Tag: statistics

Geospat Health. 2026 Feb 2;21(1). doi: 10.4081/gh.2026.1443. Epub 2026 Jun 18.

ABSTRACT

Dengue Haemorrhagic Fever (DHF) remains a public health burden in Indonesia with substantial provincial variation. We modelled province-level DHF counts in 2023 using Bayesian spatial conditional autoregressive Poisson models with population offsets. Predictors were average annual temperature (per 1°C) and the number of public health workers (province-level count). Spatial dependence was supported by Moran’s I=0.4689 (p=0.021). We fitted models using Besag-York-Mollié (BYM) and Leroux priors via Markov chain Monte Carlo and compared fit using the Deviance Information Criterion (DIC) and the Watanabe-Akaike Information Criterion (WAIC). In the BYM model, temperature was associated with lower risk (RR=0.90; 95% CrI: 0.76 to 1.07), with uncertainty including unity, whereas workforce density was associated with higher reported risk (RR=1.05; 95% CrI: 1.03 to 1.07). Estimates were similar under the Leroux prior (temperature RR=0.89; 95% CrI: 0.74 to 1.07; workforce RR=1.04; 95% CrI: 1.02 to 1.07), and BYM showed marginally better fit. Risk mapping indicated elevated burden in parts of Kalimantan and eastern Indonesia. Findings may inform geographically targeted surveillance and vector control; the workforce association should be interpreted cautiously because it may reflect reporting capacity or reactive deployment.

PMID:42312467 | DOI:10.4081/gh.2026.1443

J Prosthodont. 2026 Jun 18. doi: 10.1111/jopr.70180. Online ahead of print.

ABSTRACT

PURPOSE: To investigate, based exclusively on randomized controlled trials (RCTs), the current evidence on the influence of different prosthetic abutment designs on peri-implant clinical outcomes and esthetic parameters.

METHODS: This systematic review and meta-analysis of RCTs was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive and systematic search was conducted across multiple databases and gray literature, including MEDLINE/PubMed, Scopus, Web of Science, Embase, ReBEC, Trials, Virtual Health Library, and ProQuest, to identify RCTs comparing different abutment designs. Abutments were categorized into narrowed (concave, curved), straight (linear, convex, cylindrical), and widened (wide) profiles. The primary outcomes were marginal bone loss (MBL), probing depth (PD), and Pink Esthetic Score (PES), all assessed through meta-analyses. Secondary outcomes included abutment survival, biological and technical complications, as well as additional aesthetic parameters, including mid-facial mucosal zenith (MMZ), keratinized mucosa width (KMW), mucosal thickness (MT), mucosa position (MP), and soft tissue profile (SP). Risk of bias was assessed using the Cochrane RoB 2.0 tool, and the certainty of evidence was evaluated according to the GRADE approach.

RESULTS: The search resulted in 10,566 studies; after removal of duplicates, 5270 studies remained. Of those, 5252 were excluded based on title and abstract screening. Ultimately, 10 RCTs with follow-ups ranging from 3 to 60 months were included for quantitative and qualitative assessments. Of these, six provided data that could be pooled and were included in the quantitative analysis. Risk of bias varied among studies, with high risk observed in 2 RCTs, some concerns in 5 studies, and low risk in 3 studies, primarily related to outcome measurement and blinding, as assessed using the RoB 2.0 tool. Overall certainty of evidence was rated moderate. The meta-analyses showed no statistically significant difference in MBL, PD or PES between narrowed and straight profiles (MBL: SMD = 0.08, p = 0.66); PD: SMD = -0.05, p = 0.80; PES: SMD = -0.12, p = 0.51). Additionally, no differences were found in biological or esthetic outcomes between abutment types, with stable peri-implant parameters and high patient satisfaction. Technical complications were rare, involving early failures and occasional fractures, especially in concave abutments.

CONCLUSION: Based on the current evidence and within the limitations of the included studies, abutment shape does not appear to significantly influence peri-implant tissue response or esthetic outcomes. Further well-designed RCTs with standardized protocols, adequate sample sizes, and longer follow-up are required to increase the certainty of the evidence and improve the external validity of the findings.

PMID:42312454 | DOI:10.1111/jopr.70180

Eur J Paediatr Dent. 2026 Jun 1;27(2):154-163. doi: 10.23804/ejpd.2026.2783.

ABSTRACT

AIM: To identify and analyse the 100 most-cited articles published in paediatric dentistry journals, providing an updated bibliometric overview of the field and comparing findings with previous analysis.

