Tag: statistics

Cureus. 2026 Jun 23;18(6):e111394. doi: 10.7759/cureus.111394. eCollection 2026 Jun.

ABSTRACT

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children, marked by inattention, hyperactivity, impulsivity, and impaired motor coordination. While pharmacological and behavioral interventions remain the primary management strategies, growing evidence highlights the influence of motor-based interventions on cognitive and attentional functions. Physiotherapy approaches incorporating bimanual and whole-body movements may enhance sensory integration, bilateral coordination, and executive control. However, limited research exists on structured play-based bimanual training combined with lower-limb activities in children with ADHD. Method An experimental pre-post interventional study was conducted at the Department of Pediatric Physiotherapy, Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth (KVV), Karad, and Chaitanya Bal Rugnalaya, Karad. Eighteen children aged 6-12 years with mild to moderate ADHD were recruited through convenience sampling. Participants underwent a 12-week play-based bimanual training program with lower-limb activities using hopscotch mats, sensory boards, balance trainers, Swiss balls, and sorting tasks. Motor proficiency and behavioral outcomes were assessed pre- and post-intervention using the Bruininks-Oseretsky Test of Motor Proficiency-2, Second Edition (BOT-2) (Short Form) and Conners’ Parent Rating Scale-Revised (CPRS-R). Result Results showed statistically significant improvement in motor coordination, attention, and concentration following the 12-week intervention. BOT-2 scores improved significantly from 32.17 ± 3.35 to 41.11 ± 3.08, while CPRS-R scores reduced from 160.61 ± 25.39 to 105.56 ± 14.42, indicating decreased ADHD symptom severity and enhanced behavioral performance. Conclusion Bimanual training with lower-limb assistance is an effective, engaging physiotherapy intervention for children with ADHD. It simultaneously addresses motor coordination deficits and cognitive-behavioral deficits, making it a valuable adjunct to existing ADHD management strategies. Future large-scale randomized controlled trials are recommended to further establish its clinical efficacy.

PMID:42500756 | PMC:PMC13399577 | DOI:10.7759/cureus.111394

Cureus. 2026 Jun 24;18(6):e111407. doi: 10.7759/cureus.111407. eCollection 2026 Jun.

ABSTRACT

Glucose balance is essential for life and health. It’s regulated by organs that absorb glucose after eating and by the liver that produces glucose during fasting. This study aimed to investigate the acute effect of Nutrilite® All Plant Protein (APP), administered as a preload in 250 mL spiced buttermilk, on glycemic response to a standardized 75 g oral glucose load in individuals with compromised blood glucose levels. The impact of APP, a plant-based dietary protein formulation, was assessed using a non-randomized, fixed-sequence, controlled crossover design to evaluate its potential as a nutritional intervention to improve glycemic response. Fourteen participants were enrolled in the study. Efficacy analyses were conducted in the complete paired efficacy population, defined as participants with usable paired glucose measurements at both intervention visits and all predefined time points (n = 10). Blood glucose spikes were better regulated with APP preload at almost all time points compared to the reference product (glucose). In this acute oral glucose tolerance test (OGTT)-based setting, participants maintained glucose values within the normoglycemic range for a longer duration after the APP preload condition than after the glucose-only reference condition. In the complete paired efficacy population (n = 10), the average incremental area under the curve (iAUC) for the reference product was 3049.5 ± 1290.45. In contrast, the average iAUC for APP combined with the reference product was 700.5 ± 688.74, representing a 78% reduction. This decrease in iAUC was statistically significant (p < 0.005). The significant reduction in iAUC suggests that APP may blunt acute glycemic excursions after a 75 g oral glucose challenge. These findings should not be directly extrapolated to mixed-meal settings without additional vehicle-controlled and meal-based studies. Furthermore, the findings should be interpreted as an acute reshaping of the OGTT glucose response curve rather than as evidence of uniformly improved glycemic control throughout the full 120-minute period.

PMID:42500755 | PMC:PMC13397331 | DOI:10.7759/cureus.111407

Cureus. 2026 Jun 23;18(6):e111399. doi: 10.7759/cureus.111399. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: The role of whole brain radiotherapy (WBRT) in non-small cell lung cancer (NSCLC) brain metastases is increasingly debated in the era of immunotherapy, with much research suggesting that its use provides little benefit for this cohort of patients.

