Tag: statistics

PeerJ. 2026 Aug 12;14:e21500. doi: 10.7717/peerj.21500. eCollection 2026.

ABSTRACT

BACKGROUND: Maternal Western diet (WD) consumption during pregnancy is linked to adverse gestational and offspring metabolic outcomes. Dimethyl fumarate (DMF), a Nrf2 activator with antioxidant and anti-inflammatory properties, is a proposed therapeutic candidate, but its safety and efficacy during pregnancy remain unexplored. This pilot study aimed to establish a guinea pig model of gestational WD consumption and evaluate the feasibility of DMF treatment on maternal, placental, and fetal outcomes.

METHODS: Pregnant guinea pigs consuming a modified WD were randomized to receive either DMF or vehicle treatment beginning at gestational day 19. Maternal weight, urinalysis, blood glucose, and ketones were monitored weekly. Dams were sacrificed near-term, and placental and fetal biometric measures were recorded. The placenta was evaluated for a panel of antioxidant and angiogenic candidate genes via RT-qPCR, and maternal and fetal livers were assessed for triglyceride content, histopathology, and transcriptomic changes via RNA-sequencing.

RESULTS: DMF did not alter maternal weight, blood glucose, urinalysis, nor fetal or placental gross outcomes. Hepatic triglyceride concentrations were unaffected in both dams and fetuses. WD consumption resulted in maternal hepatic glycogen accumulation and mild vacuolar hepatopathy without fibrosis, while fetal livers exhibited microvesicular hepatopathy and abundant extramedullary hematopoiesis without fibrosis, irrespective of treatment. Placental RT-qPCR revealed that exposure to DMF led to a decrease in transcription of Sod1 (p = 0.046). For Hmgcr (p = 0.071) and Nqo1 (p = 0.067), numerical decreases were observed, although these did not meet the threshold for statistical significance. RNA-sequencing identified 38 differentially expressed genes (DEG) in maternal livers including changes in some immune-related transcripts. Fetal hepatic RNA-sequencing identified 51 DEG, distinctly different from maternal DEG, indicating an activation of interleukin 12 production. Distinct differences between fetal and maternal liver transcriptomic profiles were evident, with over 9,000 DEG (65% of annotated transcripts). Dimethyl fumarate conferred no measurable benefit on maternal or fetal hepatopathy and had a paradoxical effect in lowering placental Sod1 gene expression, but, importantly, no overt harm was appreciated. These findings establish the feasibility of a gestational guinea pig WD model and gestational DMF therapy and provide initial insights into maternal-fetal responses to DMF, most notably highlighting divergent hepatic transcriptome between dams and offspring. Future research should assess whether DMF or related Nrf2 activators can be developed as pregnancy therapeutics, explore interactions between antioxidants and placental angiogenesis, and determine long-term offspring outcomes after exposure to WD and DMF during gestational development.

PMID:42604343 | PMC:PMC13477151 | DOI:10.7717/peerj.21500

Adv Med Educ Pract. 2026 Aug 11;17:586240. doi: 10.2147/AMEP.S586240. eCollection 2026.

ABSTRACT

BACKGROUND: Lapses in professionalism remain a critical concern in medical education, with early unprofessional behaviors linked to adverse outcomes in clinical practice. Traditional interventions focus on reflection and mentorship, but alternative approaches such as graphic medicine may provide new opportunities for awareness and discussion.

OBJECTIVE: This pilot study sought to evaluate comics depicting professional and unprofessional behaviors as a tool for measuring medical student awareness of professionalism, and assess perceptual discrepancies between students and supervising faculty.

METHODS: Faculty at the University of Louisville School of Medicine provided examples of professional and unprofessional student behaviors. These examples were transformed into comics using ChatGPT, each depicting both classroom and clinical contexts. M2/M3 medical students and supervising faculty were then asked to rate the professionalism depicted in each comic using a Qualtrics-based survey and to provide qualitative feedback on the graphic medicine approach.

