Tag: statistics

Cancer Invest. 2026 Aug 24:1-11. doi: 10.1080/07357907.2026.2721530. Online ahead of print.

ABSTRACT

BACKGROUND: Although inflammation and lipid metabolism disorders have been confirmed to affect the risk of cardiovascular disease (CVD)-specific mortality and cancer-specific mortality in cancer survivors, the predictive value of the high-sensitivity C-reactive protein/high-density lipoprotein cholesterol ratio (CHR) for these outcomes remains unclear, with a paucity of relevant research evidence.

METHODS: Based on data from the National Health and Nutrition Examination Survey (NHANES) 2015-2018, a total of 1,064 cancer survivors aged ≥20 years were enrolled and followed up for 61 months. Inverse probability of treatment weighting (IPTW)-weighted Fine-Gray competing risk models, restricted cubic splines, and subgroup analyses were used to systematically explore the association between CHR and CVD-specific mortality as well as cancer-specific mortality.

RESULTS: During the follow-up period, 127 deaths occurred, including 52 cancer-specific deaths and 27 CVD-specific deaths. The level of high-sensitivity C-reactive protein (hs-CRP) was significantly higher in the CVD-specific death group, while the level of high-density lipoprotein cholesterol (HDL-C) was significantly lower in the cancer-specific death group; CHR was significantly elevated in both death groups compared with their corresponding non-death groups. After IPTW-weighted Fine-Gray competing risk adjustment, each 1-unit increment in CHR was associated with a 5.0% higher subdistribution hazard of CVD-specific mortality among cancer survivors (adjusted SHR = 1.050, P < 0.05). A weak but statistically significant overall linear association was also observed between CHR and cancer-specific mortality (P < 0.05). Restricted cubic spline (RCS) competing risk models further revealed a distinct threshold-dependent nonlinear relationship for cancer-specific mortality, with an inflection point at 3.02 mg/mmol. The hazard of cancer death increased sharply with rising CHR below this cutoff and remained stable without additional risk elevation at higher CHR levels.

CONCLUSIONS: CHR independently predicts higher subdistribution hazard of CVD-specific mortality in cancer survivors, with a 5.0% risk increase per unit elevation. While CHR shows a weak overall linear association with cancer-specific mortality, their relationship exhibits a segmented nonlinear pattern with an exploratory inflection point at 3.02 mg/mmol; this value is not a validated clinical cutoff due to limited outcome events. With distinct predictive effects for the two competing fatal outcomes, CHR could act as a convenient auxiliary biomarker for long-term mortality risk evaluation and lay a foundation for future large-cohort validation of clinical thresholds.

PMID:42637674 | DOI:10.1080/07357907.2026.2721530

Eur Heart J Cardiovasc Pharmacother. 2026 Aug 25:pvag063. doi: 10.1093/ehjcvp/pvag063. Online ahead of print.

ABSTRACT

AIMS: Hydroxychloroquine (HCQ) is commonly prescribed for malaria and autoimmune diseases, yet its potential for cardiotoxicity remains underrecognised. The objective of this study was to investigate the clinical and experimental features of HCQ-associated cardiotoxicity.

METHODS AND RESULTS: We retrospectively analysed 261 HCQ-treated patients, assessing cardiac adverse events and electrocardiographic intervals. Endomyocardial biopsy specimens were examined via transmission electron microscopy. To explore potential pathophysiological correlates, human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were exposed to HCQ, and electrophysiological, ultrastructural, contractile and autophagy-related responses were evaluated. HCQ was discontinued in 14 patients, including 3 patients with clinically significant cardiotoxicity manifesting as heart failure or an isolated conduction abnormality (1.1% of the cohort). QTc intervals increased from a median of 413 ms (interquartile range [IQR], 399-426 ms) pre-treatment to 421 ms (IQR, 407-440 ms) on-treatment (P = 0.003), indicating a modest but statistically significant change. PR interval also increased modestly from 148 ms (IQR, 140-163 ms) to 150 ms (IQR, 142-168 ms) (P = 0.041). In vitro, HCQ exposure in hiPSC-CMs prolonged corrected field potential duration (P = 0.013) and induced arrhythmic activity. Motion analysis demonstrated a reduced peak relaxation velocity (P < 0.01), with concomitant attenuation of contractile function. Transmission electron microscopy showed lamellar inclusions consistent with myelin-like bodies. HCQ exposure significantly increased autophagy-related protein levels, suggesting impaired autophagic degradation. These cellular phenotypes closely mirrored clinical manifestations of HCQ-associated electrical abnormalities and cardiomyopathy.

