Tag: statistics

JACC Cardiovasc Interv. 2026 Jan 21:S1936-8798(25)03198-X. doi: 10.1016/j.jcin.2025.12.003. Online ahead of print.

ABSTRACT

BACKGROUND: Right ventricular (RV)-pulmonary arterial (PA) coupling, a measure of RV function in relation to pulmonary afterload, has emerged as a promising prognostic marker in critically ill patients and can be readily assessed using echocardiography.

OBJECTIVES: The aim of this study was to evaluate the prognostic significance of RV-PA coupling in patients presenting with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.

METHODS: This post hoc analysis of a retrospective study analyzed 973 STEMI patients (derivation and validation cohorts) undergoing primary percutaneous coronary intervention between 2014 and 2023 (median follow-up duration 4.2 years; Q1-Q3: 2.1-6.7 years). RV-PA uncoupling was assessed using echocardiography via the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP). Using maximally selected log-rank statistics, a cutoff of 0.405 mm/mm Hg for TAPSE/sPAP ratio was identified, effectively stratifying patients into high- and low-risk groups.

RESULTS: As confirmed in an external validation cohort, patients with RV-PA uncoupling showed significantly higher 1-year all-cause mortality compared with those with preserved RV-PA coupling (33.30% [95% CI: 4.65%-53.40%] vs 3.04% [95% CI: 1.40%-4.65%]; HR for 1-year mortality: 12.60; 95% CI: 4.49-35.40; P < 0.001). TAPSE/sPAP ratio outperformed TAPSE alone in predicting 1-year mortality, as demonstrated by receiver-operating characteristic curve analysis (area under the curve: 0.732 [95% CI: 0.643-0.821] vs 0.643 [95% CI: 0.537-0.732]; P = 0.018). Multivariate analysis confirmed that RV-PA uncoupling independently predicted 1-year mortality.

CONCLUSIONS: This study highlights the importance of hemodynamic equilibrium between the RV and pulmonary circulation in STEMI patients. RV-PA uncoupling (TAPSE/sPAP ratio < 0.405 mm/mm Hg) is an independent predictor of 1-year all-cause mortality in these patients, aiding in early risk stratification.

PMID:41609536 | DOI:10.1016/j.jcin.2025.12.003

JACC Clin Electrophysiol. 2026 Jan 24:S2405-500X(25)01105-3. doi: 10.1016/j.jacep.2025.12.028. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnosis of carotid sinus syndrome requires the reproduction of spontaneous symptoms during carotid sinus massage (CSM) alongside clinical features indicative of a reflex mechanism. In contrast, the significance of asymptomatic asystolic carotid sinus hypersensitivity (CSH) remains uncertain, as it is frequently observed in older adults without syncope.

OBJECTIVES: This study aimed to evaluate the correlation between asymptomatic asystolic CSH and spontaneous events documented via implantable loop recorder (ILR).

METHODS: In this study, 92 reflex syncope patients with an asymptomatic pause >3 seconds during CSM (average 4.9 ± 1.7 seconds) received an ILR and were followed for a median of 23.1 months. The control group consisted of reflex syncope patients with negative CSM drawn from a historical ILR population and matched with the propensity score method to the CSH group based on clinical variables.

RESULTS: During the observation period, 38 (41.3%) CSH patients had recurrence of syncope, which was associated with asystole of 8.0 seconds (95% CI: 5.3-13.5 seconds) in 29 (76.3%) cases. Although the actuarial rate of total syncope recurrence in CSH group was similar to that in the control group (HR: 1.22; P = 0.40), CSH patients showed a higher rate of asystolic syncope (HR: 2.13; P = 0.011) and asystolic pauses (HR: 2.06; P = 0.009).

CONCLUSIONS: Patients with asymptomatic asystolic CSH were more likely to experience spontaneous asystolic syncope than those without CSH. Among CSH patients who experienced a recurrence of syncope documented by an ILR, the positive predictive value of an asystolic pause detected during CSM was 76.3%.

PMID:41609532 | DOI:10.1016/j.jacep.2025.12.028

Int J Dermatol. 2026 Jan 29. doi: 10.1111/ijd.70306. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis is a chronic immune-mediated disease associated with multiple systemic comorbidities. Biologic therapies have transformed the management of moderate-to-severe psoriasis; however, their high cost remains a major barrier for uninsured and socioeconomically disadvantaged individuals. The Psoriasis Biologics Center for Indigent Patients at Jackson Memorial Hospital provides a structured dermatology access model for underserved populations.