METHODS: The Web of Science database was searched up to January 2026 to identify the most-cited papers published in paediatric dentistry journals. The top 100 articles were selected and analysed for citation count, publication year, source journal, geographic distribution, authorship, study design, and thematic area. Co-occurrence network analysis was performed using VOSviewer.

CONCLUSION: Compared with the 2019 analysis, citation thresholds have risen substantially, systematic reviews have replaced cross-sectional studies as the dominant design, MIH has emerged as a leading research theme, and geographic disparities in citation accumulation persist and warrant attention.

PMID:42312443 | DOI:10.23804/ejpd.2026.2783

Libyan J Med. 2026 Dec 31;21(1):2690691. doi: 10.1080/19932820.2026.2690691. Epub 2026 Jun 18.

ABSTRACT

AIMS: This study examined the association of health literacy with quality-of-life outcomes among Jordanian adults with chronic diseases using two patient-reported outcome measures, the Long-Term Conditions Questionnaire (LTCQ) and the EuroQol five-dimension, three-level questionnaire (EQ-5D-3L). It also compared conventional regression and machine-learning (ML) approaches for modelling these relationships.

MATERIALS AND METHODS: In this cross-sectional online study, Arabic-language questionnaires were completed by Jordanian adults aged 18 years or older with at least one chronic physical, mental, or neurological condition. The survey, designed to take 10-12 minutes, included the LTCQ, EQ-5D-3L, Medication Adherence Report Scale (MARS-5), and 12-item Health Literacy Scale (HLS-Q12). A total of 901 complete responses were analyzed. Data were split into training (n = 633) and test (n = 268) sets. Multiple linear regression was used for LTCQ, Tobit regression for EQ-5D-3L index scores, and ML models were trained to explore nonlinear associations.

RESULTS: Health literacy and medication adherence were positively associated with both LTCQ (beta = 3.923 and 2.219, respectively; both p < 0.001) and EQ-5D-3L index scores (beta = 0.025, p = 0.001; beta = 0.020, p = 0.009). Number of medications was inversely associated with both outcomes. In 10-fold cross-validation, Extreme Gradient Boosting (XGBoost) showed the lowest average root mean square error (RMSE) for LTCQ (9.18; coefficient of determination [R²] = 0.384) and EQ-5D-3L (0.172; R² = 0.193), although differences between the leading models were modest.

CONCLUSION: LTCQ and EQ-5D-3L showed overlapping but distinct association patterns. LTCQ was more strongly linked with psychosocial and self-management variables, whereas EQ-5D-3L was more closely aligned with medication burden and clinical comorbidity. These findings should be interpreted as associative rather than causal and as differences in captured dimensions rather than evidence of instrument superiority.

PMID:42312418 | DOI:10.1080/19932820.2026.2690691

Hong Kong Med J. 2026 Jun 18. doi: 10.12809/hkmj2513308. Online ahead of print.

ABSTRACT

INTRODUCTION: We conducted a study to linguistically translate and psychometrically validate a translated and culturally adapted Chinese version of the European 3-item benign prostatic hyperplasia (BPH) screening tool (TOOL), then assess its diagnostic accuracy for identifying BPH with a prostate volume above 40 mL.

METHODS: The study was conducted in two phases. The first phase involved a rigorous translation process performed by skilled multilingual translators using forward and backward translation techniques. The second phase focused on psychometric validation and was conducted in urology units across our hospital network.

RESULTS: Sixty-six male patients of Chinese ethnicity, aged 18 to 90 years, who presented with lower urinary tract symptoms for at least 4 weeks were recruited. The study evaluated the TOOL’s reliability, internal consistency, and validity, including convergent, concurrent, and criterion validity. Statistical analyses demonstrated strong internal consistency (Cronbach’s alpha=0.890) and substantial test-retest reliability (intra-class correlation coefficient=0.715). The screening tool demonstrated moderate to strong correlations with both the International Prostate Symptom Score and prostate volume, supporting its validity. Furthermore, responsiveness analysis showed significant reductions in TOOL scores after surgery. The combination of the screening tool (cut-off: ≥3) and prostate-specific antigen level (cut-off: >2.35 μg/L) exhibited high sensitivity and specificity for detecting prostate volume above 40 mL (sensitivity: 92%, specificity: 73%; area under the receiver operating characteristic curve=0.842).

CONCLUSION: These findings support the reliability and validity of the TOOL as a culturally adapted instrument for evaluating lower urinary tract symptoms in Chinese-speaking populations. Its use may improve the management of BPH.