METHODS: A retrospective cohort study included patients diagnosed with NSCLC and brain metastases (2017-2020, n=147). Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression were performed, and a two-tailed p-value of <0.05 was considered statistically significant.

RESULTS: Median survival was 9.7 months, with average survival being 15.9 months from the time of diagnosis. Patients who received immunotherapy lived for 31.5 months, while those who did not lived for 14.7 months. Patients who received WBRT + immunotherapy lived an average of 19.5 months, and those who received WBRT lived an average of 10.2 months. Immunotherapy (hazard ratio (HR) 0.48, p<0.001) and stereotactic radiotherapy (SRS) (HR 0.62, p<0.001) were independently associated with improved survival. WBRT alone was associated with poorer outcomes.

CONCLUSION: WBRT alone provides limited benefit; immunotherapy and SRS improve survival and should be prioritized in future clinical practice.

PMID:42500752 | PMC:PMC13396687 | DOI:10.7759/cureus.111399

Cureus. 2026 Jun 24;18(6):e111422. doi: 10.7759/cureus.111422. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Maintaining the availability of blood components remains a major challenge for transfusion services and healthcare institutions. Blood shortages can disrupt clinical care, complicate prioritization decisions, and place substantial operational pressure on transfusion services. Limited attention has been given to the perspectives of transfusion service personnel directly involved in shortage management, particularly within tertiary healthcare settings in Riyadh, Saudi Arabia.

METHODS: A cross-sectional questionnaire-based study was conducted using a structured survey designed to assess respondent and institutional characteristics, perception of blood component shortage, practices implemented during shortage, barriers affecting shortage management, and perceived strategies to improve blood component availability. A total of 94 responses were collected from transfusion service personnel working in healthcare institutions in Riyadh. Of these, 64 respondents who were directly involved in shortage management were included in the principal analytical sample. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, New York, United States). Descriptive statistics were used to summarize demographic, institutional, and item-level response patterns. Composite domain scores were calculated, and reliability was assessed using Cronbach’s alpha. Subgroup analyses were conducted according to age, years of experience, academic qualification, and role in shortage management.

RESULTS: Blood component shortage was perceived as a meaningful and recurrent operational challenge. The mean composite scores were 3.68±0.90 for shortage perception, 4.03±0.52 for practices during shortage, 3.69±1.06 for barriers and constraints, and 4.44±0.73 for improvement strategies. The most strongly endorsed shortage-related experiences were the need for regular coordination with clinical departments and hospital leadership and the prioritization of patients or procedures during shortage periods. The most frequently reported practices included intensification of donor recruitment, close monitoring of blood inventory, and recall of repeat donors. Major perceived barriers included limited donor availability, high workload, insufficient staffing, high transfusion demand, and limited decision-making authority. Respondents showed the strongest agreement regarding improvement strategies, particularly increasing public awareness of blood donation, implementation of patient blood management programs, and establishment of a national blood service system. Postgraduate-qualified respondents demonstrated significantly higher shortage perception and stronger recognition of selected barriers.

CONCLUSIONS: Blood component shortage in tertiary healthcare settings in Riyadh is perceived not merely as a donor supply issue but as a broader system-level challenge shaped by operational demands, workforce capacity, governance limitations, and institutional coordination requirements. These findings support the need for integrated interventions combining donor awareness, patient blood management, workforce strengthening, and system-level coordination to improve the resilience and sustainability of blood component availability.

PMID:42500751 | PMC:PMC13399943 | DOI:10.7759/cureus.111422

Galen Med J. 2025 Dec 31;14(S Pt 1):e4114. doi: 10.31661/gmj.v14iSP1.4114. eCollection 2025.

ABSTRACT

BACKGROUND: This retrospective study evaluated the success rates of dental implants placed without primary stability in a private practice setting, utilizing three contemporary implant systems (Neodent GM Helix, Biotem AR, MegaGen AnyOne) and stability-oriented protocols.

