Tag: statistics

JMIR Form Res. 2026 Jul 8;10:e87163. doi: 10.2196/87163.

ABSTRACT

BACKGROUND: Symptom-based localization of brainstem ischemia is challenging because of the anatomical complexity of the brainstem and the nonspecific overlap of clinical syndromes. Whether large language models (LLMs) can meaningfully assist in this task remains uncertain.

OBJECTIVE: This study aimed to compare the performance of several OpenAI LLMs and neurologists in localizing diffusion-weighted imaging (DWI)-confirmed brainstem ischemic lesions based on symptom descriptions alone.

METHODS: In this retrospective single-center study, 109 patients with DWI-confirmed acute brainstem ischemia were included. Three neurologists and 6 LLMs (GPT-5, GPT-4, GPT-4.1, GPT-4o, o3, and o3-pro) predicted lesion localization using a combined anatomical-lateral end point (left or right midbrain, pons, and medulla) based on symptom descriptions alone. Overall and regional accuracy, the Cohen κ, 6-class confusion matrices, and point-biserial correlations between symptom count and correct prediction were assessed. Because all raters evaluated the same cases, paired McNemar tests with Benjamini-Hochberg correction were used for pairwise performance comparisons.

RESULTS: GPT-4 and GPT-4o achieved the highest overall accuracy (61/109, 56%; 95% CI 46.1%-65.5%). Agreement with the DWI reference standard remained limited across all raters, with the Cohen κ reaching a maximum of 0.291 for GPT-4o. Confusion matrices showed that higher performance was driven mainly by pontine cases, whereas misclassification remained frequent in mesencephalic and medullary lesions. Regional analyses outside the pons were imprecise because mesencephalic and medullary subgroups each contained only 16 cases. A higher number of documented symptoms was associated with correct prediction for GPT-4, GPT-5, GPT-o3, and 1 neurologist.

CONCLUSIONS: Although some LLMs showed higher relative accuracy than the participating neurologists, absolute performance remained limited and clinically insufficient. These findings are best interpreted as an exploratory benchmark under constrained conditions: absolute performance remained modest, agreement beyond chance was limited, and performance outside pontine lesions was inconclusive.

PMID:42418842 | DOI:10.2196/87163

J Vet Intern Med. 2026 Jul 1;40(4):aalag135. doi: 10.1093/jvimsj/aalag135.

ABSTRACT

BACKGROUND: Cerebrospinal fluid (CSF) analysis is a critical component in the diagnosis of equine protozoal myeloencephalitis (EPM). Test results obtained may differ based on different collection sites.

HYPOTHESIS/OBJECTIVES: Compare results of EPM-specific diagnostic tests obtained from different collections sites in EPM-affected and non-EPM affected horses.

ANIMALS: Twenty control and 7 EPM-affected horses.

METHODS: Prospective observational study. CSF was collected from the lumbosacral (LS) and cranial sites (atlantooccipital or C1-2) in 27 horses and EPM-specific diagnostic tests were performed. Data were summarized by collection site and disease status. Results were compared by Wilcoxon signed rank test in the non-EPM and EPM-affected cohorts.

RESULTS: The EPM-specific diagnostic test results (anti-Sarcocystis neurona CSF antibody titer, serum/CSF titer ratios, and S. neurona antibody index [AI]) in non-EPM affected horses did not differ based on collection site. In EPM-affected horses the median [interquartile range] CSF anti-S. neurona antibody titers were higher in samples from the LS site compared with fluid collected from the cranial sites (160 [1240] vs. 80 [600]; Wald test statistic, 21.0; P = .03) and the median serum/CSF titer ratio was also lower in fluid collected from the LS site (25 [46.8] vs 50 [93.7]; Wald test statistic, 0; P = .03). Median AI values did not differ based on CSF collection site.

CONCLUSIONS AND CLINICAL IMPORTANCE: Results of EPM diagnostic tests on CSF may differ based on collection site and lead to misdiagnosis. The AI appears to be less affected by collection site than antibody titers or the serum/CSF titer ratio.

PMID:42418837 | DOI:10.1093/jvimsj/aalag135

J Vet Intern Med. 2026 Jul 1;40(4):aalag130. doi: 10.1093/jvimsj/aalag130.

ABSTRACT

BACKGROUND: Dogs with chronic inflammatory enteropathy (CIE) are common in companion animal practice. Neutrophilic inflammatory enteropathy (NIE) is a subtype of CIE that is uncommonly reported, posing a dilemma in terms of etiology, treatment, and prognosis.

