Category: Statistics

Environ Sci Pollut Res Int. 2026 Jul 25. doi: 10.1007/s11356-026-38088-x. Online ahead of print.

NO ABSTRACT

PMID:42498872 | DOI:10.1007/s11356-026-38088-x

Surg Endosc. 2026 Jul 24. doi: 10.1007/s00464-026-13082-z. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence enables surgical robots to perform certain actions without surgeon control or semi-autonomously. Patient willingness to undergo surgery via an automated machine is a key barrier to adoption of emerging robotic technology. Further, semi-autonomous surgical robots raise numerous ethical concerns, yet little is known about patients’ perceptions of these issues. We assessed patients’ perceptions of ethical issues in semi-autonomous robot-assisted surgery (RAS) and how their perceptions would affect decision-making about undergoing semi-autonomous RAS.

METHODS: Adult patients who underwent surgery within the prior three years, with a non-autonomous robot or without any robot, were recruited via email. We conducted semi-structured teleconference interviews that included open- and closed-ended questions, to assess factors affecting patient decision-making and ethical concerns about semi-autonomous RAS, and demographics. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis.

RESULTS: Fifty patients participated. Most participants were female (62%), White (52%), and the mean age was 53. Most patients (56%) would undergo semi-autonomous RAS. However, willingness varied by which surgical process the robot would have control over. Many patients (46%) were highly willing to undergo semi-autonomous RAS when the robot has control over instruments. Four themes emerged about ethical concerns driving patients’ willingness to undergo semi-autonomous RAS: (1) desire for informed consent to express self-determination, (2) semi-autonomous RAS introduces new risks to procedures, (3) doctor-patient relationship and trust can facilitate patients’ willingness to undergo semi-autonomous RAS, and (4) semi-autonomous RAS comprises an important surgical innovation, conferring benefits.

CONCLUSION: Our findings suggest that most patients would be willing to undergo semi-autonomous RAS. Willingness was related to ethical considerations of informed consent, perceived risks, level of surgeon versus robot control over surgical processes, doctor-patient relationship, and perceived benefits. Addressing patients’ perceptions of semi-autonomous RAS may facilitate greater integration of surgical robots into clinical practice.

PMID:42498865 | DOI:10.1007/s00464-026-13082-z

Surg Endosc. 2026 Jul 24. doi: 10.1007/s00464-026-13167-9. Online ahead of print.

ABSTRACT

INTRODUCTION: This study evaluated whether a perioperative opioid-sparing multimodal pain regimen with intraoperative transversus abdominis plane (TAP) block reduces opioid use after laparoscopic paraesophageal hernia (PEH) repair while maintaining pain control.

METHODS: A retrospective chart review identified patients who underwent laparoscopic PEH repair at our institution from January 2010 to April 2025. Patients were grouped before and after implementation of a multimodal regimen with TAP block (July 2017). The regimen included scheduled acetaminophen and celecoxib. Outcomes included inpatient and follow-up pain scores (0-10), inpatient morphine milligram equivalents (MME), and opioid prescriptions at discharge or within 30 days. Statistical analysis included chi-squared, t tests, nonparametric tests, and multivariate analysis.

RESULTS: A total of 2539 patients were included (813 pre-regimen, 1726 post-regimen). Inpatient opioid use decreased from 86% to 67.6% (p < 0.001), and inpatient oral MME was significantly lower post-regimen (p < 0.001). Opioid prescriptions at discharge declined from 94.7% to 20.6% (p < 0.001). Median inpatient and follow-up pain scores were lower in the multimodal group (p < 0.0001 and p = 0.015). After adjusting for demographics, maximum inpatient pain score, and additional procedures at time of surgery, the post-regimen group remained associated with reduced inpatient opioid use (OR 0.36, p < 0.001). Median length of stay decreased from 2 to 1 day (p < 0.001). 30-day ED visits and readmissions were not significantly different (p = 0.116 and p = 0.404).

CONCLUSION: Implementation of a multimodal opioid-sparing regimen with intraoperative TAP block reduced inpatient and post-discharge opioid use after laparoscopic PEH repair, with lower pain scores and shorter hospital stays without increased ED visits or readmissions.

PMID:42498863 | DOI:10.1007/s00464-026-13167-9

J Neurol. 2026 Jul 24;273(8):491. doi: 10.1007/s00415-026-13999-4.

ABSTRACT

BACKGROUND: Few studies investigated factors that predict intensive language therapy (ILT) outcome. This study aimed to analyze multimodal neural factors that possibly underly ILT success.