RESULTS: Faculty (N=14) and students (N=20) differed in their perception of professionalism, with students rating unprofessional behaviors as less extreme in comparison. Conversely, professional behaviors were rated more positively by faculty than by students. While both groups considered the comics realistic and engaging, participants questioned their effectiveness as a learning tool in the survey format. Students also completed the survey more quickly than faculty on average, suggesting less engagement with the material in its existing survey format.

CONCLUSION: Discrepancies in perceptions of professionalism between students and faculty may explain lapses in medical professionalism exhibited by M2/M3 students at the University of Louisville. Though provided in survey format, graphic medicine may serve as an engaging entry point for discussion, through integration into small-group or reflective learning environments, for effective prevention of medical professional decline.

PMID:42604340 | PMC:PMC13477173 | DOI:10.2147/AMEP.S586240

Clin Cosmet Investig Dent. 2026 Aug 11;18:614528. doi: 10.2147/CCIDE.S614528. eCollection 2026.

ABSTRACT

PURPOSE: This in vitro study evaluated the effect of cigarette smoke from three tobacco types on the color stability and surface roughness of a nanohybrid resin composite.

MATERIAL AND METHODS: Sixty standardized Filtek Z350 XT nanohybrid resin composite discs were prepared and randomly allocated into three groups (n = 20) according to cigarette type: flavored tobacco, blond tobacco, and filterless tobacco. Baseline color and surface roughness measurements were obtained before smoke exposure. Color was assessed using the CIE L*a*b* system, and overall color change (ΔE) was calculated after the experimental period. Surface roughness was measured as arithmetic mean roughness (Ra, μm). The specimens were exposed to cigarette smoke using a custom-built smoking device under standardized conditions for 30 consecutive days, followed by final color and roughness measurements. Intergroup and intragroup comparisons were performed using appropriate parametric and non-parametric tests, with statistical significance set at p < 0.05.

RESULTS: All groups exhibited color alteration after smoke exposure. Mean ΔE values were 10.09 ± 1.78 for flavored tobacco, 13.19 ± 1.97 for blond tobacco, and 16.57 ± 3.74 for filterless tobacco, with significant intergroup differences (p < 0.001). The filterless tobacco group showed the greatest chromatic alteration. Surface roughness increased significantly within all groups after smoke exposure (all p < 0.001). Mean ΔRa values were 0.116 ± 0.039 μm, 0.139 ± 0.049 μm, and 0.148 ± 0.054 μm for flavored, blond, and filterless tobacco, respectively; however, intergroup differences in ΔRa were not statistically significant (p = 0.100).

CONCLUSION: Cigarette smoke adversely affected both the color stability and surface roughness of the tested nanohybrid resin composite. Filterless tobacco produced the greatest color alteration, whereas all tobacco types significantly increased surface roughness without significant intergroup differences in ΔRa. Under the present experimental conditions, color change was more discriminative than surface roughness for detecting differences among cigarette types.

PMID:42604339 | PMC:PMC13477168 | DOI:10.2147/CCIDE.S614528

J Clin Hypertens (Greenwich). 2026 Aug;28(8):e70351. doi: 10.1111/jch.70351.

