Tag: statistics

BMC Cardiovasc Disord. 2026 May 16. doi: 10.1186/s12872-026-05931-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have become an important therapeutic option for patients with dyslipidemia. Evolocumab and alirocumab are monoclonal antibodies targeting circulating PCSK9, whereas inclisiran is a small interfering RNA (siRNA) agent that suppresses hepatic PCSK9 synthesis and requires only twice-yearly dosing. Although these agents are proven effective in clinical trials, direct real-world comparative evidence on lipid-lowering efficacy, apolipoprotein B (apoB) reduction, safety, and adherence remains limited.

METHODS: This was a real-world, retrospective study conducted at a single center. A total of 198 patients were consecutively enrolled and assigned to three groups (n = 66 per group): inclisiran, evolocumab, or alirocumab. Baseline characteristics, including age, sex, and familial hypercholesterolemia (FH) status (assessed by DLCN criteria), were well-balanced across cohorts. All lipid parameters were analyzed using standardized automated biochemical analyzers at a centralized laboratory to ensure measurement consistency.

RESULTS: At 180 days, all three agents achieved robust and significant reductions in LDL-C from baseline (p < 0.001), with no significant differences observed between the groups. Notably, inclisiran demonstrated a numerical advantage in the reduction of apolipoprotein B (apoB) compared with evolocumab and alirocumab at 180 days (0.650 g/Lvs.0.774 g/L and 0.752 g/L, respectively), although these between-group differences did not reach formal statistical significance (p > 0.05). Treatment persistence was highest in the inclisiran group (69.7%), followed by evolocumab (56.1%) and alirocumab (50.0%). All therapies were well-tolerated with no new safety signals.

CONCLUSIONS: In this real-world study, Inclisiran, evolocumab, and alirocumab are all highly effective in lowering LDL-C in a real-world setting. Inclisiran may offer additional clinical value through superior treatment persistence and a favorable numerical trend toward enhanced apoB suppression.

PMID:42141407 | DOI:10.1186/s12872-026-05931-5

BMC Cardiovasc Disord. 2026 May 15. doi: 10.1186/s12872-026-05968-6. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular diseases (CVD) continue to be the leading cause of global mortality. Despite the alarming statistics, effective prevention of CVD remains a significant challenge in practice. The available risk stratification tools have critical limitations in the early detection of CVD. To address these gaps, it is crucial to integrate additional risk detection methods for more accurate identification of at-risk patients.

OBJECTIVES: This article addresses the limitations of conventional CVD risk factors and emphasizes the need for individualized risk evaluation. Additionally, it evaluates the role of imaging techniques in the early detection of CVD and the personalized use of aspirin therapy when subclinical atherosclerosis becomes advanced.

METHODS: This article is based on an expert literature review and reflects the outcomes of a medical advisory board meeting that was held in the Middle East (ME) region. A multidisciplinary group of experts discussed the “cardiac risk continuum” concept and the importance of advanced subclinical atherosclerosis detection beyond traditional binary CVD classification. Experts evaluated the clinical feasibility of utilizing carotid ultrasound and coronary artery calcium (CAC) scoring, and assessed the role of aspirin in primary prevention for at-risk patients.

RESULTS: The need for tailored risk assessment strategies and individualized preventive measures was highlighted. The experts agreed on the practical use of CAC scoring and/or carotid ultrasound to identify at-risk patients and quantify subclinical atherosclerosis. Data suggest that aspirin estimated benefit increases proportionally with atherosclerosis burden and becomes a net-positive at CAC > 100 or carotid plaque score above 2.

CONCLUSIONS: The experts emphasized the importance of individualized screening strategies tailored to the Middle Eastern population, considering the challenges and resource limitations in the region. They recommended selective use of CAC and carotid ultrasound to improve risk stratification and to guide a more personalized approach to managing CVD. The experts stressed the need for standardized protocols, healthcare providers’ education, and infrastructure development to ensure the effective implementation of these approaches.

PMID:42141396 | DOI:10.1186/s12872-026-05968-6

BMC Geriatr. 2026 May 15. doi: 10.1186/s12877-026-07616-2. Online ahead of print.

