Tag: statistics

Front Neurol. 2026 May 20;17:1802303. doi: 10.3389/fneur.2026.1802303. eCollection 2026.

ABSTRACT

INTRODUCTION: Accurate diagnosis of disorders of consciousness (DoC), including unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), remains a long-standing and unresolved challenge in clinical practice. Current diagnostic frameworks rely predominantly on behavioral responsiveness, with the Coma Recovery Scale-Revised (CRS-R) serving as the clinical gold standard. However, behavior-based evaluation is intrinsically vulnerable to examiner subjectivity and cognitive-motor dissociation, contributing to misdiagnosis rates of up to 40%. From a theoretical perspective, consciousness comprises both external awareness and self-awareness, yet existing DoC assessments focus almost exclusively on external sensory processing, leaving self-awareness substantially underassessed. This imbalance highlights a critical gap that motivates for complementary assessment approaches targeting underexplored dimensions of consciousness.

METHODS AND ANALYSIS: This study protocol aims to develop an EEG-based paradigm and evaluate its feasibility for assessing gut-related interoceptive processing in patients with DoC, using controlled, non-invasive rectal balloon distension. Standardized stimulation procedures, synchronized EEG acquisition, and predefined analytical pipelines will be implemented to characterize the temporal and spatial features interoceptive event-related potentials.

RESULTS: Electrophysiological and statistical analyses will be conducted to assess the feasibility, signal characteristics, and response profiles of gut-related interoceptive EEG activity across diagnostic categories. Exploratory analyses will further examine associations between interoceptive EEG markers and clinical behavioral measures.

DISCUSSION: By systematically investigating an under assessed dimension of consciousness, this study protocol aims to establish the feasibility and signal-level characteristics of gut-related interoceptive EEG responses in patients with disorders of consciousness. By providing methodological and exploratory evidence at the group level, the findings are intended to inform the design of future hypothesis-driven and validation studies, and to support the longer-term development of complementary assessment approaches that extend beyond behavior-based evaluation, with potential relevance for clinical research and public health-oriented diagnostic strategies.

CLINICAL TRIAL REGISTRATION: [ClinicalTrials.gov], identifier [NCT07208942].

PMID:42246050 | PMC:PMC13229987 | DOI:10.3389/fneur.2026.1802303

Front Neurol. 2026 May 20;17:1846726. doi: 10.3389/fneur.2026.1846726. eCollection 2026.

ABSTRACT

BACKGROUND: Continuous positive airway pressure (CPAP) is the gold standard for obstructive sleep apnea (OSA), but its clinical effectiveness in cardiovascular risk management is often limited by suboptimal adherence.

OBJECTIVE: To systematically evaluate and compare the effects of mandibular advancement devices (MAD) vs. CPAP and inactive controls on blood pressure (BP), sleep-related respiratory events, and treatment adherence in patients with OSA.

METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from database inception to February 2026. RCTs reporting ambulatory BP outcomes pre- and post-MAD treatment were included. Secondary outcomes included the apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and objective treatment adherence. Data were pooled using mean differences (MD) and 95% confidence intervals (CIs).

RESULTS: Fourteen independent RCTs (comprising 16 reports) encompassing a total of 1,141 patients, met the inclusion criteria. Compared with inactive controls, MAD showed overall trends of BP reduction. In head-to-head comparisons with CPAP, MAD demonstrated comparable cardiovascular benefits on 24-h and nighttime BP parameters. Notably, MAD achieved a significantly greater reduction in daytime systolic BP compared with CPAP (MD = -1.99 mmHg, 95% CI: -3.82 to -0.17; p = 0.03). While CPAP demonstrated superior physiological efficacy in reducing AHI (MD = 8.45 events/h, p < 0.001), MAD and CPAP yielded comparable improvements in subjective sleepiness (ESS). Crucially, pooled objective tracking data revealed that MAD had significantly longer nightly adherence than CPAP (MD = 0.71 h/night, 95% CI: 0.30 to 1.13; p < 0.001).

CONCLUSION: Despite a physiological inferiority in reducing AHI, MAD appears to offer cardiovascular benefits comparable to CPAP and demonstrates a statistically significant reduction in daytime SBP, which may be partially facilitated by its superior objective adherence. Therefore, for OSA patients who cannot tolerate CPAP, MAD may serve as a viable alternative option for cardiovascular risk management.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261303916, identifier: CRD420261303916.

