Tag: statistics

Jt Dis Relat Surg. 2026 Jul 16;37(3):626-636. doi: 10.52312/jdrs.2026.2619. Epub 2026 Jul 16.

ABSTRACT

OBJECTIVES: This study aims to compare the rates of medical complication and mortality following initial bipolar hemiarthroplasty (bHA) and reoperation procedures, as well as between different causes of reoperation (nonseptic vs. septic).

PATIENTS AND METHODS: The retrospective study included 118 patients undergoing reoperation after bHA for femoral neck fractures between January 2002 and December 2022. The primary outcomes included in-hospital complications, readmission, and mortality events, while secondary outcomes included length of hospital stay, transfusion rates, and estimated blood loss. These outcomes were compared between each patient’s initial bHA and their subsequent reoperation procedure. The two cohorts were matched using propensity scores based on age, sex, and Charlson Comorbidity Index to compare outcomes between nonseptic and septic causes of reoperation.

RESULTS: Of the 118 patients, 64 were male and 54 were female. The mean age was 77.8 ± 7.9 years, with a range of 61 to 98 years. The in-hospital complication rate was higher after reoperation than after initial bHA (15.3% vs. 1.7%, p < 0.001). Conversely, the readmission rate was higher after the initial procedure (60.2% vs. 23.7%, p < 0.001), mainly due to surgical complications. Patients undergoing reoperation had longer hospital stays, higher transfusion requirements, and more frequently received general anesthesia compared to the initial procedure (p < 0.05). In the matched cohort, septic group had higher in-hospital complication rates than the nonseptic group (23.5% vs. 3.9%, p = 0.004), while readmission and mortality rates were comparable.

CONCLUSION: Reoperations after bHA carry a higher risk of medical complications. This risk is particularly pronounced in cases related to septic conditions, underscoring the greater impact of reoperation and careful clinical attention.

PMID:42542907 | DOI:10.52312/jdrs.2026.2619

Jt Dis Relat Surg. 2026 Jul 23;37(3):581-891. doi: 10.52312/jdrs.2026.2733. Epub 2026 Jul 23.

ABSTRACT

OBJECTIVES: In this meta-analysis, we discuss the clinical efficacy of closed reduction with in situ fixation for valgus-impacted femoral neck fractures (VIFNFs) by contrasting postoperative functional recovery and complication profiles.

MATERIALS AND METHODS: We performed a systematic literature search in PubMed, Embase, Web of Science, the Cochrane Library, and ScienceDirect for publications up to October 2025. The search targeted original studies which directly compared the surgical outcomes of closed reduction and in situ internal fixation for valgus-impacted femoral neck fractures. Search terms included combinations of: valgus-impacted (or valgus impaction), femoral neck fracture, in situ, reduction, and internal fixation. Pooled data were analyzed using mean differences (MD) with 95% confidence intervals (CIs) for continuous outcomes and risk differences (RD) with 95% CIs for dichotomous outcomes.

RESULTS: The final analysis included a total of 447 patients extracted from five studies that met the predetermined inclusion criteria. The meta-analysis demonstrated that the closed reduction group exhibited a statistically significant reduction in postoperative femoral neck shortening (FNS) compared with the in situ fixation group (MD: 4.05; 95% CI: 2.68 ~ 5.42; p < 0.00001). For the caput-collum-diaphysis (CCD) angle, the closed reduction group showed a borderline significant improvement relative to the in situ fixation group (MD: 9.79; 95% CI: 0.19 ~ 19.39; p = 0.05). The in situ fixation group was associated with a substantially lower reoperation rate (RD: -0.08; 95% CI: -0.16 ~ -0.01; p = 0.04). No statistically significant intergroup differences were detected for the Harris Hip Score (HHS) (MD: -4.13; 95% CI: -9.37 ~ 1.11; p = 0.12), incidence of femoral head necrosis (RD: -0.05; 95% CI: -0.14 ~ 0.05; p = 0.36), or fixation failure rate (RD: -0.05; 95% CI: -0.17 ~ 0.06; p = 0.37).

CONCLUSION: Closed reduction yields a statistically significant advantage in reducing postoperative FNS and a borderline significant benefit in maintaining the CCD. In contrast, in situ fixation is associated with a lower reoperation rate. The two strategies show comparable outcomes for the HHS, femoral head necrosis incidence, and fixation failure rate. Thus, surgical approach should be individualized based on patient-specific profiles.

PMID:42542903 | DOI:10.52312/jdrs.2026.2733

Cureus. 2026 Jul 2;18(7):e111959. doi: 10.7759/cureus.111959. eCollection 2026 Jul.