ABSTRACT

BACKGROUND: Caregivers of individuals with vascular dementia (VaD) face various physical and psychological burdens in their daily caregiving responsibilities. This role is challenging, demanding, and often stressful due to the symptoms characteristic of this condition. The aim of this study was to assess the level of burden experienced by caregivers of individuals diagnosed with vascular dementia.

METHODS: The study included a total of 351 participants. The research was conducted anonymously and voluntarily among informal caregivers of individuals with dementia. A survey questionnaire and the Caregiver Burden Scale (CB Scale) were employed. Statistical analysis was conducted using the χ² independence test, t-test for independent samples, Mann-Whitney test, Kruskal-Wallis test, Spearman’s rank correlation coefficient, Wilcoxon signed-rank test, and Kolmogorov-Smirnov test.

RESULTS: High caregiving burden was most commonly observed in the domains of General Burden (63.2%), Disappointment (59.8%), and Social Isolation (58.1%). A significantly lower percentage of caregivers reported high burden levels in the domains of Environmental Factors (36.8%) and Emotional Engagement (34.2%).

CONCLUSIONS: Our study demonstrates that caregivers of individuals with VaD experience particularly high levels of overall burden, social isolation, and a sense of disappointment. The findings highlight the need for early interventions focused on psychosocial support, as well as preventive programs aimed at reducing caregiver strain. In the broader perspective, these results may serve as a starting point for developing comprehensive models of home care and public health targeted at caregivers of individuals with VaD.

PMID:42141395 | DOI:10.1186/s12877-026-07616-2

BMC Infect Dis. 2026 May 15. doi: 10.1186/s12879-026-13582-2. Online ahead of print.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), first identified in Wuhan, China, in December 2019, rapidly evolved into a global pandemic with substantial morbidity and mortality. Severe COVID-19 cases, particularly those with pneumonia requiring intensive care unit (ICU) admission, posed significant challenges for healthcare systems. This study aimed to evaluate and compare healthcare-associated infections (HAIs) developing in the ICU during the pre-pandemic and pandemic periods.

METHODS: This retrospective observational study was conducted at Sakarya Yenikent State Hospital, a secondary-care hospital with 50 ICU beds. Active surveillance data collected by the infection control team were analyzed for two periods: pre-pandemic (May 2018-February 2020) and pandemic (March 2020-December 2021). The number of ICU patients, patient-days, HAI rates, causative microorganisms, antimicrobial resistance patterns, and mortality rates were compared between periods. Statistical analyses were performed using Epi Info™ version 7.2.5.0, with p < 0.05 considered statistically significant.

RESULTS: A total of 1,840 patients (16,572 patient-days) in the pre-pandemic period and 2,119 patients (12,460 patient-days) in the pandemic period were followed. Mortality significantly increased during the pandemic period compared to the pre-pandemic period (40.96% vs. 24.94%, p = 0.00001). Although the overall HAI rate did not differ significantly between periods (3.26% vs. 2.73%, p = 0.333), Although the overall HAI rate did not differ significantly between periods (3.26% vs. 2.73%, p = 0.333), HAI density was higher during the pandemic. Notably, Acinetobacter baumannii-related HAIs increased significantly during the pandemic period (58.89% vs. 35.00%, p = 0.016), while distributions of other pathogens remained similar. Antimicrobial resistance patterns were more pronounced during the pandemic period.

CONCLUSION: Despite similar HAIs rates, in-hospital mortality increased during the pandemic. This was accompanied by higher disease severity, reflected by increased cardiopulmonary resuscitation rates, and a shift toward Acinetobacter baumannii infections. Although mortality was high among COVID-19-positive patients, COVID-19 status was not an independent predictor. Overall, worse outcomes during the pandemic were associated with increased disease severity and pathogen distribution rather than changes in HAI incidence.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42141392 | DOI:10.1186/s12879-026-13582-2

BMC Med Imaging. 2026 May 15. doi: 10.1186/s12880-026-02413-0. Online ahead of print.

