Tag: statistics

Foot Ankle Surg. 2026 Aug 11:S1268-7731(26)00213-4. doi: 10.1016/j.fas.2026.08.002. Online ahead of print.

ABSTRACT

BACKGROUND: This study compared seven large language models (LLMs) to identify the optimal model for foot and ankle clinical decision support.

METHODS: The LLMs answered 20 multiple-choice questions (MCQs) and 20 open-ended clinical questions. MCQ accuracy was recorded. Three blinded foot and ankle surgeons evaluated the open-ended responses based on accuracy, completeness, and clinical relevance (total score range: 3-21).

RESULTS: GPT-o3 and GPT-5 Thinking achieved the highest MCQ accuracy (95%). For open-ended evaluations, mean total scores differed significantly across the models (p < 0.001). GPT-5 Thinking (19.98 ± 0.66) and GPT-o3 (19.67 ± 0.51) attained the highest scores, significantly outperforming the other five models, with no statistical difference between these top two performers.

CONCLUSION: LLM performance for foot and ankle disorders differed substantially across models. GPT-5 Thinking and GPT-o3 exhibited superior performance under the tested conditions, emphasizing the necessity of targeted model selection for clinical decision-making. However, because LLMs evolve rapidly, these findings should be interpreted as a time-specific snapshot rather than as fixed or generalizable rankings of model performance.

PMID:42595676 | DOI:10.1016/j.fas.2026.08.002

Enferm Infecc Microbiol Clin (Engl Ed). 2026 Aug 13:503251. doi: 10.1016/j.eimce.2026.503251. Online ahead of print.

ABSTRACT

INTRODUCTION: Contact tracing for tuberculosis (TB) is an essential component of public health efforts to detect secondary cases and interrupt transmission chains. This study aimed to assess the risk factors associated with TB diagnosis and to develop a predictive clinical score for TB diagnosis among contacts of people with TB attending the outpatient clinic at Hospital Nossa Senhora da Paz (HNSP) in Cubal, Angola.

METHODS: Prospective observational study including TB contacts of all ages. Data were analyzed using descriptive and inferential statistics, including multivariable logistic regression with multiple imputation for missing data. The performance of the proposed clinical score was assessed through ROC analysis, calibration, bootstrap internal validation, and comparison with the WHO symptom-based screening approach.

RESULTS: Two-hundred and eighty-five TB contacts were included. Fifty (17.5%) contacts were diagnosed with TB, 40 (80%) of whom were children ≤15 years old. Multivariate analysis identified cough, fever, undernutrition, and peripheral lymphadenopathy as independent risk factors for TB diagnosis. These variables were incorporated into a predictive clinical score ranging from 0 to 17 points. Using a cut-off of ≥6 points, the score showed a sensitivity of 94% and a specificity of 75%, with an area under the ROC curve of 0.89 (95% CI: 0.85-0.94).

CONCLUSIONS: These findings highlight the high burden of TB among close contacts and the challenges in properly assessing them. An easy-to-use clinical score may support frontline health workers in improving TB contact tracing in settings with high burden of disease and limited resources, such as Angola.

PMID:42595669 | DOI:10.1016/j.eimce.2026.503251

Eur Urol Oncol. 2026 Aug 13:S2588-9311(26)00214-2. doi: 10.1016/j.euo.2026.07.014. Online ahead of print.

ABSTRACT

PROpel (phase 3 randomized [1:1], double-blind trial: NCT03732820) met its primary endpoint, showing statistically significantly improved investigator-assessed radiographic progression-free survival (rPFS) with olaparib plus abiraterone versus placebo plus abiraterone in biomarker-unselected first-line metastatic castration-resistant prostate cancer (mCRPC; hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.54-0.81; p < 0.0001). Median overall survival (OS) was 42.1 mo with olaparib plus abiraterone, a 7.4-mo improvement versus placebo plus abiraterone. We report efficacy in patients with single homologous recombination repair gene mutations (HRRm). Before primary analysis, HRRm status was determined by aggregating tumor tissue (FoundationOne CDx) and circulating tumor DNA (FoundationOne Liquid CDx) assay results. Overall, 28.4% of patients had an HRRm, predominantly BRCA2 (7.3%), ATM (6.2%), and CDK12 (5.0%). HRs numerically favored olaparib plus abiraterone for rPFS (BRCA2, HR, 0.20; 95% CI, 0.08-0.44; ATM, HR, 0.55; 95% CI, 0.20-1.38; CDK12, HR, 0.51; 95% CI, 0.20-1.18) and OS (BRCA2, HR, 0.20; 95% CI, 0.07-0.48; ATM, HR, 0.79; 95% CI, 0.33-1.77; CDK12, HR, 0.57; 95% CI, 0.24-1.27). Other single-gene mutations were rare (<5 events in either arm), limiting interpretation. Findings support olaparib plus abiraterone as an important first-line option for patients with mCRPC. PREVIOUS PRESENTATION: Results were previously presented in part at the ASCO-GU 2024 congress, held on January 25-27, 2024: San Francisco, CA, USA.