HYPOTHESIS/OBJECTIVES: To describe historical, clinical, clinicopathological, imaging findings, treatment, and survival in dogs with histologically confirmed NIE.

ANIMALS: Twenty-seven client-owned dogs with NIE.

MATERIALS AND METHODS: Retrospective interrogation of the hospital database between January 2015 and January 2025 identified dogs with NIE based on histological reports. Cases were regraded using modified WSAVA guidelines and classified into the minor (mild inflammation) or major (moderate or severe inflammation) groups.

RESULTS: Twenty-seven dogs were identified, with 8 and 19 dogs in the minor and major groups, respectively. The mean age was 7.7 ± 3.5 (95% CI, 6.4-9.1) years. The most common presenting signs were diarrhea (n = 21/27; 78%), vomiting (n = 21/27; 78%), weight loss (n = 20/27; 74%), hyporexia/anorexia (n = 13/27; 48%), and melena (n = 7/27; 26%). Clinicopathological abnormalities included neutrophilia (n = 12/27, 44%), hypoalbuminemia (n = 14/27, 52%), hypoglobulinemia (n = 23/27, 85%), hypocholesterolemia (n = 11/27; 41%), total hypocalcemia (n = 11/27; 41%), and hypocobalaminemia (n = 14/24; 58%). Twenty-four (89%) dogs (6 minor and 18 major) survived to discharge, with an overall median survival time of 267 (95% CI, 0-569) days, with no statistically significant difference between the major and minor groups. Peripheral neutrophilia was associated with an increased hazard of death (4.43; 95% CI, 1.16-16.99; P = .03) on univariate analysis and a significantly shorter median survival time.

CONCLUSION AND CLINICAL IMPORTANCE: Neutrophilic inflammatory enteropathy is potentially associated with poor survival. Peripheral neutrophilia might indicate a poorer prognosis.

PMID:42418836 | DOI:10.1093/jvimsj/aalag130

JMIR Form Res. 2026 Jul 8;10:e94949. doi: 10.2196/94949.

ABSTRACT

BACKGROUND: Ecological momentary assessment (EMA) enables repeated, real-time measurement of emotional states, behaviors, and contextual exposures in individuals’ daily lives. Although EMA has been increasingly used in health and behavioral research, evidence regarding the feasibility, compliance, and acceptability of smartphone-based EMA among older adults in Asian settings remains limited.

OBJECTIVE: This study aimed to evaluate the feasibility, EMA compliance, usability, and acceptability of a 14-day smartphone-based EMA protocol among community-dwelling older adults in Singapore.

METHODS: The data came from the Ecological Momentary Assessment in Ageing study, a smartphone-based EMA study designed to assess mental well-being, lifestyle behaviors, and perceived neighborhood environment among older adults. Adults aged 65 years or older in Singapore were enrolled and asked to complete 5 EMA prompts per day over 14 consecutive days using a smartphone app. Each EMA prompt remained available for up to 5 hours after delivery. EMA prompts assessed momentary mental well-being, sleep, physical activity, screen time, and perceived neighborhood environment. Feasibility indicators included recruitment and retention rates. EMA compliance was assessed as the proportion of completed EMA prompts out of all scheduled prompts. Usability and acceptability were assessed using a poststudy survey.

RESULTS: Between June 2025 and December 2025, a total of 186 individuals initially expressed interest in the study, of whom 139 (74.7%) scheduled an appointment, and 132 (95%) of the latter attended the appointment. Of those who attended, 98.5% (130/132) were enrolled. Participants had a mean age of 70.1 (SD 4.04) years; 65.4% (85/130) were female, 90.8% (118/130) were Chinese, and 65.4% (85/130) had postsecondary or university-level education. All enrolled participants completed the 14-day EMA protocol, resulting in 100% (130/130) retention. Across all participants, 99% (9007/9100) of the scheduled EMA prompts were completed. The poststudy usability survey was completed by 96.9% (126/130) of the participants. Among those who completed the poststudy usability survey, 88.1% (111/126) agreed or strongly agreed that the app was easy to use, 84.1% (106/126) agreed or strongly agreed that most people would learn to use it quickly, and 87.3% (110/126) preferred the app over face-to-face interviews. Overall, 91.3% (115/126) reported being satisfied or strongly satisfied with the app, and 100% (126/126) indicated willingness to be contacted for future research.

