Tag: statistics

JAMA Health Forum. 2026 Apr 3;7(4):e260631. doi: 10.1001/jamahealthforum.2026.0631.

ABSTRACT

IMPORTANCE: Although electronic nicotine delivery systems (ENDS) use is decreasing among youth in the US, the frequency of use is increasing among current users, particularly high school students.

OBJECTIVE: To evaluate the effectiveness of local flavored tobacco ban policies and assess whether policies may have unintended outcomes in youth in California.

DESIGN, SETTING, AND PARTICIPANTS: Repeated cross-sectional study using a confounder-adjusted dynamic difference-in-difference (DID) analysis to obtain estimates of the average treatment effect among the treated (ATT) over 6 years. Participants were middle school and high school students in the 2017-2022 California Healthy Kids Survey. Data were analyzed from February 1 to October 1, 2025.

EXPOSURES: Policy exposure (treated group) defined as attending a school in person within a jurisdiction with an active flavored tobacco ban at the time of survey administration.

MAIN OUTCOMES AND MEASURES: The primary outcome was current ENDS use, and the secondary outcome was current cigarette use. To address confounding, additional measures included racial and ethnic diversity, federal poverty level, and educational attainment, which were aggregated to the local policy jurisdiction area.

RESULTS: Among 2 805 708 middle and high school student tobacco users, local flavored tobacco bans were associated with a reduction in current ENDS use of 2.4 percentage points (ATT, -0.024; 95% CI, -0.031 to -0.017) and were not associated with current cigarette use (ATT, 0.002; 95% CI, -0.002 to 0.005). Three years after policy implementation, ENDS use was lower in jurisdictions with flavor ban compared with jurisdictions without by 1.9 percentage points (ATT, -0.019; 95% CI, -0.027 to -0.010). Four years after policy implementation, ENDS use was lower in jurisdictions with flavor ban compared with jurisdictions without by 9.3 percentage points (ATT, -0.093; 95% CI, -0.117 to -0.069).

CONCLUSIONS AND RELEVANCE: In this study, a local flavored tobacco ban policy was associated with reduced ENDS use among youth but not with cigarette use within this population. Future research should also examine trends in other states to evaluate policy adoption and enforcement.

PMID:41961492 | DOI:10.1001/jamahealthforum.2026.0631

Echocardiography. 2026 Apr;43(4):e70447. doi: 10.1111/echo.70447.

ABSTRACT

BACKGROUND: Quantitative assessment of right ventricular (RV) function by transthoracic echocardiogram (TTE) commonly relies on tricuspid annular plane systolic excursion (TAPSE) and lateral tricuspid annulus peak systolic velocity (S’). However, full cardiac cycle data may provide additional information beyond these two systolic measures.

OBJECTIVE: We sought to (1) automate the estimation of systolic parameters (TAPSE and S’) from tissue spectral Doppler imaging (Tissue Doppler Imaging [TDI]) and (2) integrate these tabular systolic parameters and the full-cycle functional signal to estimate RV systolic function.

METHODS: We identified 387 patients who underwent both TTE and cardiac magnetic resonance imaging (CMR) within 24 h. We developed and validated an automated algorithm to extract TAPSE and S’ from raw TDI. We trained two classifier models for RV dysfunction (RVEF < 45%): (1) Tabular model (RVD_TABULAR) using algorithmic measurement of TAPSE/S’ and age/sex, and (2) Integrated model (RVD_INTEGRATED), an attention-based neural network model using the entire digitized TDI waveforms in addition to tabular data.

RESULTS: In the TTE-CMR paired dataset, the proposed algorithm accurately estimated S’ (mean error: -0.05 cm/s) and TAPSE (mean error: -0.97 mm). Tabular model RVD_TABULAR achieved an AUROC of 0.71 and an AUPRC of 0.48 for predicting RVEF <45%, while the integrated model RVD_INTEGRATED achieved significantly better performance (AUROC: 0.768; AUPRC: 0.56). In the external validation cohort with pulmonary hypertension (PH), the integrated model’s prediction was significantly associated with event-free survival (p = 0.036).

CONCLUSIONS: We developed a fully automated pipeline that integrates digitized TDI waveforms with both parametric and non-parametric features to classify RVEF <45%. This approach can effectively risk-stratify patients with PH.

PMID:41961465 | DOI:10.1111/echo.70447

Updates Surg. 2026 Apr 10. doi: 10.1007/s13304-026-02616-8. Online ahead of print.