ABSTRACT

Renal artery variations are recognized as potential contributors to hypertension through altered renal perfusion and activation of renin-angiotensin system. However, their clinical and hemodynamic significance in children remains unclear. This retrospective study included 14 pediatric patients (0-18 years) with hypertension and renal artery variations. Demographic, laboratory, echocardiographic and ambulatory blood pressure monitoring (ABPM) data were analyzed at baseline and follow-up. Patients were stratified according to serum renin levels (elevated vs. normal). Accessory renal arteries and early branching were identified in 78.4% and 42.8% of patients, respectively. At baseline, 38.4% of patients had left ventricular hypertrophy and most exhibited nocturnal hypertension with impaired dipping patterns. Although daytime, nighttime blood pressure (BP) SDS values tended to decrease during follow-up; 24-h, daytime, nighttime systolic, diastolic BP and mean arterial pressure values did not change significantly in either group. Patients with elevated renin levels showed persistently higher nocturnal BP-SDS values and more pronounced non-dipping patterns. In the high-renin group, left ventricle relative wall thickness (RWT) decreased significantly from 0.41(0.36-0.43)-0.31(0.27-0.35) (p = 0.03), whereas left ventricular mass index (LVMI) remained unchanged [33(30-40] vs. 37(34-45) g/m²·⁷, p = 0.56]. In the normal-renin group, LVMI showed nonsignificant tendency to decrease [34(32-55) vs. 30(29-51) g/m²·⁷, p = 0.06], while the reduction in RWT did not reach statistical significance (p = 0.12). Renal artery variations in children should not be considered purely anatomical findings. Persistent nocturnal hypertension and impaired dipping patterns, particularly in patients with elevated renin levels, may contribute to ongoing target organ damage. Although ABPM parameters remained largely unchanged during follow-up, cardiac remodeling showed distinct patterns according to renin status.

PMID:42603783 | DOI:10.1111/jch.70351

J Clin Hypertens (Greenwich). 2026 Aug;28(8):e70345. doi: 10.1111/jch.70345.

ABSTRACT

Female nurses face unique health challenges due to pregnancy and physiological factors, yet the association between reproductive factors and blood pressure remains debated. This cross-sectional study surveyed 122 533 female nurses in Hebei Province using questionnaires and standardized blood pressure measurements. Data were collected on reproductive factors (menstrual status, number of abortions and deliveries), BMI, history of hypertensive disorders of pregnancy, and other potential confounders. Abortion was defined as pregnancy loss before 28 weeks of gestation, including both spontaneous miscarriage and induced termination, which are clinically and biologically distinct but were combined in this study due to data availability. Logistic regression and multifactorial analysis of variance were used to assess the associations of these reproductive factors with hypertension prevalence and blood pressure levels, respectively, including interaction terms for BMI and hypertensive disorders of pregnancy history. After adjusting for age, BMI, and other covariates, irregular menstruation (OR = 1.388, 95%CI: 1.302-1.478), menopause (OR = 1.328, 95%CI: 1.185-1.489), and having one delivery (OR = 1.215, 95%CI:1.004-1.471) were independently associated with higher odds of hypertension. Among nurses with prior hypertensive disorders of pregnancy, those with more than three abortions had significantly higher systolic (by 7.63 mmHg) and diastolic (by 6.38 mmHg) blood pressure compared to those with no abortion history. The findings indicate that reproductive factors are significantly associated with blood pressure in female nurses. We recommend regular blood pressure monitoring for nurses with irregular menstruation, menopause, or one delivery, proactive management of menstrual irregularities, and individualized reproductive counselling for those with a history of hypertensive disorders of pregnancy.

PMID:42603782 | DOI:10.1111/jch.70345

J Voice. 2026 Aug 15:S0892-1997(26)00396-6. doi: 10.1016/j.jvoice.2026.07.043. Online ahead of print.

ABSTRACT

INTRODUCTION: Individuals with dysphonia frequently have cognitive-emotional reactions such as catastrophization, which is characterized by excessively pessimistic thoughts, rumination, helplessness, and exaggerated symptoms. The Voice Catastrophization Index (VCI) is a patient-reported outcome measure designed to assess these psychological reactions.

OBJECTIVE: To adapt the Voice Catastrophization Index into Kannada and evaluate the psychometric properties of the Kannada version of the Voice Catastrophization Index (VCI-KA).

STUDY DESIGN: A validation study.

METHODS: The VCI was adapted into Kannada and administered to 70 patients with voice disorders (37 males and 33 females), with a mean age of 47.7 ± 15.6 years, and to 70 age- and gender-matched participants with a clinically normal voice. The Intraclass Correlation Coefficient (ICC) was used to measure test-retest reliability. Cronbach’s alpha coefficients for the domains of helplessness, rumination, and magnification were used to assess internal consistency. Convergent validity was assessed by correlating the scores of VCI-KA with the Kannada Voice-Related Quality of Life Questionnaire (VRQOL-K). The Mann-Whitney U test was used to evaluate known-group validity.

