Tag: statistics

Biomol Biomed. 2026 Apr 24. doi: 10.17305/bb.2026.14023. Online ahead of print.

ABSTRACT

Prognosis in locally advanced nasopharyngeal carcinoma (NPC) is influenced not only by tumor burden but also by systemic inflammatory and nutritional status. This study aimed to evaluate the prognostic value of the pretreatment neutrophil percentage-to-albumin ratio (NPAR) in locally advanced NPC and to determine whether its incorporation could enhance risk stratification beyond conventional staging variables. In this retrospective single-center cohort study, we analyzed 804 patients with stage II-IVa NPC who were treated with definitive radiotherapy, with or without concurrent chemotherapy. These patients were randomly assigned to a training cohort (n = 603) and a validation cohort (n = 201). The pretreatment NPAR was calculated from blood samples collected within one week prior to treatment initiation. Associations with overall survival (OS) and progression-free survival (PFS) were primarily assessed using restricted cubic spline Cox models, supplemented by secondary cutoff-based analyses. A prognostic nomogram was developed and internally validated through bootstrap resampling. Higher pretreatment NPAR was consistently associated with adverse outcomes in OS (adjusted hazard ratio [HR] 1.77, 95% confidence interval [CI] 0.97-3.23; p = 0.062) and PFS (adjusted HR 1.74, 95% CI 0.96-3.15; p = 0.066), although these associations did not achieve conventional statistical significance in fully adjusted models. The nomogram incorporating both clinicopathological variables and NPAR demonstrated superior discrimination compared to tumor-node-metastasis staging alone, with optimism-corrected C-indices of 0.625 for OS and 0.617 for PFS. In comparative analyses, NPAR and the neutrophil-to-lymphocyte ratio exhibited similar prognostic performance. In conclusion, pretreatment NPAR is associated with adverse outcomes in locally advanced NPC and may modestly enhance model-based risk stratification. However, its clinical utility should be interpreted with caution and requires external validation.

PMID:42028606 | DOI:10.17305/bb.2026.14023

Health Informatics J. 2026 Apr-Jun;32(2):14604582261444118. doi: 10.1177/14604582261444118. Epub 2026 Apr 24.

ABSTRACT

AimTo assess the effectiveness of a brief cognitive behavioral intervention (CBI) on digital dependence among nursing students in Saudi Arabia and to examine demographic and usage predictors of post-intervention outcomes.MethodsA pretest-posttest quasi-experimental study was conducted with 163 students (aged 18-23 years) at K’ University. Participants completed the Digital Addiction Scale (DAS) before and after a three-session group CBI. Paired t-tests and correlations explored inter-domain relationships, and linear regressions examined predictors of post-intervention scores.ResultsMean DAS scores improved significantly for overuse (mean difference 0.40, p < .001), non-restraint (0.22, p = .010), and dependence (0.39, p < .001). Emotional state increased but not significantly (p = .135) and inhibiting the flow of life was unchanged (p = .742). Post-intervention overuse was predicted by daily hours of device use (β = 0.94 for 3-4 h; β = 1.04 for ≥7 h; all p < .05), while other demographic factors were non-significant.ConclusionA brief CBI improved behavioral aspects of digital dependence but had limited effect on emotional dimensions. Integrating culturally adapted CBIs and digital-wellness modules into nursing curricula could reduce digital distraction and enhance self-regulation. Further controlled studies are needed to validate and expand upon these results.

PMID:42028595 | DOI:10.1177/14604582261444118

J Clin Orthop Trauma. 2026 Apr 7;77:103430. doi: 10.1016/j.jcot.2026.103430. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Unicompartmental knee arthroplasties (UKAs) are often revised to total knee arthroplasty (TKA), but concerns remain surrounding outcomes of UKA revision to TKA. The primary aim of this study was to compare revision rates of conversion UKA to TKA to matched cohorts of both primary and revision TKA procedures. Secondary aims were to compare implants characteristics, intraoperative, and functional outcomes.

METHODS: This was a single centre cohort study of all consecutive patients who underwent UKA conversion to TKA from 2012 to 2023. Patients undergoing conversion UKA with minimum two year follow-up were included and matched 1:1:1 to patients undergoing primary TKA and aseptic revision TKA, excluding periprosthetic fractures. Indications for surgery, surgical details, and postoperative outcomes, including revision rates, complications, and range of motion (ROM), were collected and compared between groups.

RESULTS: One hundred patients underwent conversion of a UKA to TKA that met inclusion criteria and were matched 1:1:1 to primary and revision TKAs (total n = 300). Post-matching, the mean age was 69.0 years and 75% were female. There was no statistically significant difference in revision rates between UKA to TKA (6.0%), primary TKA (1.0%) and revision TKA groups (14.0%), though reoperation rates were higher following UKA revision compared to primary TKA (p = 0.028). UKA conversion cases had longer operative times (103.0min vs. 72.7min, p < 0.001) and more frequent use of tibial augments (38% versus 0%, p < 0.001) and stems (56% versus 3%, p < 0.001) than primary TKA. UKA conversion demonstrated ROM similar to primary TKA (p = 1.000) but superior to revision TKA (p = 0.050).

