Tag: statistics

Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Aug 10;47(8):1432-1439. doi: 10.3760/cma.j.cn112338-20251222-00914.

ABSTRACT

Objective: To investigate the association between remnant cholesterol (RC) and the incidence of cardiovascular disease (CVD) and its subtypes among patients with type 2 diabetes mellitus (T2DM) in Jiangsu Province. Methods: This study was based on data from a community-based cohort of patients with type 2 diabetes in Jiangsu Province. Baseline data were collected between 2013 and 2014, with follow-up through December 31, 2021. Cox proportional hazards regression models were used to examine the associations between RC and the risk of CVD and its subtypes, estimating HRs and 95%CIs. Restricted cubic spline (RCS) analyses were applied to explore the dose-response relationship between RC and CVD risk. Results: Among 15 119 T2DM participants with a median follow-up of 8.04 years, 3 043 new CVD cases were identified, including 1 047 coronary heart disease (CHD) and 2 497 stroke cases. In multivariable- adjusted Cox proportional hazards regression models, compared with participants in the lowest RC quartile, those in the highest quartile had higher risks of CVD (HR=1.19, 95%CI: 1.08-1.33) and stroke (HR=1.22, 95%CI: 1.08-1.37), whereas the association between the highest RC quartile and CHD risk was not statistically significant (HR=1.15, 95%CI: 0.95-1.38). RCS analyses showed positive linear associations between RC levels and the risks of incident CVD and stroke in patients with T2DM (P for nonlinear=0.117 and 0.109, respectively). Subgroup analyses showed a multiplicative interaction between RC levels and age for stroke risk (P for interaction <0.05), with a stronger association observed among participants aged <65 years. Conclusions: Higher RC levels were associated with increased risks of CVD and stroke among patients with T2DM, with approximately linear positive associations observed for CVD and stroke. The association between RC and stroke risk was stronger among individuals aged <65 years.

PMID:42618478 | DOI:10.3760/cma.j.cn112338-20251222-00914

Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Aug 10;47(8):1422-1431. doi: 10.3760/cma.j.cn112338-20260209-00115.

ABSTRACT

Objective: To understand the association between body weight perception and suicide related behaviors among middle and high school students in Zhejiang Province, and to provide a basis for body weight management and suicide prevention. Methods: Based on the baseline survey data of the Zhejiang childhood behavior and health cohort, 7 666 subjects were included in this study the use multivariate logistic regression analysis to examine the association between body weight perception and accuracy with suicidal ideation and attempts, and OR with 95%CI were reported. Results: The proportions of feeling moderate, underweight, and overweight were 43.7%, 24.0%, and 32.3%, respectively. The rates of accurate, underestimated, and overestimated weight perception were 61.6%, 22.9%, and 15.5%, respectively. In the past 12 months, 18.4% of students had suicidal ideation, 4.9% had suicidal attempts. After adjustment for potential confounders, analysis results showed that the ORs for suicidal ideation and perceived underweight and overweight were 1.66 (95%CI: 1.40-1.97) and 1.36 (95%CI: 1.14-1.63), respectively; the ORs for suicidal ideation and underestimation and overestimation of body weight were 1.35 (95%CI: 1.15-1.58) and 1.32 (95%CI: 1.09-1.59), respectively. The ORs for suicidal attempts between perceived overweight, and overestimated weight were 1.34 (95%CI: 1.00-1.80) and 1.43 (95%CI: 1.05-1.93), respectively. There is no significant association between BMI and weight perception or weight perception accuracy. Conclusions: BMI is not associated with suicidal behavior. Both perceived overweight and underweight are positively correlated with suicidal ideation in students, while perceived overweight and overweight are positively correlated with suicidal attempts.

PMID:42618477 | DOI:10.3760/cma.j.cn112338-20260209-00115

Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Aug 10;47(8):1409-1415. doi: 10.3760/cma.j.cn112338-20251113-00822.