CONCLUSION: HCQ therapy is associated with electrical abnormalities and cardiomyopathy. Experimental findings in hiPSC-CMs recapitulate key clinical features, providing biologically supportive evidence.

PMID:42637670 | DOI:10.1093/ehjcvp/pvag063

J Trop Pediatr. 2026 Aug 20;72(5):fmag059. doi: 10.1093/tropej/fmag059.

ABSTRACT

Leave against medical advice (LAMA), discontinuation of inpatient care, remains a significant yet poorly characterized challenge in pediatric settings in low- and middle-income countries. We estimated its prevalence and identified clinical, social, and financial drivers among children admitted to a tertiary pediatric emergency unit. A prospective mixed-methods study was conducted over nine months (May 2022-January 2023). Quantitative data were collected using a predesigned case record form, and caregiver satisfaction was assessed on a pilot 10-point scale. Semistructured face-to-face interviews were conducted for qualitative analysis. Inductive thematic analysis followed Braun and Clarke’s framework. A sequential explanatory design with triangulation was employed. Of 6547 admissions, 835 (12.75%) were unplanned discharges; prevalence was higher among neonates than post-neonatal children. Among 139 eligible children (aged 0-12 years), 80 were enrolled (35 neonates, 45 older children). Most families (86%) were from lower socioeconomic strata; 60% received government financial support. About 47% required invasive ventilation, 42% vasoactive support, and 35% underwent cardiopulmonary resuscitation. Despite high satisfaction with clinical care, 97% reported severe stress (≥8/10) and 91% minimal personal support. Qualitative analysis (n = 50) identified four key themes: perceived unfavorable prognosis (64%), infrastructure limitations, indirect financial constraints, and personal beliefs. Collective family decision-making occurred in 75% of cases. LAMA was primarily driven by perceived clinical futility rather than financial barriers alone. Infrastructure constraints, indirect costs, and personal beliefs contributed meaningfully. Targeted interventions should focus on improved prognostic communication, structured family counseling, psychosocial support, and financial protection extending beyond direct medical costs.

PMID:42637666 | DOI:10.1093/tropej/fmag059

Trends Ecol Evol. 2026 Aug 24:S0169-5347(26)00210-7. doi: 10.1016/j.tree.2026.07.012. Online ahead of print.

ABSTRACT

Rare events are low-frequency environmental events whose magnitude and ecological consequences can vary across ecosystems. In this review, we clarify the terminology used to describe these anomalies and propose a statistical definition that disentangles environmental rarity and magnitude from ecological impact. Rare events generate a wide range of responses, from population declines and ecosystem reorganisation to neutral or even positive demographic outcomes. Exceptionally intense perturbations potentially dominate ecological outcomes regardless of their rarity. More commonly, however, their influence on long-term dynamics emerges from the joint effects of magnitude and return interval, such that less extreme but more frequent perturbations could contribute more consistently to population trajectories than rarer events. Long-term demographic studies are essential to identify how rare events shape ecological dynamics.

PMID:42637654 | DOI:10.1016/j.tree.2026.07.012

Ultrasound Med Biol. 2026 Aug 24:S0301-5629(26)00302-9. doi: 10.1016/j.ultrasmedbio.2026.07.027. Online ahead of print.