CONCLUSION: The findings of this study suggest conversion of UKA to TKA is more complex than primary TKA but less than revision TKA. Patients should be advised of higher reoperation rates compared to primary TKA, although similar functional outcomes. Surgeons should be prepared for increased implant complexity in these cases.

PMID:42028591 | PMC:PMC13101634 | DOI:10.1016/j.jcot.2026.103430

Mol Ther Nucleic Acids. 2026 Apr 2;37(2):102925. doi: 10.1016/j.omtn.2026.102925. eCollection 2026 Jun 16.

ABSTRACT

Propionic acidemia is a rare autosomal recessive disorder caused by mutations in the PCCA or PCCB gene, resulting in deficient propionyl-CoA carboxylase activity. We identified a unique homozygous deep-intronic PCCA variant, NM_000282.4:c.1285-1358C>G, in an individual with neonate-onset propionic acidemia. Fibroblasts from this individual expressed only PCCA mRNA containing an 84-bp pseudoexon, which is present at low levels in healthy controls, leading to the loss of PCCA and PCCB proteins and severely reduced propionyl-CoA carboxylase activity. Transfection of fibroblasts with chemically synthesized antisense oligonucleotides (ASOs) designed to skip the pseudoexon restored productive PCCA splicing, rescued PCCA protein expression, and markedly increased propionyl-CoA carboxylase activity above wild-type levels. The efficacy of the ASOs was further evaluated in fibroblasts from 7 additional individuals with propionic acidemia carrying mutations in PCCA or PCCB. ASO treatment successfully restored enzymatic activity, particularly in fibroblast lines, with residual activity exceeding 1% of normal. These findings suggest that ASO-mediated splicing correction targeting the 84-bp pseudoexon can restore mRNA, protein, and enzymatic function in individuals with deep intronic mutations, as well as in other individuals with propionic acidemia, indicating the feasibility of ASO therapy as a molecular treatment strategy for a subset of individuals with propionic acidemia.

PMID:42028575 | PMC:PMC13101689 | DOI:10.1016/j.omtn.2026.102925

Cureus. 2026 Mar 23;18(3):e105704. doi: 10.7759/cureus.105704. eCollection 2026 Mar.

ABSTRACT

Background Discharge against medical advice (DAMA) is a significant global healthcare challenge, occurring when a patient or caregiver, in pediatric cases, leaves the hospital against medical recommendations. DAMA can lead to adverse health outcomes, increased hospital readmissions, and strain on healthcare resources. This study examines the characteristics of DAMA in emergency departments (EDs) at Madinah hospitals in Saudi Arabia and explores its distribution according to demographic factors. Methodology A retrospective cross-sectional study was conducted using secondary quantitative data from hospital records at King Fahad Hospital and King Salman Bin Abdulaziz Medical City in Madinah, Saudi Arabia. Ethical approval was obtained, and descriptive statistical analyses were performed to assess demographic trends and reasons for DAMA. Results Starting from January to December 2022, a total of 1,120 DAMA cases were recorded. The highest proportion of cases was observed among middle-aged adults (30-49 years), with males accounting for 57.5% (n = 645) of cases. DAMA was more frequent on weekdays, peaking on Sundays, and most cases occurred in the afternoon and night shifts. A large proportion of patients (59.1%, n = 663) did not provide a reason for DAMA, while 28.7% (n = 322) refused admission, 4.6% (n = 52) cited long wait times, 1.7% (n = 20) had financial constraints, and 2.5% (n = 29) left after feeling better. Conclusion DAMA remains a critical concern in Saudi Arabian EDs, with a higher proportion of recorded cases among males and middle-aged adults. Contributing factors include refusal of medical care, long wait times, financial limitations, and perceived early recovery. The high prevalence of DAMA during peak hours suggests systemic challenges in hospital resource management. Addressing these issues requires improved patient education, streamlined hospital processes, and enhanced communication strategies to reduce DAMA rates and improve patient outcomes.

PMID:42028538 | PMC:PMC13102265 | DOI:10.7759/cureus.105704

Cureus. 2026 Mar 23;18(3):e105702. doi: 10.7759/cureus.105702. eCollection 2026 Mar.

ABSTRACT

INTRODUCTION: Fishing is a physically demanding occupation involving repetitive movements, heavy lifting, prolonged standing, and unstable working conditions, predisposing workers to work-related musculoskeletal disorders (WMSDs). Community-based evidence from traditional fishing populations in Tamil Nadu is limited.

