Category: Statistics

J Urol. 2026 Jun 18:101097JU0000000000005151. doi: 10.1097/JU.0000000000005151. Online ahead of print.

NO ABSTRACT

PMID:42314173 | DOI:10.1097/JU.0000000000005151

Brain. 2026 Jun 18:awag213. doi: 10.1093/brain/awag213. Online ahead of print.

ABSTRACT

Despite improved survival in recent years, long-term outcomes in patients surviving progressive multifocal leukoencephalopathy beyond the first year remain poorly defined. This international multicenter retrospective study aimed to characterize the three-year prognosis of patients with progressive multifocal leukoencephalopathy who had survived at least one year, identify factors associated with favorable outcomes and late mortality, and determine recurrence rate. Data were collected through standardized questionnaires across forty-one centers in twelve countries. Patients were eligible if they met the 2013 diagnostic criteria for definite progressive multifocal leukoencephalopathy of the American Academy of Neurology, survived at least one year after diagnosis, and had documented follow-up three years after diagnosis. Demographic, clinical, virological, and radiological data were retrieved at diagnosis, one year, and three years. Functional status was assessed using the modified Rankin Scale, with scores of 0-2 defining a favorable outcome. Generalized linear mixed models identified independent predictors of three-year functional status and late mortality. Among 1877 screened cases, 245 patients met inclusion criteria. The most common underlying causes of immunosuppression were HIV infection (48%), autoimmune/inflammatory diseases (26%), and hematological malignancies (18%). At three years, 220 patients (89.8% of the cohort) were alive and 188 (85.5% of survivors) had neurological sequelae, most frequently motor or cognitive impairment. Overall, 112/245 (45.7%) achieved a favorable functional outcome. HIV-associated progressive multifocal leukoencephalopathy (OR 2.36, 95% CI 1.05-5.28) was associated with a favourable outcome, whereas higher modified Rankin Scale score at diagnosis (OR 0.48, 95% CI 0.35-0.66) and higher number of affected brain regions on baseline MRI (OR 0.78, 95% CI 0.64-0.95) were independently associated with poorer functional outcome. Among variables collected one year after diagnosis, good functional status at that time was significantly associated with long-term favorable outcome (OR 0.01, 95% CI <0.01-0.03). Twenty-five patients (10.2%) died after the first year, with mortality associated with higher lesion burden at diagnosis and primary immunodeficiency as underlying disease. Even beyond the first year, progressive multifocal leukoencephalopathy remained the leading cause of death (11/25). Recurrence occurred in seven patients (2.9%) and was almost always fatal (6/7). This study provides a comprehensive evaluation of long-term outcomes among survivors of progressive multifocal leukoencephalopathy. These findings present a nuanced picture: while most remain neurologically impaired, nearly half achieve functional independence at three years. The results emphasize the prognostic relevance of the initial clinical and radiological burden and early functional trajectory and highlight the need for research into mechanisms driving disease recurrence.

PMID:42314166 | DOI:10.1093/brain/awag213

JMIR Res Protoc. 2026 Jun 18;15:e92511. doi: 10.2196/92511.

ABSTRACT

BACKGROUND: Workplace violence against health care professionals has increased worldwide, leading to negative psychological, professional, and organizational outcomes. Despite existing prevention and reporting programs, underreporting and lack of accessible, confidential support persist. Digital health tools, including chatbots, may offer scalable support, guidance, and follow-up for affected professionals.

OBJECTIVE: This study aims to design, develop, and validate a chatbot (Sanidad Segura) to assist health care professionals who experience workplace aggression and evaluate its usability, readability, and exploratory indicators of perceived usefulness and support in a pilot study.

METHODS: This study will follow a mixed methods design conducted in two main phases: (1) design, development, and content validation of the chatbot based on literature review, institutional protocols, and expert consensus; and (2) pilot-testing, including usability and readability assessment using standardized instruments, as well as feasibility and acceptability evaluation among health care professionals working in emergency and critical care settings in Almería (Spain). The study is aligned with the Medical Research Council framework for complex interventions, incorporating development and feasibility stages. Quantitative data will be collected using the System Usability Scale and Inflesz readability scale. Qualitative data will be collected through semistructured interviews and analyzed using thematic analysis to explore user experience and identify barriers to and facilitators of use.