ABSTRACT

OBJECTIVE: The suprascapular nerve (SSN) provides major motor and sensory innervation to the shoulder. Its accurate identification on ultrasound is challenging because of its small size, low contrast and proximity to structures with similar echotexture. This study aimed to develop and evaluate a deep learning-based approach for multi-class segmentation of the SSN and adjacent structures in dynamic supraclavicular ultrasound.

METHODS: Dynamic ultrasound videos (n = 80) from 42 healthy adults were manually annotated for the SSN, brachial plexus, subclavian artery and omohyoid muscle. A Double U-Net architecture was implemented, incorporating a VGG-19 pre-trained encoder in the first stage and a randomly initialized encoder in the second stage, together with Atrous Spatial Pyramid Pooling and Squeeze-and-Excitation blocks. Ablation experiments examined the effects of encoder choice, architectural design, annotation strategy, loss function and output weighting. Segmentation performance was evaluated using Dice similarity coefficients on an independent test set.

RESULTS: The Double U-Net significantly outperformed the baseline U-Net across all annotated structures. For SSN segmentation, the mean Dice coefficient improved from 0.51 ± 0.19 to 0.68 ± 0.11 (p = 0.03), with greater stability across test videos. A pre-trained VGG-19 encoder showed higher Dice scores than alternative encoders, without statistical significance (p = 0.12). Ablation analyses confirmed complementary contributions of both stages (p = 0.52). Multi-structure supervision yielded modest benefit, with optimal performance when all four structures were annotated (Dice 0.68 ± 0.11). Focal loss achieved the highest average Dice score, and optimal performance was obtained by emphasizing the final output with limited intermediate supervision (α:β = 0.1:0.9).

CONCLUSION: The proposed Double U-Net enables reliable multi-class segmentation of the SSN and surrounding structures in dynamic supraclavicular ultrasound, supporting its potential clinical application in suprascapular neuropathy.

PMID:42637642 | DOI:10.1016/j.ultrasmedbio.2026.07.027

Sleep Health. 2026 Aug 24:S2352-7218(26)00158-0. doi: 10.1016/j.sleh.2026.07.006. Online ahead of print.

ABSTRACT

OBJECTIVE: Nicotine and cannabis vaping are increasingly prevalent among young adults, and aiding sleep is a common reason for cannabis use. This study examined relationships between daily nicotine/cannabis vaping patterns and sleep.

METHODS: From 2023 to 2024, 111 California young adults (aged 18-29; mean age = 23.9±3.0; 64% female; 31.5% non-Hispanic White) who vaped nicotine/cannabis ≥20 days/month completed 30 consecutive days of smartphone-based surveys. Self-reported sleep outcomes included 1) sleep duration (inadequate <7 versus adequate ≥7 hours) and 2) sleep quality (0=terrible to 10=excellent). Daily vaping patterns were non-vaping, nicotine-only vaping, cannabis-only vaping, or same-day co-vaping. Generalized mixed-effects models examined day-level associations between vaping patterns and sleep that night, adjusting for other substance use and baseline covariates.

RESULTS: Of 2147 daily assessments, 51.7% reported inadequate sleep; mean sleep quality was 6.1±2.1. Nicotine-only vaping was most frequently reported (42.5% of the days), followed by same-day co-vaping (32.1%), non-vaping (16.1%), and cannabis-only vaping (9.3%). Nicotine-only vaping days had greater odds of inadequate sleep versus non-vaping (OR=1.40, 95%CI: 1.01-1.94) and versus cannabis-only days (1.93 [1.31-2.85]). Days with same-day co-vaping had greater odds of inadequate sleep compared with cannabis-only vaping (1.50 [1.01-2.23]). Associations between sleep quality and daily vaping patterns were not statistically significant.

CONCLUSIONS: Nicotine vaping was associated with inadequate sleep duration compared to non-vaping or cannabis-only vaping. Despite perceptions of cannabis as a sleep aid, cannabis vaping did not improve sleep quality compared to non-vaping. These findings highlight the need for educational efforts or interventions addressing sleep health among young adults who vape nicotine and/or cannabis.