ABSTRACT

OBJECTIVE: The cartilaginous endplate (CEP) exhibits an intrinsically short [Formula: see text] model based on ultrashort echo time (UTE) sequence, and to explore the diagnostic utility of bi-exponential [Formula: see text]-derived parameters and monoexponential UTE-[Formula: see text] mapping values in grading CEP damage. METHODS: This study retrospectively collected 46 patients who underwent lumber UTE MRI, of whom 43 met the inclusion criteria. CEP was graded into three groups according to morphological features on multiple MRI sequences: healthy (structurally intact), mild damage (localized thinning or concavity with preserved continuity), and moderately damage (defects < 50% with disrupted continuity). Multiple quantities were evaluated using the UTE sequence on the CEP manually drawn by an experienced radiologist. One-way Kruskal-Wallis test was used to inspect the distribution differences among groups. Logistic regression and support vector machine models were applied to predict the level of degeneration with a considerably good precision, and receiver operating characteristic curves suggests a distinguishable performance among those models.

RESULTS: [Formula: see text] values showed significant differences among the groups (p < 0.05), with Tukey’s test indicating the most significant difference between the moderately damaged group and the healthy controls. [Formula: see text] values were non-normally distributed but statistically different between the moderate and mild damage groups (p < 0.05), a trend also observed in monoexponential UTE-[Formula: see text] mapping values (p < 0.05). The logistic regression and SVM models performed well in identifying moderate damage (AUC of 0.878 and 0.858, respectively), but had limited ability to detect mild damage (AUC of 0.718 and 0.729). CONCLUSION: The UTE bi-exponential [Formula: see text] model enable effective separation and quantification of distinct water components within the CEP. Both [Formula: see text] and UTE-[Formula: see text] mapping show promise as imaging biomarkers for grading CEP degeneration even in the early stage of CEP degeneration.

PMID:42141391 | DOI:10.1186/s12880-026-02413-0

BMC Musculoskelet Disord. 2026 May 16. doi: 10.1186/s12891-026-09965-w. Online ahead of print.

ABSTRACT

BACKGROUND: Charcot neuroarthropathy (CN) is a debilitating joint disorder that predominantly affects patients with neuropathy, particularly those with diabetic peripheral neuropathy (DPN). CN causes painless, rapid joint destruction and often leads to foot deformity, ulceration, osteomyelitis, and, in severe cases, amputation. Its pathogenesis involves repetitive microtrauma due to loss of protective sensation, triggering an inflammatory cascade that activates osteoclasts (OCs) disproportionately relative to osteoblasts (OBs) via the RANKL-RANK-OPG pathway, resulting in progressive bone loss and joint destruction. This systematic review and meta-analysis evaluated the efficacy of anti-resorptive agents in promoting bone remodeling and alleviating clinical symptoms in patients with active or stable CN.

METHODS: Following Cochrane Collaboration guidelines, we searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing anti-resorptive agents, such as bisphosphonates, denosumab, calcitonin, and parathyroid hormone analogues, with placebo or no treatment in patients with Charcot neuroarthropathy. Two independent reviewers performed data extraction and risk-of-bias assessment using the Cochrane RoB 2 tool. Primary outcomes were bone mineral density (BMD), bone turnover markers (BTMs), time to remission, change in foot temperature, and adverse events. Statistical analyses were conducted using Stata 18, with random-effects models used to pool results.

RESULTS: We identified 936 records and nine reports describing seven RCTs met the inclusion criteria. The meta-analysis showed no significant difference in BMD between anti-resorptive agents and control groups. However, anti-resorptive therapy significantly reduced bone resorption markers. Clinical outcomes, including foot temperature change and time to remission, did not differ significantly between groups. Adverse events were similar between the intervention and control groups.

CONCLUSIONS: Although anti-resorptive agents reduce bone resorption markers in patients with Charcot neuroarthropathy, current evidence does not support their efficacy in improving BMD or providing clinically meaningful symptom relief beyond standard offloading. High-quality clinical trials and mechanistic studies are needed to define the role of these agents in CN management.

PMID:42141385 | DOI:10.1186/s12891-026-09965-w

J Racial Ethn Health Disparities. 2026 May 15. doi: 10.1007/s40615-026-03005-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Social Determinants of Health (SDoH) profoundly influence cancer outcomes, yet their distribution among racially diverse gastrointestinal (GI) cancer patients remains understudied. This study examines racial differences in SDoH between non-Hispanic White (NHW) and Non-White (including Asian, African American, and Hispanic) patients with gastrointestinal (GI) cancers using data from the All of Us Research Program.

