Category: Statistics

Physiol Plant. 2026 Mar-Apr;178(2):e70871. doi: 10.1111/ppl.70871.

ABSTRACT

The external traits of Lycium barbarum L. fruits are primary determinants of their commercial value. Ovary locule number is a fundamental developmental structure hypothesized to be a key intrinsic factor influencing these traits. However, systematic investigation into its specific role remains limited. This study systematically investigated the correlation between locule number and key fruit traits, and compared differences between wild and cultivated accessions from the Ningxia region. Multivariate statistical analyses, including correlation analysis and principal component analysis, were employed. The results revealed an unbalanced distribution of locule number, with bilocular ovaries predominating. Furthermore, locule number showed significant positive correlations with size-related traits (single fruit weight, fruit area) but negative correlations with shape indices (fruit shape index, length-to-width ratio). Interestingly, the average locule number in cultivated L. barbarum was significantly higher than in wild accessions. Cultivated accessions exhibited distinct domestication characteristics, including greater single-fruit weight, altered fruit shape index, and color. Single fruit weight and fruit roundness are identified as key indicators for predicting locule number. We conclude that ovary locule number is a key intrinsic factor determining fruit size and shape, with a trade-off: increased locule number promotes enlargement but leads to a rounder shape. Domestication has preferentially selected for genotypes with more locules and larger fruit size. Therefore, locule number can serve as an effective early phenotypic marker for quality breeding programs in L. barbarum.

PMID:41983368 | DOI:10.1111/ppl.70871

Int J Fertil Steril. 2026 Apr 13;20(2):154-158. doi: 10.22074/ijfs.2025.2042418.1769.

ABSTRACT

BACKGROUND: The prognostic value of borderline and pathological sperm morphology (SM) in infertility treatment remains unclear. This study aims to evaluate the potential impact of SM on clinical pregnancy outcomes following intrauterine insemination (IUI).

MATERIALS AND METHODS: This retrospective study reviewed IUI outcomes conducted between July 2012 to January 2017 at an infertility treatment center. Couples who underwent IUI and subsequently achieved a clinical pregnancy were included. Based on semen analysis according to the 6th edition of World Health Organization (WHO) guidelines, the couples were divided into two groups: borderline (4-13% normal forms) and pathological (<4% normal forms) SM. The study assessed the association between SM and pregnancy outcomes, specifically live birth and spontaneous abortion rates.

RESULTS: A total of 111 IUI cycles with confirmed clinical pregnancy were analyzed. Gestational complication rates were 8.3% in the borderline SM group and 17.3% in the pathological SM group, this difference was not statistically significant (P=0.255). However, live birth rates differed significantly between the two groups (borderline: 91.7%, pathological: 69.3%; P=0.009). Overall abortion rates were significantly higher in the Pathological SM group (borderline: 2.8%, pathological: 26.7%; P=0.001). First-trimester abortion rates were 5.6% and 18.7% in the borderline and pathological SM groups, respectively. Logistic regression analysis revealed that for every one-unit increase in the percentage of morphologically normal sperm, the odds of abortion decreased by a factor of 0.6 (P=0.017; OR=0.614; 95% CI: 0.412-0.916).

CONCLUSION: Pathological SM is associated with a significantly higher risk of first-trimester abortion. Therefore, SM is highlighted as a potential predictor of IUI outcomes following clinical pregnancy. Subsequently, SM should be considered a critical factor in fertility assessments, and alternative treatment strategies may be more appropriate for couples with pathological SM undergoing infertility treatment.

PMID:41983363 | DOI:10.22074/ijfs.2025.2042418.1769

Int J Fertil Steril. 2026 Apr 13;20(2):115-123. doi: 10.22074/ijfs.2025.2055868.1841.

ABSTRACT

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrine disorder and a leading cause of anovulatory infertility. This study evaluated whether adding vitamin E to a regimen of letrozole, tamoxifen, and estradiol improves ovulation outcomes in infertile women with PCOS.

MATERIALS AND METHODS: In a double-blind, randomized clinical trial conducted in Jahrom, Iran (December 2023-August 2024), 90 infertile women with PCOS were randomly assigned to two groups. Group A (n=45) received letrozole, tamoxifen, estradiol, and vitamin E, while group B (n=45) received the same regimen without vitamin E. The primary outcome was pregnancy rate; secondary outcomes included follicle size, count, and endometrial thickness, measured on cycle days 3, 7, and 12. Data were analyzed using Chi-square, Fisher’s exact, and t tests (Stata 14).