PMID:42246045 | PMC:PMC13229622 | DOI:10.3389/fneur.2026.1846726

Front Neurol. 2026 May 20;17:1784525. doi: 10.3389/fneur.2026.1784525. eCollection 2026.

ABSTRACT

BACKGROUND: The Cerebellar Neuropsychiatric Rating Scale Version 2 (CNRS-2) measures affective symptoms in cerebellar disease patients across five postulated domains of attentional control, emotional control, autism spectrum, psychosis spectrum, and social skill set, each with overshoot and undershoot symptom subdomains. A data-driven approach is needed to test our a priori model and to further explore the internal structure of the scale.

OBJECTIVES: To explore the latent structure of the CNRS-2 and evaluate the five-domain and overshoot-undershoot structure of the scale items.

METHODS: CNRS-2 was administered to 279 cerebellar subjects. Data suitability for factor analysis was assessed. Eigenvalues and parallel analysis scree plots were evaluated for factor extraction. Exploratory factor analysis (EFA) was performed to identify an optimal factor solution. The EFA-derived solution and our a priori five-domain model were examined via confirmatory factor analysis (CFA). Fit indices, item loadings, and conceptual interpretability were compared. Bifactor analysis was performed on each of the five domains of the a priori model to evaluate whether variance in domain scoring was attributable to the construct measured by the domain versus two subfactors. CFA was also applied to each domain to test the validity of the overshoot-undershoot item groupings.

RESULTS: We extracted 5, 6, and 7 factors based on eigenvalues and parallel analysis. EFA indicated that a six-factor solution best balanced statistical fit and theoretical interpretability. CFA on this EFA-derived solution and on our a priori five-domain model showed both to have acceptable statistical fit and internal consistency, but the five-domain model demonstrated stronger conceptual coherence. The bifactor analysis revealed variation in the interpretability of two subfactors within each of the domains, while CFA validated the overshoot-undershoot clustering of symptoms.

CONCLUSION: Factor analysis of the items comprising CNRS-2 provided empirical support for the clinically derived conceptual framework that defines the five domains of cerebellar neuropsychiatry. Sub-analyses of the individual domains supported the overshoot-undershoot dichotomy. Convergence between our a priori domain model and the solutions derived from EFA revealed stable and interpretable symptom clusters. These findings underscore the presence of coherent, multidimensional interrelated neuropsychiatric constructs in cerebellar disease that can be identified and measured by CNRS-2.

PMID:42246044 | PMC:PMC13230212 | DOI:10.3389/fneur.2026.1784525

Front Neurol. 2026 May 20;17:1789811. doi: 10.3389/fneur.2026.1789811. eCollection 2026.

ABSTRACT

OBJECTIVE: To evaluate oculomotor, vestibular, reaction time, and cognitive (OVRT-C) function in patients with vestibular migraine (VM) using objective eye-tracking-based metrics and to identify patterns of dysfunction relative to healthy controls.

BACKGROUND: Vestibular migraine is a common yet underdiagnosed cause of vertigo. Diagnosis remains primarily clinical, because objective neurologic and vestibular findings are often absent or inconsistent. Quantitative methods capable of capturing the multisystem manifestations of VM may improve objective characterization of the disorder.

METHODS: Participants with a clinical diagnosis of vestibular migraine were recruited from a tertiary headache center and assessed using a battery of OVRT-C tests administered with a portable eye-tracking system (Spryson Dx-100; n = 52). The test battery assessed gaze stability, saccades, antisaccades, smooth pursuit, vergence, optokinetic responses, and visual and auditory reaction times. Participants also underwent bedside neurologic and vestibular examinations and completed the Dizziness Handicap Inventory (DHI). OVRT-C metrics were compared with normative data from a database of 300 healthy adults. Univariate and stepwise multivariate logistic regression models were used to identify metrics that differentiated VM patients from controls.

RESULTS: A substantial proportion of VM patients aged 18 to 45 demonstrated abnormal OVRT-C performance compared with normative data, most prominently in horizontal and vertical saccades (54.3 and 51.4%, p < 0.0001), vertical smooth pursuit (62.9%, p < 0.0001), optokinetic responses (43.8%, p < 0.0001), and gaze stability (65.7%). Several OVRT-C metrics showed strong discriminative ability in logistic regression analyses when considering a single OVRT-C metric is considered (adjusted for participant age and gender). A multiple logistic regression model identified six OVRT-C metrics as significant indicators of VM and demonstrated excellent classification performance (AUC = 0.996), with estimated specificity of 95.9% and sensitivity of 99.7% for probability cutoff of 0.5. Moderate but statistically significant correlations were observed between OVRT-C metrics, bedside neurologic and vestibular findings, and DHI domain scores.