RESULTS: The study has been funded for a 2-year period starting on December 18, 2024. Quantitative outcomes will include usability scores (System Usability Scale), readability scores (Inflesz), and participants’ sociodemographic characteristics. Qualitative findings will identify themes related to usability, user experience, and suggestions for improvement. Integration of quantitative and qualitative findings will be conducted through triangulation to provide a comprehensive understanding of the usability, acceptability, and readability of the chatbot.

CONCLUSIONS: This study addresses the increasing incidence of workplace violence against health care professionals through the development of a new chatbot (Sanidad Segura). This intervention seeks to facilitate the identification, support, and follow-up of affected individuals while minimizing the adverse effects of such events on their physical and psychological well-being, social interaction, and professional performance. Sanidad Segura will enable confidential case reporting and provide access to tailored medical, psychological, and legal resources, as well as information about institutional support services. This project represents a crucial step toward implementing an integrated digital framework for the detection, management, and prevention of workplace violence in health care settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/92511.

PMID:42314161 | DOI:10.2196/92511

Stomatologiia (Mosk). 2026;105(3):54-59. doi: 10.17116/stomat202610503154.

ABSTRACT

OBJECTIVE: Obtaining data from dentists at medical dental organizations in various regions of the Russian Federation on issues related to professional oral hygiene.

MATERIALS AND METHODS: A survey was conducted among 600 dentists at dental organizations of various types in five regions of the Russian Federation (Moscow, Omsk, Ryazan, Samara, and Tambov). The questionnaire included general questions, questions on how to organize patient interactions during professional oral hygiene, and questions specific to performing professional oral hygiene. Over 50% of the respondents were general practitioners and dentists, while the remaining 37.4% specialized in pediatric dentistry, surgical dentistry, and orthopedic dentistry.

RESULTS: Over 69% of specialists reported a high level of availability of visual aids for demonstrating oral hygiene rules at their workplaces. Forty percent of specialists in Moscow are fully equipped with everything necessary for oral hygiene, exceeding the results obtained in a survey of dentists in other regions. A significant number of patients with signs of gingivitis and periodontitis remain, with over 72.7% of respondents indicating that they perform oral hygiene specifically for this category of patients. The most common strategies for removing mineralized plaque by dentists in dental facilities across the Russian Federation include ultrasonic scalers, Air-Flow technology, and circular brushes with pastes of varying abrasiveness. The Vector system is more accessible to dentists in larger cities. Perio tips, glycine/erythritol powders, and hand curettes are used by an average of 8.5% of specialists.

CONCLUSION: The primary approach to improving and maintaining oral hygiene will likely remain individualized recommendations from a dentist tailored to the patient’s needs, as noted by 32.8% of respondents.

PMID:42314130 | DOI:10.17116/stomat202610503154

Stomatologiia (Mosk). 2026;105(3):22-29. doi: 10.17116/stomat202610503122.

ABSTRACT

OBJECTIVE: Increasing the effectiveness of dental implantation after subantral augmentation through postoperative assessment of bone tissue and mucous membrane parameters of the maxillary sinus, taking into account the response to various bone substitutes.

MATERIALS AND METHODS: The study included 62 patients (25-65 years old) with alveolar process atrophy of the maxilla, divided into two groups depending on the stage and method of treatment: control (n=48) – two-stage sinus lifting with mineralized allogeneic spongy powder and bioresorbable membrane “Lioplast”, implantation after 6 months; main (n=76) – one-stage augmentation with allogeneic bone rings “Maxgraft Bonering”, filling with platelet-rich plasma (OPP gel, PRP gel – platelet-rich plasma-gel) and a bioresorbable membrane. The assessment was carried out using cone beam computed tomography (CBCT): thickness of the mucous membrane of the maxillary sinus (SM MMP), height of the bone tissue of the maxillary sinus (CT MMP); Implant stability was determined using the dental implant stability coefficient (DISC) using resonance frequency analysis (Osstell ISQ). Measurements were taken immediately after surgery and after 12, 24, and 36 months.