PMID:42595654 | DOI:10.1016/j.euo.2026.07.014

Allergol Int. 2026 Aug 13:S1323-8930(26)00084-5. doi: 10.1016/j.alit.2026.07.004. Online ahead of print.

ABSTRACT

BACKGROUND: Banana allergy varies geographically, but molecular sensitization patterns and fruit co-reactivity remain incompletely defined.

METHODS: We analyzed adults with IgE-mediated banana allergy from Thailand (n = 169) and Austria (n = 70) using banana extract-specific IgE (ImmunoCAP), ALEX (a multiplex allergen-specific IgE macroarray), and complementary line blotting. Country-stratified multivariable models assessed associations of sensitization patterns with systemic reactions and reaction severity.

RESULTS: Systemic reactions predominated in Thailand (156/169, 92.3%), whereas isolated oral allergy syndrome (OAS) was more common in Austria (31/70, 44.3%). Banana extract-specific IgE was positive at ≥0.35 kUA/L in 115/168 (68.5%) Thai and 48/68 (70.6%) Austrian sera. Among samples with undetectable banana extract-sIgE (<0.10 kUA/L), molecular testing identified IgE reactivity to banana allergens or cross-reactive components in 16/18 (88.9%) Thai and 6/6 (100%) Austrian sera. ALEX-based profiling showed more heterogeneous sensitization patterns in Austria, with more frequent reactivity to nsLTPs, profilins, and latex allergens, whereas isolated ALEX reactivity to the TLP surrogate Act d 2 was common in Thailand but rare in Austria (55.6% vs 6.2%). Line blotting showed markedly more frequent IgE reactivity to TLP from banana (Mus a 4) in Thai than Austrian participants (90.5% vs 45.7%). In country-stratified analyses, TLP sensitization was independently associated with systemic reactions and greater severity in Austria. Thai estimates were imprecise because TLP sensitization was near-ubiquitous and non-systemic reactions were uncommon.

CONCLUSIONS: Thai adults showed a TLP-dominant sensitization pattern, whereas Austrian profiles were more heterogeneous. TLP sensitization was associated with systemic reactions and greater severity in Austria.

PMID:42595651 | DOI:10.1016/j.alit.2026.07.004

Ann Chir Plast Esthet. 2026 Aug 13:S0294-1260(26)00047-6. doi: 10.1016/j.anplas.2026.04.003. Online ahead of print.

ABSTRACT

PURPOSE: Despite the high incidence of 5th metacarpal neck (5MCN) fracture, the literature lacks concise information about the ideal treatment option. This review aimed to compare the functional outcome of conservative and operative management of 5MCN fractures.

METHODS: The electronic databases PubMed and Scopus were used for the literature review. This review is intended to include all original studies comparing the outcomes of 5MCN fractures that were managed operatively and conservatively.

RESULTS: The final inclusion of 5 eligible studies was based on full-text screening. A total of 311 patients were analyzed from the included five studies, with a majority of males (178/203, 83.7%). Significant reduction in palmar angulation (SMD -1.23, 95% CI -2.21 to -0.25) was noted in surgical group as compared to the conservative group. No significant difference was noted in terms of grip strength (SMD 0.96, 95% CI -2 to 3.98) or shortening (SMD 1.65, 95% CI: -2.39 to 5.69) in both the groups.

CONCLUSION: Although no significant difference was noted in grip strength and shortening, there was statistically significant palmar angulation in patients treated conservatively. The vocation and expectations of each patient should be carefully considered before deciding on the course of treatment. Future studies with uniform functional outcome measurements must establish unambiguous clinical guidelines for treating 5MCN fractures.

PMID:42595633 | DOI:10.1016/j.anplas.2026.04.003

Womens Health Issues. 2026 Aug 13:S1049-3867(26)00105-2. doi: 10.1016/j.whi.2026.06.010. Online ahead of print.

ABSTRACT

OBJECTIVES: We sought to assess current and former intrauterine device (IUD) users’ interest in and experiences with IUD self-removal and to examine associations between participant characteristics, past experiences with removal, and future interest in self-removal.

STUDY DESIGN: We conducted a cross-sectional follow-up survey of HER Salt Lake participants who had ever used an IUD and consented to follow-up. Participants completed an electronic survey assessing interest in receiving self-removal information, past self-removal attempts and outcomes, and experiences with provider removal. We used descriptive statistics and χ² tests to explore self-removal interest and experiences, and differences in interest by characteristics and past removal experiences.

