Category: Statistics

J Intern Med. 2026 Jun 26. doi: 10.1111/joim.70130. Online ahead of print.

ABSTRACT

BACKGROUND: Existing models for predicting postoperative acute kidney injury (AKI) after non-cardiac surgery are often complex and insufficiently validated for broad clinical use. We developed and externally validated a simple yet accurate model for predicting both overall and critical AKI that can be readily applied in routine practice.

METHODS: The severity index model for AKI (SIM-AKI) was developed using data from 191,938 patients undergoing non-cardiac surgery at a tertiary hospital and externally validated using three independent datasets from other tertiary hospitals (n = 118,047; 86,092; 3727). Variables were selected using least absolute shrinkage and selection operator regression with 10-fold cross-validation, and predictor stability was assessed using backward elimination across 100 bootstrap resamples before multinomial logistic regression modeling. Model performance was evaluated using the C-statistic for discrimination, calibration plots, Brier scores, and decision curve analysis (DCA) for clinical utility.

RESULTS: The SIM-AKI model incorporated age, sex, diabetes mellitus, American Society of Anesthesiologists classification, cancer surgery, emergency status, major abdominal surgery, anemia, hypoalbuminemia, estimated glomerular filtration rate, intraoperative transfusion, and operation time. For overall AKI, C-statistics were 0.801 (95% CI 0.796-0.806) in development and 0.754, 0.742, and 0.759 in validation cohorts. For critical AKI, C-statistics were 0.838 (95% CI 0.826-0.850) in development and 0.796, 0.805, and 0.767 in validation cohorts, demonstrating good calibration and clinical benefit in DCA. The SIM-AKI compared favorably with existing AKI prediction models in discrimination.

CONCLUSION: SIM-AKI may serve as a reliable perioperative tool for predicting the risk of both overall and critical postoperative AKI in patients undergoing non-cardiac surgery.

PMID:42363648 | DOI:10.1111/joim.70130

Histopathology. 2026 Jun 26. doi: 10.1111/his.70202. Online ahead of print.

ABSTRACT

This systematic review with meta-analysis aims to analyse the existing literature on clinicopathological features of sporadic gastric hyperplastic polyps (GHP), with special emphasis on risk factors associated with neoplastic transformation, as well as available immunohistochemical and molecular data relevant to GHP carcinogenesis. We searched two electronic databases and included studies reporting the presence of dysplasia and adenocarcinoma arising in GHP. Meta-analysis of odds ratios (ORs) was performed using random-effects models. We included 58 studies, 11 of which were included in quantitative synthesis. The overall rate of neoplastic transformation in GHP was 6.0% and progression to adenocarcinoma was observed in 1.5%. Statistically significant risk factors for neoplastic transformation were age ≥65 years (OR 2.60; 95% confidence interval [CI] [1.88-3.59]), size ≥20 mm (OR 4.63; 95% CI [1.82; 11.77]) with increasing size thresholds, as well as intestinal metaplasia (OR 3.65; 95% CI [1.68; 7.97]). Although the evidence is limited, the available data suggest that GHP located in the cardia or arising in a dysplastic background gastric mucosa may represent higher-risk subsets. Immunohistochemical subtyping of dysplasia showed a progressive shift from a predominantly gastric phenotype in non-neoplastic GHP to a hybrid (gastric-intestinal) phenotype in dysplasia and adenocarcinoma. TP53 alterations and chromosomal instability were the most frequently reported molecular events. GHP present a significant neoplastic potential, particularly in the presence of additional clinicopathological risk factors. Lesion size, patient age and – above all – the status of the surrounding gastric mucosa should guide endoscopic management, pathological interpretation and surveillance strategies.

PMID:42363644 | DOI:10.1111/his.70202

Psychol Health Med. 2026 Jun 26:1-13. doi: 10.1080/13548506.2026.2694730. Online ahead of print.