METHODS: Lesion volume and DTI analyses were performed with 17 aphasic individuals, and complemented by fMRI analysis in 12 patients (due to drop-outs). Structural and functional data were collected at the beginning of a seven week ILT program and correlated with language changes, measured using the Aachen Aphasia Test. Additionally, all analyses were correlated with the patients’ initial aphasia severity.

RESULTS: Therapy success was associated with functional activity in right inferior and middle temporal gyri, bilateral superior frontal gyrus/ adjacent anterior cingulate cortex, and right occipital lobe (lingual gyrus, fusiform gyrus, lateral occipital cortex). Statistically uncorrected DTI analysis (p(uncorr) < .001) revealed a positive correlation between language improvement and structural integrity in the right temporal lobe and two left-hemisphere white matter clusters (frontal, parietal). Neither global nor language-specific lesion volume was correlated with therapy outcome. However, lesion volume in insula, putamen and white matter tracts was correlated with initial aphasia severity.

CONCLUSIONS: Our preliminary results suggest a predictive role of right temporal structures and functional activation in areas associated with healthy language processing. They also indicate a contribution of functional activation in brain areas associated with cognitive control and non-linguistic semantic processing. Further, lesion volume in both global and language-specific structures proved relevant for the initial severity of aphasia but not for recovery potential following ILT. Our results should be regarded as hypothesis-generating for future research.

PMID:42498848 | DOI:10.1007/s00415-026-13999-4

Eur Geriatr Med. 2026 Jul 24. doi: 10.1007/s41999-026-01565-0. Online ahead of print.

ABSTRACT

PURPOSE: Muscle health encompasses multiple components, including muscle mass, absolute strength, and muscle-specific strength (MSS). MSS, defined as strength relative to corresponding muscle mass, has emerged as a marker of muscle health, but its site-specific relevance to mobility remains unclear. Because these components are often examined separately, direct upper- and lower-limb comparisons are needed to clarify which indicators offer the most clinically relevant information on gait speed. We compared upper- and lower-limb muscle mass, absolute strength, and site-specific MSS in community-dwelling older adults.

METHODS: This cross-sectional analysis included 284 community-dwelling adults aged ≥ 65 years. Handgrip strength, knee extension strength, arm and leg muscle mass, and usual gait speed were measured. Upper-limb MSS was calculated as handgrip strength/arm muscle mass, and lower-limb MSS as knee extension strength/leg muscle mass. Age-, sex-, and body mass index-adjusted linear regression models examined associations with gait speed and compared model fit.

RESULTS: Mean age was 77.2 years; 77.1% were women. Arm and leg muscle mass were not associated with gait speed. Knee extension strength showed the strongest individual association (standardized β = 0.37, 95% confidence interval 0.23-0.51). Upper-limb MSS (β = 0.28, 0.15-0.40) and lower-limb MSS (β = 0.32, 0.21-0.44) were associated with gait speed. When entered simultaneously, upper-limb MSS (β = 0.18, 0.05-0.31) and lower-limb MSS (β = 0.27, 0.16-0.39) remained independently associated, and the combined MSS model showed the best fit.

CONCLUSION: Site-specific MSS, particularly when assessed in both upper and lower limbs, may provide complementary mobility-related information beyond limb muscle mass alone.

PMID:42498847 | DOI:10.1007/s41999-026-01565-0

Environ Monit Assess. 2026 Jul 25;198(8):875. doi: 10.1007/s10661-026-15701-7.

ABSTRACT

Afforestation of former agricultural land with silver birch (Betula pendula Roth) is increasingly promoted in Northern and Eastern Europe, yet its long-term effects on soil-plant heavy metal dynamics remain insufficiently understood. We assessed heavy metal accumulation in soil and woody biomass (stemwood and bark) 20 years after afforestation of former agricultural land at 11 plantations. Eleven elements (As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, and Zn) were initially determined, but subsequent analyses focused on five elements (Cr, Cu, Fe, Mn, and Zn) consistently detected above the limit of quantification. Metal allocation between stemwood and bark and the influence of soil physicochemical properties (pH, P, K, C_org, N_tot, bulk density and available water content) were analyzed. We also examined relationships between soil metal concentrations, tree growth, and the distribution of metals between stemwood formed at early-age (1-10 years) and late-age (11-23 years). Heavy metal accumulation was primarily governed by soil properties, with pH, P, and K showing important relationships with bioaccumulation patterns, while the role of C_org varied among elements and substrates. No statistically significant evidence was found that elevated soil metal concentrations inhibited tree growth. Within stems, metal concentrations varied with wood age, with higher levels observed in early-age wood. Overall, the findings highlight the importance of soil properties in shaping heavy metal dynamics in birch plantations and provide insight into long-term trace metal allocation in forest ecosystems established on former agricultural soils, supporting sustainable afforestation and the evaluation of woody biomass for potential bioenergy use.