RESULTS: More than one-half of the 621 participants (57%) expressed an interest in IUD self-removal. Among current IUD users, 49% reported willingness to try self-removal. One in 10 participants had attempted self-removal; 68% were successful and most (61%) reported no problems. Among those who attempted self-removal, the most commonly reported problems were experiencing more pain than they felt comfortable with (21%) and being unable to feel their IUD strings (9%). Participants who faced prior barriers to provider removal, including cost, scheduling delays, discomfort with care, or distrust of the health care system, were more likely to express interest in self-removal (p < .05). Those interested were also more often nulliparous, current IUD users, those not married or cohabitating with their partners, and those who did not identify as heterosexual.

CONCLUSION: In our sample, interest in self-removal was high, and most participants who had attempted self-removal did so successfully and without problems. Providing accessible information about self-removal in preferred formats may help to reduce barriers to IUD discontinuation and support reproductive autonomy.

PMID:42595607 | DOI:10.1016/j.whi.2026.06.010

Chin J Traumatol. 2026 Jun 29:S1008-1275(26)00128-8. doi: 10.1016/j.cjtee.2025.10.008. Online ahead of print.

ABSTRACT

PURPOSE: The ankle is the main interface between the ground and body during ambulation, standing, and any sports exercise. Ankles should be able to absorb impact-loading forces from body weight and exercise pressure, adapt to uneven ground, and allow efficient propulsion. The estimated lifetime incidence of ankle injuries is 1 out of every 10 people. Most ankle injuries occur during sports activities. The epidemiologic trends associated with chronic ankle instability suggest that current rehabilitation approaches may be inadequate. Therefore, it is uttermost important to seek alternative rehabilitation modalities, as the current conventional rehabilitation is not effective.

METHODS: This retrospective study utilized a single-blinded 3-arm parallel-randomized controlled clinical trial to assess the efficacy of various rehabilitation modalities for ankle injuries. Seventy-five participants with ankle injuries were randomly assigned to 1 of 3 groups: a control group receiving standard rehabilitation, a virtual reality (VR) group utilizing VR technology, and a mixed group combining VR with kinesiotape interventions. Each group included 25 participants who underwent 2 weeks of rehabilitation activities specific to their assigned treatment. The single-blinded design ensured that participants were unaware of their treatment assignment, minimizing bias in their responses. This methodology facilitates a comparative analysis of rehabilitation strategies, offering insights into the effectiveness of innovative approaches such as VR and kinesiotaping for ankle injury recovery. The R statistical software was used to complete the analysis. One-way ANOVA analysis was utilized to compare the statistical differences between the 3 groups.

RESULTS: Seventy-five ankle injury patients were recruited, and 96% of them finished the study. The ANOVA results show that ankle injury rehabilitation via VR and/or kinesiotape application had significant effects on reducing ankle pain, ankle edema, and anthropometric measurements compared with the control group. The VR treatment modality has positive effects on reducing the distal edema limb circumference compared to both control and mixed groups at p < 0.05.

CONCLUSION: Physical rehabilitation via immersive VR and/or kinesiotape application is considered the main rehabilitation modality for ankle injury compared to conventional physical rehabilitation.

PMID:42595598 | DOI:10.1016/j.cjtee.2025.10.008

Ultrasound Med Biol. 2026 Aug 13:S0301-5629(26)00294-2. doi: 10.1016/j.ultrasmedbio.2026.07.020. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Accurate quantification of fibroglandular tissue volume (FGV) and the fibroglandular ratio which is the ratio of FGV to the total breast volume (TBV) (FGR = FGV/TBV) is critical for assessment of a patient’s lifetime breast cancer risk and personalized screening strategies. Magnetic resonance imaging (MRI) is considered the research standard for volumetric breast composition analysis but is limited by cost, availability, and contraindications. This study evaluates the capability of quantitative transmission (QT) imaging technology to measure FGV and FGR and compares these results with MRI-derived metrics, establishing quantitative equivalence between the two modalities.

MATERIALS AND METHODS: A retrospective analysis included 53 breasts from 29 women imaged using QT scan and MRI within 30 days as part of the ACCRUE Study (ClinicalTrials.gov NCT03052166). QT data were acquired with the QT Scanner 2000 Model A and reconstructed into 3D speed-of-sound maps and respective reflection maps via a full-wave inverse scattering algorithm. FGV and FGR were computed using a fuzzy c-means segmentation as applied to the quantitative tissue maps. MRI datasets were segmented using a validated template-based method. Statistical comparisons included Pearson correlation (r), intraclass correlation coefficient (ICC), and Bland-Altman analysis.