PMID:42637626 | DOI:10.1016/j.sleh.2026.07.006

Pain Manag Nurs. 2026 Aug 24:S1524-9042(26)00258-4. doi: 10.1016/j.pmn.2026.07.023. Online ahead of print.

ABSTRACT

BACKGROUND: Fibromyalgia (FM) is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and heightened central sensitivity. Women with FM frequently experience sleep disturbances and premenstrual syndrome (PMS), yet the interrelationship among central sensitization (CS), sleep quality, and PMS remains insufficiently understood.

AIM: To examine the associations among premenstrual syndrome (PMS) severity, central sensitization (CS), and sleep quality in women with fibromyalgia, and to test whether central sensitization mediates the association between PMS severity and sleep quality.

METHODS: A cross-sectional study was conducted among 359 women with FM attending rheumatology outpatient clinics at Cairo University Hospitals, Egypt. Data were collected using Arabic versions of the Central Sensitization Inventory (CSI), Pittsburgh Sleep Quality Index (PSQI), and Premenstrual Syndrome Scale (PMSS). Analyses included descriptive statistics, Pearson correlations, and path analysis with mediation testing using SPSS v29 and AMOS.

RESULTS: Participants reported poor sleep quality (PSQI mean = 8.16 ± 4.06), high PMS severity (PMSS mean = 122.54 ± 15.74), and moderate CS symptoms (CSI mean = 51.75 ± 10.43). PMS severity was positively associated with CS (r = 0.487, p < .001) and negatively associated with sleep quality (r = -0.543, p < .001). CS was also negatively associated with sleep quality (r = -0.467, p < .001). Path analysis indicated that CS partially mediated the association between PMS severity and sleep quality.

CONCLUSION: Central sensitization partially mediates the association between PMS severity and sleep quality in women with fibromyalgia, highlighting the interconnected role of menstrual symptoms, central pain processing, and sleep disturbances.

IMPLICATIONS FOR NURSING PRACTICE: Nurses should incorporate assessment of central sensitization, sleep quality and menstrual symptom patterns when caring for women with fibromyalgia. Nursing interventions such as pain neuroscience education, cognitive-behavioral strategies, relaxation techniques and sleep hygiene counseling may help attenuate central sensitization and improve sleep-related outcomes.

PMID:42637619 | DOI:10.1016/j.pmn.2026.07.023

J Cardiothorac Vasc Anesth. 2026 Aug 3:S1053-0770(26)00646-4. doi: 10.1053/j.jvca.2026.07.056. Online ahead of print.

ABSTRACT

OBJECTIVE: Thoracic paravertebral block (PVB) is an effective analgesic technique for video-assisted thoracoscopic surgery (VATS). The intertransverse process block (ITPB) may offer comparable analgesia with a better safety profile. The aim of this study is to compare the postoperative analgesic effects of ITPB and PVB in terms of morphine consumption and pain score.

DESIGN: A randomized, double-blind, non-inferiority trial.

SETTING: A university hospital.

PARTICIPANTS: This study enrolled 55 adult patients who underwent elective VATS, with 5 subsequently excluded.

INTERVENTIONS: Fifty patients were randomly allocated (1:1) to receive either an ultrasound-guided ITPB (n = 25) or a PVB (n = 25) at the T5-6 level. Both groups received a bolus of 20 mL 0.25% bupivacaine, followed by a continuous infusion of 10 mL/h for 48 hours.

MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was total morphine consumption in the first 48 postoperative hours. Secondary outcomes comprised postoperative visual analog scale (VAS) at rest and with deep breathing and block performance time. The 48-hour morphine consumption was similar between the ITPB and PVB groups (9.9 ± 2.8 mg v 8.9 ± 2.1 mg, respectively; mean difference 1.0 mg, 95% CI -0.39 to 2.45; p = 0.151). As the upper limit of this 95% confidence interval (2.45 mg) exceeded the prespecified non-inferiority margin of 1.0 mg, non-inferiority of ITPB to PVB was not statistically confirmed. VAS scores at rest and with deep breathing were comparable at all time points (p > 0.05 for all). The block performance time was shorter in the ITP group versus the PVB group (4.3 ± 0.8 v 6.9 ± 1.4 minutes; p < 0.001).