ABSTRACT

Pancreaticoduodenectomy (PD) is associated with a long and complex recovery. Enhanced recovery programmes have improved short-term clinical outcomes, but there is a growing interest in patient-reported outcomes as an indicator for postoperative recovery. Health-related quality of life (HRQoL) and patient-reported postoperative recovery provide a wider perspective on the effects of surgery. However, the relationship between the two measures remains unexplored. Therefore, the aim of this study was to explore the relationship between HRQoL and patient-reported recovery in patients undergoing PD. This prospective, single-centre study included 77 participants who all underwent PD in the context of an enhanced recovery programme. Instruments used were the EQ-5D-3L and the SwQoL-24. Data was collected preoperatively and at 1,3,6,9, and 12 months postoperatively. Longitudinal trends were analysed using a mixed-effect repeated measures model. Predictive associations were explored via linear regression. The EQ-5D-3L improved, and the SwQoL-24 total score declined throughout the first year. The EQ-5D-3L Index and the VAS explained the SwQoR-24 value at six months and 12 months; R² 0.52/0.47 and 0.52/0.56, respectively. Preoperative EQ-5D-3L values predicted between (R²) 0.09-0.17 for 6 and 12-month SwQoR-24 values. Other tested factors were statistically non-significant. This study demonstrates a significant improvement in postoperative recovery as well as HRQoL during the first year after PD, with a strong association between the two measures. The findings also suggest that the EQ-5D-3L index and the EQ VAS have a significant but limited predictive value for postoperative recovery. Other demographical and care-related factors did not predict levels of recovery quality.

PMID:41961460 | DOI:10.1007/s13304-026-02616-8

AMB Express. 2026 Apr 10. doi: 10.1186/s13568-026-02041-5. Online ahead of print.

NO ABSTRACT

PMID:41961440 | DOI:10.1186/s13568-026-02041-5

Int J Cardiovasc Imaging. 2026 Apr 10. doi: 10.1007/s10554-026-03702-z. Online ahead of print.

ABSTRACT

Providing insights into the feasibility of pulmonary function assessment in real-world cardiovascular magnetic resonance (CMR) practice by applying Phase-REsolved FUnctional Lung imaging (PREFUL). We retrospectively analyzed consecutive patients who underwent PREFUL imaging in addition to routine 1.5T CMR between September 2023 and January 2024. PREFUL was acquired in three coronal slices, with a prototype tool used to derive quantitative perfusion and ventilation defect percentages (QDP and VDP, respectively). Cardiac function was assessed from short-axis cine images. Subgroup analyses included patients with primary pulmonary disease and reduced left ventricular ejection fraction (LVEF). Statistical analyses comprised linear regression, correlation analysis, and Kruskal-Wallis test. The final cohort included N = 172 patients (74 females), median age 60 years (IQR 46-71). PREFUL was feasible in all cases (mean scan time 60 s/slice). Multivariable regression with bootstrap-based backward selection showed associations of QDP with LVEF, pulmonary disease, age, and BMI (all p ≤ 0.005), while VDP was associated with pulmonary disease, age, and male sex (all p < 0.001). QDP correlated negatively with LV stroke volume (ρ (Spearman’s rho) – 0.336, p < 0.001) and cardiac output (ρ – 0.360; p < 0.001) and was higher in patients with LVEF < 50% (p < 0.001). Patients with primary pulmonary disease had higher QDP (p = 0.005) and VDP (p = 0.036). No correlations between cardiac function and VDP were detected (all p > 0.05). Application of PREFUL is feasible and fast in CMR routine. While QDP and VDP are affected by pulmonary disease, QDP is additionally associated with markers of cardiac function and was higher in patients with reduced LVEF.

PMID:41961412 | DOI:10.1007/s10554-026-03702-z

Environ Monit Assess. 2026 Apr 10;198(5):436. doi: 10.1007/s10661-026-15174-8.

ABSTRACT

The longstanding reliance on synthetic herbicides for aquatic weed management has imposed a significant chemical legacy on freshwater ecosystems. While effective for short-term control, these compounds often persist in water and sediments, leading to bioaccumulation and long-term ecological shifts. This review critically re-evaluates this dependency, synthesizing evidence of direct and indirect impacts on non-target organisms, including phytoplankton, invertebrates, and fish, often via sublethal physiological and behavioral effects. The rapid degradation of plant biomass can trigger regime shifts, such as algal blooms and oxygen depletion, thereby altering ecosystem structure and function. Furthermore, the challenges of herbicide resistance and the underestimated risks of commercial formulations and chemical mixtures underscore the limitations of a purely chemical approach. We argue for an urgent paradigm shift towards integrated weed management (IWM). This review provides a critical synthesis that repositions herbicides as a targeted, last-resort tool within a broader, ecologically sustainable framework. This framework prioritizes prevention, biological control, and ecological restoration to safeguard aquatic health, moving beyond the entrenched, chemical-centric paradigm. Clinical trial number: not applicable.

