Tag: statistics

Acute Med. 2025;24(4):168-174. doi: 10.52964/AMJA.1024.

ABSTRACT

BACKGROUND: Angioedema is the development of non-pitting edema of the skin and mucosal tissues of the oropharynx, upper respiratory tract, and the gastrointestinal tract. Given the potential for airway compromise, the treatment strategy usually involves a broad approach by addressing multiple underlying possible pathologies simultaneously without knowing the exact mechanism. This is a common and often necessary approach when managing a critically ill patient with incomplete information. Although the current research on TXA use in angioedema centers on ACE-I induced mechanisms, the authors frequently see it used in undifferentiated angioedema.

METHODS: This is a retrospective comparative study evaluating the effect of intravenous TXA administration to treat acute angioedema when compared to usual treatment. Hospital admissions, repeat ED visits specifically related to angioedema within 30 days, 30-day all-cause mortality, and need for an advanced airway were assessed as outcomes.

RESULTS: After applying inclusion and exclusion criteria, 562 ED encounters were identified for chart review. Matched ED encounters comparing TXA use and no TXA use were well balanced. No statistically significant difference was identified when using TXA or not for angioedema when examining the outcome variables.

CONCLUSION: No significant differences were seen between the groups when evaluating ED revisits related to angioedema, hospital admission, the need for an advanced airway, and 30-day all-cause mortality. Prospective analysis of TXA in angioedema is needed to clarify its role in acute treatment.

PMID:42462217 | DOI:10.52964/AMJA.1024

Acute Med. 2025;24(4):164-167. doi: 10.52964/AMJA.1023.

ABSTRACT

BACKGROUND: Deep vein thrombosis (DVT) is commonly managed in ambulatory care. Guidelines recommend reassessment at three months to review anticoagulation duration, but no structured follow-up pathway exists within our Trust.

AIM: To evaluate anticoagulation duration, follow-up practices, and outcomes in patients with DVT diagnosed in ambulatory care.

METHODS: Retrospective, observational service evaluation across two ambulatory care units in Manchester, UK. Patients with confirmed lower limb DVT were identified between January 2023 and June 2023. Data were collected from electronic patient records including complication rates over a 2-year period.

RESULTS: Of 307 patients assessed for suspected DVT, 90 had confirmed DVT. Most cases were unprovoked (77.8%). At discharge, 39% were prescribed 3 months’ anticoagulation, 31% 6 months, 11% lifelong, 6% received a duration range of 3-6 months, and 13% had no specified duration. Discrepancies between recommendation at discharge and primary care prescribing were seen in 53%, with nearly half receiving longer treatment. 20% had secondary care follow-up. Recurrent DVT occurred in nine patients, none of whom had received follow-up; no recurrences were seen in the followed-up group, although this difference was not statistically significant (Fisher’s exact test, p = 0.195). Bleeding events were seen in 4.4% of cases and were minor.

CONCLUSIONS: There is substantial variability in anticoagulation management following DVT in ambulatory care. Although recurrence was not observed in the followed-up group, the study was not powered to detect differences, and this finding should be interpreted cautiously. Further work is needed to establish if a follow-up DVT clinic will improve patient outcomes.

PMID:42462216 | DOI:10.52964/AMJA.1023

JMIR Cancer. 2026 Jul 16;12:e87232. doi: 10.2196/87232.

ABSTRACT

BACKGROUND: Lung cancer remains a major contributor to cancer mortality in sub-Saharan Africa (SSA), where late diagnosis, driven by low awareness, sociocultural barriers, and health system constraints, limits effective treatment. Despite the growing burden, evidence on patients’ quality of life (QoL) and symptom experience in SSA is limited.

OBJECTIVE: This study aimed to describe the common symptoms and QoL of patients with lung cancer treated at 2 hospitals in SSA, and to investigate the association of demographics, clinical characteristics, and symptom burden with QoL.