RESULTS: The VCI-KA demonstrated moderate-to-good test-retest reliability, with ICC values ranging from 0.614 to 0.798 and an overall ICC of 0.685. Cronbach’s alpha scores for helplessness, rumination, and magnification were 0.931, 0.884, and 0.798, respectively, indicating strong internal consistency across domains. Results also showed a statistically significant, moderately positive association between VCI-KA and VRQOL ratings (r = 0.545, P < 0.01), indicating acceptable convergent validity. Further, VCI-KA scores differed significantly between participants in the two groups, indicating good known-group validity.

CONCLUSIONS: The VCI-KA demonstrates satisfactory validity, reliability, and diagnostic accuracy for assessing voice-related catastrophization in the Kannada-speaking clinical sample. While the present findings support the psychometric properties of the VCI-KA, future longitudinal studies are essential to evaluate its sensitivity to change (responsiveness) following voice therapy.

PMID:42603769 | DOI:10.1016/j.jvoice.2026.07.043

Ultrasound Med Biol. 2026 Aug 15:S0301-5629(26)00297-8. doi: 10.1016/j.ultrasmedbio.2026.07.022. Online ahead of print.

ABSTRACT

OBJECTIVE: Ultrasound is central to lymph node assessment and guides targeted biopsy. However, conventional Doppler has limited sensitivity to slow microvascular flow. Super-resolution ultrasound imaging using erythrocytes (SURE) is a fast, contrast-free technique that previously demonstrated feasibility in normal axillary and inguinal lymph nodes, but not in malignant lymph nodes or in the anatomically challenging cervical region. This feasibility study evaluated whether SURE could visualize the microvascular architecture in malignant cervical lymph nodes in patients with head and neck cancer or lymphoma, with an exploratory qualitative and quantitative comparison with normal cervical lymph nodes.

METHODS: This preliminary feasibility study included five malignant cervical lymph nodes and five sonographically normal cervical lymph nodes. Conventional B-mode and Doppler images were obtained for qualitative comparison, followed by SURE acquisitions reconstructed into intensity and velocity maps. Exploratory quantitative parameters included vascular density, vessel diameter and peak flow velocity.

RESULTS: SURE depicted the microvasculature in malignant cervical lymph nodes in greater detail than Doppler. Normal lymph nodes showed organized hilar branching patterns, whereas malignant lymph nodes showed heterogeneous and disorganized vascular patterns with focal avascular regions. In this small exploratory cohort, vascular density appeared lower in malignant than in normal lymph nodes (p = 0.009), while no statistically significant differences were observed in vessel diameter or peak flow velocity.

CONCLUSION: SURE was feasible for fast, contrast-free microvascular imaging of malignant cervical lymph nodes. The findings are exploratory, and further methodological optimization and larger validation studies, including clinically indeterminate lymph nodes, are required to establish clinical utility.

PMID:42603761 | DOI:10.1016/j.ultrasmedbio.2026.07.022

Acad Radiol. 2026 Aug 15:S1076-6332(26)00561-1. doi: 10.1016/j.acra.2026.07.054. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To assess radiology residency program leadership perspectives on factors influencing interview selection and final ranking during the 2025-2026 Match, emphasizing preference signals, letters of intent, visiting rotations, virtual interviews, and academic metrics.

MATERIALS AND METHODS: A cross-sectional anonymous survey was distributed to program directors of ACGME-accredited Diagnostic Radiology and Interventional Radiology-Integrated residency programs participating in the 2026 Residency Match. Program directors were asked to complete the survey and distribute it to individuals involved in applicant interviewing or ranking. Items assessed program characteristics, application review factors, preference signals, letters of intent, visiting rotations, and interview format perceptions. Descriptive statistics were used, with exploratory subgroup comparisons performed using chi-square or Fisher’s exact tests.