MATERIALS AND METHODS: Records from 63 patients receiving 97 implants (Neodent GM Helix, n=35; Biotem AR, n=39; MegaGen AnyOne, n=23; 76 in maxilla, 21 in mandible) placed between January 2021 and September 2024 in Qazvin, Iran, were reviewed. Absence of primary stability was defined as insertion torque 10 N·cm and/or intraoperative spinning. Immediate placements (n=23) received grafting; all implants were submerged, uncovered at approximately 3 months, and loaded at approximately 4 months. Success was assessed using modified Albrektsson/Buser criteria. Statistical analysis included Wilson 95% confidence intervals and Fisher’s exact or χ² tests.

RESULTS: Overall success rate was 95.9% (93/97; 95% CI 89.9-98.4%). Success rate by system was 97.1 % (34/35) for Neodent, 94.9% (37/39) for Biotem, 95.7% (22/23) for MegaGen with no significant difference among the systems (P=0.91). Immediate placements achieved a 100% success rate (23 out of 23 implants), compared to 94.6% for delayed placements (70 out of 74 implants), with no significant difference (P=0.58). Success rates were 96.1% in the maxilla (73 out of 76 implants) and 95.2% in the mandible (20 out of 21 implants), with no significant difference (P=1.00). Four early failures occurred (≤4 weeks), all in delayed placements; no late failures were observed. Systemic conditions (diabetes, hypertension, hypothyroidism) did not increase failure rates (P=0.61). All implant failures occurred in posterior regions and delayed timing of placement, while anterior and immediately placed implants achieved 100% success.

CONCLUSION: In carefully selected cases employing atraumatic techniques, socket grafting and sealing for immediate sites, and conservative loading protocols, implants placed without primary stability demonstrated clinically acceptable success rates comparable to private practice benchmarks. Nonetheless, the absence of mechanical primary stability remains a risk factor, particularly in the posterior maxilla or type IV bone; these findings do not advocate replacing primary stability. Prospective, multicenter studies with standardized Implant Stability Quotient (ISQ) monitoring are recommended.

PMID:42500693 | PMC:PMC13109637 | DOI:10.31661/gmj.v14iSP1.4114

Front Immunol. 2026 Jul 10;17:1848431. doi: 10.3389/fimmu.2026.1848431. eCollection 2026.

ABSTRACT

BACKGROUND: Despite the proven efficacy of KRAS G12C inhibitors (KRAS G12Ci) in solid tumors, evidence from direct comparisons with standard of care is scarce, and no analysis has investigated the potential immunological basis for differential responses.

METHODS: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials (RCTs) involving solid tumors patients who had received KRAS G12Ci were retrieved from inception to March 28, 2026. Individual participant data on progression-free survival (PFS) and overall survival (OS) were extracted from the published Kaplan-Meier survival curves. When available, subgroup data by programmed death ligand 1 (PD-L1) expression were extracted to explore immune-related correlates of treatment response.

RESULTS: A total of 4 articles with 3 RCTs and 949 participants were selected. In 1-stage reconstructed individual patient data meta-analyses, PFS was better in the KRAS G12Ci group (HR, 0.62; 95% CI, 0.53-0.74; P < 0.001). However, no statistical difference in OS was observed (HR, 0.93; 95% CI, 0.74-1.16; P = 0.495). The results were confirmed by 2-stage meta-analyses which additionally exhibited an objective response rate (ORR) of 3.60 (95% CI; 2.01-6.46; P < 0.001; I² = 39.7%). Regarding PD-L1 expression, PFS benefits were observed in patients with expression levels <1% (HR, 0.56; 95% CI: 0.38-0.83; P = 0.004) and 1%-49% (HR, 0.58; 95% CI: 0.43-0.78; P < 0.001). KRAS G12Ci demonstrated a better safety profile, apart from diarrhea and rash.

CONCLUSIONS: A similar OS, but better PFS and ORR with a superior safety profile were observed in patients receiving KRAS G12Ci, suggesting that KRAS G12Ci may be more suitable for later-line therapy. Older patients, those without liver metastases, or those with PD-L1<50% may be the target population. These subgroup observations are hypothesis-generating and require prospective validation.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251146769.