RESULTS: Baseline characteristics including age (mean: 31.21 ± 6.31 Y), BMI (24.96 ± 3.45 kg/m²), and infertility duration (3.48 ± 2.70 Y) were similar between groups (P>0.05). On day 7, the vitamin E group showed significantly larger follicles (14.15 ± 0.36 mm vs. 10.90 ± 0.68 mm), more follicles (5.16 ± 0.36 vs. 3.73 ± 0.83), and thicker endometrium (7.16 ± 0.36 mm vs. 5.16 ± 0.36 mm). These advantages persisted on day 12, including improved follicular maturity and endometrial thickness. Although the pregnancy rate was higher in the vitamin E group (11.1% vs. 6.7%), the difference was not statistically significant (P=0.457). Adverse effects, including ovarian hyperstimulation syndrome (OHSS) and irregular bleeding, did not differ significantly (P=0.553).

CONCLUSION: The results indicate that the addition of vitamin E to the letrozole-tamoxifen-estradiol protocol might be associated with improved ovulatory outcomes in women with PCOS. Nevertheless, no significant effect on pregnancy rates was observed. These findings highlight the potential adjunctive role of vitamin E in ovulation induction among women with PCOS, although further large-scale randomized trials are needed to confirm its clinical relevance (number registration: IRCT20150407021653N20).

PMID:41983358 | DOI:10.22074/ijfs.2025.2055868.1841

BJS Open. 2025 Mar 5;10(2):zrag025. doi: 10.1093/bjsopen/zrag025.

ABSTRACT

BACKGROUND: Patients with sleep apnoea are at increased risk of postoperative cardiac and respiratory complications, but its prevalence in patients undergoing abdominal cancer surgery is poorly defined. The aim of this study was to estimate the prevalence of sleep apnoea in patients undergoing colorectal cancer surgery compared with community-based controls, and to assess the utility of symptoms, signs, and the STOP-Bang questionnaire in identifying sleep apnoea.

METHODS: This prospective observational study included consecutive patients scheduled for colorectal cancer surgery at Umeå University Hospital, Sweden, between 7 January 2015 and 24 May 2020. Overnight polysomnography, including electroencephalogram-based sleep scoring, was undertaken before operation. Prevalence estimates were compared with those of two community-based cohorts from Uppsala, Sweden (female participants from the Sleep and Health in Women cohort; male participants from the Men in Uppsala: A Study of Sleep Apnoea and Cardiometabolic Health cohort). The primary outcome was the prevalence of sleep apnoea.

RESULTS: Of 268 eligible patients, 5 were receiving continuous positive airway pressure therapy and 201 underwent successful polysomnography. Moderate-to-severe sleep apnoea was identified in 98 of 206 patients (48 (95% confidence interval 41 to 54)%) undergoing colorectal cancer surgery, with a similar prevalence in men and women. Among 597 community-based controls, moderate-to-severe sleep apnoea was present in 27 (24 to 31)%. After adjustment for age, sex, and body mass index, the odds ratio for moderate-to-severe sleep apnoea in patients with colorectal cancer was 1.57 (95% confidence interval 1.08 to 2.29; P = 0.019). The STOP-Bang questionnaire demonstrated acceptable sensitivity (85 (95% confidence interval 76 to 91)%) but low specificity (42 (33 to 52)%).

CONCLUSION: Approximately half of patients undergoing colorectal cancer surgery have moderate-to-severe sleep apnoea, exceeding the prevalence in community-based controls. Clinical symptoms, signs, and STOP-Bang screening are insufficient to reliably identify affected patients, indicating that overnight sleep apnoea assessment is required in this population.

PMID:41983353 | DOI:10.1093/bjsopen/zrag025

Eur J Prev Cardiol. 2026 Apr 15:zwag203. doi: 10.1093/eurjpc/zwag203. Online ahead of print.

ABSTRACT

AIM: A high polygenic score for coronary artery disease (PRSCAD) has been demonstrated to be a strong and independent predictor of atherosclerotic cardiovascular disease (ASCVD) in patients with familial hypercholesterolemia (FH). The objective was to investigate if the addition of a PRSCAD to the FH-Risk-Score enhances ASCVD risk prediction compared to the clinical score alone.

METHODS: Data from 3 independent cohorts of patients with FH have been analysed in this longitudinal study (n=1438). The FH-Risk-Score equation was used to calculate the baseline 10-year ASCVD risk. A high PRSCAD was defined as a score > 75th percentile. The performance of the Combined score was assessed using measures of discrimination (C statistics), calibration (predicted risk vs. observed risk), and reclassification (using a 10-year risk cutoff of 20%).

RESULTS: Overall, the event rate was nearly doubled in individuals having a high PRSCAD (15% vs. 9%, HR 1.77, 95% CI 1.20-2.61, P=0.004). This association was stronger in those with a genetic confirmation of FH (17% vs. 8%, HR 2.34, 95% CI 1.50-3.67, P=0.0002). The Combined score was associated with a marginally non-significant higher C-index than the FH-Risk-Score alone (0.746 to 0.750, P=0.60). The difference in C-index was significant in patients with a genetic confirmation of FH in the moderate FH-Risk-Score group (0.617 to 0.717, P=0.05).