PMID:42498846 | DOI:10.1007/s10661-026-15701-7

J Neurosurg. 2026 Jul 24:1-13. doi: 10.3171/2026.2.JNS252393. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic transsphenoidal surgery (eTSS) is a common neurosurgical procedure used to treat pituitary adenomas (PAs). The authors evaluated the incidence of complications, early readmission, and early reoperation following eTSS for PAs and identified clinical, surgical, and tumor characteristics predictive of these outcomes.

METHODS: The data of all patients with histologically confirmed PAs who underwent eTSS at the authors’ institution between May 2011 and September 2024 were retrospectively reviewed. Thirty-day postoperative complications were grouped into surgical and medical categories. Early readmission and early reoperation were defined as occurring within 90 days of discharge and surgery, respectively.

RESULTS: A total of 709 endoscopic transsphenoidal operations (655 direct and 54 extended approaches) were performed in 693 patients. The median tumor diameter (IQR) was 24 (17-32) mm, and 656 cases (93%) were macroadenomas. Cavernous sinus invasion on MRI was noted in 32.2% of cases. Fifteen percent were reoperations. Gross-total resection was achieved in 63.5% of patients, and the median length of stay was 3 days. Surgical complications included postoperative CSF leakage (4.2%), epistaxis (2.7%), cranial nerve palsy (1.0%), worsened vision (1.0%), meningitis (1.0%), stroke (0.8%), hydrocephalus (0.7%), hematoma (0.6%), sinusitis (0.6%), abdominal hematoma or infection (0.4%), carotid artery injury (0.1%), and death (0.3%). Medical complications included transient diabetes insipidus (8.7%), permanent diabetes insipidus (2.4%), bacteremia/sepsis (0.7%), pneumonia (0.3%), and deep venous thrombosis/pulmonary embolism (0.1%). Early readmission and early reoperation were observed in 10.2% and 4.8% of cases, respectively. The most common reasons for early readmission were delayed hyponatremia (4.2%), CSF leakage (1.8%), infection (1.1%), epistaxis (0.7%), and hypocortisolemia (0.1%), while the most common reasons for early reoperation were CSF leakage (2.5%), residual tumor (1.3%), worsened vision (0.6%), infection (0.6%), and hematoma (0.3%). Predictors of complications included increasing tumor diameter, firm tumor consistency, the presence of an intraoperative CSF leak, and use of an extended approach. While not statistically significant, rates of postoperative CSF leakage (5.1% vs 3.4%), early readmission (11.4% vs 9.1%), and early reoperation (5.7% vs 4.0%) decreased from the first half of the cohort to the second half of the cohort.

CONCLUSIONS: Endoscopic TSS for PAs is associated with low morbidity and mortality, although a number of complications are possible. Readmission and reoperation following eTSS occur less frequently when endocrine readmissions can be averted. The results of this study provide information on the risks associated with eTSS and serve as a guide for neurosurgeons to counsel patients undergoing this procedure.

PMID:42497462 | DOI:10.3171/2026.2.JNS252393

J Neurosurg Pediatr. 2026 Jul 24:1-7. doi: 10.3171/2026.3.PEDS25569. Online ahead of print.

ABSTRACT

OBJECTIVE: Early referral of patients with suspected sagittal suture synostosis is important as it enables minimally invasive surgery. To encourage early referrals, the authors’ craniofacial center has increased its efforts to educate referring healthcare providers. This study evaluated the developments of timely referral and age at referral of patients with sagittal suture synostosis.

METHODS: Nonsyndromic patients born between 2000 and 2020 were included in this cohort study. The type of surgery was mainly based on age at referral: frontobiparietal remodeling was done if the patient was older than 6 months of age, and a minimally invasive procedure was done if the patient was younger. Logistic regression was performed to assess the relationship between the year of birth and the probability of a timely first visit (i.e., before 5.5 months).

RESULTS: A total of 698 patients were included, with a median age at first visit of 3.6 months. Of the patients born in 2000, 60% had their first visit before the age of 5.5 months, compared to 77% of those born in 2020. Since 2010, there has been a statistically significant positive association between the year of birth and the probability of having the first visit on time (OR 1.10, 95% CI 1.03-1.18). Overall, pediatricians were the most frequent referrers.

CONCLUSIONS: The proportion of timely referred patients with nonsyndromic sagittal suture synostosis has increased over the past 20 years, and since 2010, there has been a statistically significant increase in the probability of timely referral, allowing for more patients to be treated with minimally invasive spring-assisted correction. Further efforts are needed to increase timely referrals and raise awareness among parents and healthcare providers.