METHODS: A community-based cross-sectional study was conducted among 125 fishermen aged ≥18 years engaged in fishing for at least one year. Participants were selected through simple random sampling. Data were collected using a pretested structured questionnaire, and musculoskeletal symptoms were assessed using the Standardized Nordic Musculoskeletal Questionnaire. Descriptive statistics were computed, and associations were analyzed using the chi-squared test with statistical significance set at p≤0.05.

RESULTS: The majority of participants were male (76.8%) and aged ≥40 years (60%), with most having >10 years of fishing experience (80.8%) and working >8 hours per day (68.8%). Musculoskeletal pain was highly prevalent, particularly in the lower back (83.2%), shoulders (73.6%), and knees (70.4%) over the past 12 months. Longer working hours (>8 hours/day) and greater duration of fishing (>10 years) were significantly associated with increased prevalence of musculoskeletal pain, especially in the lower back and knees. Male participants also reported significantly higher prevalence of shoulder and lower back pain.

CONCLUSION: Musculoskeletal disorders are highly prevalent among fishermen in Pulicat, predominantly affecting the lower back, shoulders, and knees. Prolonged working hours and extended occupational exposure are key associated factors. These findings highlight the need for targeted ergonomic interventions, structured occupational health education, and inclusion of fisherfolk in occupational health and social protection programs to mitigate the burden of musculoskeletal morbidity and improve overall work capacity.

PMID:42028532 | PMC:PMC13101749 | DOI:10.7759/cureus.105702

Cureus. 2026 Mar 23;18(3):e105714. doi: 10.7759/cureus.105714. eCollection 2026 Mar.

ABSTRACT

The deep inferior epigastric perforator (DIEP) free flap is the gold standard for autologous breast reconstruction. We identified a knowledge gap among dressing clinic nurses in a unit establishing a DIEP reconstruction service. A quality improvement project was undertaken to deliver a structured educational programme for nursing staff involved in postoperative follow-up of these patients. The intervention comprised formal teaching, dissemination of standardised care pathways, case-based discussions, and opportunities for theatre observation. Thirty-seven participants completed pre- and post-intervention questionnaires assessing self-reported confidence and knowledge across five domains, with additional qualitative feedback. Baseline confidence varied, particularly regarding flap assessment, recognition of complications, and patient counselling. Following the intervention, there was a statistically significant improvement in confidence across all five domains (p<0.001). Nearly all participants (97%) recommended the teaching programme. Qualitative feedback highlighted an improved understanding of flap anatomy, enhanced confidence in escalation of concerns, and greater engagement within the multidisciplinary team. Theatre observation was reported as particularly impactful. Our structured educational intervention significantly improved dressing clinic nurses’ confidence and perceived competence in managing patients following DIEP reconstruction. This approach offers a practical framework to support safe service development and multidisciplinary integration when introducing new microsurgical services.

PMID:42028516 | PMC:PMC13102268 | DOI:10.7759/cureus.105714

Cureus. 2026 Mar 23;18(3):e105677. doi: 10.7759/cureus.105677. eCollection 2026 Mar.

ABSTRACT

Introduction Implantation of a permanent cardiac pacemaker (PPM) is critical for managing rhythm disorders and prolonging survival. Beyond clinical outcomes, implantation can affect patients’ quality of life (QoL), encompassing physical and mental dimensions. The present study aimed to evaluate QoL among patients undergoing PPM implantation, both before implantation and at 6 and 12 months post-implantation, as well as the associated perspectives and behaviors after 6 and 12 months. Methods In the present study, 112 patients undergoing PPM implantation were enrolled at a public hospital in Athens between 2023 and 2025. Participants were selected by the method of convenience sampling. Data collection was performed using the 36-Item Short Form Health Survey (SF-36). Scores for the Physical Component Summary (PCS) and the Mental Component Summary (MCS) were calculated using QoL scores that range from 0 to 100, with higher scores indicating higher QoL. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, NY, USA). Statistical significance was set at p < 0.05. Results The PCS presented a mean of 36.2 ± 4.6, and the MCS a mean of 40.9 ± 13.5 before implantation. Post-implantation at 6 and 12 months, the mean PCS score was 34.7 ± 4.9 and 35.3 ± 4.3, respectively, while the mean MCS score was 55.6 ± 8.3 and 59.3 ± 7.7, respectively. Better PCS at 6 and 12 months was associated with adherence to regular follow-up (p = 0.013 and p = 0.027), antiarrhythmic therapy (p = 0.004 and p = 0.041), assistance at home (p = 0.026 and p = 0.012), and being physically active (p = 0.022 and p = 0.004). Better MCS at 6 and 12 months was associated with anxiety about rhythm disorders (p = 0.013 and p = 0.016), participation in social activities (p = 0.001 and p = 0.001), assistance at home (p = 0.001 and p = 0.019), and being physically active (p = 0.001 and p = 0.001). Conclusion Assessing both QoL and patients’ perspectives before and after PPM implantation provides valuable insights into the real-world impact of this therapy and informs patient-centered care.