RESULTS: In the study group, by 36 months, a more stable maxillary sinus thickness was observed (2.83±0.14 mm in the study group and 4.84±0.72 mm in the control group, p<0.01), along with a higher maxillary sinus height (10.83±0.43 mm in the study group and 9.23±0.46 mm in the control group, p<0.05) and DIC (80.44±0.27 units in the study group and 78.51±0.62 units in the control group, p<0.05). Statistically significant time and between-group differences (p<0.001) confirm progressive osseointegration and reduced postoperative swelling without complications.

CONCLUSION: One-stage subantral augmentation with allogeneic bone rings and PRP is superior to the two-stage method in terms of peri-implant tissue stability, minimizing the risk of Schneiderian membrane perforation and mucosal hypertrophy. Preoperative CBCT analysis and the use of bioresorbable materials are recommended to optimize dental implant placement.

PMID:42314126 | DOI:10.17116/stomat202610503122

J Med Internet Res. 2026 Jun 18;28:e86249. doi: 10.2196/86249.

ABSTRACT

BACKGROUND: Case definitions are essential for effectively communicating public health threats. However, the absence of a standardized, machine-readable format poses significant challenges to interoperability, epidemiological research, data sharing, and the application of computational methods, including artificial intelligence. These barriers complicate collaboration across regions and organizations and hinder technological progress in public health.

OBJECTIVE: This study aims to propose and release the first open, machine-readable format for representing case and syndrome definitions, together with tools and resources that enable their standardized and scalable use.

METHODS: We developed the Open Syndrome Definition, a structured, machine-readable schema for representing case and syndrome definitions. We compiled official public health case definitions from multiple institutions and converted them into standardized, machine-readable representations using open-source tools. These tools, available through GitHub under the Massachusetts Institute of Technology license, automate the translation of narrative definitions into structured data. We also created a platform for browsing, analyzing, and contributing new definitions on our initiative website.

RESULTS: The Open Syndrome Definition format enabled consistent, automated representation of case definitions across different diseases and jurisdictions. The conversion tools achieved high semantic fidelity, as assessed by qualitative expert review, between narrative and structured representations, supporting human verification and automated analysis. The dataset and accompanying tools demonstrated structural and semantic interoperability by standardizing definitions from various health systems into a unified format and integrating existing medical ontologies through JSON for Linked Data. To further illustrate practical applicability and downstream usage, we introduced a data filtering prototype that allows users to upload their own datasets and verify the results against the standardized definitions.

CONCLUSIONS: The Open Syndrome Definition establishes a foundation for consistent and machine-readable public health definitions, facilitating reproducible research and interoperability at scale. By enabling systematic data exchange and artificial intelligence-driven analysis, it strengthens public health preparedness and supports more rapid, coordinated responses to emerging health threats.

PMID:42314117 | DOI:10.2196/86249

Neurology. 2026 Jul 14;107(1):e218198. doi: 10.1212/WNL.0000000000218198. Epub 2026 Jun 18.

ABSTRACT

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF)-associated ischemic stroke is often managed as a single clinical entity; however, prognosis may vary depending on whether AF was detected after the stroke or whether the stroke occurred despite prior oral anticoagulant (OAC) use. We aimed to describe long-term outcomes after ischemic stroke across 3 distinct AF phenotypes: AF complicated by ischemic stroke despite prior anticoagulation (AFIDA), AF complicated by ischemic stroke without prior anticoagulation (OAC-naive AF), and AF detected after stroke (AFDAS).

METHODS: This nationwide cohort study used the DeSC-IQVIA database, an administrative claims database covering approximately 16 million individuals in Japan. Adult stroke survivors with AF discharged with OAC prescriptions between April 2014 and January 2025 were included. Three mutually exclusive AF phenotypes defined by AF detection timing and prior anticoagulation status: AFIDA, OAC-naive AF, and AFDAS (diagnosed during the index hospitalization). The primary outcomes were hospitalization for recurrent ischemic stroke or systemic embolism (SE). The secondary outcomes included major bleeding, heart failure (HF) hospitalization, and all-cause mortality. Cumulative incidence was estimated using the Aalen-Johansen method, accounting for the competing risk of death. Adjusted subdistribution hazard ratios (aSHRs) were estimated using Fine-Gray models.

