Category: Statistics

Int J Radiat Oncol Biol Phys. 2026 Aug 15:S0360-3016(26)04147-7. doi: 10.1016/j.ijrobp.2026.07.051. Online ahead of print.

ABSTRACT

PURPOSE: Lattice radiation therapy is an innovative three-dimensional implementation of spatially fractionated radiation therapy. This study aimed to develop a novel lattice-based proton arc therapy (PAT) technique to deliver a highly modulated peak-valley spatial dose distribution and a modulated linear energy transfer (LET) distribution.

METHODS AND MATERIALS: We introduced a PAT lattice algorithm that optimizes three key components, including energy-layer selection, spot assignment, and LET optimization (PAT_LESL). A simulated annealing algorithm was used to select the optimal energy layers. Meanwhile, an adaptive spot assignment strategy was implemented using a spot-sparsity optimization algorithm based on the primal-dual active set with continuation to achieve an improved peak-to-valley dose ratio (PVDR). Subsequently, LET optimization was achieved using the alternating direction method of multipliers with a minimum monitor unit constraint. Eighteen patients were selected to evaluate plan quality and delivery efficiency compared with the lattice technique based on the previously reported spot-scanning proton arc therapy energy sequence optimization algorithm (PAT_seq). Feasibility and dosimetric accuracy were further validated using clinical phantom measurements.

RESULTS: Compared with PAT_seq, the PAT_LESL plan exhibited improved dose and LET distributions with higher delivery efficiency. More specifically, PAT_LESL achieved steeper dose gradients, improving the PVDR from 16.90 ± 18.04 to 41.85 ± 29.69 (p < 0.01), shortening the beam delivery time by 37.43%, and increasing the target spot coverage by 44.12% while reducing the spot number by 93.78%. It also increased the mean LET in the LTV from 2.84 ± 0.38 to 3.59 ± 0.26 keV/μm (p < 0.01), on average. Meanwhile, the phantom measurement confirmed high agreement between the planned and delivered results.

CONCLUSIONS: A novel PAT lattice technique using adaptive spot assignment and LET optimization could deliver an enhanced peak-valley spatial dose distribution. Experimental validation on a clinical proton system confirmed deliverability and dosimetric accuracy, which may facilitate future clinical translation of proton lattice radiotherapy.

PMID:42603564 | DOI:10.1016/j.ijrobp.2026.07.051

Int J Radiat Oncol Biol Phys. 2026 Aug 15:S0360-3016(26)04154-4. doi: 10.1016/j.ijrobp.2026.07.063. Online ahead of print.

ABSTRACT

PURPOSE: Significant advancements in external beam radiotherapy (RT) over the past 20+ years have occurred with evolution from 2D techniques based on plain film x-rays to three-dimensional (3D) conformal and intensity modulated photon techniques. Likewise, proton radiotherapy (PRT) was also introduced and has become more widely available. Each advance in radiation technique improves targeting and has the potential to mitigate late effects associated with RT. In this study, we use metadata from past and present Children’s Oncology Group (COG) trials that included RT to describe the evolution of different RT modalities across time and disease sites.

METHODS: Imaging and Radiation Oncology Core (IROC) database was queried for protocols with at least one patient receiving RT during 1998-2025. Protocol metadata including primary disease site, study timeline and quality assurance (QA) was extracted, as was non-identifiable patient-level variables including age, institution, year of enrollment, and RT modality utilized. Descriptive statistics were used for downstream analysis.

RESULTS: The study population comprised 8,898 patients, including 7,881 from the USA and 1,017 from other countries. The median age at enrollment was 9 years; California, Texas, Florida and New York were among the top contributing states. Of the 83 included COG trials, 48 included at least one patient receiving PRT. The number of trials allowing PRT peaked in 2010 with 17 protocols. Trials involving central nervous system (CNS) tumors and rhabdomyosarcoma soft tissue sarcomas (RST) dominated both in the number of trials and enrollment. They were also among the earliest to incorporate PRT into treatment protocols. From 1998 to 2025, 3D photon-based treatments declined from 73% to 15%, while IMRT/VMAT usage rose from 26% to 89% over the same interval. The use of PRT increased from 2% pre-2000 to nearly 40% in 2021, which has since stabilized. QA review demonstrated >90% protocol compliance across all RT modalities both nationally and internationally.