METHODS: This was a cross-sectional study that consecutively recruited patients with lung cancer from 2 teaching hospitals in SSA: Bugando Medical Centre (BMC) in Tanzania and the University of the Witwatersrand Centre of Respiratory Excellence (WITS-CORE) in South Africa. Data collected included demographics, clinical information, and performance status using the Eastern Cooperative Oncological Group Performance Scale (ECOG-PS). Health-related QoL was assessed using the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The study followed all ethical procedures, and data were analyzed using both descriptive and inferential statistics in Stata 18. A P value of <.05 was considered statistically significant.

RESULTS: A total of 174 patients with lung cancer were enrolled across the 2 sites. The score on the EORTC QLQ-C30 global health status/QoL subscale was low, with a median of 41.67 (IQR 33.33-41.67), and it varied by site. Patients from WITS-CORE demonstrated higher social functioning scores, while those from BMC reported greater financial difficulties. A low global health status/QoL score was independently associated with the BMC site (adjusted odds ratio [aOR] 3.5, 95% CI 1.3-9.3) and poor performance status (ECOG-PS 3-4; aOR 3.4, 95% CI 1.2-6.6). Furthermore, symptoms such as nausea and vomiting, pain, dyspnea, insomnia, appetite loss, diarrhea, and financial struggles were all associated with a low global health status/QoL score.

CONCLUSIONS: QoL among patients with lung cancer in SSA is poor. Low QoL is strongly associated with the Multinational Lung Cancer Control Program study site, poor performance status, and a range of symptoms and financial difficulties. Addressing these factors may help to improve patient outcomes and well-being in SSA.

PMID:42462209 | DOI:10.2196/87232

JCO Clin Cancer Inform. 2026 Jul-Sep;10(3):e2500213. doi: 10.1200/CCI-25-00213. Epub 2026 Jul 16.

ABSTRACT

PURPOSE: Enzalutamide or abiraterone, combined with androgen-deprivation therapy, is standard of care for metastatic castration-sensitive prostate cancer (mCSPC). However, no trials have compared these drugs. This study compared clinical outcomes in patients with mCSPC treated with enzalutamide or abiraterone.

METHODS: This retrospective cohort study included patients with mCSPC initiating enzalutamide or abiraterone between January 1, 2020, and December 31, 2023, within the nationwide US Veterans Affairs health care system. Inverse probability of treatment weighting was used to balance baseline characteristics. Restricted mean survival time (RMST) differences in overall survival (OS), time to treatment switch or death (TTS), and prostate cancer survival (PCS) were evaluated.

RESULTS: The study included 5,135 patients with mCSPC treated with enzalutamide (1,803) or abiraterone (3,332). The median age was 74.33 years; 58.0% were non-Hispanic White, 28.2% non-Hispanic Black, and 5.6% Hispanic. After weighting, baseline characteristics were well balanced. The median follow-up was 18.74 months for abiraterone and 24.76 months for enzalutamide. Outcomes were similar overall: for OS, the 3-year RMST difference was 0.72 months (95% CI, -0.06 to 1.50); for TTS, the 3-year RMST difference was 0.53 months (95% CI, -0.45 to 1.51), and for PCS, the 1-year RMST difference was -0.12 months (95% CI, -0.35 to 0.11). In subgroup analysis, enzalutamide was associated with improved OS among patients age 75 years and older (3-year RMST difference: 1.65 months, 95% CI, 0.41 to 2.89), but not among younger patients (3-year RMST difference: 0.13 months, 95% CI, -0.86 to 1.11).

CONCLUSION: In this nationwide cohort study, enzalutamide and abiraterone yielded comparable OS, TTS, and PCS outcomes overall, although a small but statistically significant OS benefit was observed for enzalutamide among older patients (≥75 years). These real-world findings from the largest integrated US health care system may provide guidance for selecting mCSPC treatments, although residual confounding cannot be fully excluded.

PMID:42462188 | DOI:10.1200/CCI-25-00213

Neurology. 2026 Aug 11;107(3):e218282. doi: 10.1212/WNL.0000000000218282. Epub 2026 Jul 16.