PMID:42312411 | DOI:10.12809/hkmj2513308

Haematologica. 2026 Jun 18. doi: 10.3324/haematol.2026.300790. Online ahead of print.

ABSTRACT

Adults with primary central nervous system lymphoma (PCNSL) who are ineligible for consolidative whole-brain radiotherapy (WBRT) or autologous stem-cell transplantation (ASCT) due to advanced age, comorbidities, or impaired performance status have limited treatment options. Lenalidomide is active in relapsed PCNSL, but prospective data on its use as maintenance are limited. We conducted a multicenter phase II trial of lenalidomide maintenance in adults with PCNSL who achieved at least a partial response after 2-6 cycles of methotrexate- and rituximab-based chemoimmunotherapy and were not candidates for WBRT or ASCT. Lenalidomide 15 mg was given orally on days 1-21 of 28-day cycles for up to 12 cycles or until progression or toxicity. The primary endpoint was 2-year progression-free survival (PFS) from maintenance initiation. Thirty-one patients were enrolled (median age 72 years); 30 received lenalidomide with a median of 11 cycles, and 50% completed all 12. At a median follow-up of 20.7 months, the 2-year PFS was 58.8% (95% CI, 43.4-79.8%), exceeding the pre-specified alternative threshold of 55%, although the formal one-sample log-rank test did not reach statistical significance (p = 0.084). The 2-year overall survival was 83.9%. Grade 3-4 neutropenia occurred in 53.3%, whereas most non-hematologic adverse events were grade 1-2. Treatment was discontinued for toxicity in 13%; one grade 5 pneumonia occurred, and no thromboembolic events were observed. These findings suggest that lenalidomide maintenance is feasible and potentially beneficial in consolidation-ineligible PCNSL patients, though the hypothesis-generating nature of this single-arm study warrants confirmation in randomized comparative trials.

PMID:42312406 | DOI:10.3324/haematol.2026.300790

Haematologica. 2026 Jun 18. doi: 10.3324/haematol.2025.300090. Online ahead of print.

ABSTRACT

This study aimed to evaluate the prognostic significance of FDG-PET/CT-derived biomarkers, including volumetric and dissemination metrics, in newly diagnosed multiple myeloma (NDMM). A total of 146 NDMM patients who underwent baseline FDG-PET/CT before any treatment between 2014 and 2022 at two institutions were retrospectively analyzed. Metabolic tumor burden was quantified using total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG), while spatial dissemination was assessed by the maximal interlesional distance (Dmax), defined as the greatest threedimensional Euclidean distance between lesion centroids. Lesions were segmented semi-automatically using LIFEx software with a 41% SUVmax threshold and a minimum SUV of 2.5. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method, and optimal cutoffs were determined using maximally selected rank statistics. Among PET-derived parameters, TMTV and Dmax were significantly associated with PFS and OS and retained independent prognostic value after adjustment for clinical and biological prognostic factors. In multivariate analysis performed in separate models due to collinearity, TMTV > 18.6 cm³ (PFS: HR = 2.17, p = 0.003; OS: HR = 2.23, p = 0.04) and Dmax > 23.2 cm (PFS: HR = 1.89, p = 0.01; OS: HR = 2.69, p = 0.01) remained independent prognostic factors. Dmax represents an independent PET-derived biomarker reflecting spatial disease dissemination in NDMM. The combined evaluation of dissemination and volumetric parameters may improve baseline risk stratification, providing a more comprehensive assessment of disease biology and potentially guiding therapeutic decisions in multiple myeloma.

PMID:42312402 | DOI:10.3324/haematol.2025.300090

Circ Cardiovasc Interv. 2026 Jun 18:e016573. doi: 10.1161/CIRCINTERVENTIONS.126.016573. Online ahead of print.

ABSTRACT

BACKGROUND: Recent observational studies have suggested that early treatment (<12 hours from diagnosis) of intermediate risk pulmonary embolism (PE) with catheter-based therapies may reduce morbidity and mortality. However, the effect of early versus late mechanical thrombectomy on acute pulmonary hemodynamics and right ventricular mechanics is less well defined.

METHODS: Patients enrolled in SYMPHONY-PE were divided into one of 2 groups based on the time from baseline CT pulmonary angiography to mechanical thrombectomy: Early <12 hours versus late ≥12 hours. The primary safety end point was the rate of major adverse events within 48 hours, as adjudicated by an academic independent safety board. The primary efficacy end point was the core-lab assessed mean change in right ventricle-to-left ventricle ratio from baseline to 48 hours.