CONCLUSION: Objective OVRT-C testing reveals quantifiable abnormalities in oculomotor, vestibular, and cognitive dysfunction in patients with vestibular migraine. These findings support the feasibility of eye-tracking-based multimodal assessments as complementary tools for characterizing vestibular migraine and warrant further validation in larger and longitudinal cohorts.

PMID:42246042 | PMC:PMC13229772 | DOI:10.3389/fneur.2026.1789811

Patient Prefer Adherence. 2026 May 29;20:583856. doi: 10.2147/PPA.S583856. eCollection 2026.

ABSTRACT

PURPOSE: Hypertension (HTN) combined with prediabetes (pre-DM) has become an important public health concern worldwide. Patients need to adhere to both pharmacological and non-pharmacological treatments in order to regulate both blood pressure and blood glucose levels and reduce the risk of serious complications. This study examined factors associated with treatment adherence in people with both HTN and pre-DM.

METHODS: A cross-sectional study was conducted between January and March 2025. A sample of 275 people with both HTN and pre-DM was recruited from 11 subdistrict health-promoting hospitals (HPHs) in Sai Noi, a semi-rural district in Nonthaburi Province, Thailand. Data were collected using structured questionnaires. Multiple regression analysis was used to examine factors associated with treatment adherence.

RESULTS: It was revealed that female sex, knowledge about HTN and pre-DM/T2DM, social support, patient-provider relationship, convenience of traveling to health services, and convenience in using these services were significantly positively correlated with adherence to treatment. Meanwhile, experience of medication side effects, smoking, and alcohol consumption were negatively correlated with it. The multiple regression model was statistically significant in predicting treatment adherence (F = 11.36 (5, 269), p < 0.001) and included overall support from family (B = 2.23, p < 0.001), smoking (B = -132.61, p < 0.001), experience of medication side effects (B = -89.51, p = 0.004), knowledge of pre-DM/T2DM (B = 14.67, p = 0.013), and patient-provider relationship (B = 2.23, p = 0.033) as significant factors.

CONCLUSION: Disease-related knowledge, support from family, and patient-provider relationship positively influence treatment adherence of people with both HTN and pre-DM, while side effects of medication and smoking negatively influence it. These findings provide valuable insights for health officials that could inform future intervention and management strategies for this dual-risk population.

PMID:42246022 | PMC:PMC13231884 | DOI:10.2147/PPA.S583856

Front Cell Infect Microbiol. 2026 May 20;16:1831616. doi: 10.3389/fcimb.2026.1831616. eCollection 2026.

ABSTRACT

BACKGROUND: Fluoroquinolone resistance in Escherichia coli isolated from urinary tract infections (UTIs) is an increasing global concern, with marked variation across regions and specific agents. Estimating resistance prevalence is essential to guide empirical therapy and strengthen antimicrobial stewardship programs.

METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines, including English-language observational studies published through December 2025. PubMed, Embase, and Web of Science were searched for reports on fluoroquinolone-resistant E. coli in UTIs. Study quality was evaluated using the modified Newcastle-Ottawa Scale. Pooled prevalence estimates were calculated using a random-effects model, and heterogeneity was assessed with the I² statistic. Subgroup analyses were performed by fluoroquinolone agent. Robustness was examined through sensitivity analyses, while meta-regression explored associations between sample size and resistance prevalence. Publication bias and influential studies were evaluated using DOI and Baujat plots.

RESULTS: Among 9,033 identified records, 36 studies met the inclusion criteria. The overall pooled prevalence of fluoroquinolone resistance in E. coli was 31.09% (95% CI, 24.89%-38.05%). Resistance estimates were 30.32% (95% CI, 22.60%-39.34%) for ciprofloxacin, 27.57% (95% CI, 9.01%-59.40%) for levofloxacin, and 68.75% (95% CI, 55.94%-79.76%) for pefloxacin. Sensitivity analyses demonstrated stable pooled estimates ranging from 30% to 32%. Meta-regression suggested an inverse association between study sample size and reported resistance rates. One study contributed modestly to heterogeneity.