RESULTS: Among 21,586 patients (median age, 83 years [interquartile range (IQR), 78-88 years]; 10,604 [49.1%] female), 6,604 (30.6%) were classified as having AFIDA, 11,875 (55.0%) as having OAC-naive AF, and 3,107 (14.4%) as having AFDAS. During the 38,593 person-years of follow-up, 2,028 patients experienced stroke/SE. The 5-year cumulative incidence of stroke/SE was highest in AFIDA (18.6% [95% CI 17.0%-20.2%]), followed by OAC-naive AF (13.0% [95% CI 12.0%-13.9%]) and AFDAS (10.5% [95% CI 9.0%-12.1%]). Compared with OAC-naive AF, AFIDA was associated with a higher risk of recurrent stroke/SE (aSHR, 1.38; 95% CI 1.25-1.52), whereas AFDAS was associated with a lower risk (aSHR, 0.87; 95% CI 0.75-1.00). Among secondary outcomes, AFIDA showed an increased risk of HF hospitalization (aSHR, 1.15; 95% CI 1.02-1.31).

DISCUSSION: Long-term prognosis after AF-associated stroke is heterogeneous across AF phenotypes, with AFIDA representing a high-risk group and AFDAS representing a low-risk group. These findings highlight the need to treat these clinically identifiable phenotypes as distinct target populations for secondary prevention strategies and future clinical trials.

PMID:42314108 | DOI:10.1212/WNL.0000000000218198

Neurology. 2026 Jul 14;107(1):e218179. doi: 10.1212/WNL.0000000000218179. Epub 2026 Jun 18.

ABSTRACT

BACKGROUND AND OBJECTIVES: Recent randomized trials reported no overall functional benefit of endovascular treatment (EVT) for distal medium-vessel occlusion (DMVO) and did not identify consistent effect modifiers to guide patient selection. Consequently, the role of EVT-particularly for M2 occlusions-remains controversial. We investigated whether baseline clinical severity modifies the association between successful recanalization and 90-day outcome in patients with M2 occlusion.

METHODS: Multicenter retrospective cohort study at 2 tertiary stroke centers including consecutive adults with acute ischemic stroke due to M2 occlusion (January 2015-January 2023) triaged by multimodal CT and treated with EVT. The primary end point was functional independence (modified Rankin Scale [mRS] ≤ 2) at 90 days. Secondary end points included symptomatic intracerebral hemorrhage (sICH), mRS 0-1, and penumbra salvage volume (PSV). The primary analysis used multivariable logistic regression with baseline National Institutes of Health Stroke Scale (NIHSS) modeled linearly and an NIHSS×recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b) interaction term. Johnson-Neyman probing and inverse probability weighting (IPW) were applied; a supplementary restricted cubic spline analysis was performed to explore potential nonlinearity.

RESULTS: Among 147 patients, 85 (58%) achieved successful recanalization. The mean age was 74 years (SD 13), and 47% were female. Higher baseline NIHSS (adjusted odds ratio [aOR] 0.83 per point, 95% CI 0.73-0.94) and older age (aOR 0.96 per year, 95% CI 0.94-0.99) were associated with lower odds of functional independence. NIHSS significantly modified the association between recanalization and outcome (interaction p = 0.03). The magnitude of the association between successful recanalization and functional independence was larger at higher NIHSS. Model-based estimates suggested a descriptive crossover around NIHSS 10, whereas statistical evidence of benefit emerged only at higher NIHSS values. Successful recanalization was associated with greater PSV (+33 mL, p = 0.01). In the PSV interaction model, onset-to-imaging time differed by recanalization status (p < 0.01): time was positively associated with PSV in the mTICI ≤2a group, but near zero in mTICI ≥2b. IPW analyses were concordant. sICH occurred in 8.2% vs 4.8% (p = 0.42).

DISCUSSION: In M2 occlusions, the magnitude of the association between successful recanalization and functional independence was larger at higher NIHSS and not reliably demonstrable at lower NIHSS. These findings support a severity-informed, individualized EVT approach while remaining hypothesis-generating rather than prescriptive for specific NIHSS thresholds. Major limitations include the retrospective observational design and potential residual confounding.

