Category: Statistics

J Clin Oncol. 2026 Jan 16:JCO2502821. doi: 10.1200/JCO-25-02821. Online ahead of print.

NO ABSTRACT

PMID:41632520 | DOI:10.1200/JCO-25-02821

Jpn J Clin Oncol. 2026 Feb 3:hyag010. doi: 10.1093/jjco/hyag010. Online ahead of print.

ABSTRACT

BACKGROUND: Total gastrectomy (TG) is commonly performed as the standard treatment for upper third advanced gastric cancer (AGC). Proximal gastrectomy (PG) may be a potential alternative procedure for upper-third AGC. However, its oncologic safety remains uncertain. This study aimed to compare the long-term outcomes of PG and TG for upper-third AGC and to evaluate the oncological safety of PG.

METHODS: We retrospectively analyzed the data of patients who underwent PG or TG for clinical T2-T4aNanyM0 upper-third gastric cancer at six institutions between 2018 and 2022. To minimize selection bias, propensity score matching (PSM) was performed at a 1:1 ratio. The primary endpoint was overall survival (OS).

RESULTS: A total of 208 patients with upper-third AGC were included. After PSM, 104 patients were selected for analysis, with 52 patients in each group. The 3-year OS rates were 81.8% in the PG group and 70.8% in the TG group, with no statistically significant difference between the two groups (P = .167), with a hazard ratio for PG of 0.58 (95% confidence interval, 0.27-1.27; P = .173). Subgroup analysis revealed that the hazard ratio for OS was significantly lower in the PG group than in the TG group among patients with tumor diameters <50 mm.

CONCLUSIONS: The long-term survival outcomes of PG and TG for upper-third AGC patients are comparable, suggesting that PG may be an oncologically acceptable option in carefully selected patients.

PMID:41632509 | DOI:10.1093/jjco/hyag010

J Anim Sci. 2026 Feb 3:skag021. doi: 10.1093/jas/skag021. Online ahead of print.

ABSTRACT

The objectives of this study were to evaluate the effect of diet type on feed intake, animal performance and intake rank in mature, gestating Angus cows (130 ± 13 days pregnant at trial initiation) and to identify differentially expressed genes associated with each diet type. Forty-eight gestating commercial Angus cows (708 ± 52 kg of body weight; 7 ± 0.75 years old) were assigned to one of two diet sequences, concentrate-forage (CF) or forage-concentrate (FC), representing the order in which the two diets were consumed. In the first period, two of the four pens were assigned to the CF sequence and two to the FC sequence. Each pen contained an automatic waterer as well as four GrowSafe® feed intake units (GrowSafe System Ltd., Airdire, Alberta). The forage diet consisted of 100% processed hay (10.0% CP, 1.98 Mcal ME/kg DM) while the concentrate diet consisted of 43.0% hay, 22.0% corn, 24.0% soybean hulls, and 11.0% supplement on a DM basis (11.7% CP, DM basis and 2.43 Mcal ME/kg DM). Following a 14-day adaptation period, feed intake and body weight (BW) gain were recorded for 56 days. Subsequently, diet type was switched and followed by 14 days of adaptation to the new diet and 48 days of feed intake and BW gain measurement. Intake and performance data from this crossover study were analyzed using mixed model methods in SAS v9.4. There was a diet by period interaction (P < 0.01) for ADG with cows in the FC sequence gaining more weight than expected while consuming forage. Spearman rank correlation for dry matter intake (DMI) was 0.70 (P < 0.01) for FC cows and 0.36 (P < 0.1) for CF cows. In contrast, there was no significant relationship for average daily gain (ADG) among the two diet types, regardless of sequence (P > 0.4). In total, RNA sequencing of muscle tissue from the first period identified differentially expressed genes (DEG) associated with diet type. Enriched biological processes were identified by functional enrichment analysis of the DEG using g: Profiler and were primarily associated with energy metabolism and lipid biosynthesis. The results of this study support the hypothesis that gene expression in muscle responds differently when cows consume low-quality forage versus high-quality, energy-rich diets, even though feed intake rank correlations were high in the FC sequence and moderate in the CF sequence.

PMID:41632486 | DOI:10.1093/jas/skag021

JAMA Netw Open. 2026 Feb 2;9(2):e2556840. doi: 10.1001/jamanetworkopen.2025.56840.

ABSTRACT

IMPORTANCE: Reproductive factors are associated with ovarian cancer risk, but their influence may differ across menopausal status and birth cohorts.