ABSTRACT

Objective: To describe the incidence of primary immune thrombocytopenia (ITP) among children ≤5 years in Chongqing from 2019 to 2024. Methods: A retrospective dynamic cohort of resident children aged ≤5 years was established using data from the Chongqing Health and Medical Big Data Platform between 2019 and 2024. ITP cases were identified using the International Classification of Diseases Tenth Revision (ICD-10) code “D69.3” and regular expression-based keywords matching of Chinese free-text clinical records. New-onset cases were defined using a 90-day washout period. The incidence density of ITP and its 95%CI were calculated using the Poisson distribution. Poisson regression models were used to estimate the associations between incidence density and risk factors including sex, age, residence type, calendar year, and season. Results: A total of 2 608 631 ≤5 years children were enrolled in the cohort, of whom 51.95% were males and 62.50% resided in urban areas. We identified 1 294 new-onset ITP cases, accounting for 1 468 incident episodes. The overall incidence density of ITP was 16.18 per 100 000 person-years (95%CI: 15.37 per 100 000 person-years – 17.03 per 100 000 person-years). The female-to-male incidence density ratio was 0.73, indicating a statistically significant difference (P<0.001). No statistically significant differences in incidence density were observed across calendar years, although a seasonal pattern was noted, with a higher incidence from April to June. The highest risk of ITP was observed among infants, with two peaks in incidence density occurring at 2-3 months and 9 months of age. Incidence density ratio for rural vs. urban children was 0.58 (95%CI: 0.51-0.65) (P<0.001). Conclusion: From 2019 to 2024, the incidence of ITP among children ≤5 years in Chongqing was characterized by a stable temporal trend, a male predominance, a peak in infancy with distinct early-life peaks, and higher incidence in urban populations, along with a moderate seasonal variation.

PMID:42618475 | DOI:10.3760/cma.j.cn112338-20251113-00822

Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Aug 10;47(8):1401-1408. doi: 10.3760/cma.j.cn112338-20260123-00068.

ABSTRACT

Real-world studies have been widely used in clinical and public health research to evaluate effectiveness, assess risks, and inform health policy decision-making. However, real-world data typically lack randomization and controlled interventions, are often heterogeneous, and exhibit substantial population heterogeneity, posing major challenges for uncertainty assessment and multi-source evidence integration in statistical inference. Bayesian methods, by combining prior information with observed data, provide a flexible and coherent framework for statistical inference in complex data environments. The paper systematically reviews the major applications of Bayesian methods in real-world studies, with a particular focus on the theoretical foundations, modeling strategies, and applicability of state-of-the-art information borrowing approaches. In addition, we summarize recent advances in Bayesian causal inference, hierarchical modeling, and related methods in real-world research. Finally, this paper discusses the methodological issues that need to be addressed when applying Bayesian methods to real-world research, providing a reference for related research.

PMID:42618474 | DOI:10.3760/cma.j.cn112338-20260123-00068

Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Aug 10;47(8):1395-1400. doi: 10.3760/cma.j.cn112338-20260123-00067.

ABSTRACT

With the rapid growth of precision medicine and the increasing demand for novel drug development, traditional development strategies and trial designs are no longer adequate for contemporary clinical research, prompting regulatory agencies, industry, and academia to explore more flexible and efficient approaches. Bayesian methods are emerging as a vital statistical tool for innovative clinical trial design due to their flexibility and strong interpretability. In critical fields of clinical trials such as dose finding and optimization, adaptive design, external information borrowing, and master protocol design, Bayesian methods have demonstrated unique value distinct from traditional frequentist approaches. This paper systematically reviews common Bayesian methods in innovative clinical trial design and discusses crucial considerations for their application, aiming to guide the standardized, rational use of Bayesian methods.

PMID:42618473 | DOI:10.3760/cma.j.cn112338-20260123-00067

Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Aug 10;47(8):1389-1394. doi: 10.3760/cma.j.cn112338-20260123-00066.

