Tag: pubmed

Stat Methods Med Res. 2026 Aug 21:9622802261475687. doi: 10.1177/09622802261475687. Online ahead of print.

ABSTRACT

In most multi-arm randomized controlled trials, all participants need to be eligible to be randomized to all the arms. This means some participants are excluded from participating in multi-arm studies. We propose to relax this by considering a ‘differential randomization’ approach that allows the inclusion of participants who are eligible for some but not all arms, as in some innovative trial approaches. We refer to a multi-arm design that employs differential randomization as an ‘inclusive design’ because it maximizes participant inclusion. Considering superiority comparisons for a normal endpoint, we evaluate the performance of some analysis methods for a three-arm inclusive design by simulation studies. Methods include pairwise or overall regression analysis, an averaging approach that pools summary statistics using prevalence rate, and a meta-analysis type framework. We compare the statistical power when the inclusive design employs different treatment allocation schemes. We find that using equal allocation ratio within each subpopulation leads to a higher disjunctive power than using equal allocation across arms, when the many-to-one comparisons are analysed using the corresponding pairwise data separately as opposed to using all data in a single regression analysis. We find that differential covariate-outcome relations among patients can affect the property of the inference.

PMID:42627367 | DOI:10.1177/09622802261475687

Dentomaxillofac Radiol. 2026 Aug 21:twag059. doi: 10.1093/dmfr/twag059. Online ahead of print.

ABSTRACT

OBJECTIVES: This retrospective diagnostic accuracy study compared magnetic resonance imaging and ultrasonography in 98 temporomandibular joints from 49 patients for evaluating disc position, disc configuration, joint effusion, condylar degenerative changes, and bone marrow edema.

METHODS: A total of 98 temporomandibular joints from 49 patients who underwent both modalities were retrospectively evaluated by two independent, blinded observers using established classification systems. All imaging was performed prior to the initiation of any specific TMJ treatment. Intra- and inter-observer agreement, the diagnostic accuracy of ultrasonography relative to the magnetic resonance imaging reference standard, diagnostic likelihood ratios, and associations between parameters were analysed statistically.

RESULTS: Intra- and inter-observer agreement was good to excellent for both modalities (Kappa 0.71-0.91, p < 0.05). Ultrasonography showed high sensitivity and specificity for disc displacement (94.4-97.4% and 61.5-70.0%) and effusion (87.5-92.3% and 84.0-87.0%), but more limited performance for bone marrow edema, particularly in specificity (60.0-61.1%). On the left side, magnetic resonance imaging identified bone marrow edema in 63.3% of cases compared with 36.7% on ultrasonography (p = 0.015). Folded and convex disc configurations and marked or severe effusion were both associated with displacement without reduction (p ≤ 0.046).

CONCLUSIONS: Ultrasonography appears suitable as a first-line screening modality for selected TMJ abnormalities, whereas magnetic resonance imaging remains indispensable whenever bone marrow pathology or complex internal derangement is suspected.

ADVANCES IN KNOWLEDGE: This study provides direct, same-patient diagnostic accuracy data comparing ultrasonography with magnetic resonance imaging across multiple temporomandibular joint pathologies, including an indirect ultrasonographic assessment of bone marrow edema via cortical irregularity, clarifying which findings ultrasonography can reliably screen for and which still require magnetic resonance imaging confirmation.

PMID:42627352 | DOI:10.1093/dmfr/twag059

Can J Psychiatry. 2026 Aug 21:7067437261477547. doi: 10.1177/07067437261477547. Online ahead of print.

ABSTRACT

ObjectiveInternet-based Cognitive Behavioural Therapy (iCBT) is a scalable alternative to therapist-guided CBT, requiring fewer therapist resources. We compared health system costs in individuals receiving minimally guided iCBT (self-directed online modules with asynchronous therapist support) to those receiving therapist-guided CBT (scheduled, one-on-one sessions) in Ontario, Canada (January 2020-August 2021).MethodsThis retrospective cohort study leveraged linked health-administrative data to estimate person-centred health system costs, overall and mental health (MH)-related, one- and two-years post-treatment for all major healthcare services (emergency departments, hospitalizations, physician visits, long-term/home care, and outpatient prescription drugs). Generalized linear models were used to examine the effect of treatment modality on costs, adjusting for patient sociodemographic characteristics, clinical factors, and pre-treatment healthcare utilization.ResultsAmong N = 167 individuals enrolled in iCBT and N = 300 receiving CBT, we found that iCBT recipients were more likely to use MH-related acute care and outpatient services (primary care physicians and psychiatrists) following treatment. The average MH-specific costs per person were $1,668 for iCBT (95% CI $0, $7,299) and $979 ($0, $4,821) for standard CBT 1-year post-treatment and $4,086 ($0, $17,049) and $2,023 ($0, $9,027), respectively, 2 years post-treatment. However, following regression adjustment for sociodemographic characteristics, baseline symptoms, and pre-treatment MH-related service use, there were no statistically significant differences in one-year and two-year post-treatment total or MH-related costs between the groups (P > .05). This finding remained robust among individuals meeting criteria for anxiety and depression treatment effectiveness.ConclusionsiCBT may represent a scalable approach to expanding access to MH care without significantly increasing long-term health system costs.