OBJECTIVE: To examine the associations between reproductive factors and ovarian cancer risk stratified by menopausal status and birth cohort.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based cohort study obtained data from the National Health Insurance Service (NHIS), a single-payer system covering 97% of the population in South Korea. Women aged 40 years or older who underwent NHIS health screening in 2009 and had reproductive, clinical, and other data were included and followed up until ovarian cancer diagnosis, death, or December 31, 2022. Data were analyzed in March 2025.

EXPOSURES: Age at menarche, parity, breastfeeding duration, oral contraceptive use, age at menopause, total reproductive span, and hormone replacement therapy use.

MAIN OUTCOMES AND MEASURES: Incident ovarian cancer identified from NHIS claims with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes C56, C57, and C48 and confirmed through the Rare/Intractable Disease Registry (code V193). Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% CIs.

RESULTS: A total of 2 285 774 women (932 637 [40.8%] premenopausal, 1 353 137 [59.2%] postmenopausal; mean [SD] age, 54.9 [10.85] years) were included in the final analytic cohort. The mean (SD) follow-up duration overall was 10.7 (2.99) years, and 10 729 ovarian cancer cases were identified during follow-up. Early menarche (aged ≤12 vs >16 years) was associated with higher ovarian cancer risk in both premenopausal women (HR, 1.37; 95% CI, 1.16-1.61) and postmenopausal women (HR, 1.24; 95% CI, 1.00-1.54). Parity of 2 or more births was associated with lower risk in both groups (HR, 0.68 [95% CI, 0.58-0.79] and 0.71 [95% CI, 0.60-0.85]). Breastfeeding for 12 months or longer and oral contraceptive use for 1 year or longer were associated with lower risk in premenopausal women but not postmenopausal women (HR, 0.86 [95% CI, 0.77-0.96] and 0.75 [95% CI, 0.61-0.93]). Among postmenopausal women, later menopause (at age ≥55 years; HR, 1.36 [95% CI, 1.11-1.66]), longer reproductive span (≥40 years; HR, 1.21 [95% CI, 1.09-1.34]), and hormone replacement therapy use for 2 to 5 years (HR, 1.20 [95% CI, 1.07-1.34]) were associated with higher risk. Parity-related risk reduction was attenuated in the 1960s birth cohort (HR, 1.07; 95% CI, 0.52-2.19; P for interaction = .36).

CONCLUSIONS AND RELEVANCE: This cohort study found that reproductive factors were associated with ovarian cancer risk, with distinct patterns across menopausal status and birth cohorts. These findings highlight the need for tailored prevention strategies in aging, low-fertility populations.

PMID:41632476 | DOI:10.1001/jamanetworkopen.2025.56840

JAMA Netw Open. 2026 Feb 2;9(2):e2557337. doi: 10.1001/jamanetworkopen.2025.57337.

ABSTRACT

IMPORTANCE: The 2022 Supreme Court decision in Dobbs v Jackson Women’s Health Organization resulted in immediate abortion bans or severe restrictions in 22 US states. While mental health consequences of restricted abortion access have been suggested, their distribution across socioeconomic strata remain unclear for postpartum depression (PPD) among Medicaid populations.

OBJECTIVE: To assess associations of state-level abortion bans enacted after Dobbs with the incidence of PPD, focusing on socioeconomic status (SES) differences.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a difference-in-differences (DD) analysis for Medicaid claims data from Kythera Labs (approximately 60% of US Medicaid population) from January 2019 to December 2024. Women and adolescents aged 12 to 55 years with pregnancies resulting in live births or stillbirths were stratified into SES terciles based on zip code-level census data.

EXPOSURE: State-level abortion bans or restrictions implemented after Dobbs, defined by residence in trigger law states.

MAIN OUTCOMES AND MEASURES: The primary outcome was incidence of PPD within 12 months following delivery, identified through validated claims-based algorithms.