PMID:42500683 | PMC:PMC13396023 | DOI:10.3389/fimmu.2026.1848431

Front Immunol. 2026 Jul 10;17:1869012. doi: 10.3389/fimmu.2026.1869012. eCollection 2026.

ABSTRACT

INTRODUCTION: Disease-related malnutrition can develop in colorectal cancer (CRC) patients, negatively affecting postoperative clinical outcomes. Nutritional status should be assessed using standardised tools and laboratory parameters to identify malnourished patients and introduce personalised, targeted dietary interventions based on epigenetics, immunologically-related aspects, and gut microbiome. The primary aim of this study is to analyse the immunonutritional status of CRC patients in the preoperative period. The secondary aim is to assess the link between albumin-to-globulin ratio (AGR), prognostic nutritional index (PNI), and TNM staging.

PATIENTS AND METHODS: This study initially included 21 patients with histopathological confirmation of CRC qualified for surgical resection of the tumour. Immunologically-related nutritional status parameters, i.e., AGR and PNI, were calculated for selected 12 patients. The optimal cut-off value of PNI was determined, allowing patients to be divided into two independent groups: PNI-low and PNI-high. The link between AGR, PNI, and TNM was analysed.

RESULTS: TNM classification of the 12 selected participants revealed that most participants classified as T3 (67%), lymph node metastasis was identified in 50% of patients, and there were no distant metastases. Among selected patients, the analysis of mean values of immunological laboratory tests showed that they were within the normal range, except for lymphocyte levels, which were reduced (22.03 ± 7.31%). The optimal cut-off value was set at 51.74 for PNI; thus, patients were accordingly divided into PNI-low and PNI-high groups (<51.74, 34% of cases; ≥51.74, 66%, respectively). PNI-low was initially associated with more advanced cases (based on T assessment) compared to PNI-high (100% versus 75%; respectively); however, it failed to reach statistical significance (p = 0.515; effect size 0.2889; CI 95%, CI = 0.0110-7.5681). Therefore, this finding should be interpreted with caution. Lymph node metastasis was found more often in the PNI-high group than in the PNI-low group.

CONCLUSIONS: Overall concentrations of albumin and total protein were not decreased in CRC patients; however, these parameters allow calculation of AGR and PNI. The link between PNI-low and locally advanced cases of CRC based on T assessment can potentially exist; nevertheless, it should be confirmed with more clinical data. Lymph node metastasis was more often observed in the PNI-high group. This status is also related to higher levels of AGR. A PNI-low value is more related to local than distant pathological processes associated with CRC.

PMID:42500671 | PMC:PMC13395656 | DOI:10.3389/fimmu.2026.1869012

Front Immunol. 2026 Jul 10;17:1855859. doi: 10.3389/fimmu.2026.1855859. eCollection 2026.

ABSTRACT

OBJECTIVE: Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis. Immune checkpoint inhibitor (ICI) monotherapy has shown limited efficacy in PDAC, whereas the potential clinical value of first-line ICI-based combination regimens remains unclear. Through a systematic review and meta-analysis, this study aimed to evaluate the efficacy and safety of first-line ICI-based combination regimens in advanced PDAC.

METHODS: PubMed, Embase, The Cochrane Library, Scopus, Web of Science, CNKI, Wanfang Data, VIP, and CBM were searched up to April 4, 2026, to identify clinical studies evaluating first-line ICI-based combination therapy for advanced PDAC. Study screening and data extraction were performed in accordance with PRISMA guidelines.

RESULTS: Eight clinical trials involving 379 patients were included. In RCT-only analyses, ICI-based combination regimens showed favorable but statistically non-definitive trends for OS (HR = 0.83, 95% CI: 0.65-1.06) and PFS (HR = 0.75, 95% CI: 0.53-1.05), while ORR was improved (OR = 2.19, 95% CI: 1.32-3.64). Single-arm pooled analysis showed a median PFS of 6.2 months and an ORR of 38.0%. In terms of safety, combination therapy increased the risk of specific Grade 3 or higher adverse events, but the overall incidence was clinically manageable.