ABSTRACT

The prior distribution refers to a probabilistic description of the uncertainty of unknown parameters by researchers before observing sample data. It is a prerequisite and key step in Bayesian statistical methods, as well as a major challenge encountered in practical applications. Based on four dimensions-information content, probabilistic characteristics, relationship with the likelihood function, and structural hierarchy-this paper comprehensively sorts out the types of prior distributions, illustrates the impact of prior distributions on results through a combination of theory and case studies, and discusses in depth the key issues that need to be prioritized when selecting prior distributions. In addition, this paper elaborates on the importance and implementation methods of sensitivity analysis for prior distributions and introduces key points for reporting Bayesian statistical inference results. Only by rationally selecting prior distributions and standardizing Bayesian statistical inference can the scientific value of Bayesian statistics be fully realized.

PMID:42618472 | DOI:10.3760/cma.j.cn112338-20260123-00066

Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Aug 10;47(8):1383-1388. doi: 10.3760/cma.j.cn112338-20260123-00064.

ABSTRACT

Bayesian statistics dates back to the 18th century. Its development was once hindered by computational complexity. However, as computing methods and technologies have advanced, Bayesian statistics has demonstrated its advantages across many research scenarios, including small-population studies, information borrowing, complex and innovative designs, and dynamic decision-making. Recently, regulatory authorities in China, the United States, and Europe have issued guidelines, acknowledging the role of Bayesian statistics in new drug research and development. This paper introduced the basic concepts, theoretical foundations, and inference frameworks of Bayesian statistics. Bayesian statistics uses Bayes’ theorem to combine prior information with sample data to derive the posterior distribution, which serves as the basis for Bayesian inference and decision-making. Unlike the traditional frequentist approach, which focuses on “analyzing only the data from the current study”, the Bayesian approach aims to “integrate and use previous information together with current data,” thereby forming a statistical decision-making approach that continuously accumulates and makes dynamic decision-making. The paper also discussed the strengths and weaknesses of the frequentist and the Bayesian, as well as their respective strengths and weaknesses. The authors note that the two inference frameworks will be used in a complementary manner in the future, and Bayesian methods play an invaluable role in advancing innovative medical research.

PMID:42618471 | DOI:10.3760/cma.j.cn112338-20260123-00064

J Visc Surg. 2026 Aug 19:S1878-7886(26)00139-6. doi: 10.1016/j.jviscsurg.2026.07.008. Online ahead of print.

ABSTRACT

INTRODUCTION: Anoperineal fistula (APF) treated by fistulectomy provides the best anatomical results but carries a high risk of anal incontinence. Sphincter reconstruction might improve these outcomes, but limited comparative data are available in the literature. The purpose of this study was to compare the outcomes of fistulotomy plus sphincter reconstruction (FSR) and sphincter-sparing techniques for APF repair.

METHOD: This two-center retrospective study included patients undergoing FSR or ligation of the intersphincteric fistula tract (LIFT) or rectal advancement flap (control group) techniques.

RESULTS: Of the 119 patients included, 95 (79.8%) underwent FSR. There were no statistically significant differences in demographic characteristics between groups. More inter- or trans-sphincteric fistulas were included in the control group, while there were more complex fistulas in the FSR group (P<0.001). The healing rate was 76.2% in the control group compared to 91.6% in the FSR group (P=0.056). No statistically significant difference was found in the overall complication (8.4%) or overall anal incontinence rates (14.7%) (P>0.9). In contrast, the recurrence rate was higher in the control group than in the FSR group (P<0.001). In multivariable analysis, FSR was associated with a lower risk of recurrence compared to the control group (OR=0.16; 95% CI: 0.03-0.77).

CONCLUSION: This study suggests that FSR may be superior to the other techniques in terms of cure without increasing morbidity or the risk of anal incontinence.

PMID:42618469 | DOI:10.1016/j.jviscsurg.2026.07.008

Cardiovasc Revasc Med. 2026 Aug 14:S1553-8389(26)00366-0. doi: 10.1016/j.carrev.2026.08.007. Online ahead of print.