RESULTS: The study comprised 102 597 individuals pre-Dobbs (mean [SD] age, 27.21 [5.82] years; 47 305 individuals in trigger states and 55 292 individuals in nontrigger states) and 61 113 individuals post-Dobbs (mean [SD] age, 27.48 [5.92] years; 30 451 individuals in trigger states and 30 662 individuals in nontrigger states). Individuals in trigger states were younger than individuals in nontrigger states both pre-Dobbs (mean [SD] age, 26.53 [5.69] years vs 27.97 [5.84] years) and post-Dobbs (mean [SD] age, 26.61 [5.77] years vs 28.34 [5.94] years). Both pre- and post-Dobbs, individuals in trigger states were more likely to reside in rural areas (pre-Dobbs: 10 562 individuals [22.33%] vs 10 079 individuals [18.23%]; post-Dobbs: 6739 individuals [22.13%] vs 5220 individuals [17.02%]) and low-SES areas (pre-Dobbs: 20 136 individuals [42.57%] vs 13 771 individuals [24.91%]; post-Dobbs: 12 924 individuals [42.44%] vs 7283 [23.75%]); they were less likely to have obstetrical complications (pre-Dobbs: 31 243 individuals [66.05%] vs 42 780 individuals [77.37%]; post-Dobbs: 21 052 individuals [69.13%] vs 24 577 individuals [80.15%]) or maternal complications (pre-Dobbs:7732 individuals [16.34%] vs 10 839 of individuals [19.60%]; post-Dobbs: 5779 of 30 451 individuals [19.04%] vs 6508 individuals [21.17%]). Women with lowest SES residing in trigger states experienced a 9.0% relative increase in PPD diagnoses post-Dobbs vs similar women in nontrigger states (DD coefficient, 0.090; 95% CI, 0.035-0.146; P = .001). No associations were observed in middle or high SES groups.

CONCLUSIONS AND RELEVANCE: In this cohort study, state-level abortion bans following Dobbs were associated with a disproportionate increase in the risk of PPD among women and adolescents in low-SES communities. These findings underscore the need for targeted mental health support and policy interventions to mitigate the unequal burden of such legislation on vulnerable populations.

PMID:41632475 | DOI:10.1001/jamanetworkopen.2025.57337

JAMA Netw Open. 2026 Feb 2;9(2):e2557361. doi: 10.1001/jamanetworkopen.2025.57361.

ABSTRACT

IMPORTANCE: The requirement for in-person, often daily, attendance at opioid treatment programs (OTPs) makes travel times a barrier to methadone treatment. Research on methadone accessibility has primarily focused on travel via personal vehicle, and there is uncertainty about public transit travel time to methadone treatment.

OBJECTIVE: To estimate travel time via personal vehicle vs public transit to methadone treatment in the state of Connecticut.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included geospatial analysis of median travel time to nearest OTP via personal vehicle and public transit from all census block groups (CBGs). This study took place in the state of Connecticut in 2023. Participants were all CBGs in Connecticut.

EXPOSURES: Participants were characterized by racial and ethnic demographics; household income; car ownership; urban, suburban, or rural designations; and per-capita opioid overdose deaths.

MAIN OUTCOMES AND MEASURES: The primary outcome was the median travel time to nearest OTP by via personal vehicle and public transit. Spatial error models using k-nearest neighbor spatial weight matrices were estimated to assess the associations between sociodemographic characteristics and travel times for each transportation mode (personal vehicle vs public transit) at the CBG level.

RESULTS: From the centroids of the 2702 CBGs in Connecticut, the median (IQR) travel time to the closest OTP was 11.0 (7.5-16.3) minutes by personal vehicle and 41.7 (31.0-49.5) minutes via public transit, with 1431 CBGs (53%) lacking access to public transit or having high public transit times (>60 minutes or no trip available). Travel times via public transit increased along the urban-rural gradient and across CBGs with an increasing percentage of non-Hispanic White residents. Median (IQR) travel times to an OTP from the 489 CBGs with the highest per-capita overdose death rates were 8.2 (5.9-11.7) minutes by personal vehicle and 37.6 (27.8-48.5) minutes by public transit, with 166 (34%) lacking public transit access.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study of barriers to access to methadone treatment suggest that areas with high overdose death rates, low car ownership, and high public transit travel times should be targets for interventions (eg, mobile services or greater use of take-home doses for patients) to lower travel-based barriers to methadone. Current federal statutes and regulations governing methadone provision are the greatest barrier, as they directly require often daily transit to opioid treatment clinics. Reducing this barrier requires policy changes.

PMID:41632474 | DOI:10.1001/jamanetworkopen.2025.57361

JAMA Netw Open. 2026 Feb 2;9(2):e2557415. doi: 10.1001/jamanetworkopen.2025.57415.

ABSTRACT

IMPORTANCE: As SARS-CoV-2 JN.1 lineage descendants continue to evolve, evaluating COVID-19 vaccine effectiveness (VE) against severe COVID-19 remains important to guide vaccination strategies.

OBJECTIVE: To estimate the VE of the 2024-2025 COVID-19 vaccines against COVID-19-associated hospitalization and severe in-hospital outcomes overall and by time since dose (7-89, 90-179, and ≥180 days), JN.1 descendant lineage (KP.3.1.1, XEC, LP.8.1), and spike protein mutations associated with immune evasion.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, test-negative, case-control study conducted by the Investigating Respiratory Viruses in the Acutely Ill Network included adult patients (aged ≥18 years) hospitalized between September 1, 2024, and April 30, 2025, at 26 hospitals in 20 US states. Case patients presented with COVID-19-like illness and positive SARS-CoV-2 nucleic acid or antigen test results; control patients had COVID-19-like illness but tested negative for SARS-CoV-2.