CONCLUSIONS: A 14-day smartphone-based EMA protocol was highly feasible and acceptable among community-dwelling older adults in Singapore, with high retention and compliance and favorable usability ratings. These findings support the use of EMA methodologies in aging research within Asian contexts and suggest that older adults can successfully engage with repeated smartphone-based assessments when protocols are appropriately designed and supported.

PMID:42418824 | DOI:10.2196/94949

Clin Exp Dent Res. 2026 Aug;12(4):e70403. doi: 10.1002/cre2.70403.

ABSTRACT

OBJECTIVES: This systematic review aims to assess the effectiveness of varnishes for the remineralization of white spot lesions in primary teeth.

METHODS: A database search was conducted in MEDLINE and the Cochrane Library to screen for articles relevant to the topic of the review. Risks of bias in randomized studies were assessed using the ROB2 tool and GRADE evidence levels.

RESULTS: Seven studies met all inclusion criteria and were included. Differences in varnish composition and characteristics can affect the anticaries properties. Bioactive additives had a statistically significant reduction in ICDAS scores.

CONCLUSIONS: Intensive application of remineralizing varnishes demonstrated a significant effect on the remineralization and control of carious lesion activity. New-generation fluoride appear to be more effective than conventional sodium fluoride varnishes.

PMID:42418809 | DOI:10.1002/cre2.70403

J Magn Reson Imaging. 2026 Jul 8. doi: 10.1002/jmri.70444. Online ahead of print.

ABSTRACT

BACKGROUND: Environmental conditions established at facility design, construction, updates, and/or procurement of specialized equipment are the foundation of safe MR practice. Establishing an institutional MR safety program must take into consideration the conditions of the MR environment, and staff training should be tailored to its features.

PURPOSE/HYPOTHESIS: To identify the concordance on conditions for a safe MR environment among a variety of widely known national guidance documents.

STUDY TYPE: Analysis of guidance documents.

POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL: Not applicable.

FIELD STRENGTH/SEQUENCE: Not specific to field strength.

ASSESSMENT: Information was extracted from national MR safety guidance documents about the expected conditions in a safe MR environment, and categorized among (1) facility design, (2) MR equipment selection, and (3) peripheral equipment. Commonalities and differences were identified.

STATISTICAL TESTS: Descriptive statistics.

RESULTS: Six publicly available national guidance documents for MR safety were obtained, from countries with relatively high density of MR systems (between 9 and 38 MR systems per million inhabitants): Australia, New Zealand, Sweden, Switzerland, UK, and USA. Full or partial concordance was observed among many measures related to facility design (21/25 conditions), MR equipment features (7/9 conditions), and peripheral equipment (10/13 conditions).

DATA CONCLUSION: This work identified the common and divergent recommendations on facilities and equipment from a variety of guidance documents from national sources. Highlighting common (and uncommon) features recommended by guidance can help users identify weaknesses in their MR environment. This could inform jurisdictions/countries without official guidance and serve in the development of future guidance documents or MR safety training materials.

EVIDENCE LEVEL: 5.

TECHNICAL EFFICACY: 1.

PMID:42418802 | DOI:10.1002/jmri.70444

J Cardiovasc Electrophysiol. 2026 Jul 8. doi: 10.1111/jce.70437. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple randomized controlled trials (RCTs) have compared the efficacy of pulmonary vein isolation adjunct (PVI+) techniques with PVI alone in patients with persistent atrial fibrillation (AF). However, these comparisons have been limited by a small sample size or conflicting results. It remains unclear if there is any benefit offered by these PVI+ techniques.

OBJECTIVES: We conducted a systematic review and meta-analysis of RCTs and compared the efficacy of different PVI+ techniques with PVI alone. We hypothesized that as compared with PVI alone, the PVI+ techniques have a superior efficacy in freedom from atrial arrhythmias.

METHODS: A systematic search of MEDLINE and EMBASE was conducted. The outcomes of interest included freedom from atrial arrhythmias, freedom from AF, procedure time, fluoroscopy time, ablation time and procedural complications. For dichotomous outcomes, Mantel-Haenszel risk ratios (RR) with 95% CIs were calculated using random-effects model. For the continuous outcomes standardized mean differences (SMD) were calculated. Subgroup analyses were conducted for various PVI + techniques including posterior wall isolation, linear lines, complex fractionated atrial electrograms, and low voltage area ablation.

