Tag: statistics

BMC Infect Dis. 2026 Jan 27. doi: 10.1186/s12879-026-12590-6. Online ahead of print.

ABSTRACT

BACKGROUND: Eradicating hepatitis C virus (HCV) with direct-acting antivirals (DAAs) reduces hepatocellular carcinoma (HCC) risk, but its impact on post-hepatectomy outcomes remains uncertain. We evaluated whether achieving sustained virological response (SVR) improves prognosis in HCV-related HCC after curative hepatectomy.

METHODS: This retrospective cohort study included HCV-related HCC patients undergoing hepatectomy (2017-2024). Patients were stratified by SVR status: DAA-treated Group (achieved SVR post-DAA) and Untreated Group (no treatment). Kaplan-Meier analysis compared recurrence-free survival (RFS) and overall survival (OS); Cox regression identified prognostic factors.

RESULTS: Among 75 patients undergoing curative hepatectomy, the DAA-treated Group demonstrated significantly superior 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates compared to the Untreated Group (p < 0.01). Multivariate analysis indicated that SVR was significantly associated with improved outcomes for both endpoints (p < 0.01). Exploratory stratified analysis indicated that while SVR conferred a robust survival benefit in HBV-negative patients (p < 0.01), this advantage did not reach statistical significance in the HBV-coinfected subgroup. Notably, the prognostic value of SVR was rigorously validated through propensity score matching (n = 52) and a 3-month landmark analysis designed to mitigate immortal time bias; both sensitivity analyses consistently confirmed that SVR was associated with significant improvements in OS and RFS (p < 0.05).

CONCLUSION: Successful eradication of HCV via DAA therapy significantly enhances post-hepatectomy survival and mitigates recurrence risks.

PMID:41593527 | DOI:10.1186/s12879-026-12590-6

BMC Geriatr. 2026 Jan 27. doi: 10.1186/s12877-026-07031-7. Online ahead of print.

ABSTRACT

BACKGROUND: Rural populations in the U.S. face a disproportionate burden of Alzheimer’s Disease and Related Dementias (ADRD), characterized by delayed diagnosis, limited access to care, and high mortality. Medicare data, given their extensive coverage of older adults and ability to capture longitudinal care trajectories, are a critical resource for understanding these disparities. However, no previous review has systematically synthesized evidence specific to rural Medicare beneficiaries with ADRD. This scoping review maps the existing evidence and highlights critical areas where further rural ADRD research is needed.

METHODS: We conducted a systematic search on PubMed, MEDLINE, CINAHL, Scopus, and Web of Science from January 1, 2000 to March 5, 2025. Peer-reviewed studies were included if they examined ADRD outcomes in rural Medicare populations. Information on study designs, health outcomes, population characteristics, rurality definitions, risk factors, access to care, quality of services, healthcare utilization, statistical methods, and policies or interventions were extracted and synthesized.

RESULTS: Thirty-three studies were included, most published after 2019 (72.7%). The predominant study designs were cohort (60.6%) and cross-sectional (30.3%), with heavy reliance on Medicare Fee-for-Service data (84.8%). The literature focused primarily on care delivery (30.3%) and hospitalization outcomes (21.2%), whereas far fewer studies examined ADRD incidence, prevalence, mortality, medication use, and dementia subtypes. Lifestyle factors were assessed in 18.2%, whereas environmental exposures were rarely studied (3.0%). Methodologically, studies relied largely on simple regression approaches, used inconsistent rurality definitions, and rarely evaluated policy interventions.

CONCLUSIONS: Rural Medicare beneficiaries with ADRD remain underrepresented in research despite their disproportionate burden. Future studies should address inconsistent rural definitions, limited consideration of medication use, lifestyle and environmental exposures (natural and built), and rural-specific policy evaluations.

PMID:41593510 | DOI:10.1186/s12877-026-07031-7

BMC Gastroenterol. 2026 Jan 27. doi: 10.1186/s12876-026-04644-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Lactate clearance (LC) has emerged as a potential prognostic marker in critically ill patients. However, its role in predicting massive transfusion (MT) requirements in upper gastrointestinal bleeding (UGIB) patients remains unclear. This study aimed to evaluate the predictive value of LC for MT requirements in patients with UGIB.

METHODS: This retrospective study included 452 patients diagnosed with UGIB between September 2021 and September 2023. Patients were divided into MT and non-MT groups, with MT defined as ≥ 10 units of red blood cell transfusion within 24 h or ≥ 4 units within 1 h. LC was calculated as [(Initial lactate – 1-hour lactate)/Initial lactate] × 100. Appropriate statistical analyses were performed to evaluate the predictive value of LC for MT.