PMID:42627350 | DOI:10.1177/07067437261477547

Am J Orthod Dentofacial Orthop. 2026 Aug 21:S0889-5406(26)00346-X. doi: 10.1016/j.ajodo.2026.06.016. Online ahead of print.

ABSTRACT

INTRODUCTION: Space opening with clear aligner therapy has been little researched. The aim of this retrospective observational study was to investigate the predictability of the Invisalign appliance (Align Technology, San José, Calif) in opening space for the permanent maxillary lateral incisor (PMLI).

METHODS: Data from Align Technology’s digital treatment planning software system, ClinCheck (Align Technology, San Jose, Calif), were evaluated to determine the initial, predicted, and achieved space opening for the PMLI in patients satisfying the selection criteria. Acquisition of the relevant measurement values was performed using the Geomagic (3D Systems, Rock Hill, SC) metrology system. A mixed-effects model was used to account for within-patient dependence among tooth spaces and the 2 one-sided tests for equivalence testing and Bland-Altman analysis were employed.

RESULTS: Space opening for 41 PMLIs in 25 patients with a mean age of 21.2 ± 13.0 years was evaluated. Approximately 65.2%-69.8% of predicted space opening was achieved, with the mean differences between predicted and achieved values ranging from 0.9 ± 1.0 mm to 1.4 ± 1.2 mm (P <0.05). For patients <18 years of age, the mean difference between predicted and achieved canine angulation changes was 9.4 ± 9.1°, with 95% limits of agreement from -8.4° to +27.2° (P = 0.015). Mean differences between predicted and achieved canine angulation changes in patients ≥18 years of age (5.3 ± 6.4°) and central incisor angulation changes in patients <18 years of age (-0.1 ± 8.0°) and ≥18 years of age (-4.8 ± 7.6°) were not statistically significant.

CONCLUSIONS: The findings can help clinicians better understand the planning of space opening for PMLIs before clear aligner therapy commences and provide baseline information for future research.

PMID:42627321 | DOI:10.1016/j.ajodo.2026.06.016

Am J Orthod Dentofacial Orthop. 2026 Aug 21:S0889-5406(26)00391-4. doi: 10.1016/j.ajodo.2026.06.021. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this study was to evaluate the relationship between mandibular first molar inclination, Andrews’ WALA-facial axis (FA) distance, and vertical skeletal pattern in adolescent and adult samples using cone-beam computed tomography and 3-dimensional intraoral scan data.

METHODS: Cone-beam computed tomography and 3-dimensional model data from untreated adolescents (n = 20; mean age, 15.32 years) and adults (n = 50; mean age, 41.13 years) with near-normal occlusion were analyzed. Measurements included WALA-FA distance, buccolingual inclination of the mandibular first molars, and the Frankfort-mandibular plane angle. Statistical tests included t tests and correlation analyses.

RESULTS: Adolescents had a significantly greater mean WALA-FA distance (2.85 mm) than adults (2.28 mm; P <0.0001). A significant positive correlation existed between molar inclination and WALA-FA distance in both groups. In adolescents only, a significant negative correlation was found between molar inclination and the Frankfort-mandibular plane angle. Molar inclination (approximately 15° lingual) did not differ significantly between the groups.

CONCLUSIONS: In subjects with normal occlusion, WALA-FA distances for the mandibular first molars are not constant; adults have smaller WALA-FA distances than adolescents, and mandibular first molars have a lingual inclination of approximately 15° in both adults and adolescents. Clinicians should consider the natural buccolingual inclination of the teeth and alveolar bone and apply individualized WALA-FA guidelines to support long-term stability and function.