RESULTS: A total of 18 RCTs comprising 3459 patients (PVI + = 1956, PVI alone=1503) were included. There was no statistically significant difference between the two arms in the freedom from atrial arrhythmias (RR 1.10; 95% CI [1.00-1.22]; p = 0.06; I² = 56%), and freedom from AF (RR 1.12; 95% CI [0.99-1.25]; p = 0.06; I² = 63%). PVI+ techniques were associated with a statistically significant increase in procedure time (SMD 1.46; 95% CI [0.76-2.15]; p < 0.0001; I² = 96%), fluoroscopy time (SMD 0.45; 95% CI [0.06-0.84]; p = 0.02; I² = 91%), and ablation time (SMD 1.32; 95% CI [0.74-1.90]; p < 0.00001; I² = 95%). There was no statistically significant difference in the pooled total complications between PVI + vs. PVI alone (RR 1.61; 95% CI [0.99-2.62]; p = 0.05; I² = 26%).

CONCLUSIONS: This meta-analysis of 18 RCTs shows that there is no difference in the freedom from atrial arrhythmias with various PVI + techniques vs. PVI alone in patients with persistent AF. Further large RCTs are needed to determine the ideal ablation strategy for these patients.

PMID:42418771 | DOI:10.1111/jce.70437

J Cardiovasc Electrophysiol. 2026 Jul 8. doi: 10.1111/jce.70447. Online ahead of print.

ABSTRACT

INTRODUCTION: Atrial fibrosis is an adverse factor for arrhythmia recurrences and thromboembolic events in atrial fibrillation (AF). Cardiac magnetic resonance imaging (CMRi) has emerged as a noninvasive tool for its assessment, though evidence remains conflicting.

METHODS AND RESULTS: Sixty ablation-naïve patients with AF scheduled for first-time catheter ablation were enrolled (78% men, 67% paroxysmal AF, 73% heart failure reduced ejection fraction [HFrEF]). Prior to the procedure, CMRi was performed in sinus rhythm (SR) on a 1.5T system using a high-resolution (1.3 mm isotropic) free-breathing 3D LGE sequence with echo-navigator end-expiratory gating and whole-heart coverage. Left atrium (LA) fibrosis was quantified using the commercially available ADAS 3D software, with fibrosis defined at four image intensity ratios (IIR) thresholds (0.97, 1.2, 1.32, and 1.61 times mean blood-pool signal intensity). High-density electroanatomical mapping (EAM) was performed in SR, and low-voltage substrates (LVS) were quantified at three bipolar voltage thresholds (0.5, 0.25, and 0.1 mV). LVS-EAM were identified in 97%, 88%, and 45% of patients at 0.5, 0.25, and 0.1 mV, respectively. LGE-CMRi was detected in 100%, 97%, 63%, and 17% of patients at IIR thresholds of 0.97, 1.2, 1.32, and 1.61, respectively. Quantitative correlation between CMR- and EAM-derived fibrosis was negligible to weak across all threshold combinations. When fibrosis was analyzed dichotomously, agreement was highest between EAM 0.5 mV and CMR IIR 0.97 (0.97, 95% CI [0.92, 1.00]; p < 0.001) and IIR 1.2 (1, 95% CI [1.00, 1.00]; p < 0.001), and between EAM 0.25 mV and CMR IIR 0.97 (0.87 95% CI [0.76, 0.97]; p < 0.001) and IIR 1.2 (0.9, 95% CI [0.81, 0.99]; p < 0.001).

CONCLUSIONS: In an ablation-naïve AF population with a predominance of HFrEF patients, CMR- and EAM-derived measures of atrial fibrosis showed poor quantitative correlation across multiple threshold combinations. Although agreement improved when fibrosis was analyzed dichotomously (presence vs. absence of fibrosis), the highest agreement was observed at the most sensitive threshold combinations. The findings of our study highlight the need for standardized, validated, and reproducible CMR protocols for native atrial fibrosis assessment in order to provide a noninvasive alternative to EAM.

PMID:42418763 | DOI:10.1111/jce.70447

J Cardiovasc Electrophysiol. 2026 Jul 8. doi: 10.1111/jce.70450. Online ahead of print.

ABSTRACT

BACKGROUND: Intracardiac echocardiography (ICE)-guided left atrial appendage occlusion (LAAO) from left atrium under local anesthesia showed potential advantages over transesophageal echocardiography (TOE). This study sought to demonstrate the intraprocedural efficiency and safety of LAAO with ICE guidance in right atrium.