ABSTRACT

BACKGROUND AND OBJECTIVES: Endovascular thrombectomy (EVT) improves outcome in acute ischemic stroke (AIS) due to large vessel occlusion, yet the optimal anesthetic strategy remains controversial. Previous meta-analyses using frequentist methods reported no significant differences between general anesthesia (GA) and non-GA techniques; however, a recently published trial reported a high posterior probability of functional benefit with GA. We aimed to update the existing systematic review and to re-examine the cumulative randomized evidence using Bayesian statistical methods.

METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to January 3, 2026, for randomized controlled trials (RCTs) comparing GA with non-GA strategies during EVT in adults with AIS. Primary outcomes were functional independence (modified Rankin Scale [mRS] 0-2) at 90 days, successful reperfusion (thrombolysis in cerebral ischemia 2b-3), and 90-day mortality. Bayesian random-effects meta-analyses with weakly informative priors were performed. Results are reported as odds ratio (OR) or mean difference (MD) with 95% credible intervals (CrIs). A posterior probability of superiority exceeding 80% was considered substantial evidence of benefit. Meta-regression and sensitivity analyses were conducted.

RESULTS: Ten RCTs (n = 1,601; mean age 70.0 years; 46.6% female) were included. For functional independence, GA was associated with a 94.2% posterior probability of superiority (OR 1.24, 95% CrI 0.94-1.66). GA was associated with higher successful reperfusion rates (OR 1.73, 95% CrI 1.23-2.43; P (superiority) > 99%). No substantial differences were observed for 90-day mortality (OR 0.92, 95% CrI 0.67-1.27; P [superiority] 69%), excellent functional outcome (mRS 0-1; OR 1.06, 95% CrI 0.80-1.41; P [superiority] 67%), or symptomatic intracranial hemorrhage (OR 0.93, 95% CrI 0.56-1.52; P [superiority] 62%). GA was associated with increased intraoperative hypotension (OR 4.28, 95% CrI 2.35-7.86; P [superiority] 0.01%) and increased pneumonia risk (OR 1.60, 95% CrI 0.95-2.81; P [superiority] 3%).

DISCUSSION: This meta-analysis using a Bayesian approach provides evidence that GA during EVT for AIS is associated with improved functional outcomes, challenging previous conclusions of equivalence. These findings should be interpreted considering open-label designs and heterogeneous non-GA comparators. They suggest that GA may be preferred but confirmatory evidence is needed.

PMID:42462185 | DOI:10.1212/WNL.0000000000218282

Am J Biol Anthropol. 2026 Jul;190(3):e70321. doi: 10.1002/ajpa.70321.

ABSTRACT

OBJECTIVES: Root surface morphology has been used to examine functional signals related to diet and taxonomic affinities in primates with varying degrees of success. The aim of this study is to determine if the use of the functionally significant root cervix can enhance our understanding of these relationships in catarrhines.

MATERIALS AND METHODS: Two-dimensional (2D) semilandmark points were collected using cross sections taken from the cervix of all three mandibular molar positions in a sample of extant catarrhines (n = 68). Multivariate regression was used to examine the influence of size on Procrustes aligned data. Standard and phylogenetic principal component analyses were performed for each molar position. Phylogenetic generalized least squares (PGLS) were used to correct for nonindependence.

RESULTS: Allometric effects were statistically significant (p < 0.05) but weak for each position (M₁ = 0.096, M₂ = 0.064, M₃ = 0.062). Phylogenetic signal, multivariate K, was significant for each molar but less than expected under Brownian motion (K_mult < 1). PGLS removed all functional signal related to dietary ecology at M₁ for phylogenetically aligned PCA (PACA) and phylogenetic PCA (pPCA) components. These signals were diminished but not eliminated at M₂ (PACA) and M₃ (pPCA).