ABSTRACT

BACKGROUND: Aortic root replacement with a prosthetic valve is often required during type A aortic dissection repair (TAAD). With the advent of transcatheter aortic valve replacement (TAVR), the use of bioprosthetic valves has increased.

METHODS: Patients undergoing acute TAAD repair from January 2007 through January 2025 were identified. Those who underwent aortic root replacement with a prosthetic valve were included. Multivariable Cox proportional hazards modeling was performed to evaluate the association between valve type and long-term mortality.

RESULTS: Of the 587 patients who underwent type A aortic dissection repair, 158 patients received a prosthetic valve during root replacement. Mechanical valves (MV) were used in 74 (46.8%) and bioprosthetic valves (BV) in 84 (53.2%). The MV group was younger (51.6 vs. 65.3 years, P < 0.001), with similar rates of malperfusion syndromes between groups. 30-day mortality was 8.2% and comparable between the groups. Reoperation for bleeding was more frequent in the MV group but not statistically different (8.5% vs. 4.8%, P = 0.51). Cox Hazard analysis showed that bioprosthetic valve was independently associated a higher risk for long-term mortality (HR 3.23, 95% CI 1.39-7.69, P < 0.001).

CONCLUSION: While reoperation for bleeding was more observed in patients receiving a mechanical valve, a bioprosthetic valve was associated with a higher risk for long-term mortality. While valve choice may not be available to patients in emergent high acuity situations, it is relevant when surgeons make decisions regarding appropriate prosthesis in patients undergoing surgery for acute TAAD.

PMID:42618428 | DOI:10.1016/j.carrev.2026.08.007

Transplant Proc. 2026 Aug 19:S0041-1345(26)00373-8. doi: 10.1016/j.transproceed.2026.07.028. Online ahead of print.

ABSTRACT

INTRODUCTION: Delayed graft function (DGF) is a common early complication after renal transplantation. We aimed to investigate the clinical efficacy and safety of prolonged intermittent renal replacement therapy (PIRRT) in the treatment of patients with DGF after renal transplantation.

METHODS: Clinical information on 80 patients who underwent renal transplantation in The 924th Hospital of the PLA Joint Logistics Support Force, from August 2021 to April 2024 was collected. According to the different hemodialysis methods, they were divided into: prolonged intermittent renal replacement therapy (PIRRT) and intermittent hemodialysis group (IHD). We investigate the effects of 2 dialysis methods on DGF after renal transplantation by comparing the recovery time of transplanted kidney function, the incidence of dialysis complications, and final blood creatinine level between the 2 groups.

RESULTS: Forty patients of PIRRT group and 40 patients of IHD group conformed to our inclusion criteria. Mean DGF time in the PIRRT group was shorter than in the HDF group(10.45 day2 VS 16.43 days, P < .05, urea clearance (Kt/V) in the PIRRT group was better than in the IHD group (1.58VS1.3, P < .05), the incidence of hemodialysis complications was also low in the PIRRT group and there was a statistical difference in total dialysis time between the 2 groups. After therapy, both groups had considerably decreased mean levels of PCT, CRP, and IL-6 (P < .05). However, the IHD group had significantly higher NGAL levels than the PIRRT group (444.39 ± 182.62∶ 274.45 ± 96.34, P < .05). There was no significant difference in KIM-1 levels between the IHD and PIRRT groups. The recovery of renal function in both groups was assessed, and there was no significant difference in serum creatinine levels before therapy (P = .682 > .05). However, there were significant changes in serum creatinine levels between the 2 groups 1 month and 3 months after therapy (P = .021 and P = .016, respectively), showing that the medication was effective in improving renal function recovery. However, there was no statistically significant difference in serum creatinine levels between the 2 groups 6 months later (P = .125), showing that the recovery of renal function in both groups approached similarity after a given amount of time.

CONCLUSION: PIRRT was used for hemodialysis treatment of patients with DGF after renal transplantation. It can shorten the duration of DGF, reduce renal damage during DGF, and promote the recovery of transplanted kidney function.

PMID:42618415 | DOI:10.1016/j.transproceed.2026.07.028