METHODS: We conducted a descriptive retrospective cohort study of patients with moderate-to-severe psoriasis receiving biologic therapy through a dedicated safety-net access program between 2005 and 2025. Patient demographics, comorbidities, and management strategies were obtained from electronic medical records and standardized intake questionnaires. Only descriptive statistics were performed; standardized disease severity and quality-of-life measures such as the Psoriasis Area and Severity Index (PASI) or the Dermatology Life Quality Index (DLQI) were not available.

RESULTS: A total of 450 patients (mean age 52.6 years; 54% female) were included. Nearly half (49.8%) presented with at least one systemic comorbidity. The most common were psoriatic arthritis (35.1%), hypertension (31.3%), diabetes mellitus (20%), cardiovascular disease (19.1%), obesity (13.8%), and dyslipidemia (12.2%). Psychiatric comorbidities included depression (9.6%) and anxiety (3.8%). Infectious conditions occurred at higher-than-expected frequencies, including hepatitis B/C (3.8%), latent tuberculosis (3.6%), and human immunodeficiency virus (HIV) (2.7%). Care delivery was organized within a structured safety-net model that incorporated standardized screening protocols, referral pathways, and multidisciplinary coordination to support biological access for uninsured patients.

CONCLUSIONS: This 20-year descriptive cohort characterizes comorbidity burden and biologic access within an indigent psoriasis population. This study does not assess clinical outcomes or treatment effectiveness. These findings describe a care delivery framework that may inform future health system and health equity-focused initiatives.

PMID:41609515 | DOI:10.1111/ijd.70306

Clin Cancer Res. 2026 Jan 29. doi: 10.1158/1078-0432.CCR-25-2916. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the efficacy and safety of poly(ADP-ribose) polymerase inhibitor (PARPi) rechallenge combined with bevacizumab as maintenance therapy in patients with platinum-sensitive recurrent ovarian cancer previously treated with a PARPi.

EXPERIMENTAL DESIGN: KGOG 3056/NIRVANA-R is a multicenter, single-arm, phase II trial that enrolled 44 patients with platinum-sensitive recurrent ovarian cancer who had received ≥2 prior lines of platinum-based chemotherapy and prior PARPi maintenance. Eligible patients achieving a response to the most recent platinum therapy received daily niraparib and triweekly bevacizumab until disease progression or unacceptable toxicity. The primary endpoint was the 6-month progression-free survival (PFS) rate, analyzed using Simon’s two-stage design with adaptive statistical inference.

RESULTS: The primary endpoint was met, with 26 of 44 patients (59.1%) remaining progression-free at 6 months. The estimated 6-month PFS rate was 68% [95% confidence interval (CI), 55%-85%], and the median PFS was 11.5 months [95% CI, 7.9-not reached]. Subgroup analyses suggested greater benefit in patients with a longer treatment-free interval after the penultimate chemotherapy and in those who achieved a complete response to the most recent chemotherapy. Grade ≥3 treatment-related adverse events occurred in 27.3% of patients, with no treatment-related deaths or new safety signals observed.

CONCLUSIONS: This is the first report of PARPi rechallenge with bevacizumab as maintenance therapy in this setting. The combination demonstrated promising efficacy, particularly in patients with favorable platinum responsiveness, and warrants further investigation in biomarker-driven studies.

PMID:41609513 | DOI:10.1158/1078-0432.CCR-25-2916

J Trauma Acute Care Surg. 2026 Jan 29. doi: 10.1097/TA.0000000000004930. Online ahead of print.

ABSTRACT

BACKGROUND: Teaching hospitals serve as referral centers for pediatric trauma care. However, the impact of interhospital transfer on outcomes in pediatric traumatic brain injury (TBI) within urban teaching hospitals remains unclear. Hence, we examined whether transferred pediatric TBI patients to urban teaching hospitals experienced different outcomes from directly admitted patients, hypothesizing that results would be comparable.