PMID:42627320 | DOI:10.1016/j.ajodo.2026.06.021

Soft Matter. 2026 Aug 21. doi: 10.1039/d6sm00639f. Online ahead of print.

ABSTRACT

The liquid crystalline ferroelectric nematic (N_F) phase is well known for its distinctive physical and electrical properties, namely the bulk polarity. It is therefore important to consider whether the nematic bulk properties are affected by very highly polar molecules and underlying polar phases. In this paper, we present a detailed temperature-dependence of the splay (K₁₁) and bend (K₃₃) elastic constants, and the Fréedericksz threshold voltage for a positive dielectric anisotropy LC mixture exhibiting both non-polar (N) and polar (N_F) nematic phases, and include theoretical discussions. Such properties are compared to those of two conventional nematic liquid crystals (NLCs). In the N_F LC mixture, we show a marked reduction in the splay elastic constant (1.8-0.5 pN) and the threshold voltage (150-35 mV), across the nematic phase, at temperatures much lower than the nematic to isotropic transition. The values for K₁₁ and V_th linearly extrapolate to 0 pN and 0 V respectively, at the nematic to the intermediate nematic (N_X) phase transition. Such reduction in the splay elastic constant, which is a deviation from conventional nematic behaviour, is attributed to flexoelectric coupling becoming significant at these temperatures. Corrections with temperature dependent flexoelectric coupling for the elastic constants, dielectric permittivity, and Fréedericksz threshold voltage, are discussed in detail.

PMID:42627296 | DOI:10.1039/d6sm00639f

Cancer Control. 2026 Jan-Dec;33:10732748261481970. doi: 10.1177/10732748261481970. Epub 2026 Aug 21.

ABSTRACT

PurposeTo investigate the relationship between time to treatment initiation (TTI) of definitive radiotherapy and survival outcomes in locally advanced head and neck cancers (LAHNC).MethodsWe retrospectively included patients diagnosed between 2005 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The multivariate regression analysis, recursive partition analysis, penalized spline function, chi-square test, Kaplan-Meier method, and multivariate Cox proportional-hazards models were used for statistical analyses.ResultsA total of 18657 patients were included. Patients were stratified into 3 groups: no delay (<36 days), at risk of delay (36-61 days), and delay (>61 days). Compared to patients who initiated radiotherapy within 61 days, patients who initiated radiotherapy after 61 days had a higher risk of death in 5-year cancer-specific survival (CSS) (no delay vs. at risk of delay vs. delay: 58.7% vs. 60.5% vs. 50.5%) (P<0.001) and overall survival (OS) (no delay vs. at risk of delay vs. delay: 47.7% vs. 49.5% vs. 39.4%) (P<0.001). Patients in the delay group had worse outcomes in CSS (hazard ratio [HR], 1.209; 95% confidence interval [CI], 1.143-1.278; P<0.001) and OS (HR, 1.199; 95% CI, 1.146-1.256; P<0.001). In patients with oral cavity, oropharyngeal, and laryngeal cancers, the risk of death progressively rose as the treatment was delayed. However, there was no significant difference in the risk among patients with hypopharyngeal cancer.ConclusionsFor patients with LAHNC, delay of definitive radiotherapy leads to inferior survival. Our study highlights that the threshold of 36 and 61 days significantly affects survival and identifies patients experiencing these delays.

PMID:42627284 | DOI:10.1177/10732748261481970

Gen Dent. 2026 Sep-Oct;74(5):45-50.

ABSTRACT

The coronoid process plays a key role in mandibular function, but its morphometric characteristics remain underexplored. This cross-sectional study aimed to perform a detailed morphometric analysis of the coronoid process using cone beam computed tomography (CBCT). Coronoid height, condylar height, coronoid thickness, and coronoid-zygomatic distance were mea-sured bilaterally on CBCT images of 194 women and 149 men aged 18 to 86 years. The coronoid-condylar ratio (CCR) was analyzed in terms of the coronoid-condyle index, in which a CCR of 1.07 or less (≤ 1.07) is considered normal; a CCR greater than 1.07 and up to 1.15 (1.07 < CCR ≤ 1.15) is considered suggestive of pathology and should be investigated; and a CCR greater than 1.15 (> 1.15) is considered indicative of coronoid process hyperplasia. Statistical analyses included Student t test, analysis of variance, and Tukey tests for parametric measurements and Mann-Whitney U, Kruskal-Wallis, and Bonferroni tests for nonparametric measurements. A significance level of 5% was adopted. The measurements revealed that the coronoid process height was significantly greater in men than in women, but there were no statistically significant differences between age groups. The greatest condylar heights were observed in men, but the difference from the heights in women was only significant on the right side. Condylar height measurements differed with age; values decreased significantly on both sides beginning at 35 years. The coronoid thickness and coronoid-zygomatic distance were significantly reduced in individuals 35 years and older but did not differ between the sexes. There was a predominance of CCRs ≤ 1.15 on both sides, and CCRs > 1.15 were concentrated in patients aged 54 years or older. This study provides CBCT-based morphometric reference data on the coronoid process, highlighting variations by sex and age that may support diagnosis and improve surgical planning in cases of suspected anatomical alterations.