RESULTS: The final analytic cohort included 85 respondents. The most highly weighted interview selection factors were first-attempt pass on USMLE Step 1/COMLEX Level 1, USMLE Step 2 CK/COMLEX Level 2 CE score, and Gold/Silver preference signals, rated highly considered or essential by 90.6%, 88.2%, and 87.1%, respectively. For final ranking, overall interview impression was rated highly considered or essential by 94.1% and selected among the most significant factors by 91.8%. Letters of intent had limited overall influence, although 35.3% reported ranking an applicant higher because of one. Visiting rotations positively influenced ranking for 77.6%. Fully virtual interviews were used by 91.8%, but 44.7% reported a negative effect on applicant evaluation.

CONCLUSION: Standardized examination performance and preference signals strongly influence interview selection, whereas interview performance dominates final ranking. Away rotations remain influential, while letters of intent appear most impactful in closely contested ranking decisions.

PMID:42603754 | DOI:10.1016/j.acra.2026.07.054

Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Jul 7:S2212-4403(26)00345-7. doi: 10.1016/j.oooo.2026.06.024. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the efficacy of cone fit measurements of digital periapical (PA) and stationary intraoral tomosynthesis (s-IOT) images and compare them to the physical measurement of gutta-percha (gold standard).

STUDY DESIGN: Images of 40 extracted teeth with gutta-percha in their prepared root canals were acquired using digital PA and 3D s-IOT devices (Portray system), while the physical cone length of the gutta-percha was measured using a digital vernier caliper. Digital PA cone length was measured using MiPACS Dental Enterprise Viewer Software with a polyline measurement tool. Cone length in the s-IOT images was measured by scrolling through synthetic images taken at different angle disparities. All measurements were recorded and subjected to statistical analysis.

RESULTS: Interclass correlation coefficient (ICC) test showed statistical significance. The gold standard vs s-IOT measurements had the highest reliability across all groups, often exceeding 0.9. Comparisons involving PA (PA vs gold standard and PA vs s-IOT) tend to have lower reliability, with several confidence intervals including 0. Statistically significant P-values across all comparisons suggest these ICCs are meaningful, but confidence intervals highlight potential issues with data variability.

CONCLUSIONS: While both modalities differed from the gold standard, s-IOT demonstrated a clear advantage in measurement accuracy and reliability.

PMID:42603742 | DOI:10.1016/j.oooo.2026.06.024

J Rheumatol. 2026 Aug 15:jrheum.2026-0178. doi: 10.3899/jrheum.2026-0178. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate serum Phoenixin-14 (PNX-14) levels in Familial Mediterranean Fever (FMF) and Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) patients during both attack and attack-free periods to investigate its potential biomarker value.

METHODS: A total of 140 children were included in this cross-sectional study: 46 FMF, 48 PFAPA, and 46 healthy children. Blood samples were collected during both febrile and attack-free periods in the FMF and PFAPA patients, whereas samples from healthy controls were collected at a single time point. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum amyloid A (SAA), fibrinogen, and serum PNX-14 levels were evaluated. Serum PNX-14 levels were measured using ELISA. SPSS 25 was used for statistical analyses.

RESULTS: PNX-14 levels were significantly higher during attack periods in FMF and PFAPA patients compared to attack-free periods and healthy controls (p < 0.001). PNX-14 levels during attack-free periods were also higher in both patient groups than in healthy controls (p < 0.001). While a positive correlation was observed between PNX-14 levels and CRP (rho = 0.222, p = 0.04), no significant correlation was observed with ESR, SAA, or fibrinogen. No significant associations were observed between PNX-14 levels and disease severity (PRAS), colchicine treatment duration, or daily colchicine dose in the FMF group.

CONCLUSION: PNX-14 may be part of a neuroimmune response aimed at resolving inflammation in autoinflammatory processes and could be a potential immunomodulatory biomarker. PNX-14 may be a complementary indicator reflecting inflammatory burden or the healing process.

PMID:42603718 | DOI:10.3899/jrheum.2026-0178