ABSTRACT

Sickle Cell Disorder (SCD) is a complex, multi-system blood condition affecting 7.78 million people, with 80% of global cases in sub-Saharan Africa, especially Nigeria. The condition is associated with physical health complications and increased risk of emotional difficulties, highlighting the need for scalable psychosocial interventions for adolescents with SCD in Nigeria. This pilot study assessed the effect of Bibliotherapy as a low-intensity, scalable intervention for adolescents with SCD. The non-randomised pilot-controlled trial involved 42 adolescents with SCD recruited from a Sickle Cell Centre and a Haematology Clinic. Participants were stratified by gender, age and baseline Rosenberg Self-Esteem (RSE) scores, and dyad-matched into Intervention and Control groups to reduce baseline differences. The treatment arm received weekly, virtual, group-based, manualised Bibliotherapy over five weeks, based on selected texts from a memoir by a Nigerian psychiatrist who lived with SCD. Pre-specified primary outcome was the RSE score; secondary outcomes were Hope, Depressive symptoms and Satisfaction with the intervention. The control group received no intervention beyond routine psychoeducation. Participants were aged 13-19 years (M = 16.1, SD = 1.96), with 59.5% females. Controlling for baseline scores, age and gender, the intervention showed a statistically significant effect on self-esteem scores with medium effect size {F (1,37) = 4.84, p = 0.03, Partial Eta Squared = 0.12}, but no significant effect on Hope {F (1,36) = 0.64, p = 0.20, Partial Eta Squared = 0.04} or depressive symptoms {F (1,36) = 0.95, p = 0.34, Partial Eta Squared = 0.03}. All participants in the intervention arm found the book interesting and indicated that it helped them believe they could succeed despite having SCD. They expressed satisfaction with the intervention. This pilot Bibliotherapy intervention was feasible, well received and showed promising efficacy on self-esteem. Larger controlled trials are recommended to establish the generalisability of these findings in the region.Pan African Clinical Trial Registry (Registration Number PACTR202110602061985).

PMID:42363631 | DOI:10.1080/13548506.2026.2694730

Personal Ment Health. 2026 Aug;20(3):e70091. doi: 10.1002/pmh.70091.

ABSTRACT

We critically appraise the study by de Bruin et al., which examined whether avoidant personality traits and avoidant coping predict differential outcomes of cognitive-behavioral therapy (CBT) versus short-term psychodynamic psychotherapy (STPP) in adult depression. Although the authors address an important clinical question regarding dimensional personality assessment in treatment selection, several methodological issues may limit the strength of their conclusions. First, avoidant personality traits were operationalized using a composite score derived from subtracting extraversion from neuroticism on the NEO-FFI. Although dimensional models are increasingly encouraged, this approach may not adequately capture the multifaceted construct of avoidant personality pathology, which includes features such as rejection sensitivity, shame, social inhibition, and feelings of inadequacy, and may instead reflect broader negative affectivity or introversion. Second, the study may have been underpowered to detect moderation effects, which typically require larger samples than main effect analyses. Attrition and participant exclusion may have further reduced statistical power, limiting the ability to identify meaningful treatment interactions. Therefore, the absence of significant moderation effects should be interpreted cautiously and not taken as definitive evidence of equivalent treatment efficacy across levels of avoidant pathology. Despite these limitations, the study contributes to growing research on dimensional personality approaches in depression treatment, and further well-powered studies using validated measures are warranted.

PMID:42363611 | DOI:10.1002/pmh.70091

Inhal Toxicol. 2026 Jun 26:1-15. doi: 10.1080/08958378.2026.2689661. Online ahead of print.

ABSTRACT

OBJECTIVE: Some of the varieties of talc were reported to contain a small fraction of elongate particles, including tremolite. The biological effects of tremolite were demonstrated in literature as dependent on the habit of particles (asbestiform vs. non-asbestiform). The objective of this paper is to utilize advanced methodologies of risk evaluation to determine if risk of mesothelioma could be elevated in persons utilizing talcum powder.

METHODS: Monte Carlo simulation was used to calculate potency factors, cumulative exposure, and mesothelioma risk for a hypothetical scenario.

RESULTS: Excess risk of mesothelioma for the person would be estimated as 0.22 cases per 1,000,000 per lifetime, with 5th percentile of 0.003 and 95th percentile of 0.873. Upper bound of excess mesothelioma risk is lower than the U.S. EPA benchmark for the general population and also comprises only about 1.4% of the mesothelioma baseline level in unexposed people. The morphological habit of tremolite particles reported in talc was typical for non-asbestiform variety.

CONCLUSIONS: Quantitative risk assessment can be used to evaluate possible health outcomes of airborne exposure to talcum powder.

PMID:42363609 | DOI:10.1080/08958378.2026.2689661

J Ultrasound Med. 2026 Jun 26. doi: 10.1002/jum.70344. Online ahead of print.

ABSTRACT

OBJECTIVES: To establish gestational age-specific reference ranges for the intraplacental vascular index measured using microvascularity-flow ultrasound software (VI^MV) and to evaluate its variation by placental location, parity, and pregnancy outcome.

METHODS: This prospective study enrolled 354 singleton pregnancies, of which 243 (68.64%) uncomplicated cases were used to construct reference ranges. A residual bootstrap method with 500 iterations was applied to square-root-transformed VI^MV values, followed by back-transformation to derive the 5th, 50th, and 95th percentiles with 95% confidence intervals. Group differences were assessed using quantile regression, and associations with Doppler parameters were examined.