CONCLUSION: Continuous ITPB resulted in similar 48-hour morphine consumption, pain scores, and complication rates to continuous PVB for VATS, together with a shorter time to perform the block. However, the non-inferiority of ITPB to PVB was not statistically confirmed.

PMID:42637591 | DOI:10.1053/j.jvca.2026.07.056

ISA Trans. 2026 Aug 22:S0019-0578(26)00430-1. doi: 10.1016/j.isatra.2026.08.016. Online ahead of print.

ABSTRACT

To mitigate the degradation in transfer diagnostic performance caused by unseen target domains in complex industrial scenarios, a novel saliency-aware heterogeneous independence decoupling network (SA-HIDN) is proposed for mechanical transfer fault diagnosis. Initially, a heterogeneous decoupled feature extractor is constructed to align the network capacity with the distinct physical attributes of signal components. It employs a deep branch with deep resonance shrinkage to perform soft-thresholding denoising for domain-invariant fault impulses, and a shallow branch with a statistical feature layer to explicitly capture global statistical moments as domain-specific condition features. Subsequently, a statistical independence constraint based on the Hilbert-Schmidt Independence Criterion (HSIC) is introduced to mathematically force the fault and condition subspaces to be independent in the reproducing kernel Hilbert space, effectively suppressing high-order information leakage between decoupled branches. Finally, a saliency-aware adaptive fusion (SAAF) module is developed to proactively protect subtle fault signatures and achieve high-fidelity feature reconstruction through a saliency-masking compensation mechanism. Extensive experiments on planetary transmission and train transmission system datasets demonstrate that the proposed SA-HIDN achieves transfer diagnostic accuracies of 98.13% and 94.48% on two datasets, respectively. These quantitative results and mechanistic analyses confirm that the proposed method significantly outperforms state-of-the-art methods while maintaining a favorable balance between diagnostic precision and computational cost.

PMID:42637588 | DOI:10.1016/j.isatra.2026.08.016

Ren Fail. 2026 Dec;48(1):2700810. doi: 10.1080/0886022X.2026.2700810. Epub 2026 Aug 24.

ABSTRACT

BACKGROUND: Serum uric acid is associated with chronic kidney disease (CKD) progression; however, causality remains uncertain. Although renal urate handling, rather than merely hyperuricemia, may dominate kidney outcomes, the prognostic value of urinary urate indices and the potential modifying effect of urate-lowering therapy (ULT) remain unclear.

METHODS: This retrospective study included patients with an estimated glomerular filtration rate (eGFR) of 15-60 mL/min/1.73m². Exposures were fractional excretion of uric acid (FEUA) and the urinary uric acid-to-creatinine ratio (UUCR). Major adverse kidney event (MAKE) was defined as ≥40% decline in eGFR, initiation of kidney replacement therapy, or death. Associations between FEUA and MAKE, and the modifying effect of ULT were evaluated using Kaplan-Meier analyses and multivariable Cox proportional hazards models, including stratification by baseline ULT.

RESULTS: Among 551 patients (244 receiving ULT), 117 experienced MAKE over a median follow-up of 2.3 years. In the adjusted analysis, FEUA <5.5% was associated with a higher overall risk (hazard ratio [HR], 3.56; 95% CI, 1.96-6.48), with a stronger association in the no-ULT group (HR, 11.59; 95% CI, 3.80-35.31). Conversely, FEUA was not associated with the outcome within the ULT group. FEUA × ULT interaction was significant, indicating that the prognostic meaning of FEUA depends on concomitant ULT.Conclusion: Reduced urinary urate excretion was associated with a higher risk for MAKE. ULT modifies the prognostic impact of FEUA, underscoring the clinical relevance of renal urate handling when assessing kidney risk in CKD and suggesting that pharmacological urate-lowering may modify this risk.

PMID:42637577 | DOI:10.1080/0886022X.2026.2700810