CONCLUSIONS: Over 25 years of COG experience, photon therapy has transitioned from 3D conformal to IMRT/VMAT, while PRT use has continued to expand, particularly in CNS and RST trials. These trends highlight how pediatric cooperative-group studies continue to shape national standards and underscore the need for future work linking modality adoption with toxicity, survivorship, and access across diverse treatment settings.

PMID:42603563 | DOI:10.1016/j.ijrobp.2026.07.063

J Affect Disord. 2026 Aug 15:122364. doi: 10.1016/j.jad.2026.122364. Online ahead of print.

ABSTRACT

BACKGROUND: This post-hoc analysis examined the effect of sustained psychiatric medication on suicide reattempt risk among Korean patients with depression following an initial attempt.

METHODS: Using the Korean Health Insurance Review and Assessment Service (HIRA) database, we identified adults aged 18 years and older diagnosed with depressive disorder who attempted suicide in 2014 (N = 4925; mean age 47.4 ± 17.3 years, range 19-96). Sustained psychiatric medication was defined as receiving antidepressant or antipsychotic treatment for ≥75% of the six months after the index attempt. Stabilized inverse-probability-of-treatment weighting (IPTW) based on propensity scores addressed baseline imbalances. Logistic regression assessed one-year reattempt risk; survival analyses examined long-term risk over up to seven years (from index through August 31, 2020; median follow-up 5.9 years, maximum 6.7 years). Exploratory subgroup analyses compared patients <65 and ≥ 65 years.

RESULTS: After IPTW, baseline characteristics were balanced. The one-year reattempt rate was 5.3% with medication versus 7.9% without (OR:0.65, 95% CI:0.504-0.846, P = 0.001). Survival analyses over the seven-year follow-up showed no significant long-term difference (IPTW-adjusted log-rank P = 0.886). The protective effect was evident only in patients <65 years (OR:0.621, 95% CI:0.471-0.822, P < 0.001), with no significant effect in those ≥65 years.

CONCLUSIONS: Sustained psychiatric medication after a suicide attempt reduces one-year reattempt risk in patients with depression, in particular in those aged under 65 years. The benefit of initial treatment did not persist over seven years, suggesting that the effect of continued treatment beyond six months warrants future investigation.

PMID:42603561 | DOI:10.1016/j.jad.2026.122364

Georgian Med News. 2026 Jun;(375):222-229.

ABSTRACT

BACKGROUND: Tamsulosin and 5α-reductase inhibitors (finasteride and dutasteride) are widely prescribed for benign prostatic hyperplasia (BPH). However, their systemic effects on metabolic, renal, and hepatic functions remain incompletely understood.

OBJECTIVE: To evaluate the safety profile of tamsulosin monotherapy compared with combination therapies (tamsulosin plus finasteride or dutasteride) on lipid profile, renal function, liver enzymes, and bilirubin levels in men with BPH.

METHODS: This cross-sectional study included 102 male participants aged >50 years, divided into five groups: healthy controls (n=26), newly diagnosed treatment-naïve BPH (n=25), BPH receiving tamsulosin monotherapy >3 months (n=26), BPH receiving tamsulosin+finasteride >3 months (n=11), and BPH receiving tamsulosin+dutasteride >3 months (n=14). Serum lipid profile (total cholesterol, triglycerides, HDL-C, LDL-C, VLDL, atherogenic index), renal function (urea, creatinine, eGFR, uACR), liver function (ALT, AST, ALP, GGT, albumin), and bilirubin fractions (total, direct, indirect) were measured using standardized automated methods.

RESULTS: Lipid profile parameters showed no significant differences between treatment groups and controls, with all values remaining within desirable ranges. Renal function tests, including serum urea, creatinine, eGFR, and urinary albumin-to-creatinine ratio, demonstrated no clinically significant alterations across all BPH treatment groups compared to controls. Liver enzymes (ALT, AST, ALP, GGT) and serum albumin levels remained within normal limits across all groups. Total, direct, and indirect bilirubin concentrations showed no significant elevation, indicating preserved hepatic excretory function. Notably, no statistically significant differences were observed between tamsulosin monotherapy and combination therapy groups for any of the measured parameters.