ABSTRACT

Background MRI radiomics has recently gained attention for evaluating intratumoral heterogeneity in thoracic malignancies. Thymic epithelial tumors (TETs) include a wide spectrum from the low-risk thymoma group (LRG) to thymic carcinoma (TC), but imaging-based differentiation remains challenging. This study aimed to assess the utility of MRI texture analysis for differentiating TET subtypes according to the 2021 WHO classification. Methods Forty-seven patients with histologically proven TETs (19 LRG, 18 high-risk thymoma group (HRG), and 10 TC) underwent preoperative MRI including T1-, T2-, diffusion-weighted (DWI), and apparent diffusion coefficient (ADC) sequences. Texture analysis was performed using LIFEx software (version 7.6.0; French Alternative Energies and Atomic Energy Commission, Paris, France). A total of 41 texture features were extracted from manually delineated three-dimensional tumor volumes. Statistical comparisons were performed using Kruskal-Wallis and Mann-Whitney U tests with Benjamini-Hochberg false discovery rate correction. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Results Among the 47 lesions, 24, 28, and 37 texture parameters differed significantly between LRG-HRG, LRG-TC, and HRG-TC, respectively. The highest area under the curve (AUC) values were 0.785 for DWI coefficient of variation in differentiating LRG from HRG, 0.933 for T1WI morphological radius in differentiating LRG from TC, and 0.867 for ADC intensity variance in differentiating HRG from TC. Conclusions MRI-based texture analysis provides a promising noninvasive approach for differentiating thymic epithelial tumor subtypes according to the WHO classification. Sequence-specific texture parameters demonstrated moderate to high diagnostic performance, particularly for differentiating low-risk thymoma from thymic carcinoma. These findings suggest that MRI radiomics may contribute to preoperative risk stratification and treatment planning in patients with thymic epithelial tumors.

PMID:42542899 | PMC:PMC13428655 | DOI:10.7759/cureus.111959

Cureus. 2026 Jul 29;18(7):e113599. doi: 10.7759/cureus.113599. eCollection 2026 Jul.

ABSTRACT

Introduction In recent years, artificial intelligence (AI)-generated prostate whole-gland segmentation has shown promise for clinical use. This study compares AI- and human-derived prostate segmentation on magnetic resonance imaging (MRI) and evaluates its practical application. Methods A retrospective study from December 2020 to December 2022 evaluated 31 randomly selected patients who had previously undergone MRI-ultrasound (US)-guided fusion biopsies. AI-generated auto-contours of the whole-gland prostate, seminal vesicle, and urethra were produced using the ProtégéAI feature of the MIM Software from MRIs obtained on GE Signa HDxt 3.0T and Siemens Altea Magnetom 1.5T scanners. The same MRIs were independently contoured manually by a board-certified urologist (U) and a board-certified radiologist (R) using MIM Software contouring tools. Volumetric conformity among the three contour sets was assessed using the Dice similarity coefficient, Hausdorff distance (HD), and mean distance to agreement (MDA). Contouring time was recorded for each method, with AI timed from command execution to file generation and physicians timed from file opening to save. Pairwise Wilcoxon signed-rank tests (JMP Pro 15) compared contouring times and similarities across AI to urologist (AI-U), AI to radiologist (AI-R), and urologist to radiologist (U-R) contours. Results The average volumetric Dice similarity, HD, and MDA for the AI-U contours were 0.875±0.039, 9.186±4.004 mm, and 1.410±0.511 mm for the whole-gland prostate, 0.283±0.185, 18.117±13.265 mm, and 4.907±4.992 mm for the urethra, and 0.377±0.244, 14.708±9.489 mm, and 4.260±4.092 mm for the seminal vesicle. For the AI-R contours, the values were 0.757±0.072, 17.562±7.240 mm, and 3.050±1.339 mm for the prostate, 0.162±0.105, 19.956±11.962 mm, and 4.798±3.879 mm for the urethra, and 0.451±0.219, 16.069±9.245 mm, and 4.075±3.734 mm for the seminal vesicle. For the U-R contours, the values were 0.769±0.070, 15.109±6.177 mm, and 2.733±1.265 mm for the prostate, 0.144±0.091, 13.560±7.087 mm, and 3.406±1.985 mm for the urethra, and 0.471±0.216, 12.981±6.756 mm, and 3.264±2.308 mm for the seminal vesicle. Using the Wilcoxon signed-rank test with statistical significance defined as p<0.01, the AI-U Dice similarity for the prostate differed significantly from both the AI-R and U-R comparisons. Similarly, AI-U demonstrated significantly different HD values than both AI-R and U-R, whereas the AI-R and U-R HD comparison was statistically insignificant. All pairwise MDA comparisons for the prostate were statistically significant. For the urethra, the AI-U Dice similarity differed from the other two comparisons, while for HD, the AI-R and U-R comparisons differed significantly from each other. No significant differences were observed among the three comparisons for the seminal vesicle across any metric. The average times to produce contours for the AI, urologist, and radiologist were 96.5 seconds, 285.8 seconds, and 217.9 seconds, respectively (p<0.01 for each time comparison). Conclusion This study suggests that AI may be a useful tool for prostate segmentation workflows in streamlining MRI-US prostate cancer diagnostics by producing similar contouring results in less time. Additional investigation should be conducted regarding the differences between the pathological outcomes of AI and non-AI contours, and the accuracy, cost analysis, and efficiency of AI technology should be elucidated.