METHODS: We conducted a cross-sectional study of pediatric TBI hospitalizations from 2016 to 2021 using the National Inpatient Sample database. Patients were categorized as direct admissions or transfers. Propensity score matching (1:2 with replacement) was performed using demographic, clinical, and hospital-level variables. Outcomes included in-hospital mortality, medical complications, length of stay (LOS), and postdischarge rehabilitation referral.

RESULTS: Out of 28,548 total patients, 15,324 were successfully matched with 7,239 (47.2%) interhospital transfers. Baseline demographics, clinical, and hospital characteristics were well balanced between the two groups (all standardized mean differences <10%). Unadjusted in-hospital mortality was similar between transferred and directly admitted patients (3.6% vs. 3.4%, p = 0.49). However, transferred patients experienced longer LOS (median, 2 days; interquartile range, 1-6; p < 0.001), fewer discharges to rehabilitation (5.7% vs. 6.7%, p < 0.001), and higher complications (deep vein thrombosis, 1.2 vs. 0.9; p = 0.04; urinary tract infection, 1.6 vs. 1.1; p = 0.005). After multivariable adjustment, transfer status was not associated with mortality (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.89-1.28) and rehabilitation discharge (OR, 0.92; 95% CI, 0.80-1.06). However, transfer remained independently associated with longer LOS (OR, 1.31; 95% CI, 1.24-1.39) and higher complications (OR, 1.25; 95% CI, 1.09-1.44).

CONCLUSION: Interhospital transfer was not associated with mortality or rehabilitation discharge among pediatric TBI patients treated at urban teaching hospitals. However, longer LOS and higher complications among transferred patients raise equity and system efficiency concerns. While statistically significant, these differences were modest and may not be clinically meaningful, warranting further research with more granular data.

LEVEL OF EVIDENCE: Original article, cross-sectional study; Level III.

PMID:41609509 | DOI:10.1097/TA.0000000000004930

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002018. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cohort study.

OBJECTIVE: To identify factors associated with minimally invasive surgery (MIS) utilization and compare inpatient outcomes between MIS and open fusion for traumatic thoracic vertebral fractures using a multicenter trauma registry.

SUMMARY OF BACKGROUND DATA: MIS is increasingly utilized in spine surgery due to its potential to reduce perioperative morbidity. However, its role in managing traumatic thoracic vertebral fractures remains unclear, and large-scale comparisons of MIS versus open fusion in this setting are limited.

METHODS: Adult patients (≥18 y) who underwent thoracic fusion for traumatic thoracic fractures between 2019 and 2021 were identified from the American College of Surgeons Trauma Quality Program database using ICD-10 codes. Patients were stratified by surgical approach (MIS vs. open), and demographic, injury, and clinical characteristics-as well as inpatient outcomes-were compared using chi-squared and t-tests. Multivariable logistic regression was performed to identify patient and injury factors associated with MIS utilization. A P-value < 0.05 was considered statistically significant.

RESULTS: Of 8999 patients undergoing thoracic fusion, 370 (4.1%) received MIS. MIS utilization was associated with older age, lower Injury Severity Scores, and less severe neurological impairment. The number of vertebral levels fused did not differ by approach. MIS patients had significantly shorter length of stay, higher home discharge rates, and lower rates of complications, intensive care unit admission, and mechanical ventilation.

CONCLUSION: This multicenter cohort study identifies key patient and injury characteristics associated with MIS utilization in thoracic trauma. While MIS was associated with some favorable inpatient outcomes, this may be due to selection bias rather than procedural effect. Further prospective studies are needed to clarify appropriate indications and long-term outcomes.

PMID:41609462 | DOI:10.1097/BSD.0000000000002018

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002028. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: The purpose of our study is to identify CT characteristics of unilateral cervical spine facet fractures that are predictive of instability on MRI.

SUMMARY OF BACKGROUND DATA: Management of isolated subaxial cervical spine facet fractures is typically based on the neurological status of the patient and perceived stability of the injury. It has been shown that the degree of ligamentous instability can help predict instability and need for surgery, and MRIs are increasingly being used to evaluate these injuries, but not always. While there are studies that evaluate radiographic characteristics of facet fractures on CT, there are few that specify which CT findings predict instability on MRI.