METHODS: In a multicenter randomized controlled trial to assess whether the imaging quality of a novel DynaSight ICE system (SONOSEMI, Shenzhen, China) is noninferior to the SoundStar (Biosense Webster, USA), a sub-group analysis was performed in patients who underwent LAAO under local anesthesia with ICE guidance in right atrium.

RESULTS: Thirty-three of 66 in the DynaSight group and 30 of 67 in the SoundStar group were performed LAAO with ICE guidance in right atrium. There were no statistical differences between two groups in baseline characteristics including demographics, cardiovascular comorbidities, CHA2DS2-VASc score, and HAS-BLED score. Both ICE systems had similar clear image qualities according to multi-plane assessments for home view, atrial septum and left atrium, and judgments for occluders including displaying location and resolution. There was comparable procedural successful rate for device implantation (100% in the DynaSight group vs. 96.67% in the SoundStar group, p = 0.4762) and occurrence of major peri-procedural complications including tamponade, device embolism, death, major bleeding, and ischemic stroke/transient ischemic attack/systemic embolism (0 of 33 in the DynaSight group vs. 3 of 30 in the SoundStar group, p = 0.1022).

CONCLUSIONS: The DynaSight ICE system has the same clear image quality as the SoundStar, which-guided LAAO with the catheter in right atrium is intraprocedural effective and safe for device implantation.

PMID:42418757 | DOI:10.1111/jce.70450

Neurology. 2026 Aug 11;107(3):e218268. doi: 10.1212/WNL.0000000000218268. Epub 2026 Jul 8.

ABSTRACT

BACKGROUND AND OBJECTIVES: Early-onset dementia (EOD), affecting individuals younger than 65 years, imposes a substantial socioeconomic burden. However, evidence on long-term income trajectories and productivity loss across EOD subtypes remains limited. The aim of this study was to evaluate income trajectories and societal productivity loss in individuals with different EOD subtypes.

METHODS: This retrospective, population-based longitudinal cohort study included all patients with EOD from Kuopio University Hospital and Oulu University Hospital referral area between January 2010 and December 2021. Diagnoses were re-validated through clinical data review. For each study case, 10 randomly selected matched controls were used. Demographics, education, and comorbidities were obtained from national registers. Annual gross income was retrieved from Statistics Finland tax records. The Human Capital Approach was used to calculate productivity losses, in effect by estimating the annual income difference relative to controls using a generalized estimating equation regression model, with panel data spanning 15 years before diagnosis and the year of diagnosis.

RESULTS: The EOD cohort comprised 793 patients (50.4% women; mean age 59.6 years): 421 with Alzheimer disease (AD), 179 with frontotemporal dementia (FTD) spectrum disorders, 46 with α-synucleinopathies (α-SYNUs), and 147 with other EOD etiologies. Compared with 7,926 age-matched and sex-matched controls, patients with EOD showed substantial and progressively increasing productivity loss up to 15 years before diagnosis, with cumulative losses of €74,577 (46,423-102,732) per patient. In the AD group, productivity loss emerged 6 years before diagnosis (€2,767; 95% CI 18-5,515; p = 0.024) and reached €11,431 at diagnosis (95% CI 8,676-14,184; p < 0.001). In the FTD group, loss appeared 11 years before diagnosis (€4,799; 95% CI 433-9,166; p = 0.031) and increased to €16,116 at diagnosis (95% CI 11,671-20,561; p < 0.001). In the α-SYNU group, differences were variable and significant only at diagnosis (€11,284; 95% CI 2,574-19,993; p < 0.011). In the “other EOD” group (predominantly vascular and mixed dementias), productivity loss remained consistently high across the follow-up (e.g., €8,744 at diagnosis; p < 0.001).

DISCUSSION: This large-scale longitudinal study demonstrates significant productivity loss up to 15 years before EOD diagnosis, with variation across dementia subtypes. Earlier recognition and targeted interventions are needed in the future to mitigate the substantial socioeconomic burden of EOD.

TRIAL REGISTRATION INFORMATION: This study is part of DEGE-RWD-research project (protocol registered to ClinicalTrials.gov: NCT06209515), coordinated by Neurocenter Finland.

PMID:42418748 | DOI:10.1212/WNL.0000000000218268