist, has demonstrated antidepressant effects in major depressive disorder (MDD), particularly among patients with higher baseline insomnia symptoms.

OBJECTIVE: To investigate flexibly dosed seltorexant vs flexibly dosed quetiapine extended release (quetiapine-XR) as adjunctive treatment to a selective serotonin (SSRI) or serotonin-norepinephrine (SNRI) reuptake inhibitor.

SETTING: Outpatient.

DESIGN: Randomized, active-controlled, multicenter, exploratory phase 2 study with screening (≤4 weeks), double-blind treatment (24 weeks), and post-treatment follow-up (2 weeks) phases.

PARTICIPANTS: Patients with MDD and inadequate response to 1-3 SSRIs/SNRIs, including an ongoing SSRI/SNRI, in the current depressive episode.

INTERVENTIONS: Flexibly dosed seltorexant (20 or 40 mg) or quetiapine-XR (150 or 300 mg, with 2-day initial dosing of 50 mg) once daily as adjunctive therapy to an SSRI/SNRI. Randomization (1:1) was stratified by baseline Insomnia Severity Index total score (≥15 vs <15). Safety, tolerability, and preliminary efficacy were evaluated.

MAIN OUTCOMES AND MEASURES: Primary efficacy endpoint was time to all-cause study drug discontinuation. Secondary efficacy endpoints included change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score. Subgroup analyses included MADRS change by mode dose (MD; most frequent daily dose received by a patient during the study). Safety and tolerability also were assessed.

RESULTS: Time to all-cause discontinuation (estimated 25th percentile [80% CI]: seltorexant, 62 [38, 83] days vs quetiapine-XR, 42 [35, 61] days; hazard ratio [80% CI]: 0.83 [0.6, 1.2]) and all-cause discontinuation (seltorexant, 41.2% vs quetiapine-XR, 47.1%; 2-sided p=.5355) did not differ significantly between treatment groups. For the seltorexant 20-mg MD group, MADRS total scores consistently improved over time and reductions were numerically greater at Weeks 18 and 24 versus the seltorexant 40-mg MD and the combined quetiapine-XR groups, and patients with higher baseline insomnia symptoms had greater improvement in MADRS total score, consistent with prior studies showing efficacy at 20 but not 40 mg (Savitz, et al. 2019; Mesens, et al. 2025). Treatment-emergent adverse event rates were 65.4% for seltorexant and 80.8% for quetiapine-XR.

CONCLUSIONS AND RELEVANCE: Results support the favorable tolerability and preliminary efficacy of seltorexant 20 mg daily as adjunctive treatment in patients with MDD, especially those with insomnia symptoms, and suggest potential approaches to differentiate seltorexant from quetiapine-XR in future adequately powered studies. Trial registration. Clinicaltrials.gov identifier: NCT03321526.

PMID:41795948 | DOI:10.1093/ijnp/pyag009

Fam Process. 2026 Mar;65(1):e70128. doi: 10.1111/famp.70128.

ABSTRACT

The purpose of this mixed methods study is to explore the impact of a culturally adapted parent-directed training program in the United States on 90 Latine parents’ perceptions of their child’s strengths and social functioning. In addition, the study aimed to investigate the impact of the program on Latine parents’ stress and their empowerment to advocate for their children. Participants were 90 Latine parents who participated in a 10-session culturally adapted training program. Quantitative analyses of pre-post data on the Family-Outcome Survey-Revised Scale, the stress subscale of the DASS-21, and Quality of Play Questionnaire indicated statistically significant improvements. Estimates of effect size and clinical significance were also measured. Analyses indicated clinically significant changes for some Latine parents. Approximately 1 out of 4 Latine parents reported clinically significant improvements (i.e., meaningful improvement) or improvements without clinical significance as related to advocacy for their child’s rights, and 1 out of 3 Latine parents reported clinically significant improvements or slight improvements in understanding their child’s strengths. Approximately 1 out of 3 Latine parents reported clinically significant improvements or slight improvements in reducing their stress symptoms, and approximately 1 out of 3 parents reported clinically significant improvements or slight improvements in their child’s social functioning. Our qualitative findings also revealed that participants (a) appreciated the role of parent leaders, (b) applied evidence-based strategies to help their children, and (c) connected with other parents to create a community. An implication for this study is that graduate programs need to continue to teach future practitioners how to engage in interdisciplinary and interprofessional work to provide effective services to culturally diverse populations.

PMID:41795938 | DOI:10.1111/famp.70128

Endocr J. 2026 Mar 7. doi: 10.1507/endocrj.EJ25-0437. Online ahead of print.