METHODS: A retrospective review of 49 patients with unilateral cervical facet fractures during a 7-year period from a level I trauma center was performed. All patients had a CT and an MRI performed. Measurements of fracture fragments were obtained from CT scans. MRIs were examined by an independent radiologist and assigned an instability score. CT measurements were compared with MRI instability scores to determine which parameters were predictive of the need for operative stabilization.

RESULTS: Forty-nine patients were identified with unilateral cervical spine facet fractures. Thirty patients initially were treated nonoperatively, and 19 patients underwent surgical stabilization. One patient failed nonoperative management, having neurological deficits and pain at follow-up, and underwent a C6-C7 ACDF later. The average instability score in the operative group was 3.34, versus 1.06 in the conservative treatment group (P<0.001). Fracture displacement (P=0.013), multifragmentary fractures (P<0.001) and MRI instability score (P<0.001) were correlated with a statistically significant increased likelihood of operative necessity.

CONCLUSIONS: Fracture size did not directly correlate with ligamentous injury. Displacement and multifragmentary fractures on CT scan were had the highest correlation with instability scores on MRI. This suggests that patients with subaxial cervical facet fractures that are comminuted or have significant displacement may require operative stabilization.

LEVEL OF EVIDENCE: Level III.

PMID:41609460 | DOI:10.1097/BSD.0000000000002028

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002030. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To compare the advantages and disadvantages of two different foraminoplasty methods.

SUMMARY OF BACKGROUND DATA: Foraminoplasty is one of the most important steps in FELD surgery. In recent years, different surgical instruments for foraminoplasty have been invented, mainly, including reamer/trephine and bone drill. Different foraminoplasty methods have different effects and limitations on the surgical outcome.The aim of this study was to compare surgical outcomes, anesthesia satisfaction, and learning curves between two different foraminoplasty procedures.

PATIENTS AND METHODS: A total of 109 patients with lumbar disc herniation (LDH) treated with full endoscopic lumbar discectomy (FELD) by the same group of physicians from October 2020 to February 2022. Patients underwent foraminoplasty with bone drill were divided into group A, while foraminoplasty with trephine as group B. Back and leg visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated at different time follow-up for evaluating surgical outcomes. Different types of anesthesia were recorded, and patients’ intraoperative pain assessment was evaluated. Learning curve was presented with operation time in chronological order.

RESULTS: There were statistically differences between VAS-back postoperative (P=0.0077) on 6 months. There was also a statistical difference in back pain symptom scores under the interaction between groups and time (P=0.147). The intraoperative VAS score of group A was significantly higher group B (P=0.008). Migration herniated discs and foraminoplasty method were the main factors affecting intraoperative pain. The operation time of group A was shorter than that of group B, while there was no statistical difference (P=0.782).

CONCLUSIONS: Both surgical techniques can achieve good curative effect (excellent rate: 87.7% vs. 89.1%). Patients in group A recovered faster on postoperative function. Patients in group B had better intraoperative experience.

PMID:41609454 | DOI:10.1097/BSD.0000000000002030

Mikrobiyol Bul. 2026 Jan;60(1):53-71. doi: 10.5578/mb.2026018.