CONCLUSION: First-line ICI-based combination regimens showed encouraging antitumor activity in advanced PDAC, particularly for radiological response. However, definitive survival benefits were not established in RCT-only analyses, and further large-scale randomized trials are needed.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261440306, identifier CRD420261440306.

PMID:42500667 | PMC:PMC13396027 | DOI:10.3389/fimmu.2026.1855859

Front Immunol. 2026 Jul 10;17:1839715. doi: 10.3389/fimmu.2026.1839715. eCollection 2026.

ABSTRACT

OBJECTIVE: This study aims to summarize and appraise the credibility of existing epidemiological evidence on the association between periodontal diseases (PDs) and the risk of site-specific cancers.

METHODS: PubMed, Embase, and Cochrane Library were searched from inception to June 2026. Meta-analyses of observational studies investigating PDs and cancer risk were included. Each association was classified into five levels according to a predefined criterion, which included statistical significance, heterogeneity, sample size, and bias assessment. AMSTAR 2 was used to evaluate the quality of studies. Corrected covered area and the author’s own meta-analysis were performed to ensure a rigorous methodology.

RESULTS: In total, 66 associations from 38 meta-analyses investigating 14 cancer types were appraised, including head and neck cancer (HNC), oral, lung, breast, esophageal, gastric, pancreatic, liver, colorectal, bladder, kidney, prostate, melanoma, and hematopoietic and lymphatic cancers. Among 23 main associations, highly suggestive evidence was identified in associations between PDs (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.85-3.17) in HNC, and PDs in oral cancer (OR, 2.94; 95% CI, 2.13-4.07). Another seven associations were recommended as suggestive evidence (class III). Fourteen associations were classified as weak (class IV) or showing no significant evidence (class V).

CONCLUSION: Associations between PDs and site-specific cancers demonstrated varying levels of evidence. This analysis highlighted strong correlations in HNC and oral cancer, while failing to show credible evidence for the remaining 12 cancers. Overall, our study yielded novel insights into oral health interventions, calling for the incorporation of periodontal health into public health policy.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024585375, identifier CRD42024585375.

PMID:42500648 | PMC:PMC13395657 | DOI:10.3389/fimmu.2026.1839715

Indian J Anaesth. 2026 Jul;70(7):821-828. doi: 10.4103/ija.ija_1635_25. Epub 2026 Jul 21.

ABSTRACT

BACKGROUND AND AIMS: del Nido cardioplegia (DC), initially developed for paediatric cardiac surgery, is increasingly used in adult procedures due to its ability to provide prolonged myocardial protection with a single dose. However, its superiority over blood cardioplegia (BC) remains unclear. This study compared the effects of DC and BC on acid-base balance, potassium levels, and metabolic profiles in adults undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).

METHODS: A retrospective observational study was conducted at a tertiary care centre over a period of 6 months. Forty-seven patients were divided into Group BC (received blood cardioplegia) and Group DC (received del Nido cardioplegia). Arterial blood gases were recorded at four intraoperative time points. The four time points were T1, baseline before CPB; T2, immediately after cardioplegia administration; T3, post-rewarming just before separation from CPB; and T4, before transfer to the intensive care unit. Statistical analyses were performed using independent t-tests and Chi-square tests, or their equivalent non-parametric alternatives when appropriate.

RESULTS: Group DC exhibited a significantly higher potential of hydrogen (pH) (7.49 vs 7.43, P = 0.003) and base excess (0.15 vs – 1.80 mmol/L, P = 0.014) at post-rewarming (T3). Potassium was lower in group DC at baseline (T1). Blood glucose was significantly higher in group BC at T3 (275 vs 207 mg/dL, P < 0.001) and T4 (258 vs 217 mg/dL, P = 0.033). Five patients in the DC group required blood transfusion during CPB.

CONCLUSION: DC and BC showed largely comparable intraoperative metabolic and physiological profiles, with most observed differences remaining within acceptable physiological ranges and of limited clinical significance. DC may be a practical alternative to BC; however, larger prospective studies evaluating direct myocardial injury markers and postoperative outcomes are needed.

PMID:42500639 | PMC:PMC13399266 | DOI:10.4103/ija.ija_1635_25