PMID:42497457 | DOI:10.3171/2026.3.PEDS25569

Cancer Res Commun. 2026 Jul 24. doi: 10.1158/2767-9764.CRC-26-0165. Online ahead of print.

ABSTRACT

Black/African American populations, globally, bear the greatest prostate cancer (CaP) burden compared to other racial/ethnic groups. Addressing CaP disparities in Black men is complex, requiring a patient-centered, community-centric and comprehensive approach. This study integrates iCCaRE Consortium findings and broader literature to address unmet needs in survivorship care. The iCCaRE Consortium implemented five complementary pilot studies using mixed-methods designs, including feasibility trials, qualitative research, and observational analyses across the United States and sub-Saharan Africa. Descriptive statistics, subgroup analyses, and qualitative thematic analyses were performed across these studies. Collectively, projects addressed multilevel determinants including social, behavioral, and biological drivers of disparities. Project 1 implemented a Virtual Reality Assistant (ViRA) across clinical and community settings, with ongoing evaluation in pragmatic trials. Project 2 showed strong patient preference for home-based cancer care. Project 3 enrolled demonstrated trends toward improved health-related quality of life. Project 4 identified key themes influencing survivorship experiences. Project 5 identified biological mechanisms linking stress, immune modulation, and symptom burden. The iCCaRE pilot projects demonstrate the feasibility and early impact of a consortium-based, transdisciplinary approach to addressing CaP disparities in Black men. These findings highlight the importance of integrating patient-centered interventions, community engagement, and biological insights to inform scalable strategies aimed at improving survivorship outcomes and advancing health equity. The iCCaRE Consortium demonstrates that a transatlantic, patient-centered, and multidisciplinary approach integrating social, clinical, and biological factors can generate scalable strategies to improve survivorship outcomes and advance equity in CaP care for Black men.

PMID:42497456 | DOI:10.1158/2767-9764.CRC-26-0165

J Magn Reson Imaging. 2026 Jul 24. doi: 10.1002/jmri.70458. Online ahead of print.

ABSTRACT

BACKGROUND: Assessment of amyloid-β (Aβ) burden and associated iron deposition and neurodegeneration is important for Alzheimer’s disease (AD) management. Although quantitative susceptibility mapping (QSM) detects iron and myelin changes, conventional metrics suffer from signal cancelation between paramagnetic and diamagnetic components. Consequently, spatial interactions between these independent susceptibility sources and Aβ burden remain unestablished.

PURPOSE: To investigate spatial associations between regional Aβ burden and independent paramagnetic and diamagnetic susceptibility sources using χ-separation.

STUDY TYPE: Prospective.

POPULATION: A total of 77 participants with mild cognitive impairment or dementia (mean age, 74 years; women, 50) examined using QSM and amyloid positron emission tomography (PET) (¹⁸F-flutemetamol or ¹⁸F-florbetapir).

FIELD STRENGTH/SEQUENCE: 3 T/QSM (3-dimensional multi-echo gradient-echo sequence).

ASSESSMENT: χ-separation decomposed QSM data into paramagnetic (χ-para) and diamagnetic (χ-dia) components. Centiloid-scale maps standardized PET quantification for voxel-wise analysis. The spatial relationship between Aβ load and susceptibility metrics was analyzed using voxel-wise correlations within AD-signature cortical regions.

STATISTICAL TESTS: Voxel-wise spatial associations between Centiloid values and QSM metrics were evaluated using Pearson’s coefficients. Spatial association was considered statistically significant if the 99% confidence interval (CI) did not cross zero.

RESULTS: Conventional QSM showed near-zero cortical susceptibility and obscured pathological details owing to physiological cancelation. χ-separation unmasked susceptibility sources. Local Aβ deposition was consistently associated with reduced absolute χ-dia across cortical regions (mean r range: -0.267 to -0.098; all 99% CIs did not cross zero), consistent with alterations in net diamagnetic susceptibility sources, potentially involving myelin-related components. χ-para showed weaker and regionally heterogeneous associations with Aβ burden, with a positive association most evident in the precuneus (mean r = 0.072, 99% CI: 0.052-0.092).

DATA CONCLUSION: χ-separation reveals region-specific cortical alteration associated with regional Aβ pathology. By separating these susceptibility sources, this method may provide complementary information to conventional QSM, offering a refined, noninvasive approach for characterizing amyloid-associated tissue changes in AD.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

PMID:42497445 | DOI:10.1002/jmri.70458