METHODS: A total of 6,620 participants with GI cancer were identified using ICD-10 and SNOMED codes, of whom 1,831 completed the SDoH survey and were included in the analysis. Descriptive statistics summarized SDoH constructs such as social cohesion, support, and neighborhood disorder. Variables were categorized using validated scoring tools or grouped into tertiles. Group comparisons used chi-square, t-tests, or Wilcoxon rank-sum tests.

RESULTS: Among the 1,831 participants included in the overall cohort, 80.7% (n = 1,478) identified as non-Hispanic White and 13.9% (n = 255) as Non-White, including Black or African American (6.2%), Hispanic or Latino (6.4%), and Asian (1.4%). NHW participants were older (71.0 vs. 64.2 years) and reported greater social cohesion (3.9 vs. 3.6, p < 0.001) and support (3.9 vs. 3.7, p < 0.001). Non-White patients reported higher perceived discrimination (1.7 vs. 1.5, p = 0.016), daily spiritual experience (4.5 vs. 3.7, p < 0.001), neighborhood disorder (2.2 vs. 2.1, p < 0.001), food insecurity (23.6% vs. 5.8%, p < 0.001), and housing issues (41.8% vs. 21.8%, p < 0.001). Delayed care (47.1% vs. 26.8%, p < 0.001) and unaffordability of care (9.9% vs. 3.4%, p < 0.001) were also more common.

CONCLUSION: Significant racial disparities in SDoH were observed among GI cancer patients. Non-White individuals faced greater economic hardship, environmental disadvantage, and barriers to healthcare access.

KEY MESSAGES: WHAT IS KNOWN ON THIS TOPIC: Racial disparities in gastrointestinal cancer outcomes persist, but the social and structural factors underlying these differences are not routinely captured in oncology research. Many cancer datasets emphasize clinical characteristics while underrepresenting patient-reported social, economic, and neighborhood conditions. Addressing social determinants of health is increasingly recognized as necessary to advance equity in cancer care delivery.

WHAT THIS STUDY ADDS: This study provides a comprehensive, patient-reported assessment of social determinants of health among GI cancer patients in the All of Us Research Program. Non-White patients experience a higher burden of economic instability, neighborhood disadvantage, perceived stress,and barriers to accessing healthcare services. These findings identify concrete social risk domains that can inform equity-focused screening, care navigation, and policy interventions within oncology practice.

PMID:42141357 | DOI:10.1007/s40615-026-03005-y

Environ Int. 2026 May 9;212:110286. doi: 10.1016/j.envint.2026.110286. Online ahead of print.

ABSTRACT

BACKGROUND: Climate change threatens global health, particularly among vulnerable populations such as pregnant individuals and their newborns. Evidence linking heat to premature birth is largely based on single-location studies or heterogeneous meta-analyses, leaving important gaps regarding underrepresented regions, preterm subgroups, and the role of maternal and infant characteristics.

OBJECTIVES: To quantify the association between heat and preterm birth (PTB) across multiple countries, assess gestational-age-specific effects, and identify maternal vulnerability factors.

METHODS: We analysed 36.6 million births occurring during the warm season from 250 locations in 13 countries to assess heat effects on PTB. Distributed lag non-linear models (DLNM) with quasi-Poisson regression estimated heat-PTB associations and the fraction of PTB attributable to heat. Gestational-age subcategories (extreme, very, late, and at-term) and socio-economic vulnerability profiles were also examined.

RESULTS: Overall, 1.4% (95% CI: 1.3-1.5) of PTB were attributable to heat (855 PTB per million births), with national burdens from 628 to 1,347 PTB per million. Higher susceptibility was suggested for younger, single, non-primiparous, less-educated, and socio-economically deprived mothers, and among female fetuses. Late PTB showed the largest risk; at-term births also displayed a small but consistent heat-related increase.

CONCLUSIONS: This large analysis of heat-related PTB using harmonized individual-level data indicates that heat increases PTB risk, with variations across countries and climates. It also shows that heat can trigger labour beyond the typical PTB window, affecting pregnancies not usually considered clinically vulnerable. Overall, these findings underscore the need for strategies to mitigate heat-related risks during pregnancy, particularly among socio-economically vulnerable populations.

PMID:42139755 | DOI:10.1016/j.envint.2026.110286

J Neurosurg Pediatr. 2026 May 15:1-9. doi: 10.3171/2025.12.PEDS25317. Online ahead of print.