RESULTS: VI^MV increased significantly with advancing gestational age (linear coefficient 1.88, p = .007), following a curvilinear pattern with mild late-gestation downturn (quadratic coefficient – 0.036, p = .011). Posterior placentas showed slightly higher early values, although this difference was not significant; from 31 weeks onward, anterior placentas demonstrated significantly higher VI^MV (mean difference + 15.4, p = .010 at 31-35 weeks; +11.6, p = .003 at 36-40 weeks). Multiparous women showed a modestly higher fitted trajectory and a similar non-significant trend toward higher birthweight, but parity was not independently associated with VI^MV. Pregnancies complicated by maternal disease, hypertensive disorders, or small-for-gestational-age neonates exhibited lower trajectories than uncomplicated pregnancies, although these differences were not statistically significant. VI^MV was inversely associated with uterine and umbilical artery pulsatility indices and positively associated with umbilical vein time-averaged mean velocity.

CONCLUSIONS: Gestational age-specific VI^MV reference ranges were established. VI^MV may provide an adjunctive quantitative marker for assessing placental vascular adaptation and identifying pregnancies with altered placental perfusion.

PMID:42363588 | DOI:10.1002/jum.70344

Med Sci Monit. 2026 Jun 27;32:e951747. doi: 10.12659/MSM.951747.

ABSTRACT

BACKGROUND Chat Generative Pre-Trained Transformer (ChatGPT) is an advanced artificial intelligence (AI) tool that has become increasingly integrated into daily life. In Saudi Arabia, government initiatives actively encourage the adoption of AI technologies, yet information on public perceptions of this technology remains insufficient. This study assessed public awareness, attitudes, beliefs, and perceptions about ChatGPT in Saudi Arabia. MATERIAL AND METHODS A cross-sectional survey was conducted among individuals living Saudi Arabia, from July to September 2025. Data were collected via an online questionnaire consisting of 25 items collecting information on demographic characteristics, their perceptions, awareness, and use of ChatGPT, and their attitudes and perceived obstacles regarding ChatGPT. Descriptive statistics were used for data analyzing using SPSS version 26. RESULTS Of participants 1069, 56.7% were female and 76.5% held a university degree. While 48.7% were somewhat familiar with ChatGPT, over half (54.6%) of them reported positive attitudes toward ChatGPT. Perceived benefits included productivity and educational enhancement, but concerns centered on overdependence (61.3%), incorrect information (55.7%), job loss (54.2%), and biased content (53.5%). Key obstacles were lack of credibility (76%) and confidentiality concerns (68.5%). The findings indicate that gender (P=0.001), age (P=0.001), and educational attainment (P=0.001) are important factors influencing familiarity and comfort with ChatGPT in daily life. CONCLUSIONS The Saudi public demonstrates a balanced perspective toward ChatGPT, recognizing its potential to enhance productivity and education while expressing valid concerns about trust and accuracy. Targeted awareness and policy measures are needed to build confidence and responsible adoption.

PMID:42363582 | DOI:10.12659/MSM.951747

Medicine (Baltimore). 2026 Jun 26;105(26):e49266. doi: 10.1097/MD.0000000000049266.

ABSTRACT

The triglyceride-glucose-Chinese visceral adiposity index (TyG_CVAI) has been validated as an effective predictor of early stroke. However, its predictive efficacy across different glycemic metabolic states remains unexplored. This study utilized data from the China Health and Retirement Longitudinal Study, including 7744 stroke-free participants. Participants were categorized into 3 glycemic groups: diabetes mellitus (DM), prediabetes mellitus (Pre-DM), and normal glucose regulation (NGR). K-means clustering further divided participants into 2 clusters based on TyG_CVAI fluctuations: Cluster 1 (lower TyG_CVAI) and Cluster 2 (higher TyG_CVAI). The primary outcome was the first stroke occurrence. Statistical analyses included Kaplan-Meier survival curves, Cox proportional hazards models, restricted cubic spline analysis, and receiver operating characteristic curve analysis to assess associations between baseline TyG_CVAI and stroke risk. Over 9 years (2011-2020), 540 participants (7.0%) experienced a first stroke. Participants in Cluster 2 (higher TyG_CVAI) exhibited a significantly elevated stroke risk compared to Cluster 1. Kaplan-Meier analysis revealed significant differences in stroke incidence between clusters among Pre-DM, NGR, and the overall population (P < .001), but not in the DM group (P = .071). Cox regression models, adjusted for confounders, confirmed a significant positive correlation between TyG_CVAI and stroke risk in the overall population, Pre-DM, and NGR groups. The hazard ratios and 95% confidence intervals for Cluster 2 versus Cluster 1 were 1.40 (1.15-1.71), 1.42 (1.07-1.88), and 1.68 (1.19-2.36), respectively. In contrast, no significant association was observed in the DM group (P > .1). Restricted cubic spline analysis further supported that higher TyG_CVAI levels correlated with increased stroke risk. Elevated baseline TyG_CVAI is significantly associated with stroke risk in middle-aged and older adults. However, its predictive capacity is attenuated in individuals with diabetes compared to those with normal glycemic metabolism. These findings underscore the importance of considering glycemic status when evaluating TyG_CVAI as a stroke predictor.