CONCLUSIONS: The influence of size on the morphology of the root cervix is limited and does not impact functional signals related to either phylogeny or diet. Observed morphological variation of the root cervix is driven in part by both phylogeny and diet. However, these variables share a strong relationship, and more work is needed to disentangle the two.

PMID:42460573 | DOI:10.1002/ajpa.70321

Curr Cardiol Rev. 2026 Jul 10. doi: 10.2174/011573403X461776260628210313. Online ahead of print.

ABSTRACT

INTRODUCTION: The association between the gut microbiota and aortic dissection(AD) progression remains to be fully characterized, and current evidence regarding the influence of cortisol on this relationship remains inconclusive. The aim of this study was to determine whether cortisol levels contribute to this association.

METHODS: A two-sample Mendelian Randomization (MR) approach was implemented, incorporating gut microbiota summary statistics derived from a large-scale genome-wide association meta-analysis (n=18,340) performed by the MiBioGen consortium. Additionally, summary-level data on aortic dissection were obtained from the FinnGen Consortium R10 release, which included 967 cases and 381,977 controls. To investigate causal relationships, the study implemented inverse-variance weighting, a weighted model, a weighted median, MR-Egger, and MRPRESSO. Mediated MR analyses were performed on bacteria identified as causally associated with aortic dissection, along with intermediate metabolites derived from 1,400 blood metabolites, and the metabolites that mediated the relationship between them were identified. The study employed Cochran’s Q test to examine heterogeneity in the genetic instruments.

RESULTS: Seven gut microbiota species with elevated abundance potentially exerts a protective or negative effect on aortic dissection. In particular, the Ruminococcus gnavus group may have a deleterious effect on aortic dissection via changes in cortisol levels.

CONCLUSION: This study offers novel insights into the involvement of gut microbiota in the prevention of aortic dissection and the complex relationship between them. Additionally, it underscores the significance of randomized controlled trials in determining the association linking gut microbiota with aortic dissection risks.

PMID:42460537 | DOI:10.2174/011573403X461776260628210313

Recent Adv Inflamm Allergy Drug Discov. 2026 Jul 10. doi: 10.2174/0127722708469832260704203619. Online ahead of print.

ABSTRACT

INTRODUCTION: Dyslipidemia (DLP) is an increase in lipid accumulation; as a result, hypertriglyceridemia causes body inflammation. One risk factor for inflammation is the development of dry eye disease (DED). This study aims to investigate the correlation between the erythrocyte sedimentation rate and C-reactive protein ratio (ESR/CRP ratio) and lipid profile biomarkers as indicators for dyslipidemia in dry eye disease patients.

METHODS: The study was designed based on a case-control study of n=200 patients with dyslipidemia in the King Abdulaziz Medical Center (KAMC) – Jeddah hospital community, who were randomly selected. The patient data were collected for two groups: the control group, dyslipidemia only (DLP; n= 144), and the study group, dyslipidemia with dry eye disease (DLPDED; n= 56). All patients’ demographic and laboratory findings data were retrospectively extracted from the hospital records using the BestCare platform; then, the PRISM software analyzed the statistical data (GraphPad Inc., San Diego, CA, USA). A significance level of p <0.05 was adopted for validation.

RESULTS: This study found that females were more common in DLP-DED patients than DLP patients. Moreover, DLP-DED patients have triglyceride values higher than DLP patients, with a statistically significant difference (p < 0.0001). Compared the correlation of ESR/CRP ratio between groups, only DLP-DED patients showed a positive correlation between ESR/CRP ratio and total cholesterol and between ESR/CRP ratio and low-density lipoprotein (LDL) in the DLP-DED group with statistically significant differences p = 0.0223 and p = 0.0393, respectively.

DISCUSSION: The positive correlation between the ESR/CRP ratio and LDL and cholesterol levels in DLP-DED patients supported a previously published study on DED patients versus non- DED.