PMID:42627276

Chaos. 2026 Aug 1;36(8):083140. doi: 10.1063/5.0338320.

ABSTRACT

The analysis of random walks on networks often relies on global quantities that average over nodes, thereby masking local differences in diffusion speed. This study introduces a vertex-level quantity Hi, defined as the finite-window fitted scaling exponent of the mean squared resistance distance ⟨Ωi2(t)⟩∼Cit2Hi from a given node i. We found nodes with Hi values below 0.5 (echo effect) and above 0.5 (catapult effect). The exponent is computed exactly via matrix powers of the transition matrix. We systematically evaluate Hi on several synthetic network families, generalized Sierpiński graphs, Newman-Watts small-world networks, and a custom grid-path-complete graph, and on two real-world networks (international E-road network and western U.S. power grid). We found nodes with Hi values less than 0.5 (subdiffusive regime) and greater than 0.5 (apparent superdiffusion) in both model networks and real-world networks. Analysis of model networks shows that when a node has an echo effect, its Hi value is less than 0.5, whereas when it has a catapult effect, its Hi value is greater than 0.5. In the two real networks, most nodes are in the subdiffusive regime and the overall heterogeneity of the local diffusion exponents is low, as indicated by Rényi indices of 0.0835 (E-road network) and 0.0555 (power grid). Comparisons with classical centrality measures indicate that Hi provides information not captured by those measures. The local diffusion exponent offers a vertex-level, dynamics-based tool for identifying structural bottlenecks and node roles, complementing global network characterizations.

PMID:42627263 | DOI:10.1063/5.0338320

Shock. 2026 Aug 21. doi: 10.1097/SHK.0000000000002925. Online ahead of print.

ABSTRACT

Delirium is a frequent neuropsychiatric complication in critical illness associated with increased risk of long-term cognitive impairment and mortality. We hypothesized that lower cerebral tissue oxygen saturation (cStO2) levels measured with near infrared spectroscopy (NIRS) associate with worse outcome, including mortality, and the risk for developing delirium in circulatory shock. We conducted the prospective, observational, multi-center study (ASSESS-SHOCK, ClinicalTrials.gov: NCT03814564), from April 2019 to May 2023. We enrolled adult circulatory shock patients within 24 hours of intensive care unit (ICU) admission. We registered cStO2 continuously for 48 hours using INVOS™ NIRS devices. We calculated the time-weighted mean cStO2 values and areas under the predefined thresholds of 60%, 50%, and 40% respectively. The primary objective was the association of time-weighted mean cStO2 during 0-48 hours with development of delirium during days 1-7. Secondary endpoints were ICU- and 90-day mortality. We included 256 patients, of whom 87 (34%) developed delirium. The 0-48 h mean cStO2 values did not differ between patients with and without delirium: 61.6% (interquartile range [IQR] 57.3 to 67.7) vs 63.1% (IQR 57.7 to 68.1, p=0.716), respectively. Lower time-weighted mean cStO2 during 48 hours was, however, associated with higher 90-day mortality: in non-survivors cStO2 was 60.0% (IQR 52.8 to 64.7) compared to 63.9% (IQR 58.1 to 68.9) in survivors (p<0.001). Conclusions: In circulatory shock, lower mean cStO2 values were not associated with delirium but they were associated with 90-d mortality. NIRS monitoring could serve as an adjunct method for identifying patients at risk for developing adverse outcomes, including mortality. Trial registration: ClinicalTrials.gov Identifier: NCT03814564, registered 15 January 2019. The ASSESS-SHOCK study: Assessment of peripheral perfusion, tissue oxygen saturation, endothelial function, and coagulation disorder in circulatory shock.

PMID:42627201 | DOI:10.1097/SHK.0000000000002925