PMID:42542897 | PMC:PMC13428640 | DOI:10.7759/cureus.113599

Cureus. 2026 Aug 1;18(8):e113791. doi: 10.7759/cureus.113791. eCollection 2026 Aug.

ABSTRACT

Introduction The use of health services expanded during the pandemic and became a regular part of healthcare. There is not a lot of information about how these services are used over the long term and how patients engage with them. This study examined how patients used telemental health services at King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia, from 2019 to 2025. Objectives To evaluate how telemental health services were used and how patients engaged with them during the time before the pandemic, during the pandemic, and after the pandemic. The study also compared how many appointments were completed and the characteristics of patients who had virtual appointments versus in-person appointments. Methods This was a retrospective, repeated cross-sectional census study of electronic health record data on all scheduled mental health appointments, virtual and in-person, at KAMC from January 1, 2019, to December 31, 2025. All eligible encounters and unique patients across 12 facilities were included using total enumeration rather than sampling. Data were cleaned and analyzed in Python using Google Colab. Descriptive statistics were used to summarize appointment and patient characteristics. Chi-square tests were used to compare categorical variables, including appointment completion by encounter type, and the Mann-Whitney U test was used to compare patient age between virtual and in-person appointments. A binary logistic regression model was used to identify factors associated with appointment completion, including encounter type, pandemic period, and patient demographics. Results The study included 479,643 appointments with 51,323 patients at 12 facilities. Overall, 9% of the appointments were virtual. In 2019, there were no appointments, but their use increased during the pandemic and then stayed steady at around 11% to 12% per year after 2021. Overall, 55% of appointments were completed. Virtual appointments had a higher completion rate than in-person appointments, with 60% of virtual appointments being completed compared to 54% of in-person appointments. We also found that patients who had virtual appointments were substantially older and that virtual appointments were mostly used for follow-up visits rather than new patient appointments. Conclusion Telemental health services went from being an emergency solution during the pandemic to a part of mental health services at the facility. The study found that virtual appointments were associated with patient engagement, which means that patients were more likely to complete their appointments. These findings support the continued use of a hybrid of in-person and virtual mental health services. The findings provide information to support the planning and development of telemental health services. Telemental health services are a part of the healthcare system, and they can be an effective way to deliver the services.

PMID:42542890 | PMC:PMC13428641 | DOI:10.7759/cureus.113791

PeerJ. 2026 Jul 29;14:e21545. doi: 10.7717/peerj.21545. eCollection 2026.

ABSTRACT

BACKGROUND: Protein supplements have gained popularity among gym users in Saudi Arabia. This study aimed to collect data from adults in Saudi Arabia focusing on six components related to protein supplements: demographic characteristics of participants, health and physical activity information, knowledge and attitudes, use, health beliefs, and safety concerns.

METHOD: This study was a cross-sectional, observational online survey targeting adults in Saudi Arabia. Participants included males and females aged 18 and older. Participants who did not complete the survey, as well as pregnant or breastfeeding women, were excluded. Ethical approval was obtained from the Deanship of Scientific Research at Qassim University. Data were analyzed by gender using SPSS version 25, with descriptive statistics and chi-square tests. A total of 358 participants completed the online questionnaire, while two participants did not complete it between March 29, 2024 and December 31, 2024.