PMID:42314098 | DOI:10.1212/WNL.0000000000218179

JCO Oncol Pract. 2026 Jun 18:OP2501191. doi: 10.1200/OP-25-01191. Online ahead of print.

ABSTRACT

PURPOSE: Given the importance of timely comprehensive genomic profiling (CGP) for the treatment of cancer, this study aimed to provide generalizable estimates of turnaround time (TAT) for tissue-based CGP. Secondary aims were to identify TAT trends over time and explain variation based on clinical, demographic, and administrative factors.

METHODS: Data for solid tumor samples profiled from 2018 through 2024 from a commercial laboratory were analyzed. Descriptive statistics were used to summarize and compare TAT between sites. Linear regression was used to assess for yearly trends and to measure associations between clinical, demographic, and administrative variables and TAT.

RESULTS: A total of 271,574 solid tumor malignancies originating from 5,497 clinical sites were included in the analysis. The overall TAT (specimen collection to CGP results reporting) decreased from a median of 43 days (IQR, 31-72) to 32 days (IQR, 22-51) from 2018 to 2024. When comparing overall TAT for 2024 by clinical site, the shortest and longest overall TAT quintiles were 23.1 days (IQR, 20.6-24.6) and 46.5 days (IQR, 42.7-50.8), respectively (P < .001). There was variability in timeliness of ordering between sites with a median time from biopsy to CGP ordering of 10.0 days (IQR, 8.0-12.0) versus 30.8 days (IQR, 26.6-35.0) for the shortest and longest quintiles, respectively. Factors associated with shorter ordering and overall TAT included, but were not limited to, higher clinical site ordering volumes, cancer type, and ordering method.

CONCLUSION: Delay in the time from biopsy to CGP ordering was the largest contributor to protracted TAT and varied between clinical sites. Increasingly, the appropriate treatment of cancer is dependent on biomarker testing and delays in testing likely contribute to suboptimal patient care.

PMID:42314086 | DOI:10.1200/OP-25-01191

Arthroscopy. 2026 Jun 18. doi: 10.1002/arj.70370. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of preoperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) use on medical complications, emergency department use, and orthopaedic complications in obese patients undergoing arthroscopic rotator cuff repair.

METHODS: Obese patients (defined by relevant ICD-10 codes and confirmed by body mass index measurements) undergoing primary arthroscopic rotator cuff repair before June 2023 with at least 2-year follow-up were found in the TriNetX database and stratified according to GLP-1 RA use before surgery. Patients prescribed GLP-1 RAs were propensity-matched 1:1 to non-GLP-1 RAs controls by age, sex, ethnicity, and comorbidities. Outcomes assessed included emergency department use at 30 and 90 days, medical complications assessed at 90 days, and orthopaedic complications (including revision, retear, and conversion to arthroplasty rates, defined by ICD-10 codes) assessed at 1 and 2 years postoperatively. Statistical analysis was performed using TriNetX’s built-in statistical platform.

RESULTS: Following matching, both cohorts consisted of 1183 patients and had no baseline differences. At 90 days, there were no significant differences in medical complications, including acute kidney injury, pneumonia, venous thromboembolism, urinary tract infection, or cardiac events. At 1 and 2 years, GLP-1 RA use was associated with significantly lower revision rates after left-sided repairs (2.3% vs 7.2%, OR 0.3, P < .001; 4.0% vs 8.2%, OR 0.5, P = .010, respectively). In subgroup analyses, women undergoing left-sided repairs showed significantly lower retear rates at both 1 and 2 years (19.1% vs 30.9%, OR 0.5, P = .009; 20.2% vs 33.5%, OR 0.5, P = .004).

CONCLUSIONS: GLP-1 RAs appear to be generally safe for preoperative use in obese patients undergoing arthroscopic rotator cuff repair and were associated with decreased rates of revision and retear in certain subgroups.

LEVEL OF EVIDENCE: Level III, retrospective comparative case series.

PMID:42314072 | DOI:10.1002/arj.70370