CONCLUSION: Overall, the addition of polygenic information using PRSCAD percentiles to the FH-Risk-Score estimate did not significantly enhance ASCVD risk prediction in patients with FH. Replication efforts with larger number of individuals and incident cases are warranted.

PMID:41983333 | DOI:10.1093/eurjpc/zwag203

Glob Health Action. 2026 Dec;19(1):2648401. doi: 10.1080/16549716.2026.2648401. Epub 2026 Apr 15.

ABSTRACT

Climate change has become one of the most critical health issues globally in the twenty-first century with children bearing the disproportionate burden of the burden since they are more vulnerable than adults because of their physiological, behavioral, and developmental capacities. It is a systematic review that rates the evidence of the relationship between climatic exposures such as heat, air-pollution, and extreme weather events and pediatric health outcomes. The number of peer-reviewed studies involved was 23 published in 2000-2025, which represented different geographic areas and study designs and assessed acute and chronic health outcomes. The Newcastle-Ottawa Scale and the ROBINS-I tool were used to evaluate the methodological quality, and the majority of the studies had low to moderate risks of bias. The narrative synthesis shows that there are always links between air pollutants especially PM2.5, NO2 and O3 and respiratory morbidity, prevalence of asthma and hospitalization of children. Amplified temperatures as well as heat waves were associated with increased cases of heat illness, dehydration, and febrile state in infants and young children. There were elevated cases of diarrheal and vector-related infections, especially in low-resource settings, which were linked to extreme weather events especially floods. Although the overall results were similar, significant differences in the regions and methods were found, and low-income countries show little evidence. In addition, exposures as analyzed in most studies were usually considered individually, which may have underestimated the cumulative or compound climate risks.

PMID:41983323 | DOI:10.1080/16549716.2026.2648401

Epidemiol Psychiatr Sci. 2026 Apr 15;35:e25. doi: 10.1017/S2045796026100572.

ABSTRACT

AIMS: Prevention of child maltreatment – incorporating physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence – is a clearly defined global policy priority. Global Burden of Disease studies have focused on estimating burden attributable to childhood sexual abuse omitting other forms of child maltreatment. This study aims to estimate burden attributable to child maltreatment using data from the first comprehensive national study, the Australian Child Maltreatment Study (ACMS), accounting for the co-occurrence of multiple forms, the complex impact of multi-type maltreatment and the contribution of interrelated factors.

METHODS: We estimated burden attributable to child maltreatment by age and gender for Australia in 2021. Risk-outcome pairs that met criteria for sufficient evidence for a causal relationship were included. Relative risks were estimated as a function of exposure based on data from the ACMS incorporating increased risk with multi-type maltreatment and adjustment for confounding. Levels of exposure in each of the 32 mutually exclusive combinations or patterns of child maltreatment were estimated based on ACMS data by age and gender. The theoretical minimum risk exposure level was determined as no exposure to child maltreatment in the population and population attributable fractions (PAFs) were calculated. Attributable mortality, years of life lost, years lived with disability and disability-adjusted life years (DALYs) were estimated by multiplying PAFs by the relevant burden of disease estimates by age and gender for Australia in 2021. Sensitivity analyses were conducted to assess the robustness of the results. Uncertainty was propagated into attributable burden estimates using Monte Carlo simulation methods.

RESULTS: Overall, child maltreatment accounted for 6.6% (95% uncertainty interval (UI), 6.2-6.9%) of all DALYs for women and 6.4% (95% UI, 6.0-6.7%) of all DALYs for men in Australia in 2021. An estimated 71.2% of self-harm, 57.1% of anxiety disorders and 49.3% of major depressive disorder (MDD) DALYs in women, and 63.8% of self-harm, 55.9% of anxiety disorders and 42.9% of MDD DALYs in men were attributable to child maltreatment.

CONCLUSIONS: Child maltreatment contributes to a substantial proportion of burden of disease in Australia, equivalent to leading lifestyle-related risk factors such as high body mass index, high blood pressure and smoking. This research significantly advances knowledge of the disease burden attributable to child maltreatment and provides novel methodology for measuring the impact of all five forms of child maltreatment combined on mental health and health risk behaviours nationally and globally.

PMID:41983278 | DOI:10.1017/S2045796026100572

Res Synth Methods. 2026 Apr 15:1-18. doi: 10.1017/rsm.2026.10090. Online ahead of print.