CONCLUSION: Tamsulosin administered alone or in combination with finasteride or dutasteride for more than three months demonstrated non-significant differences in the measured biochemical parameters among the studied groups represented by no adverse effects on lipid metabolism, renal function, liver enzymes, or bilirubin homeostasis. These findings support the safe use of these therapeutic regimens in elderly BPH patients, including those with underlying metabolic or organ function concerns. Further prospective longitudinal studies with larger sample sizes are warranted to confirm these observations.

PMID:42603338

Georgian Med News. 2026 Jun;(375):212-221.

ABSTRACT

INTRODUCTION: Chronic venous insufficiency of the lower extremities remains one of the most significant problems of modern vascular surgery and angiology because of its high prevalence, progressive course, and association with edema, trophic skin changes, and impaired quality of life. In patients with CEAP C3-C5 disease, the outcome of surgical treatment depends not only on elimination of pathological venous reflux, but also on the degree of surgical trauma and the risk of local postoperative complications.

AIM: To evaluate the effect of a modified dissection technique for incompetent perforating veins with preservation of the accompanying artery on the incidence of local postoperative complications in patients with CEAP C3-C5 chronic venous insufficiency of the lower extremities.

MATERIALS AND METHODS: A single-center prospective non-randomized comparative clinical study was conducted at the Department of Cardiovascular Surgery of the Medical Hospital of Semey State Medical University in 2018-2021. The study included 62 patients aged 22 to 48 years with clinically significant chronic venous insufficiency of the lower extremities CEAP C3-C5 who required surgical treatment. The main group consisted of 32 patients who underwent modified dissection of incompetent perforating veins with preservation of the accompanying artery, whereas the comparison group included 30 patients operated on using the conventional technique. Preoperative assessment included clinical examination, duplex ultrasound scanning, CEAP classification, and VCSS scoring. The primary endpoint was the overall incidence of local postoperative complications; the secondary endpoint was the change in VCSS over follow-up. Statistical analysis was performed using Fisher’s exact test and the Mann-Whitney U test; p<0.05 was considered statistically significant.

RESULTS: The groups were comparable at baseline in age, CEAP clinical class distribution, and initial VCSS values. In the comparison group, local postoperative complications occurred substantially more often than in the main group. Subcutaneous hematomas were observed in 26.7% versus 6.3% of patients (p=0.040), postoperative limb edema in 40.0% versus 3.1% (p<0.001), ecchymosis in 10.0% versus 0, and skin necrosis in 6.7% versus 0, respectively. The overall incidence of at least one local postoperative complication was 53.3% in the conventional surgery group and 9.4% in the modified surgery group (p=0.00024). Absolute risk reduction was 43.9%, relative risk was 0.18, relative risk reduction was 82.4%, and the number needed to treat was 2.3. VCSS dynamics also favored the modified technique: at 6 months the score was 5 [4;6] versus 6 [5;8] (p=0.028), and at 12 months it was 4 [3;5] versus 6 [5;7] (p=0.011) in the main and comparison groups, respectively.

CONCLUSIONS: The modified dissection of incompetent perforating veins with preservation of the accompanying artery was associated with a significant reduction in the incidence of local postoperative complications in patients with chronic venous insufficiency of the lower extremities CEAP C3-C5 compared with the conventional technique. The method is associated with a more favorable early postoperative course and better subsequent clinical improvement according to VCSS, which supports its use as a tissue-sparing and pathogenetically justified surgical approach.

PMID:42603337

Georgian Med News. 2026 Jun;(375):166-174.

ABSTRACT

OBJECTIVE: To identify key clinical, laboratory, and imaging predictors of adverse outcomes in elderly patients aged 60-74 years with COVID-19.

MATERIALS AND METHODS: A comprehensive retrospective analysis was conducted among elderly patients diagnosed with COVID-19. The participants were divided into two groups: survivors (n=50) and non-survivors (n=140). The study was conducted from May to October 2021 at the City Clinical Infectious Diseases Hospital No.3 in Astana, Kazakhstan. Statistical analysis was performed using non-parametric methods, including the Mann-Whitney U test.