ABSTRACT

To explore the association between stress hyperglycemia ratio (SHR) levels and cognitive function in older patients with diabetes or prediabetes. Cognitive function was assessed through a composite Z-score, the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) subtest, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). SHR was calculated as the fasting blood glucose divided by the estimated average glucose from glycated hemoglobin. In subsequent analyses, SHR was divided into quartiles (quartiles 1 to 4), with the second quartile serving as the reference group. A weighted linear regression model was used to assess the association between SHR and cognitive function. After adjusting the corresponding covariates, the analysis revealed that compared to the second quartile, the first [β: -0.26; 95% confidence interval (CI): -0.39- -0.12], third (β: -0.13, 95% CI: -0.25- -0.02), and fourth (β: -0.21, 95% CI: -0.36- -0.06) quartiles were all associated with a decrease in Z-score. The first quartile was associated with a decline in AFT (β: -1.46, 95% CI: -2.57- -0.36). The first (β: -3.72, 95% CI: -6.06- -1.38) and fourth (β: -2.58, 95% CI: -4.98- -0.17) quartiles were associated with a decline in DSST. No statistically significant associations were observed between any of the quartile groups and CERAD (all p > 0.05). Both higher and lower SHR were associated with poorer overall cognitive function, with higher and lower SHR being related to worse memory dimensions, while lower SHR was associated with impaired executive function.

PMID:41795936 | DOI:10.1507/endocrj.EJ25-0437

Circ J. 2026 Mar 7. doi: 10.1253/circj.CJ-25-0889. Online ahead of print.

ABSTRACT

BACKGROUND: Because the prognostic value of lipoprotein(a) [Lp(a)] levels in Japanese patients remains unclear, we assessed their distribution and association with long-term outcomes in ST-segment elevation myocardial infarction (STEMI).

METHODS AND RESULTS: In our retrospective analysis of 868 consecutive patients with STEMI, the median serum Lp(a) level was 15.75 mg/dL at admission, and the median follow-up was 736.5 days. Using restricted cubic spline analysis, we stratified patients into high (≥47.26 mg/dL) and low (<47.26 mg/dL) Lp(a) groups. The high Lp(a) group had a higher proportion of older and female patients, with lower body weight, estimated glomerular filtration rate, and stent use, and higher dyslipidemia prevalence than those in the low Lp(a) group. The 5-year cumulative incidence of the composite primary endpoint (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or any revascularization) was significantly higher in the high Lp(a) group, primarily because of a high rate of any revascularization. Patients with elevated Lp(a) levels demonstrated higher rates of any revascularization for both de novo and restenotic lesions than those with lower levels. After adjusting for confounders, a high Lp(a) level was identified as an independent predictor of the primary endpoint (hazard ratio:1.932; 95% confidence interval:1.255-2.974).

CONCLUSIONS: In Japanese patients with STEMI, elevated Lp(a) levels were independently associated with worse long-term outcomes.

PMID:41795930 | DOI:10.1253/circj.CJ-25-0889

Environ Health Prev Med. 2026;31:17. doi: 10.1265/ehpm.25-00403.

ABSTRACT

BACKGROUND: Exposure to microplastics (MPs) can have adverse gastrointestinal effects by inducing inflammation and oxidative stress. The types of MPs in stool vary with the dietary intake. However, how MPs in the intestinal tract influence the inflammatory cytokine levels in the gastrointestinal tract in healthy individuals remains unclear, particularly in Japan, characterized by a high intake of vegetables and seafood. In this study, we investigated the relationship between food intake, stool MPs, and inflammatory markers in healthy Japanese individuals, and estimated the sources of the stool MPs.

METHODS: Twenty-two participants completed a questionnaire on daily food intake for 7 days. Thereafter, stool samples were collected to examine MP density via Fourier-transform infrared spectrophotometry. On day 8, blood samples were collected and analyzed for serum oxidative stress markers and cytokine levels. Next, the effect of total stool MP particle density (Low vs. High) on oxidative stress markers and cytokines levels was analyzed.

RESULTS: The median total MP particle density of the participants (median age: 44 years) was 7.20 MP particles per g of stool. Seafood intake was higher in the High MP group than in the Low MP group, with a Mann-Whitney U test yielding p = 0.035 for seafood intake. However, after the false discovery rate (FDR) correction, this effect was not significant. Nevertheless, the effect size for seafood intake was large, suggesting an association with MP level. Relative to the Low MP group, the High MP group showed significantly higher thymic stromal lymphopoietin (TSLP) levels (odds ratio: 13.5; 95% confidence interval: 0.99-183, p = 0.050). The analysis further revealed that the seafood consumed by the High MP group contained significant amounts of polyethylene (PE) and polypropylene (PP), MPs commonly used in plastic packaging (PE, p = 0.028; PP, p = 0.053).

CONCLUSION: This study showed that stool MP particle density is likely associated with seafood intake and the TSLP level, implying that excessive MP intake may adversely affect human health. Therefore, measures to reduce MP exposure are urgently required.

PMID:41795929 | DOI:10.1265/ehpm.25-00403