RESULTS: QT and MRI measurements demonstrated strong correlations for both FGV (r = 0.893) and FGR (r = 0.915, p < 0.0001). Mean biases were -13.2 cm³ for FGV and +12.7% for FGR. Regression slopes were 0.63 and 1.35, respectively, with significant proportional bias for both (p < 0.0001). Systematic differences were consistent with modality-specific contrast mechanisms and field-of-view definitions; the strong correlation and stable, predictable bias support quantitative concordance between the modalities.

CONCLUSION: QT technology provides accurate, reproducible, and volumetric quantification of breast fibroglandular tissue, demonstrating strong concordance with MRI. These results supported FDA clearance of the QT FGR feature, establishing it as a validated quantitative imaging biomarker for clinical breast density assessment.

PMID:42595593 | DOI:10.1016/j.ultrasmedbio.2026.07.020

Surgeon. 2026 Aug 13:S1479-666X(26)00049-1. doi: 10.1016/j.surge.2026.08.002. Online ahead of print.

ABSTRACT

AIMS: Distal radius fractures (DRFs) are prevalent injuries, particularly among the elderly and young active individuals. Recent studies have emphasized the timing of surgical intervention, which may influence complication rates and functional outcomes. While some reviews have found no significant differences in outcomes between early and late surgery, others have suggested benefits from early intervention. Current guidelines from the British Orthopaedic Association Audit Standards for Trauma (BOAST) recommend surgical fixation within specific timeframes, yet optimal timing remains a topic of ongoing debate. This systematic review and meta-analysis aimed to assess the impact of surgical timing on complication rates and functional outcomes in closed DRFs.

METHODS: A comprehensive search was conducted across multiple electronic databases, including PubMed, EMBASE, and the Cochrane Library, to identify relevant studies. Eligible studies included randomized control trials and observational studies which compared early versus late surgical treatment. Meta-analyses were conducted on pooled data from compatible studies.

RESULTS: Fourteen studies involving 2104 patients were included in this analysis. Meta-analysis revealed late surgical intervention was associated with an 8% increase in complication rates (95% CI 4% to 13%). Functional outcomes demonstrated that early surgery led to improved range of motion in flexion, pronation, and supination; however, no statistically significant differences were observed in extension. Further, Patient-Reported Outcome Measures did not exhibit significant differences between early and late surgical interventions.

CONCLUSION: Early surgical intervention for DRFs is associated with lower complication rates and improved range of motion, however it does not improve patient reported outcomes.

PMID:42595586 | DOI:10.1016/j.surge.2026.08.002

Arch Bronconeumol. 2026 Aug 13:S0300-2896(26)00276-0. doi: 10.1016/j.arbres.2026.07.002. Online ahead of print.

ABSTRACT

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) predominantly affects older adults. Frailty is increasingly recognized as an important feature of IPF, although its prognostic value remains uncertain. This study aimed to assess the prevalence of frailty and concordance among validated instruments, characterize the principal domains of vulnerability identified through comprehensive geriatric assessment (CGA), and evaluate the prognostic value of integrating frailty with indices of respiratory disease severity in older adults with IPF.

METHODS: We conducted a prospective, single-center study of patients aged 65 years or older with confirmed IPF. Frailty was assessed using the Fried frailty phenotype (FFP), a CGA-derived Frailty Index (CGA-FI), and the Clinical Frailty Scale (CFS). The primary outcome was a composite of all-cause mortality or acute exacerbation during follow-up. Cox proportional hazards models and bootstrap-derived concordance indices were used to evaluate prognostic associations and model discrimination.

RESULTS: Among the 140 patients included, the prevalence of frailty ranged from 16.4% according to the CGA-FI to 22.3% according to the FFP, whereas 19.3% were classified as frail according to the CFS. During a median follow-up of 465 days (IQR, 221-1076 days), 35 patients (25.0%) experienced the composite outcome. Frailty assessed using the CFS (CFS ≥5: HR, 3.94; 95%CI, 1.81-8.58) and a higher Gender-Age-Physiology (GAP) stage (GAP II-III: HR, 3.11; 95%CI, 1.39-7.00) were independently associated with the composite outcome. The integrated GAP-CFS model showed good discrimination, with a bootstrap-derived Harrell C index of 0.72 (95%CI, 0.62-0.81). Patients who experienced events also had higher Strength, Assistance in Walking, Rising From a Chair, Climbing Stairs, and Falls (SARC-F) scores and greater functional impairment.

CONCLUSIONS: Frailty is common and clinically relevant in IPF. Integrating frailty measures with pulmonary indices improves prognostic stratification and supports the use of the CFS and CGA to guide personalized, multidimensional care.

PMID:42595561 | DOI:10.1016/j.arbres.2026.07.002