RESULTS: A total of 33 patients (7.3%) required MT, whereas 419 (92.7%) did not. LC was significantly lower in the MT group (p < 0.001). ROC analysis revealed that LC had an area under the curve (AUC) of 0.840 (95% CI: 0.799-0.880), with a cutoff value of 30% (sensitivity: 87.9%, specificity: 74.0%). When combined with the Glasgow-Blatchford score (GBS), the diagnostic accuracy improved further (AUC = 0.880, 95% CI: 0.855-0.920).

CONCLUSION: Lower LC was associated with a higher likelihood of MT in UGIB patients. When combined with the GBS, LC may support early risk stratification during initial assessment. However, given the retrospective design, these findings should be interpreted cautiously and require external validation in prospective multicenter studies before clinical implementation.

PMID:41593508 | DOI:10.1186/s12876-026-04644-5

BMC Anesthesiol. 2026 Jan 28. doi: 10.1186/s12871-026-03649-7. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia, and may lead to delayed recovery and prolonged hospital length of stay. While propofol has been shown to reduce PONV risk, volatile anesthetics like sevoflurane are associated with a higher incidence.

OBJECTIVE: This study compares the incidence of PONV within 24 h after surgery between propofol based total intravenous anesthesia (TIVA) and a hybrid technique using low-dose propofol infusion with sevoflurane in patients with a prior history of PONV and/or motion sickness.

DESIGN: A prospective, single-blind, randomized controlled clinical trial was conducted in adult patients undergoing laparoscopic surgery at Penn State Health Milton S. Hershey Medical Center from February 2024 to March 2025.

INTERVENTION: Patients received either TIVA or a low-dose propofol infusion combined with sevoflurane. The primary outcome was the cumulative incidence of PONV within 24 hours postoperatively. Secondary outcomes included PONV in the post-anesthesia care unit (PACU) and use of rescue antiemetics.

RESULTS: A total of 65 patients were included, (32 hybrid anesthesia, 33 propofol TIVA). PONV occurred in 28% of patients receiving hybrid anesthesia compared to 21% receiving TIVA (p = 0.44). At 24 h, PONV was reported by 59% in the hybrid group and 42% in the TIVA group (p = 0.17).

CONCLUSION: Low-dose propofol infusion combined with sevoflurane resulted in PONV rates that were not statistically different from propofol-based TIVA.

TRIAL REGISTRATION: NCT05759481, registered on 02/22/2023.

PMID:41593496 | DOI:10.1186/s12871-026-03649-7

BMC Gastroenterol. 2026 Jan 28. doi: 10.1186/s12876-026-04649-0. Online ahead of print.

ABSTRACT

BACKGROUND: Relative fat mass (RFM) is a simple anthropometric indicator of body fat. Although its association with hepatic steatosis has been examined in previous studies, its predictive value for the more severe stages of liver disease, specifically advanced hepatic fibrosis (AHF) and cirrhosis, has not been systematically evaluated. This study aimed to explore the associations between RFM and the presence of MASLD, AHF, and cirrhosis.

METHODS: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2023. Logistic regression models were constructed to estimate the associations of RFM with the prevalence of MASLD, AHF, and cirrhosis, adjusting for relevant demographic, lifestyle, and clinical covariates. To facilitate clinical interpretation, odds ratios (ORs) were calculated per standard deviation (SD) increase in RFM. Restricted cubic spline (RCS) models were applied to explore the nonlinear relationships. Subgroup analyses were conducted to assess robustness, and mediation analyses were performed to evaluate the potential indirect effects of diabetes and dyslipidemia.

RESULTS: Among 5,327 participants, 2,453 had MASLD, 230 had AHF, and 93 had cirrhosis. When analyzed per SD increase in RFM, the adjusted ORs were 1.93 (95% CI: 1.64-2.27) for MASLD, 1.98 (95% CI: 1.45-2.71) for AHF, and 1.83 (95% CI: 1.33-2.52) for cirrhosis, indicating substantial clinical relevance. Nonlinear associations were observed in spline analyses. The associations were generally consistent across subgroups. Mediation analysis indicated partial mediation by diabetes and dyslipidemia.

CONCLUSION: This study suggests that higher RFM is positively and nonlinearly associated with MASLD, and more importantly, with the risk of AHF and cirrhosis. Given its simplicity and non-invasiveness, RFM may serve as a practical adjunct screening indicator for identifying individuals at elevated risk of advanced fibrosis within the MASLD spectrum. Longitudinal studies are needed to validate these findings.

PMID:41593487 | DOI:10.1186/s12876-026-04649-0

Malar J. 2026 Jan 27. doi: 10.1186/s12936-026-05795-2. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to assess the community-based prevalence of malaria reservoirs following cases visiting health facilities. The diagnostic performance of microscopy in detecting community-based malaria parasites was compared to nested polymerase chain reactions (PCR).