PMID:42028515 | PMC:PMC13100549 | DOI:10.7759/cureus.105677

Cureus. 2026 Mar 23;18(3):e105691. doi: 10.7759/cureus.105691. eCollection 2026 Mar.

ABSTRACT

BACKGROUND: Adult traumatic brachial plexus injury (BPI) is a severe peripheral nerve injury that frequently results in significant upper limb disability in young individuals. The epidemiology varies with different geographical locations. This study aimed to analyze the demographic profile, mechanisms of injury, injury severity patterns, referral timelines, and reconstructive burden of adult traumatic BPI in a tertiary care institution of northern India.

METHODS: A retrospective observational study was conducted at the All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India, over a two-year period. Adult patients (≥18 years) with clinically and radiologically confirmed traumatic BPI were included. Cases of obstetric and iatrogenic brachial plexus injury were excluded. Data regarding age, sex, mechanism of injury, level and severity of plexus involvement, time to presentation, associated injuries, and management modality were collected. Descriptive statistical analysis was performed.

RESULTS: Seventy-five adult patients were included, with a mean age of 29.1 years; 69 (92%) were male. Road traffic accidents were the predominant cause, with two-wheeler accidents accounting for 78.7% of cases. Complete C5-T1 involvement was observed in 59 patients (78.7%). Forty-five patients (60%) presented more than six months after injury. At the time of analysis, 51 patients (68%) had undergone surgical intervention, including primary nerve transfer and secondary reconstructive procedures, while 24 (32%) had not undergone operative treatment.

CONCLUSION: Adult traumatic BPI in this semi-urban North Indian cohort was predominantly associated with high-energy two-wheeler accidents and a high proportion of complete plexus injuries, with frequent delayed presentation. These findings highlight the substantial reconstructive demand in tertiary centers and underscore the need for improved referral pathways and trauma prevention strategies.

PMID:42028511 | PMC:PMC13101400 | DOI:10.7759/cureus.105691

Cureus. 2026 Mar 23;18(3):e105712. doi: 10.7759/cureus.105712. eCollection 2026 Mar.

ABSTRACT

Objective The purpose of this investigation was to identify the mortality rate at three months and one year for patients 65 years old or older with a nonoperatively managed pelvic ring fracture. Materials and methods A retrospective comparative cohort study was performed at a single level 1 trauma tertiary referral center. From 2014 to 2019, we reviewed all patients older than 65 years who underwent nonoperative treatment for a pelvic ring fracture (Current Procedural Terminology codes 27193 or 27197). Demographics, including age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI), were recorded. Mortality status and death dates were determined from our institutional electronic health record and cross-referenced with the TriNetX database (Cambridge, MA, USA). The primary outcome was the standardized mortality ratio (SMR) for one-year mortality, calculated by comparing observed deaths in the study population with expected deaths in the age- and sex-matched general population. Secondary outcomes included three-month and one-year mortality rates, as well as demographic variables associated with mortality. Results A total of 307 patients met the inclusion criteria. There were 41 (13.4%) that died within three months and 77 (25.1%) that died within 1 year. Compared to the general population, pelvic ring fracture patients demonstrated an SMR of 3.12 (95% confidence interval: 2.46, 3.85) for one-year mortality. Compared with patients alive at three months post-injury, deceased patients did not differ significantly in age (80.9 ± 8.6 vs. 81.0 ± 9.7 years; p = 0.964), BMI (24.3 ± 5.2 vs. 25.9 ± 5.9; p = 0.062), or sex (p = 0.507). Alive patients had a lower mean CCI compared to deceased patients (5.4 ± 2.1 vs. 6.8 ± 2.8; p < 0.001). At one year, deceased patients did not demonstrate statistically significant age differences (80.5 ± 8.5 vs. 82.4 ± 9.5 years; p = 0.103), BMI (24.5 ± 5.3 vs. 24.5 ± 5.5; p = 0.922), or sex (p = 0.835), and alive patients had a lower mean CCI (5.2 ± 2.0 vs. 6.6 ± 2.6; p < 0.001). Conclusions Geriatric patients who undergo nonoperative treatment of pelvic ring fractures have a threefold higher one-year mortality compared to their age- and sex-matched peers who do not have pelvic ring fractures. There is an association between mortality and higher comorbidity burden, and clinicians should counsel patients on the elevated risk of post-injury mortality based on comorbidity status. This has implications for counseling patients and their families, as such an approach may inform surgical decision-making and ensure that treatment plans are tailored to the patient’s overall health and prognosis.

PMID:42028491 | PMC:PMC13102135 | DOI:10.7759/cureus.105712