PMID:41961347 | DOI:10.1007/s10661-026-15174-8

Environ Monit Assess. 2026 Apr 10;198(5):435. doi: 10.1007/s10661-026-15295-0.

ABSTRACT

Heavy metal pollution in soil has become an environmental challenge attracting global concern. In China, the national standard GB15618-2018 is widely adopted for classifying heavy metal pollution risk in agricultural soils into three levels, including the background, screening, and intervention levels. However, it only specifies risk screening and intervention values for five heavy metals (Hg, Cd, As, Pb, Cr), which make systematic risk classification for other metals unfeasible. To address this limitation, an integrated method combining GB15618-2018 with the geo-accumulation index (I_geo) is proposed. Risk levels are determined preferentially through risk values specified in GB15618-2018, and otherwise by I_geo values (with new thresholds of 1.4 and 3.7). Analysis of 493 soil samples from the Yuanjiang area confirmed I_geo as a valid supplementary tool, enabling unified three-level risk classification for all heavy metals. Application in the Yuanjiang area showed most areas at the background level, with small screening-level patches requiring supervision and rare intervention-level spots requiring control. Source apportionment using multivariate statistical analyses mainly identified three distinct sources: ultramafic rocks (Cr, Ni, Co, Hg, As), Pb-Zn mineralization (Cd, Pb, Zn), and Cu mineralization (Cu and V). Although developed within China’s regulatory framework, the proposed method addresses a challenge common to many countries, namely incomplete regulatory coverage for certain heavy metals, and thus offers a template adaptable to other regions worldwide.

PMID:41961342 | DOI:10.1007/s10661-026-15295-0

Eur J Pediatr. 2026 Apr 10;185(5):252. doi: 10.1007/s00431-026-06917-3.

ABSTRACT

Alagille syndrome (ALGS) is a rare multisystem disorder most commonly resulting from pathogenic variants in JAG1 and, less frequently, NOTCH2. We evaluated long-term native liver survival (NLS) and overall survival (OS) in a Korean ALGS cohort and compared the genetic characteristics of this cohort with those of the Global ALagille Alliance (GALA) study cohort. We retrospectively reviewed 60 patients with clinically diagnosed ALGS at Seoul National University Hospital. Forty-three patients with genetically confirmed disease were analyzed. Eight patients (18.6%) underwent liver transplantation (median age: 3.9 years), revealing a lower rate than that in the comparator cohort. The estimated NLS percentages at 5, 10, and 18 years were 86.9%, 86.9%, and 76.6%, respectively, exceeding those in previous reports. The corresponding OS rates were 90.2%, 86.9%, and 86.9%, respectively. The following types of JAG1 variants were identified in 41 patients (95.3%): frameshift (34.1%), nonsense (26.8%), missense (24.4%), and splice-site (9.8%) variants and in-frame deletions (4.9%). Compared with the reference group, our cohort exhibited a greater frequency of non-protein-truncating variants (missense variants and in-frame deletions; p = 0.023) and no structural variants (p = 0.043). Two patients (4.7%) carried NOTCH2 nonsense variants. Mortality was significantly higher among patients with frameshift variants compared with patients with non-frameshift variants (4 of 5 deaths; p = 0.035).

CONCLUSION: Compared with the GALA cohort, Korean patients with ALGS exhibited more favorable long-term NLS and a higher proportion of non-protein-truncating JAG1 variants, alongside the absence of structural variants. These findings suggest potential genetic influences and highlight the need for multicenter validation.

WHAT IS KNOWN: • The Global ALagille Alliance (GALA) study reports native liver survival (NLS) rates of 66.8%, 54.4%, and 40.3% at 5, 10, and 18 years, respectively, in patients with Alagille syndrome. • NLS rates are higher among Asians, with unclear genotype-phenotype correlations.

WHAT IS NEW: • Compared to the GALA study cohort, the Korean cohort demonstrates superior NLS rates of 86.9%, 86.9%, and 76.6% at 5, 10, and 18 years and a higher frequency of non-truncating JAG1 variants, along with the absence of structural variants. • Protein-truncating variants are associated with higher initial gamma-glutamyl transferase levels, while frameshift variants are associated with reduced overall survival.

PMID:41961327 | DOI:10.1007/s00431-026-06917-3

Eur J Pediatr. 2026 Apr 10;185(5):250. doi: 10.1007/s00431-026-06914-6.