ABSTRACT

Meta-analysis is a cornerstone of evidence synthesis, yet challenges arise when studies report heterogeneous summary statistics, such as means and standard deviations (SDs) versus medians, interquartile ranges (IQRs), or other percentiles. Excluding studies that report only medians and IQRs can introduce bias and reduce precision, particularly when outcomes are skewed, which is common in clinical research. Although several methods exist to estimate means and SDs from alternative summaries, many rely on strong normality assumptions, exhibit computational burden, or fail to adequately account for the precision of reported quantiles (e.g., extreme values versus medians). To address these limitations, we propose two flexible weighted estimators for estimating the mean and SD from reported quantiles. The methods leverage inverse-variance and inverse-variance-covariance weighting, respectively, to enhance both accuracy and precision. Additionally, our methods are flexible enough to accommodate any set of reported quantiles and various underlying distributions, and they can be readily implemented using standard statistical software. Simulation studies demonstrate that the weighted estimators provide nearly unbiased estimates of the mean and SD with high precision in most cases, especially for large sample sizes. In a real-world meta-analysis, the estimates obtained using the proposed estimators closely aligned with those derived from true sample statistics. These approaches are particularly valuable for skewed outcomes and offer a practical and user-friendly solution for researchers seeking to integrate heterogeneous data while improving accuracy and precision.

PMID:41983277 | DOI:10.1017/rsm.2026.10090

Bone Jt Open. 2026 Apr 15;7(4):540-548. doi: 10.1302/2633-1462.74.BJO-2025-0322.R1.

ABSTRACT

AIMS: The Reimers migration percentage (MP) is the gold-standard radiological parameter used to aid decision-making regarding surgical management of hip displacement in cerebral palsy (CP). Accurate measurement is important to risk stratify patients and allow timely onward referral from community teams to paediatric orthopaedic services. We performed a study to determine whether experts and novices could use a free smartphone app (HipScreen (HS) app) as a valid method for measuring MP in CP.

METHODS: Using the HS app, two groups measured MP in 20 pelvis radiographs (40 hips) at weeks 0 and 2. The ‘inexperienced’ group included four community physiotherapists with no CP experience. The ‘experienced’ group included four community physiotherapists and two paediatricians with CP experience. All participants watched the tutorial videos on the HS app website. HS app measurements were then compared with gold-standard picture archiving and communication system (PACS) measurements conducted by a senior paediatric orthopaedic surgeon. Modified Pearson correlation (r) was used to determine inter-rater reliability between HS app and PACS measurements. Intraclass correlation coefficient (ICC) was then used to assess intrarater reliability. The mean absolute deviation (MAD) was calculated to compare raters with the gold standard.

RESULTS: HS app measurements in the experienced and inexperienced groups showed highly significant correlation with the gold-standard measurements (p < 0.001). There were no significant differences between intra- or inter-group measurements at weeks 0 and 2 with r > 0.86 and p < 0.001. Both inter- and intra-rater reliability were excellent with ICC > 0.9. There was no statistically significant difference in the MAD within individual measurements and compared with the gold standard.

CONCLUSION: The HS app is accurate in measuring MP in CP when used by non-specialists and specialists. Non-specialists do not require additional supplementary training. These findings suggest app efficacy and safety in regional and national hip surveillance programmes for children with CP.

PMID:41983275 | DOI:10.1302/2633-1462.74.BJO-2025-0322.R1

Acta Oncol. 2026 Apr 15;65:282-288. doi: 10.2340/ao.v65.45593.

ABSTRACT

BACKGROUND AND PURPOSE: We aimed to describe temporal changes in diagnostic work-up, treatment, and prostate cancer (PCa) mortality in locally advanced PCa in 2016-2024 in Sweden. Patient/material and methods: Men registered in the National Prostate Cancer Register of Sweden in 2016-2024 with locally advanced PCa; clinical T stage 3-4, no distant metastases, and prostate-specific antigen < 100 ng/ml were included. We computed the proportion of use of prostate magnetic resonance imaging (MRI) before biopsy, radical prostatectomy, radical radiotherapy, androgen deprivation therapy, and abiraterone, and described the trend in PCa mortality across three calendar periods.

RESULTS: During the 9-year study period 7,484 men with locally advanced PCa were identified. Use of MRI before biopsy increased from 3% in 2016 to 73% in 2024. Concomitantly, radical treatment increased from 35% to 48%, entirely due to increased use of radiotherapy. Abiraterone was not used before 2022 but 31% received this treatment in 2024. The 3-year PCa mortality decreased from 8% (95% confidence interval [CI]: 7-9) in 2016-2018 to 6% (95% CI: 4-8) in 2022-2024.

INTERPRETATION: In this nationwide, population-based study of men with locally advanced PCa, the use of MRI before biopsy, radical radiotherapy, and treatment with abiraterone increased over time. These changes coincided with a modest decrease in 3-year PCa mortality.

PMID:41983270 | DOI:10.2340/ao.v65.45593