CONCLUSION: Given the significant correlations between the ESR/CRP ratio and lipid profile, examining the ESR/CRP ratio is recommended as routine screening of dyslipidemia patients with ocular surface diseases such as dry eye disease to provide clinically beneficial diagnosis and treatment approaches and prevent future eye complications in DLP patients.

PMID:42460530 | DOI:10.2174/0127722708469832260704203619

Curr Neuropharmacol. 2026 Jul 10. doi: 10.2174/011570159X468669260626223524. Online ahead of print.

ABSTRACT

BACKGROUND: Genetic evidence implicates the contribution of the gut-brain axis to neurodegenerative diseases (NDDs). Alterations in gut microbiota and inflammation are key pathophysiological contributors. Elucidating the genetic basis and the role of cytokines can provide insights into mechanisms linking gut microbial composition to neurodegeneration.

METHODS: Using aggregated statistics from five large-scale Genome-Wide Association Studies (GWAS) on Alzheimer’s disease, Parkinson’s disease, dementia with Lewy bodies, multiple sclerosis, and amyotrophic lateral sclerosis, bidirectional two-sample Mendelian Randomization (MR) was used to examine the associations. A two-step multivariable Mendelian randomization approach incorporates data from 91 cytokines to explore potential mediators.

RESULTS: The study reveals 18 positive and 17 negative effects between gut microbiota and NDDs, as well as 10 positive and 10 negative effects between cytokines and NDDs. Remarkably, mediation analysis identified a causal pathway, with evidence that plasma neurturin levels partially mediate the association from genus Ruminococcus2 to multiple sclerosis, with a mediation proportion of 19.19% (OR = 1.038, 95% CI = 1.001-1.086, P = 0.044). No pleiotropy or heterogeneity was detected.

DISCUSSION: These MR findings provide compelling evidence for a genetically anchored gutimmune-brain network in NDDs, with cytokines as intermediates. Bidirectional effects highlight disease-specific microbial signatures and inflammatory contexts. The Ruminococcus2-neurturin pathway in multiple sclerosis may offer mechanistic specificity, aligning with neurotrophic and anti-inflammatory signaling pathways.

CONCLUSION: This study emphasizes the importance of gut microbiota alterations in NDDs and explores inflammation’s partial intermediary role. The findings suggest potential targets for personalized neurodegeneration prevention strategies.

PMID:42460525 | DOI:10.2174/011570159X468669260626223524

J Surg Oncol. 2026 Jul 16. doi: 10.1002/jso.70337. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the survival impact of radical hysterectomy versus simple hysterectomy on non-endometrioid endometrial cancer with cervical involvement.

METHODS: We conducted a multicenter retrospective cohort study of 422 women with uterine serous carcinoma or uterine clear cell cancer treated between 2013 and 2020 at four tertiary teaching hospitals. We classified the patients by the type of hysterectomy. Overall survival and disease-free survival were analyzed and compared using the Kaplan-Meier method and the log-rank test. To adjust for the potential confounders, the Cox proportional hazards regression model was employed.

RESULTS: Our cohort included 275 women who underwent radical hysterectomy and 147 women who underwent simple hysterectomy. The baseline characteristics of the two groups did not differ significantly. There was no statistical difference in recurrence between the two groups (23.8% vs. 20.4%, p = 0.456). Compared with a simple hysterectomy, a radical hysterectomy was not associated with improved overall survival (hazard ratio 0.93, 95% confidence interval 0.69-1.26, p = 0.652), and improved disease-free survival (hazard ratio 0.96, 95% confidence interval 0.72-1.26, p = 0.745). After adjusting for potential confounders, the analysis showed that the type of hysterectomy did not affect overall survival (hazard ratio 0.99, p = 0.968) and disease-free survival (hazard ratio 1.01, p = 0.985) in non-endometrioid endometrial cancer with cervical involvement.

CONCLUSION: Radical hysterectomy was not associated with a survival benefit in non-endometrioid endometrial cancer with cervical involvement.

PMID:42460510 | DOI:10.1002/jso.70337