RESULT: Regarding knowledge and attitudes, about 68.2% of participants (including both users and non-users of protein supplements) were aware of protein supplements, with males (81.3%) showing significantly higher awareness than females (63.7%). Additionally, 64.8% of participants (both male and female) were unaware of the risks associated with protein supplements. Of all participants, 56% of males and 39.3% of females did not believe that natural protein sources are enough for muscle building, indicating a significant difference. About 127 participants (35.5%) reported using protein supplements either currently or in the past, with no significant difference between males and females. Of those who reported using protein supplements, 11.8% experienced some side effects and were significantly less knowledgeable about the amount of protein they should consume from food and how much protein is enough for their needs. The majority of protein supplement users (48.8%) did not know if protein powders could contain doping agents, with females reporting significantly higher responses than males. Regarding safety concerns, only 43.3% of protein supplement users looked for protein supplements marked with NSF Certified for Sport^® on the package, with no significant difference between males and females. Finally, 78% of protein supplement users expressed a need for more information on how to select the best protein supplements, with the highest need found in females and participants who exercise regularly, who showed significantly higher needs for additional guidance.

CONCLUSIONS: There remains a significant need for increased education about the proper use of protein supplements to minimize potential side effects and increase understanding of their health risks and safety concerns.

PMID:42542879 | PMC:PMC13428538 | DOI:10.7717/peerj.21545

Cureus. 2026 Jul 1;18(7):e111896. doi: 10.7759/cureus.111896. eCollection 2026 Jul.

ABSTRACT

BACKGROUND: Orthodontic treatment involves the placement of appliances such as brackets, bands, and wires that are foreign objects within the oral cavity. These appliances, combined with the long treatment duration, can pose various physical and psychological challenges for patients. Understanding these challenges and assessing patient knowledge and attitudes may facilitate targeted patient education and improve treatment compliance.

METHODS: A cross-sectional questionnaire-based survey was conducted among 150 patients (aged 15-30 years) undergoing active orthodontic treatment. A structured, pre-validated 20-item questionnaire assessed treatment-related challenges, knowledge, and attitudes toward orthodontic treatment. Data were analyzed using descriptive statistics. Prevalence estimates with 95% confidence intervals (95% CIs) were calculated for all variables.

RESULTS: Food lodgment (54.7%; 95% CI: 46.7%-62.6%) and pain (53.3%; 95% CI: 45.3%-61.3%) were the most frequently reported challenges. Posterior bracket breakage (73.3%) was more frequently reported than anterior bracket breakage (26.7%). The majority of patients demonstrated a positive attitude: 93.3% took extra care in brushing, 86.7% were aware of the need for retainers, and 95.3% would recommend orthodontic treatment to others. Overall treatment satisfaction was high, with 90.6% rating their experience as good or very good.

CONCLUSION: Food lodgment, pain, and oral ulcers were the most prevalent challenges during orthodontic treatment. Despite these difficulties, patients displayed good knowledge and a positive attitude toward their treatment, highlighting the effectiveness of patient education and counseling.

PMID:42542876 | PMC:PMC13428491 | DOI:10.7759/cureus.111896

Clin Interv Aging. 2026 Jul 28;21:607805. doi: 10.2147/CIA.S607805. eCollection 2026.

ABSTRACT

BACKGROUND: Older adults with atrial fibrillation (AF)-associated acute ischemic stroke are prone to disability, depressive symptoms, and falls; the prognostic value of vitamin D status is uncertain.

METHODS: We conducted a single-center prospective cohort study of patients aged ≥65 years with ECG-confirmed AF and imaging-confirmed acute ischemic stroke at a tertiary hospital in China (January 2022-August 2024). Serum 25-hydroxyvitamin D [25(OH)D] within 48 hours was modeled per 10 ng/mL decrement and as <20 vs ≥20 ng/mL. Outcomes were 3-month modified Rankin Scale (mRS) shift, Barthel Index (BI), and PHQ-9 ≥10, plus 12-month time to first fall (death as a competing event) and total falls rate. Models adjusted for prespecified baseline confounders.

RESULTS: Among 802 participants, median age was 76.2 years (IQR, 71.6-80.6); 60.7% had 25(OH)D <20 ng/mL. Three-month mRS/BI, 3-month PHQ-9, and falls follow-up data were available for 776 (96.8%), 762 (95.0%), and 742 (92.5%) participants, respectively. Each 10 ng/mL lower 25(OH)D was associated with worse 3-month mRS shift (common OR 1.17, 95% CI 1.05-1.31) and lower BI (β -3.9, 95% CI -6.2 to -1.6). Depressive symptoms occurred in 16.8% and were more common with 25(OH)D <20 ng/mL (OR 1.54, 95% CI 1.07-2.22). Among 742 with falls follow-up, low 25(OH)D predicted first fall (HR 1.29, 95% CI 1.07-1.55) and a higher recurrent falls rate (IRR 1.33, 95% CI 1.10-1.61).