EXPOSURE: Receipt of a 2024-2025 COVID-19 vaccine at least 7 days before illness onset.

MAIN OUTCOMES AND MEASURES: Main outcomes were COVID-19-associated hospitalization and severe in-hospital outcomes (supplemental oxygen therapy, acute respiratory failure, intensive care unit admission, and invasive mechanical ventilation or death). Logistic regression was used to estimate the odds of vaccination in case and control patients, adjusting for demographics, clinical characteristics, and enrollment region. The VE was estimated as (1 – adjusted odds ratio) × 100%.

RESULTS: A total of 8493 patients (median [IQR] age, 66 [54-76] years; 4338 female [51.1%]), including 1888 case patients with COVID-19 (among whom 951 [50.4%] had successful whole-genome sequencing, including 348 [36.6%] with KP.3.1.1, 218 [22.9%] with XEC, and 134 [14.1%] with LP.8.1 infections) and 6605 control patients were enrolled. Vaccine effectiveness against COVID-19-associated hospitalization was 40% (95% CI, 27%-51%), and protection was sustained through 90 to 179 days after vaccination. Vaccine effectiveness was higher against the most severe outcome of invasive mechanical ventilation or death at 79% (95% CI, 55%-92%). It was 49% (95% CI, 25%-67%) against hospitalization with KP.3.1.1, 34% (95% CI, 4%-56%) against XEC, and 24% (95% CI, -19% to 53%) against LP.8.1, with increasing median time since dose receipt among vaccinated case patients due to sequential circulation patterns (60, 89, and 141 days, respectively). The VE was similar against lineages with spike protein S31 deletion (41% [95% CI, 22%-56%]) and T22N and F59S substitutions (37% [95% CI, 9%-57%]).

CONCLUSIONS AND RELEVANCE: In this multicenter, case-control analysis of VE, 2024-2025 COVID-19 vaccines may have provided protection against hospitalizations and severe in-hospital outcomes as multiple JN.1 descendant lineages circulated. Monitoring COVID-19 VE, including stratifying by SARS-CoV-2 lineage and spike protein mutations, remains important to guide COVID-19 vaccine composition and recommendations.

PMID:41632473 | DOI:10.1001/jamanetworkopen.2025.57415

JAMA Netw Open. 2026 Feb 2;9(2):e2557546. doi: 10.1001/jamanetworkopen.2025.57546.

ABSTRACT

IMPORTANCE: Depression and factors reflecting neighborhood social structure (ie, socioeconomic deprivation, ethnic heterogeneity, residential mobility, and urbanicity) have each been linked to criminal convictions. However, how the association between depression and crime varies across different neighborhood types, and the extent to which it reflects unmeasured familial confounding, remains unclear.

OBJECTIVE: To examine whether the association between depression and violent and nonviolent criminal convictions varies across neighborhood types, and to assess the extent to which unmeasured familial factors contribute to the association.

DESIGN, SETTING, AND PARTICIPANTS: This population-based matched cohort and sibling-comparison study used data from Swedish national registers from 1986 to 2020. Follow-up spanned from 2001 to 2020. Statistical analyses were performed from January to November 2025. The cohort included individuals with a diagnosis of depression, each matched to 5 population controls without depression by birth year, sex, and neighborhood type.

EXPOSURE: Outpatient depression diagnosis (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F32-F33.9) recorded from 2001 to 2020.

MAIN OUTCOMES AND MEASURES: The primary outcomes were violent and nonviolent criminal convictions after diagnosis, identified through the National Crime Register. Conditional logistic regression estimated odds ratios (ORs) across 4 neighborhood types (resource-limited, rural low-diversity, urban professional, and urban affluent neighborhoods), with sibling comparisons used to assess familial confounding.

RESULTS: Among 571 470 matched individuals, 95 245 (36 297 male [38.1%]; median [IQR] age at first diagnosis, 20 [17-24] years) had depression. Depression was associated with increased odds of both violent and nonviolent convictions across all neighborhood types in unadjusted models. After adjustment for prior convictions, substance use disorder, and attention-deficit/hyperactivity disorder, associations remained significant in all but resource-limited neighborhoods (violent conviction OR, 1.14 [95% CI, 0.97-1.33]; nonviolent conviction OR, 1.01 [95% CI, 0.92-1.11]). A second sample included 42 585 individuals with depression and their full siblings without depression (total, 85 170 individuals). Sibling comparisons showed partial attenuation, indicating that familial confounding accounted for some, but not all, of the associations. Sibling-matched estimates were largely consistent with fully adjusted general population-matched estimates (eg, violent convictions in rural low-diversity neighborhoods: sibling-matched OR, 1.50 [95% CI, 1.33-1.69] vs general population-matched OR, 1.51 [95% CI, 1.39-1.65]).