CONCLUSION: This analysis demonstrates substantial and geographically heterogeneous fluoroquinolone resistance in E. coli causing UTIs, with particularly high rates reported in China, Iran, and Bangladesh. While ciprofloxacin resistance was considerable, pefloxacin exhibited the highest prevalence. These findings reinforce the importance of enhanced stewardship initiatives, improved resistance surveillance, harmonized reporting standards, and further investigation into resistance mechanisms and data gaps in underrepresented regions.

PMID:42246010 | PMC:PMC13229869 | DOI:10.3389/fcimb.2026.1831616

Front Vet Sci. 2026 May 20;13:1793754. doi: 10.3389/fvets.2026.1793754. eCollection 2026.

ABSTRACT

INTRODUCTION: Raw meat-based diets (RMBD) are increasingly popular among dog guardians, yet the role of personal nutrition habits and pet-guardian relationships in their adoption remains unclear. This study examines how these factors, alongside previously identified drivers of pet food selection, specifically relate to the decision to feed RMBD.

METHODS: Data from 433 dog guardians were collected via an e-survey, from which 46 questions were selected for analysis in this study. Participants were placed into raw or cooked groups based on their dogs’ primary diet. Responses were assessed using descriptive statistics and univariate logistic regression.

RESULTS: A cooked diet was the primary feeding method for 291 participants, while 142 reported providing a diet that included at least one raw element. Households with an income exceeding CA $100,000 were predictive of raw feeding, while possession of graduate education was protective against it. Intact dogs of medium size were also associated with raw feeding practices. Compared to supermarkets and veterinary clinics, pet specialty stores were significantly more likely to be used by raw feeders for pet food purchases. Additionally, the provision of supplements to ensure dietary balance was linked to raw feeders, with the inclusion of fish oil increasing the odds of feeding RMBD. Raw feeding was also associated with greater perceived knowledge of canine nutrition and a preference for minimally processed pet foods, whereas emphasis on the convenience or cost of feeding reduced the likelihood of adopting RMBD. Survey questions evaluating guardians’ nutrition habits and perceived relationships with their pets did not predict diet group membership.

CONCLUSION: Differences between raw feeders and guardians feeding cooked diets were observed in demographics (e.g., income and education), dog characteristics (e.g., breed size and sexual status), supplement use, pet food opinions and purchasing locations, and perceived dog nutrition knowledge. However, no differences were found in personal nutrition habits or the perceived human-animal bond.

PMID:42245978 | PMC:PMC13231891 | DOI:10.3389/fvets.2026.1793754

Front Vet Sci. 2026 May 20;13:1817578. doi: 10.3389/fvets.2026.1817578. eCollection 2026.

ABSTRACT

The clinical significance and ultrasonographic features of intermediate patellar ligament (IPL) desmopathy in horses are still debated and considered nonspecific. Elastosonography allows assessment of tissue elasticity in response to an external stimulus. The aim of the study was to describe the elastosonographic characteristics of the equine IPL, evaluate the feasibility of both strain (SE) and two-dimensional shear wave elastography (2D-SWE), and assess the consistency of the data obtained from these techniques. 20 adult horses of mixed breed, sex and athletic use were selected and allocated to a Sound Group (GS, n.15) or a Lame Group (GL, n.5) based on orthopedic examination findings, according to the presence a stifle-originating lameness and/or with ultrasonographic evidence of IPL lesion. SE and 2D-SWE of both IPLs were performed in longitudinal and transverse scans. Using the same Region of Interest (ROI), SE evaluated the Elasticity Index of the IPL (EI_IPL) and the Strain Ratio (SR) between the IPL and infrapatellar fat pad, while 2D-SWE measured Shear Wave Velocity (m/s) and Young’s modulus (kPa). Feasibility of both techniques was good, with acceptable to good Intraclass Correlation Coefficient (0.7 < ICC < 0.9) (p < 0.05). No significant differences were found between left and right limb, or between intraoperator measurements (Wilcoxon test). No correlation was observed between SE variables (EI and SR) or SWE variables (m/s and kPa) and IPL diameter/thickness ratio (Pearson correlation). SE was able to differentiate between GS and GL, with an EI of the IPL that was statistically higher in GS in transverse scan (respectively, 1.9 and 1.7; p = 0.001). Equine IPL can be efficiently investigated using SE and 2D-SWE. It exhibits elastosonographic characteristic of a hard, non-deformable structure, with increased stiffness in cases of chronic injuries.

PMID:42245976 | PMC:PMC13229688 | DOI:10.3389/fvets.2026.1817578

Front Vet Sci. 2026 May 20;13:1812140. doi: 10.3389/fvets.2026.1812140. eCollection 2026.