ABSTRACT

HyperCKemia is a frequent laboratory finding in pediatric practice and may reflect a wide spectrum of conditions, ranging from benign transient states to rare primary neuromuscular disorders. The lack of pediatric-specific diagnostic algorithms complicates risk stratification and clinical decision-making. A retrospective cohort study was conducted, including patients under 18 years of age with hyperCKemia referred to a tertiary reference center between January 2017 and December 2024. Clinical, laboratory, genetic, and histological data were collected. Statistical analyses included univariate testing and logistic regression to identify predictors of primary disease. A total of 119 patients were included (median age 10 years; 76.5% male). Most were symptomatic at presentation (87.4%), and 80.3% met criteria for rhabdomyolysis. A primary disorder was identified in 25.2% of patients, while 52.1% had secondary causes, predominantly viral myositis, and 22.7% remained undiagnosed. Metabolic myopathies accounted for the majority of primary diagnoses (60.0%), followed by muscular dystrophies (23.3%) and inflammatory myopathies (13.3%). Persistent hyperCKemia and male sex emerged as strong independent predictors of primary disease (OR 8.5 and 5.1, respectively). Muscle weakness and exercise intolerance were exclusive to primary disorders. Genetic testing yielded a diagnosis in 26.8% of tested patients, with targeted next-generation sequencing proving particularly valuable.

CONCLUSIONS: In pediatric hyperCKemia, persistent CK elevation and male sex are key predictors of underlying primary neuromuscular disease. A phenotype-driven, stepwise diagnostic approach incorporating early genetic testing may improve diagnostic yield and optimize resource utilization.

WHAT IS KNOWN: • HyperCKemia in children is most frequently secondary to benign conditions such as viral myositis, while primary neuromuscular disorders are less common but clinically significant. • Creatine kinase levels lack specificity, and the diagnostic approach increasingly relies on genetic testing.

WHAT IS NEW: • Persistent hyperCKemia and male sex were identified as independent predictors of primary disease. • Most primary disorders occurred in patients with CK over 1000 UI/L, and higher inter-crisis CK levels were associated with an increased likelihood of underlying disease.

PMID:41961319 | DOI:10.1007/s00431-026-06914-6

Abdom Radiol (NY). 2026 Apr 10. doi: 10.1007/s00261-026-05420-5. Online ahead of print.

ABSTRACT

BACKGROUND: Response evaluation of pancreatic ductal adenocarcinoma (PDAC) with routine contrast-enhanced CT (CECT) using RECIST is currently inadequate for identification of patients benefiting from chemotherapy treatment, as the majority of patients show stable disease. This might lead to inappropriate treatment and potentially diminishes patients’ quality of life. Recent developments in CT perfusion (CTP) show its potential as a biomarker to evaluate therapy response in PDAC.

PURPOSE: To investigate quantitative CT Perfusion as a prognostic biomarker during chemotherapy treatment in patients with PDAC.

MATERIALS AND METHODS: This prospective cohort trial included patients between January 2018 and December 2022 with biopsy-proven PDAC of all stages who underwent CT Perfusion before (i.e. baseline) and after three months of chemotherapy treatment. A previously developed AI-assisted CTP analysis method provided automatic segmentations of tumor and pancreas parenchyma. A trilinear non-parametric CTP contrast-enhancement model described the upslope and the peak of the time intensity curve for both tumor and parenchyma. Perfusion features of baseline and follow-up scans were compared to calculate the percentual difference. The primary endpoint was the association between quantitative CTP parameters and overall survival (OS). Secondary endpoints included comparison with RECIST 1.1 and CA 19-9 response criteria for prognostic stratification. Statistical analysis included Kaplan-Meier curves and log-rank test.

RESULTS: A total of 25 patients were included. Treatment response based on RECIST 1.1 criteria showed two cases with progressive and 23 with stable disease. Patients with increased peak enhancement after chemotherapy demonstrated significantly longer survival compared to those with decreased enhancement (p = 0.02). In contrast, CA19-9 response (≥ 30% decrease) did not significantly differentiate survival (758 days vs 371 days, p = 0.27). Furthermore, CTP found more patients with a higher chance of long survival compared to RECIST (60% vs 25% survival in 24 months). In the subgroup with RECIST stable disease CTP still finds patients with a significantly longer survival (p = 0.02). Combined analysis showed that patients with both CTP increase and CA19-9 response had the best median survival at 758 days (IQR: 561-895).

CONCLUSION: Our study demonstrates that quantitative CTP is associated with better identification of long-term survivors than RECIST, based on increased peak enhancement after chemotherapy. Quantitative CTP may serve as a valuable complement to current treatment assessment methods in patients with PDAC.

PMID:41961316 | DOI:10.1007/s00261-026-05420-5