ABSTRACT

Hyperemesis gravidarum (HEG) is a pregnancy complication characterized by severe nausea, vomiting more than four times a day and dehydration, especially occurring in the first trimester of pregnancy. In recent years it has been shown that the intestinal bacterial microbiome profile may be associated with a wide range of diseases. The aim of this study was to determine whether the intestinal bacterial microbiome profiles differ between pregnant women diagnosed with hyperemesis gravidarum (HEG) and those with healthy pregnancies. Fresh stool samples were collected from 15 pregnant women diagnosed with HEG and 14 healthy pregnant women who did not have any complaints in the first trimester. After DNA isolation from the samples, 16S rRNA gene-based microbial profiling was performed with next-generation sequencing. The 16S rRNA V3-V4 region was sequenced with paired-end reads (2×250 base pair) on the Illumina MiSeq platform. The average sequence number for each sample was similar (HEG= ~2.54 million, control= ~1.48 million; p> 0.05). After quality filtering, reads obtained from all samples were analyzed by rarefaction at equal depth. Alpha diversity measures were found to be significantly higher in the HEG group compared to the control group (Shannon, ACE, and Chao1 indices; p< 0.05 for all). In the beta diversity analysis, it was observed that the gut microbiome compositions of the two groups were separated; In the Principal Coordinates Analysis plot, the groups were clearly clustered and the group difference was found to be statistically significant by PERMANOVA test (p< 0.01). Significant differences were also found in the comparisons at the taxonomic level. At the class level, the relative abundance of Clostridia was significantly higher in the HEG group (p< 0.05), while the class Bacilli was dominant in the control group (p< 0.05). At the family level, the abundances of Lachnospiraceae and Prevotellaceae were found to be significantly higher in the HEG group than in the control group (p< 0.05). In contrast, at the family level, the rates of Enterobacteriaceae and at the genus level, the rates of Escherichia-Shigella were found to be significantly higher in the control group (p< 0.05). Some bacterial taxa detected only in the HEG group samples were also noteworthy: Collinsella, Blautia, and Dialister genera, which are only found in the intestines of patients with HEG, were not detected in the control group. In conclusion, these findings reveal that there are significant differences between the intestinal microbiome profiles of pregnant women with HEG and healthy pregnant women. The high microbial diversity observed in the HEG group and changes in certain bacterial groups suggest that processes related to lipid and carbohydrate metabolism may play a role in the pathogenesis of HEG. In the future, the clinical significance and possible therapeutic targets of these differences can be evaluated with more comprehensive studies aiming at clarifying causality.

PMID:41609448 | DOI:10.5578/mb.2026018

Mikrobiyol Bul. 2026 Jan;60(1):28-40. doi: 10.5578/mb.202601112.

ABSTRACT

Acute gastroenteritis (AGE) is an important public health problem that is very common all over the world. Knowing the causative agents is important for understanding the clinical course of the disease, effective treatment and necessary precautions to be taken. In this study, we aimed to determine the pathogen distribution in AGE cases admitted to our center using multiplex real-time polymerase chain reaction (mRt-PCR) and to demonstrate the clinical and laboratory differences between luminal (type I) and mucosal/invasive (type II) infections. We also aimed to define biomarker thresholds to facilitate decision-making in situations where access to advanced diagnostic tests is limited. Eighty-five patients aged ≥ 18 years were retrospectively analyzed between June and September 2023. Clinical complaints, stool macroscopy and laboratory results recorded at admission including; leukocyte count, neutrophil/ lymphocyte ratio (NLR), hemoglobin, platelet count, C-reactive protein (CRP), renal and hepatic function tests and lactate dehydrogenase (LDH) values were recorded. Stool samples were evaluated by microscopic examination, culture/antigen tests and Bio-Speedy Gastroenteritis mRt-PCR (MX-24L). According to PCR results, the cases were categorized as a pathogen-negative group, a mucosal-type infection group and a luminal-type infection group. Appropriate statistical tests were used, ROC analysis was performed for CRP, NLR and platelet count to predict mucosal type. The median age was 54 years (interquartile range= 38-67) and 56.5% were male. At least one pathogen was detected by PCR in 76% (65/85) of the cases; the most common were Campylobacter spp. (17.3%), enteroinvasive Escherichia coli (12.9%) and norovirus (12.9%). 41.2% of the cases were mucosal type, 35.3% were luminal-type and 23.5% were in the group in which no causative agent was detected. Age was higher in the mucosal type group (p= 0.009). Red color/blood in stool and fever were significantly more common in mucosal type group (both p< 0.001); vomiting was more common in mucosal type group (p= 0.016). CRP and NLR values were significantly higher in mucosal type group (both p≤ 0.001), while platelet count was lower (p= 0.021). ROC analysis revealed CRP as the strongest predictor for mucosal type group. mRt-PCR enables high-rate detection of acute gastroenteritis pathogens, supporting accurate and early treatment and contributing to a reduction in unnecessary antibiotic use. By using this test, the most frequently identified acute gastroenteritis pathogens in our region were detected as Campylobacter, norovirus and EIEC. In settings where these tests are not available, CRP levels ≥ 42.5 mg/L and/or NLR ≥ 3 may serve as indicators in favor of mucosal-type pathogens and thrombocytopenia may further support this clinical profile. The use of simple and easily accessible biomarkers in combination with clinical findings may contribute to more effective field management of AGE cases.

PMID:41609446 | DOI:10.5578/mb.202601112