PMID:42363562 | DOI:10.1097/MD.0000000000049266

Medicine (Baltimore). 2026 Jun 26;105(26):e49516. doi: 10.1097/MD.0000000000049516.

ABSTRACT

Breast cancer (BC) has the highest cancer incidence and mortality in women worldwide, and the relationship between serum enzymes and BC has been inconsistent in previous observational studies. In this paper, 2-sample Mendelian randomization (MR) is used to clarify the causal relationship between them. The serum enzymes in 216,026 study subjects from Finnish heritage subjects as the exposure data. The BC included 212,402 study subjects in United Kingdom Biobank as the result data. We performed univariable MR with 5 MR methods inverse variance weighted, MR-Egger regression, weighted median, simple mode, and weighted mode and multivariable MR to estimate the effect of serum enzymes independent of BC. Finally, we performed a series of sensitivity analyses as validation of primary MR results. The single nucleotide polymorphisms screened in this study were mostly strong effect instrumental variables. A total of 5 forest plot model results indicate that abnormal serum enzyme levels have a significant causal relationship with BC. MR analysis of different models of abnormal serum enzyme levels gave consistent direction estimates, and their slopes were relatively consistent. Serum enzyme indicators did not consider heterogeneity in the MR results of BC (Cochran Q P value > .05, I 2 < 50%). MR-Egger’s results show that there is no effect of pleiotropy(P ≥ .05, intercepts were close to 0). Sensitivity analysis showed that no significant change in the estimated effect value of abnormal serum enzyme levels was found, indicating the stability of the results. inverse variance weighted model results indicate that BC has no causal effect on abnormal serum enzyme levels (P value > .05). The results of multivariate MR showed that serum enzyme indicators still have a significant direct effect on BC. Our findings suggest that a significant statistical causal association between abnormal serum enzyme levels and the risk of BC. Abnormal serum enzyme levels have important clinical implications and might be used as BC risk.

PMID:42363553 | DOI:10.1097/MD.0000000000049516

Medicine (Baltimore). 2026 Jun 26;105(26):e49310. doi: 10.1097/MD.0000000000049310.

ABSTRACT

Coronavirus disease 2019 (COVID-19) was reported to persist long-term in the brain and leave several long-term neurologic sequelae. However, the causal relationship between COVID-19 and brain aging is still unknown. The genome-wide association study (GWAS) data on COVID-19 phenotypes (susceptibility, hospitalization, and severity), involving a total of 5,779,391 participants, were collected from the COVID-19 Host Genetics Initiative. In addition, GWAS data on longitudinal changes in 15 brain structures, assessed via magnetic resonance imaging across the lifespan, were sourced from the ENIGMA Consortium and involved 15,640 participants. Two-sample Mendelian randomization was conducted to infer the causal relationship between COVID-19 and longitudinal brain changes. Multi-trait GWAS meta-analysis, colocalization, and fine-mapping analyses were performed to identify shared genetic etiologies. H3K27me3 ChIP-seq was used to evaluate the regulatory effect of colocalized loci. Two-step Mendelian randomization was applied to explore potential mediating mechanisms across multi-omics layers, including proteomics, metabolomics, and immunomics. Our results showed that COVID-19 hospitalization (β = -262.405, P = .041) and severity (β = -177.676, P = .049) were genetically associated with atrophied volume of total brain during longitudinal change. This suggests that individuals with advanced COVID-19 may be more susceptible to accelerated global brain aging. Caudate was genetically affected by all COVID-19 phenotypes. Seven variants were shared between advanced COVID-19 and global brain aging. rs117169628 was colocalized between advanced COVID-19 and global brain aging, and exerted an inhibitory effect on CDH15 expression, further strengthening the causality. Six metabolites, 1 protein, and 1 immune trait were identified as potential mediators. Our study indicates that advanced COVID-19 might be genetically associated with accelerated brain aging. Brain health should be paid more attention in long COVID-19.

PMID:42363551 | DOI:10.1097/MD.0000000000049310