ABSTRACT

BACKGROUND: The equine temporomandibular joint (TMJ) is divided into two non-communicating joint (discotemporal DTJ and discomandibular DMJ) compartments. Ultrasound has been extensively used as a diagnostic tool in the horse, but previous work has reported that ultrasound-guidance did not improve the success rate of TMJ arthrocentesis. However, this research focused only on the larger, easily accessed, DTJ compartment. However, most of the osseous pathology of the equine TMJ has been reported to be in the smaller DMJ.

OBJECTIVE: To determine whether using ultrasound-guidance would reduce the number of attempts to successfully perform arthrocentesis of the equine TMJ, specifically the DMJ.

STUDY DESIGN: Experimental study using cadaver animals.

METHODS: The TMJ regions of seven thawed cadaver heads were clipped and cleansed. Arthrocentesis of the left DTJ and DMJ was attempted before repeating the attempts using ultrasound guidance. The number of attempts required to perform successful arthrocentesis of each joint compartment was documented before the second operator performed the same task. The same procedures were then performed on the opposite side of the head.

RESULTS: As operators gained experience, their success rate climbed. Statistically, none of the other documented outcome variables significantly affected the number of attempts to obtain successful arthrocentesis. Despite that, ultrasound-guidance allowed immediate unequivocal evidence of successful arthrocentesis into the targeted joint compartment.

MAIN LIMITATIONS: Low number of normal cadaver horse heads and a lack of randomization of attempt techniques.

CONCLUSIONS: This study shows that ultrasound-guidance did not reduce the number of attempts required for successful DTJ, or DMJ arthrocentesis. However, it did allow for the immediate unequivocal evidence of successful arthrocentesis into the targeted joint compartment.

PMID:42245975 | PMC:PMC13229617 | DOI:10.3389/fvets.2026.1812140

Front Med (Lausanne). 2026 May 20;13:1719823. doi: 10.3389/fmed.2026.1719823. eCollection 2026.

ABSTRACT

OBJECTIVE: Dysmenorrhea is a prevalent gynecological disorder impairing quality of life for women of reproductive age. Although traditional herbal decoctions (THDs) are widely used for dysmenorrhea in Korea, robust real-world evidence regarding their clinical outcomes and safety is limited. This descriptive, hypothesis-generating registry study aimed to examine individualized THDs for dysmenorrhea using registry data from a multicenter observational study.

METHODS: This multicenter, prospective observational registry study enrolled women aged 19-65 years with dysmenorrhea from 33 traditional Korean medicine (TKM) clinics and one TKM hospital in Korea (July 2022-June 2023). Participants were categorized into a THD group (received THDs for ≥10 days) and a non-THD group. Primary outcomes were changes in pain intensity (Numeric Rating Scale, NRS), duration of menstrual pain, and analgesic consumption (defined as the number of analgesic tablets taken per menstrual cycle), assessed at each visit. To address confounding and selection bias, a difference-in-differences analysis using inverse probability of treatment weighting (IPTW) based on propensity scores was performed. Missing data were handled using complete-case analysis, supported by Little’s MCAR test (p = 0.39). Safety was assessed by monitoring and categorizing adverse events.

RESULTS: A total of 119 participants in the THD group and 16 in the non-THD group completed the study. Both groups demonstrated significant within-group reductions in menstrual pain intensity over time. Regarding between-group differences, the THD group showed a significantly greater observed reduction in menstrual pain intensity at visit 2 compared to the non-THD group (Estimate = -1.41, p = 0.029); no significant between-group difference was observed at other time points. Analgesic use also showed a statistically significant observed decrease in the THD group at visit 2 (Estimate = -1.63, p = 0.001). No statistically significant between-group difference was identified for pain duration at any time point. Mild adverse events were reported by 9 participants (7.6%) in the THD group; all resolved spontaneously. No adverse events occurred in the non-THD group.

CONCLUSION: These preliminary findings suggest that individualized THDs may be associated with reduced menstrual pain intensity and analgesic consumption in women with dysmenorrhea in real-world settings; however, significant between-group differences were observed at a single time point only, pain duration did not differ significantly between groups, and comparative safety conclusions remain constrained by the small control group. Larger, adequately powered studies are needed to confirm these exploratory findings.

PMID:42245970 | PMC:PMC13230185 | DOI:10.3389/fmed.2026.1719823