RESULTS: Early thrombectomy was performed in 44% (48/109) of patients and was associated with a larger reduction, approaching statistical significance, in right ventricle-to-left ventricle ratio (0.52±0.50 versus 0.37±0.34; P=0.071). Mean pulmonary artery pressure decreased significantly more in patients receiving early thrombectomy (8.6±5.2 versus 5.8±5.0 mm Hg; P=0.006). The major adverse events rate was similar (P=0.431) between groups, and there were no mortalities. The differences in efficacy outcomes were greatest in higher-risk patients per the Composite Pulmonary Embolism Shock score.

CONCLUSIONS: Early mechanical thrombectomy was associated with larger reductions in right ventricle-to-left ventricle ratio and mean pulmonary artery pressure, with no significant differences in safety event rates compared with patients who underwent late thrombectomy. Randomized trials are needed to test these associations.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06062329.

PMID:42312382 | DOI:10.1161/CIRCINTERVENTIONS.126.016573

Ren Fail. 2026 Dec;48(1):2685354. doi: 10.1080/0886022X.2026.2685354. Epub 2026 Jun 18.

ABSTRACT

The atherogenic index of plasma (AIP) is a lipid-based marker of cardiovascular risk, yet its prognostic value for severe acute kidney injury (AKI) in critically ill patients with cardiovascular disease (CVD) remains uncertain. This retrospective study analyzed 5,872 patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, with external validation in the eICU Collaborative Research Database (eICU-CRD). The primary outcome was stage 3 AKI, and secondary outcomes included renal replacement therapy (RRT) and length of stay. Stage 3 AKI was observed in 20.7% of patients, with the incidence increasing across AIP quartiles (Q1-Q4: 15.9-26.8%), and 5.3% of patients requiring RRT (Q1-Q4: 2.6-10.9%). High AIP was associated with stage 3 AKI (adjusted OR = 1.35; 95% CI: 1.11-1.64), RRT (OR = 1.95; 95% CI: 1.33-2.87), longer hospital LOS (β = 3.58; p < 0.001) and ICU LOS (β = 1.14; p < 0.001). Restricted cubic splines revealed linear associations between AIP and both renal outcomes (stage 3 AKI and RRT). Mediation analysis indicated that stage 3 AKI mediated 12.6% of the association between the AIP and in-hospital mortality. The predictive models achieved AUCs of 0.916 for RRT and 0.727 for stage 3 AKI. These associations with renal outcomes were robust, as confirmed by entropy balancing and external validation in the eICU-CRD. Elevated AIP is a robust, externally validated predictor of stage 3 AKI and RRT, with substantial predictive accuracy for RRT. Furthermore, it appears to influence in-hospital mortality partially through renal injury, warranting confirmation in future prospective studies.

PMID:42312375 | DOI:10.1080/0886022X.2026.2685354

J Alzheimers Dis. 2026 Jun 18:13872877261457126. doi: 10.1177/13872877261457126. Online ahead of print.

ABSTRACT

BackgroundIn cerebral small vessel disease (CSVD), the burden of white matter hyperintensities (WMH) does not fully account for cognitive impairment, suggesting the involvement of intermediary mechanisms.ObjectiveWe investigated whether a gray matter atrophy network acts as the key mediator linking topologically specific (deep) WMH to multidomain cognitive dysfunction.MethodsIn this retrospective study, 260 patients with CSVD (62 cognitively normal, 125 with mild impairment, 73 with dementia) were included. Cognitive status was assessed neuropsychologically. 3.0 T MRI identified an atrophy network. We then conducted pre-specified mediation analyses and a primary confirmatory analysis using structural equation modeling (SEM) to test whether this atrophy network mediated the effect of deep WMH on cognitive performance.ResultsA 41-region atrophy network was identified, primarily involving the medial temporal lobe and thalamus, that was significantly associated with cognitive status. The final SEM demonstrated excellent fit, showing that higher deep WMH burden was associated with greater network atrophy (β = 0.145, p < 0.05), which in turn was strongly associated with poorer executive function (β = -0.64, p < 0.001) and memory (β = -0.572, p < 0.001). The direct effect of WMH on cognition was not statistically significant in the model.ConclusionsOur findings suggest that in CSVD, a unified network of gray matter atrophy acts as a powerful statistical mediator in the effect of deep white matter injury on cognitive decline. This atrophy pattern may represent a more direct biomarker of the neurodegenerative process underlying cognitive impairment than WMH burden alone.

PMID:42312368 | DOI:10.1177/13872877261457126