CONCLUSION: Lower baseline 25(OH)D was consistently associated with poorer functional recovery, greater depressive symptom burden, and higher fall risk and recurrence, supporting 25(OH)D as a pragmatic prognostic marker; multicenter validation and targeted trials are warranted.

PMID:42542873 | PMC:PMC13428550 | DOI:10.2147/CIA.S607805

Environ Geochem Health. 2026 Aug 1;48(12):500. doi: 10.1007/s10653-026-03401-7.

ABSTRACT

This study evaluated the radioactivity levels and associated radiological health risks of groundwater surrounding a coal-based super thermal power plant in Jhajjar district, Haryana, India. A total of seventy groundwater samples were gathered from thirty-five locations within a 20 km radius, along with five background sites located beyond that distance and were analysed for ⁴⁰K, ²³⁸U, and ²³²Th using a Sodium Iodide, Thallium-activated (NaI (Tl)) scintillation detector. The activity concentrations in the 20 km area varied from 0.11 to 37.72 Bq/L for ⁴⁰K (with an average of 8.14 ± 0.37 Bq/L), 0.01 to 3.13 Bq/L for ²³⁸U (average 0.82 ± 0.07 Bq/L), and 0.01 to 3.52 Bq/L for ²³²Th (average 0.45 ± 0.04 Bq/L). These levels were notably higher than the regional background levels measured beyond 20 km. The Annual Effective Dose and the Excess Lifetime Cancer Risk derived from radiological parameters showed the variation from 0.047 to 0.489 mSv y⁻¹, and 1.64 × 10⁻⁴ to 17.12 × 10⁻⁴ respectively. Approximately 60% of the groundwater samples exceeded the WHO (2017) guideline value for uranium (²³⁸U; 0.5 Bq/L), while about 40% exceeded the World Health Organization (WHO, 2017) reference level for Total Annual Effective Dose from drinking water (0.1 mSv y⁻¹). Furthermore, five sampling locations (W14, W17, W 18, W19 and W21) exceeded the International Commission on Radiological Protection (ICRP, 2007) benchmark for Excess Lifetime Cancer Risk (1 × 10⁻³). The elevated radionuclide concentrations within the 20 km radius were likely influenced by fly ash dispersion from the thermal power plant, as inferred from spatial, statistical, and wind-direction patterns, in addition to natural contributions from the regional geology. These results set a quantitative radiological baseline for the study area and showed how important it is to regularly check the groundwater to make sure it meets international radiological safety standards.

PMID:42542540 | DOI:10.1007/s10653-026-03401-7

Eye (Lond). 2026 Aug 1. doi: 10.1038/s41433-026-04781-x. Online ahead of print.

ABSTRACT

BACKGROUND: To quantitatively assess the entrance angle variability and location of perforating scleral vessels (PSVs) in highly myopic eyes and to investigate its association with myopic choroidal neovascularisation (mCNV) versus lacquer cracks (LC).

METHODS: Entrance angles from the sclera to choroid were measured on each B-scan OCT using ImageJ and associated angle metrics were calculated per PSVs. Additional variables included subfoveal choroidal thickness (SFCT) and vessel-to-fovea distance (VFD). In mCNV eyes the total number of injections and treatment duration were also accounted.

RESULTS: A total of 42 eyes were included, 25 with mCNV and 17 with LC. Eyes with mCNV demonstrated significantly greater PSV angular variability including angular standard deviation, and their normalised metrics compared to LC eyes (all p < 0.001). VFD was shorter in the mCNV group (50.2 ± 52.6 µm vs. 91.5 ± 39.6 µm, p = 0.006). Normalised angle metrics correlated positively with the total number of anti-VEGF injections (r ≈ 0.37, p < 0.05), whereas no association was observed with treatment duration. In multivariable regression, no predictors reached statistical significance although normalised angle range (NAR) showed a trend toward a negative association with VFD (p = 0.060).

CONCLUSIONS: PSV angular variability was markedly greater in mCNV eyes and correlated with anti-VEGF injection burden reflecting higher treatment intensity but not longer disease duration. These findings suggest that PSV geometry influences LC and mCNV, may serve as an imaging biomarker of disease activity in mCNV. Shorter VFD and greater angular dispersion likely reflect structural and hemodynamic alterations predisposing to mCNV.

PMID:42542506 | DOI:10.1038/s41433-026-04781-x