RESULTS: Elderly patients aged 60-74 years accounted for 48% of all in-hospital deaths during the study period (140 of 292 deaths). Adverse outcomes were strongly associated with the development of a systemic inflammatory response. In the non-survivor group, critical median values were identified for C-reactive protein (CRP) – 97.9 mg/L, interleukin-6 (IL-6) – 38.15 pg/mL, and the lung involvement on CT imaging – 45.0% (IQR: 30.0-60.0%). Concomitant chronic bronchopulmonary pathology was also more frequent in the non-survivor group than in the survivor group (31% vs. 8%). Statistically significant differences between non-survivors and survivors were found for CRP levels (p=0.001), IL-6 levels (p=0.024), CT -assessed lung involvement (p=0.032), and chronic bronchopulmonary pathology (p=0.001).

CONCLUSION: This study identified critical markers of clinical decompensation in COVID-19 patients aged 60-74 years: lung involvement≥ 45% on CT imaging (CT-2/CT-3), IL-6 >40 pg/mL, and CRP >100 mg/L. Concomitant bronchopulmonary pathology was significantly more frequent among non-survivors than among survivors (31% vs. 8%) and was associated with an adverse outcome. These findings support the need for early targeted therapy when the specified threshold values are reached.

PMID:42603331

Georgian Med News. 2026 Jun;(375):153-160.

ABSTRACT

AIM OF THE STUDY: To analyze current mental health problems, assess the prevalence of mental disorders, identify key determinants, and evaluate access to mental health care in different countries.

MATERIAL AND METHODS: A narrative analytical review with a comparative synthesis of international and national data on mental health for 2019-2025 was conducted, including scientific publications, reports and estimates from the World Health Organization, Global Burden of Disease, World Mental Health, the Organization for Economic Co-operation and Development, and national data from Ukraine.

RESULTS: Mental health significantly affects quality of life, productivity, and social stability. The COVID-19 pandemic, military conflicts, and economic instability have increased the prevalence of depressive, anxiety, and stress-related disorders worldwide. A high global burden of mental disorders and major regional differences were identified. The treatment gap remains especially high in low- and middle-income countries, where less than 10% of the population receives adequate care. In developed countries, coverage reaches 20-40%, although inequalities, long waiting times, and stigmatization persist. In Ukraine, the prevalence of mental disorders is estimated at 31-36% due to socio-economic instability and military conflict.

CONCLUSIONS: The findings highlight the need to integrate mental health services into primary health care, expand community-based support models, and implement comprehensive policies to reduce the global burden of mental disorders.

PMID:42603329

Georgian Med News. 2026 Jun;(375):128-137.

ABSTRACT

Maxillary transverse deficiency (MTD) in adults is difficult to treat due to partial or complete fusion of the midpalatal suture and the limited effectiveness of conventional orthodontic expansion techniques. Traditional methods often lead mainly to dentoalveolar changes and may cause tooth inclination, periodontal complications, and instability of treatment outcomes. The purpose of this study was to analyze morphometric changes of the maxillary complex in adult patients after treatment with standard and individualized MARPE appliances using cone beam computed tomography (CBCT) and to compare their effectiveness in achieving skeletal expansion. Adult patients with diagnosed maxillary transverse deficiency were treated with either a standard MSE-type Microimplant-Assisted Rapid Palatal Expander (MARPE) or a customized MARPE appliance developed using digital planning. CBCT examinations were performed before treatment and after the expansion phase as part of clinically indicated diagnostic and treatment monitoring protocols. Morphometric analysis included measurements of transverse parameters of the maxillary complex. Statistical analysis was conducted using paired t-tests, the Mann-Whitney U-test, and analysis of variance (ANOVA) with a significance level of p<0.05. Both appliances provided effective maxillary expansion and significant increases in transverse parameters of the upper jaw. However, the individualized MARPE demonstrated greater effectiveness compared to the standard MSE-type appliance in terms of intermolar width gain (4.8±1.5 mm versus 3.4±1.2 mm) and the frequency of midpalatal suture opening (85% versus 60%). CBCT enabled accurate three-dimensional visualization of skeletal changes and objective monitoring of treatment outcomes. The study provides a comparative evaluation of standard and customized MARPE appliances in adult patients based on CBCT morphometric data, emphasizing the advantages of individualized appliance design. Both MARPE systems are effective for treating maxillary transverse deficiency in adults. However, customized MARPE appliances provide more precise positioning, better anatomical adaptation, and potentially greater long-term stability of expansion results.