METHODS: From July to October 2022, reactive case detection was conducted in Sile village, Gamo Zone, in the Southern Rift Valley of Ethiopia. Within six days of identifying an index case, all individuals in the same household and neighboring households were screened for malaria by microscopy, with nested PCR for confirmation. Asexual parasite and gametocyte density were measured microscopically.

RESULTS: Of the 2434 individuals visited following 142 PCR-confirmed index cases, 2009 were included in the final analysis. The PCR-corrected, microscopy-based malaria prevalence in the study community was 3.6% (72/2009; 95% CI 2.8-4.5). Subsequent PCR analysis of randomly selected microscopy-negative samples identified an additional 33 submicroscopic infections, yielding a submicroscopic prevalence of 10.1% (33/326; 95% CI 7.2-13.9). Submicroscopic prevalence was 4.6% for P. vivax (15/326; 95% CI 2.6-7.5) and 4.3% (14/326; 95% CI 2.4-6.9) for P. falciparum. Mixed infections comprised 1.3% (4/326; 95% CI 0.3-3.1) of the cases. Overall, submicroscopic infections accounted for 31% (33/105; 95% CI 22.6-40.8) of the total PCR-confirmed malaria cases in the community, indicating that nearly one-third were missed by microscopic examination. Index cases had higher asexual parasite density (16,177 vs. 1900/μL; P < 0.001) but lower gametocyte carriage than reactive cases, despite similar gametocyte densities (600 vs. 482/μL; P = 0.08). The gametocyte carriage rate was higher among P. vivax (22/32; 69%) than among P. falciparum (6/27; 22%) reactive cases.

CONCLUSION: The high gametocyte carriage rate among microscopy-reactive cases highlights the potential role of community-based infections in sustaining malaria transmission.

PMID:41593453 | DOI:10.1186/s12936-026-05795-2

Hand (N Y). 2026 Jan 27:15589447251406715. doi: 10.1177/15589447251406715. Online ahead of print.

ABSTRACT

BACKGROUND: There are no studies about the biomechanical behavior of ligamentous reconstructions in the trapeziometacarpal (TM) joint. The aim of our study was to analyze the stabilizing effect of 2 different dorsoradial ligament reconstructions of the TM joint: (1) monofascicular ligament reconstruction; and (2) bifascicular ligament reconstruction.

METHODS: Ten fresh-frozen human cadaveric upper extremities were used. The dorsoradial dislocation of the thumb metacarpal (MC1) after applying a dislocating force was measured in 4 different situations using a 3-dimensional motion tracking system: (1) with the dorsoradial and ulnar ligaments intact; (2) after their section; (3) after dorsal ligament reconstruction with the bifascicular technique; and (4) after reconstruction with the monofascicular technique. The data were further analyzed and considered statistically significant at P < .05.

RESULTS: The MC1 moved dorsoradially 0.36 cm (standard deviation [SD] 0.19 cm) with the intact ligaments. After sectioning the ligaments, the displacement was 0.64 cm (SD 0.24 cm). With the bifascicular technique, the MC1 moved 0.31 cm (SD 0.16 cm), and with the monofascicular technique, it moved 0.57 cm (SD 0.19 cm).

CONCLUSIONS: The monofascicular reconstruction technique seems to be insufficient to stabilize the TM joint. Dorsal ligament reconstruction with the bifascicular technique restores the original stability of the TM joint. Moreover, it is not necessary to reconstruct the ulnar ligament to restore the dorsoradial stability of the TM joint after bifascicular reconstruction.

PMID:41593449 | DOI:10.1177/15589447251406715

Neurosurg Rev. 2026 Jan 28;49(1):164. doi: 10.1007/s10143-025-04074-z.

ABSTRACT

BACKGROUND: The choice of structural grafts for transforaminal lumbar interbody fusion (TLIF) may influence clinical and radiographic outcomes. It remains unclear whether using one versus two grafts per level affects postoperative results.

PURPOSE: To compare clinical and radiographic outcomes in patients undergoing one- or two-level TLIF with either one or two structural grafts per level.

METHODS: This is a single-center post hoc analysis of prospectively collected data (October 2011-April 2017). The study allocated subjects who underwent one- or two-level TLIF into two groups based on the number of structural allografts per spinal level. Primary clinical outcomes included Visual Analog Scale, VAS back and leg; Oswestry Disability Index, ODI; Short Form, SF-36 v2, Physical and Mental Component Summary. Secondary radiographic outcomes included fusion rates, lumbar/segmental sagittal alignment, anterior and posterior vertebral body height.

RESULTS: A total of 115 patients were included: 38 and 78 were implanted with one or two grafts per level, respectively. At the 24 months postoperatively, there were no significant differences between the groups in primary clinical and radiographic outcomes, nor complication rates. However, both groups showed statistically significant (p < 0.0001) improvements from baseline across all primary clinical measures at the 24 months follow-up.