CONCLUSIONS AND RELEVANCE: In this cohort study of the Swedish general population, the association between depression and criminal convictions varied across neighborhood types and was partially explained by familial factors. These findings underscore the relevance of considering contextual and familial influences and may offer insights for prevention and intervention strategies responsive to neighborhood social environments.

PMID:41632471 | DOI:10.1001/jamanetworkopen.2025.57546

J Trauma Acute Care Surg. 2026 Jan 21. doi: 10.1097/TA.0000000000004896. Online ahead of print.

ABSTRACT

BACKGROUND: Previous trials have found a modest survival benefit from tranexamic acid (TXA) administration after polytrauma, but the early discrimination of the survival benefit observed suggests that the clinical effect of TXA may be multifactorial, not solely through bleeding reduction. Plasmin is known to directly cleave and activate complement proteins, and TXA can inhibit plasmin generation. We hypothesized that polytrauma patients who received TXA would demonstrate less complement activation compared with placebo controls.

METHODS: Patient plasma was obtained from 53 polytrauma patients enrolled in the Pre-hospital Antifibrinolytics for Traumatic Coagulopathy and Hemorrhage (PATCH) trial of prehospital TXA (1 g bolus plus 1 g drip over 8 hours) versus placebo in the emergency department, at 8 hours, and at 24 hours after admission. Complement activation and regulatory markers were measured via multiplex, and plasmin-antiplasmin levels via enzyme-linked immunosorbent assay. Pairwise comparisons of analytes between TXA and placebo at each time point were performed with significance set at p < 0.05.

RESULTS: The median age was 41.0 years (interquartile range, 28-57 years), 69.8% were male, the median Injury Severity Score was 38.0 (27.0-50.0), and all included patients were blunt mechanism. At early time points (emergency department and 8 hours), patients who received TXA did not demonstrate a reduction in C3a, C5a, sC5b-9, or plasmin-antiplasmin relative to placebo. At 24 hours, there was a significant increase in both C3a (274.0 vs. 416.6 ng/mL, p = 0.0024) and C5a (9.4 vs. 11.6 ng/mL, p = 0.0462) in the TXA group.

CONCLUSION: A 1 g bolus plus 1 g drip of TXA paradoxically increased complement activation at 24 hours in the TXA group. These findings support that TXA is essential in the inflammatory pathway after trauma. The delayed increase in complement may reflect the timing of TXA dosing and the shift to urokinase as the main plasminogen activator at later time points after injury. These results raise important questions about the optimal dosing of TXA in trauma patients.

PMID:41632465 | DOI:10.1097/TA.0000000000004896

AANA J. 2026 Feb 1;94(1):42-48. doi: 10.70278/AANAJ/.0000001057.

ABSTRACT

Obstetric anesthesia is an important subspecialty of anesthesia requiring specialized training to meet the distinctive needs of maternal care. Variations in obstetric anesthesia education create deficiencies for some nurse anesthesiologists upon graduation. The purpose of this study was to evaluate incorporating dedicated obstetric anesthesia rotation for nurse anesthesia residents at a northeastern university, focusing on training outcomes, preparedness, and perceptions of obstetric anesthesia as a subspecialty. Certified registered nurse anesthetists (CRNAs) graduated between 2018 and 2023 received a survey. Two groups were analyzed: with and without the obstetric rotation. The survey assessed clinical experience, obstetric anesthesia preparedness, and perceptions of obstetric anesthesia as a specialty using Likert-scale questions and open-ended feedback. Numerical data were analyzed using descriptive statistics, paired t-tests, and graphical representation. CRNAs with the obstetric rotation reported significantly fewer challenges meeting minimum epidural requirements, higher confidence in managing obstetric cases, and greater recognition of the importance of the training. In contrast, CRNAs without the rotation highlighted deficiencies in epidural training. An obstetric rotation is important to instill the confidence necessary for CRNAs to achieve full scope of practice capabilities. In addition to an obstetric specialty rotation, recommendations include advocacy for CRNA training, a focus on obstetric anesthesia subspecialty development, and access for educators to resources assisting in creating this rotation.

PMID:41632460 | DOI:10.70278/AANAJ/.0000001057