PMID:42603326

Georgian Med News. 2026 Jun;(375):118-127.

ABSTRACT

BACKGROUND: Surgical treatment of tumours of the maxilla and hard palate is often associated with persistent functional and psychosocial impairment, making quality-of-life assessment an important component of rehabilitation evaluation. The objective of the present study was to assess the applicability and psychometric characteristics of an adapted bilingual (Russian-Kazakh) version of the UW-QOL v4.1 questionnaire in patients after surgical treatment of tumours of the maxilla, hard palate, and adjacent anatomical regions, as well as to analyse quality-of-life outcomes depending on the method of functional rehabilitation.

MATERIALS AND METHODS: A cross-sectional study included 104 patients after surgical treatment of maxillary and hard palate tumours. Translation and cultural adaptation were performed using forward translation, expert consensus, and pilot testing. Internal consistency, test-retest reliability, and construct validity were assessed using standard psychometric methods. Statistical analysis was performed using IBM SPSS Statistics 26.0.

RESULTS: The overall Cronbach’s α coefficient for the 14 questionnaire domains was 0.878, indicating high internal consistency. Test-retest reliability demonstrated strong correlations across all domains (r=0.904-0.983; p<0.001). The lowest quality-of-life scores were observed in the “Saliva” (41.3±21.2) and “Taste” (43.6±21.5) domains. Patients with advanced-stage disease and those who underwent multimodal treatment had significantly lower Physical Function and Social-Emotional Function scores compared with patients with early-stage disease and monotherapy (p≤0.001). Patients using obturator prostheses demonstrated significantly higher quality-of-life scores than patients without prosthetic rehabilitation (p<0.001). Financial limitations were the most common reason for refusal of obturator rehabilitation (55.6%).

CONCLUSIONS: The adapted bilingual version of the UW-QOL v4.1 questionnaire used in the present study demonstrated good psychometric properties and may be applied for quality-of-life assessment in patients after surgical treatment of maxillary and hard palate tumours in the Republic of Kazakhstan. The findings also highlight the importance of accessible functional rehabilitation in this patient population.

PMID:42603325

Georgian Med News. 2026 Jun;(375):111-117.

ABSTRACT

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity of taxane-based chemotherapy in breast cancer. Cryotherapy using cooling gloves and socks has been investigated as a preventive strategy, although evidence remains inconsistent. This study evaluated the effect of preventive cryotherapy on neuropathy-related pain and symptom burden in patients receiving taxane-containing chemotherapy.

METHODS: This prospective multicenter controlled study included patients with stage I-IV breast cancer treated with taxane-based chemotherapy between March 2023 and September 2025. Patients either received cryotherapy during chemotherapy infusion or standard treatment without cryotherapy. Outcomes were assessed using the Edmonton Symptom Assessment System (ESAS) and EORTC QLQ-CIPN20 questionnaire. The primary outcome was final ESAS pain score. Secondary outcomes included clinically meaningful pain (ESAS ≥4), change in pain from baseline, neuropathy-related extremity pain, overall symptom burden, and functional impairment.

RESULTS: A total of 190 patients were included (95 cryotherapy; 95 control) in the final analysis. No statistically significant difference was observed in adjusted final ESAS pain scores between groups, although a trend toward higher pain scores was observed in the cryotherapy group. Clinically meaningful pain (ESAS≥4) was more frequent in the cryotherapy group (20.0% vs 8.4%; p=0.022). Adjusted analyses demonstrated higher neuropathy-related extremity pain scores in the cryotherapy group. No significant differences were observed in overall symptom burden or functional impairment.

CONCLUSION: Preventive cryotherapy did not demonstrate a significant reduction in neuropathy-related pain in patients receiving taxane-based chemotherapy. Neuropathy-specific outcomes suggested higher extremity pain in patients undergoing cryotherapy. Further randomized studies with standardized protocols are warranted.

PMID:42603324