CONCLUSIONS: One or two structural grafts per level yield comparable clinical and radiographic outcomes in one- or two-level TLIF. When feasible, using a single graft per level may be considered without compromising patient outcomes.

PMID:41593407 | DOI:10.1007/s10143-025-04074-z

Drug Saf. 2026 Jan 28. doi: 10.1007/s40264-025-01634-6. Online ahead of print.

ABSTRACT

BACKGROUND: The US Food and Drug Administration (FDA) requires pharmaceutical manufacturers to implement Risk Evaluation and Mitigation Strategy (REMS) programs for certain medications that carry serious safety risks. One possible REMS requirement is routine monitoring via laboratory tests. However, in March 2020, the FDA issued a temporary enforcement discretion policy enabling prescribers to apply medical judgment for completing REMS-required laboratory testing.

OBJECTIVE: We aimed to assess whether physicians were aware of the FDA’s temporary policy and if they changed their laboratory testing practices during the coronavirus disease 2019 pandemic.

METHODS: We designed a survey of US physicians prescribing one of seven medications: ambrisentan, bosentan, clozapine, isotretinoin, lenalidomide, pomalidomide, and thalidomide. The study was conducted over two waves, May 2022 to October 2022 and October 2022 to January 2023. Multivariable logistic regression modeling was used to examine predictors of each outcome.

RESULTS: The combined response rate between the two waves of survey administration was 21%. Among 949 physician respondents, 438 (47%; 927 question respondents) reported awareness and 192 (21%; 926 question respondents) reported changing practices. Among the 438 physicians who reported awareness, 176 (40%) reported changing practices. Characteristics associated with awareness included sex (female vs male, odds ratio [OR] = 1.92, 95% confidence interval [CI] 1.37-2.69); recency of medical school graduation (25-34 vs ≤ 15 years, OR = 0.50, 95% CI 0.31-0.81); practice setting (academic hospital vs outpatient group, OR = 0.58, 95% CI 0.37-0.88); prescribing experience (≥ 21 vs ≤10 patients, OR = 2.92, 95% CI 2.06-4.14); and timing of survey completion (wave 2 vs wave 1, OR = 0.47, 95% CI 0.34-0.66). Characteristics associated with practice changes included race (Asian vs White, OR = 0.62, 95% CI 0.38-0.99) and awareness of FDA’s policy (yes vs no, OR = 14.07, 95% CI 7.93-24.96), in addition to sex (female vs male, OR = 1.99, 95% CI 1.31-3.01), recency of medical school graduation (≥ 35 vs < 15 years: OR = 0.53, 95% CI 0.30-0.93), and timing of survey completion (wave 2 vs wave 1: OR = 0.58, 95% CI 0.34-0.99).

CONCLUSIONS: Although policy awareness was correlated with laboratory practice changes, fewer than half of physicians who were aware of the FDA’s policy reported changing their practices.

PMID:41593404 | DOI:10.1007/s40264-025-01634-6

Indian J Pediatr. 2026 Jan 28. doi: 10.1007/s12098-026-05992-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the accuracy of Face2Gene (F2G) app in the diagnosis of a genetic syndrome as a first correct response, after uploading the image of the patient in the app (top 1 accuracy), first 3 responses (top 3 accuracy), and first 10 responses (top 10 accuracy) out of 30 differential diagnoses given by the app. Also, to determine the accuracy of the app for rare and ultra-rare diagnoses given by the app.

METHODS: Frontal facial images of individuals with the diagnosis of a genetic syndrome (established clinically or molecularly) were analysed with and without additional clinical features.

RESULTS: In this study, a total of 118 children were recruited. Overall, the molecularly confirmed eventual diagnosis appeared in the “top 10” suggested syndromes by Face2Gene in 75/118 cases, providing a diagnostic yield of 63.6%. In this study, the top 1 accuracy for correct first diagnosis by the app and clinician’s first diagnosis was 45.8% (n = 54). The Mcnemar test was examined for the clinician’s accurate diagnosis as compared to top 1, top 3, and top 10 accuracy by the app and the p-value was statistically significant for top 10 accuracy (0.0005) and not for the top 1 and 3 diagnoses. The top 10 accuracy for the app in the rare cases was 21/30 cases (70%), and for ultra-rare cases was 28/64 (43.8%).

CONCLUSIONS: The Face2Gene app is useful as an assistant to clinicians in the diagnosis of rare and ultra-rare diseases. The top 10 accuracy is better than clinical diagnosis, and the yield is better for the ultra-rare cases and the single gene disease category, too.

PMID:41593402 | DOI:10.1007/s12098-026-05992-6