ABSTRACT

OBJECTIVE: Fetal myelomeningocele repair (FMMR) has shown significant promise in decreasing the incidence of myelomeningocele (MMC)-associated hydrocephalus. In this study, the authors report on the reversal of hindbrain herniation via FMMR. They also describe biometric changes in third ventricle anatomy, which influences the outcome of endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC).

METHODS: At the Arnold Palmer Hospital for Children and Winnie Palmer Hospital for Women & Babies, the maternal and fetal inclusion and exclusion criteria developed by the Management of Myelomeningocele Study (MOMS) were applied to determine eligibility for prenatal MMC repair. Patient charts, prenatal fetal MRI, ultrasonography studies, and postnatal brain MRI for the first 50 FMMRs performed between 2019 and 2024 were retrospectively reviewed for this study. Ventricle size was measured prior to fetal surgery, as was the clivus-supraocciput angle (CSO) on fetal and postnatal images. Neonates were stratified into hydrocephalic and nonhydrocephalic groups for comparative analysis. The hydrocephalic group included patients who had undergone ETV/CPC or insertion of a ventriculoperitoneal shunt (VPS).

RESULTS: A total of 50 women underwent FMMR. One woman did not consent to inclusion in the study, 8 patients remained in utero at the time of analysis, and 3 patients died. Of the 38 patients included in the analysis, 21 (55%) underwent treatment for their symptomatic hydrocephalus; 4 received a VPS, and 17 underwent ETV/CPC. Four ETV/CPC cases did not respond to the treatment and were scheduled for VPS insertion, resulting in an overall ETV/CPC success rate of 70.6% (12/17) in the study. A statistically significant difference in the mean prenatal ventricle size was observed between the nonhydrocephalic (9.61 mm) and hydrocephalic (12.1 mm, p = 0.023) groups. Additionally, a significant difference in the CSO angle in the first month after birth was noted between the groups (67.2° vs 76.7°, p = 0.01).

CONCLUSIONS: There is strong evidence that FMMR decreases MMC-related hydrocephalus by reversing hindbrain herniation and altering the developmental anatomy of the third ventricle. This makes ETV/CPC a safe alternative to CSF shunting because of the newly altered anatomy of the third ventricle and posterior fossa. Larger studies are recommended to further evaluate fetal brain development after FMMR.

PMID:42139738 | DOI:10.3171/2025.12.PEDS25317

J Neurosurg. 2026 May 15:1-7. doi: 10.3171/2026.1.JNS252444. Online ahead of print.

ABSTRACT

OBJECTIVE: Predicting language lateralization using functional MRI (fMRI) in patients with cerebral vascular malformations close to language areas is essential for treatment decision-making and patient outcomes. Functional MRI-based prediction is challenged because of potential remodeling processes and hemodynamic phenomena. However, there is a lack of possible factors influencing laterality prediction. The authors hypothesized that there might be an impact of lesion type and location on language lateralization.

METHODS: This retrospective study included 24 patients with arteriovenous malformations (AVMs), 11 patients with cavernomas, and 15 healthy controls. Participants performed a subvocal verb-generation task during fMRI. Data analysis in Statistical Parametric Mapping (SPM) 12 involved realignment, coregistration, and smoothing for preprocessing. The authors conducted a whole brain analysis using the general linear model approach at the individual level and calculated the lateralization indices (LIs) using the LI toolbox implemented in SPM independently based on the frontal, temporal, and parietal lobes.

RESULTS: The mean absolute LIs were above 0.2 in all groups. Distribution between groups varied significantly (p = 0.032, f = 0.34). A significant difference was found between patients with AVMs and healthy controls (p = 0.038, r = 0.628). Specifically, patients with frontal AVMs showed significantly lower frontal LIs than did healthy controls (p = 0.032, r = 0.435). In contrast, LIs in cavernoma patients did not differ significantly from controls (p = 0.313). No significant difference was observed between language-adjacent and language-distant lesions (p = 0.14).

CONCLUSIONS: The results of this study suggest that lesion type and location influence language lateralization prediction. Frontal AVMs exhibit significantly lower LIs, requiring caution and experience in interpreting results to ensure patient safety. Cavernomas did not influence LI. Further research with larger cohorts is necessary to understand the underlying causality and neuroplastic changes involved.

PMID:42139736 | DOI:10.3171/2026.1.JNS252444