Category: Statistics

Mult Scler Relat Disord. 2026 May 26;112:107283. doi: 10.1016/j.msard.2026.107283. Online ahead of print.

ABSTRACT

INTRODUCTION: Cognitive impairment (CI) is a significant burden for patients with multiple sclerosis (MS). However crucial its assessment is, longitudinal measurement of cognitive performance is susceptible to learning effect, making the results of repeated evaluations difficult to interpret. Reliable change index (RCI) and standardized regression based norms (SRB) are accepted statistical methods to assess the reliability of a difference score between two observations. Thus, our aims were to provide RCIs and SRBs for all three subtests of the Brief International Cognitive Assessment for MS (BICAMS) battery and to measure the prevalence of true cognitive worsening and improvement.

METHODS: We retrospectively evaluated the first interim analysis data of the longitudinal follow-up or our BICAMS prevalence study-cohort after 1-year. We analyzed the data of 242 MS patients.

RESULTS: We calculated both the RCIs and the SRBs for all three subtests of the BICAMS battery. According to the RCI, 5.4%, 6.9% and 14.6% worsened while 12.3%, 34.3% and 10.6% improved on the SDMT, BVMT-R and CVLT-II respectively. In case of SRB method, 3.8%, 8.3% and 19.7% worsened while 3.8%, 7.6% and 0.0% improved. The κ values revealed a mild-to-moderate agreement (κ=0.391-0.540; p<0.001). In case of the BVMT-R and the CVLT-II assessments the baseline scores influenced this outcome significantly (BVMT-R: OR: 1.068; 90%CI: 1.001-1.138; CVLT-II: OR: 1.096; 90%CI: 1.041-1.153).

CONCLUSION: Comparing the methods, RCI seems to be better in cases with already established CI, while SRB, the more complex method, seemingly detects change better in cognitively intact patients.

PMID:42241785 | DOI:10.1016/j.msard.2026.107283

Poult Sci. 2026 May 20;105(9):107156. doi: 10.1016/j.psj.2026.107156. Online ahead of print.

ABSTRACT

The type VI secretion system (T6SS) is an important fitness determinant of Salmonella enterica serovar Typhimurium (S. Typhimurium) during host colonization and bacterial competition. Tldi1 has been identified as an immunity protein associated with a T6SS antibacterial toxin-immunity module, but its contribution to avian infection remains unclear. This study investigated whether Tldi1 affects the infection outcome of S. Typhimurium in young chickens. Three-day-old Hy-Line Brown chickens were challenged with the wild-type strain SL1344, a tldi1 deletion mutant, or a complemented strain. Clinical signs, body weight, liver and spleen indices, splenic bacterial loads, tissue pathology, cecal mucin staining, inflammatory cytokine expression, intestinal barrier-related gene expression, and cecal microbiota composition were evaluated. Compared with wild-type infection, the tldi1 deletion mutant caused milder clinical signs, lower liver and spleen indices, reduced splenic bacterial loads, and attenuated histopathological lesions in the liver, spleen, ileum, and cecum. The mutant also induced lower expression of several pro-inflammatory cytokine genes and partially alleviated the downregulation of intestinal barrier-related genes. Complementation of tldi1 largely restored the wild-type infection phenotype. Cecal 16S rRNA sequencing showed that tldi1 deletion was associated with altered microbial community features and reduced inter-individual dispersion; however, overall beta-diversity differences were not statistically significant. These findings indicate that Tldi1 contributes to the in vivo fitness and infection-associated pathology of S. Typhimurium in chickens. The results provide a basis for further investigation of T6SS toxin-immunity modules as potential targets for controlling Salmonella infection in poultry.

PMID:42241763 | DOI:10.1016/j.psj.2026.107156

Poult Sci. 2026 May 25;105(9):107171. doi: 10.1016/j.psj.2026.107171. Online ahead of print.

ABSTRACT

As a consequence of the inevitable hatch window and the processing and transporting steps in conventional hatchery practices, broiler chicks may spend up to 20 – 60 h without access to feed and water post-hatch. To assess the immediate and long-term effects of post-hatch feed deprivation, 960 Ross308 broilers were allocated to a randomized complete block design with time of hatch during the hatch window as the blocking factor. Within each block, chicks were randomly assigned to one of three treatments: immediate feed access post-hatch (T0), feed access at 24 h (T1), or 48 h biological age (BA) (T2). Performance parameters were measured at the end of each feeding phase, while relative organ weights, duodenal morphological parameters and fasted nutrient metabolite concentrations were assessed as repeated measures at 24 h, 48 h, 72 h, 96 h, days 7 and 10 BA, and at days 14, 28 and 42. Between hatch and day 11, T2 chicks had a higher average daily feed intake compared with T0 and had the highest feed conversion ratio (FCR). Overall, between hatch and day 42, T2 chicks had the least efficient FCR and tended to have the lowest body weight at the end of each feeding phase. Significant effects of post-hatch feed deprivation on the physiological measurements were limited to the relative bursa (RBW) and liver (RLW) weights and were limited to the first two weeks post-hatch, with T2 chicks having a lower RBW compared with T1 between hatch and day 11. Concurrently T1 chicks had a lower RLW compared with T0, which reversed by day 14 as T1 had higher RLW than T0. No effects of post-hatch feed deprivation were present on duodenal morphology and fasted nutrient metabolites, however the effect of sex was present in several of these and relative organ weight parameters. Due to the frequent sampling schedule, insights were gained into the development of post-hatch nutrient metabolism, which may help to further optimize nutritional composition of starter feeds for on-farm hatched broilers.

PMID:42241752 | DOI:10.1016/j.psj.2026.107171

Heart Lung. 2026 Jun 4;79:102861. doi: 10.1016/j.hrtlng.2026.102861. Online ahead of print.

ABSTRACT

BACKGROUND: In South Asia, climate change caused rising urban heat, and rapid urbanisation has become a major public health concern, particularly for cardiovascular health. However, socioeconomic factors (including income, education, and housing quality) have not been comprehensively included in any of the previous studies.

OBJECTIVES: This study aimed to examine the association between prolonged heat extended exposure and the prevalence of cardiovascular disease.

METHODS: A cross-sectional study was conducted with 1300 adults aged ≥ 19 years, recruited from different urban centers. Data was collected from June to August 2025 using a structured questionnaire, assessing cardiovascular health indicators, heat exposure levels, socioeconomic status, and perceptions of public health policies. Multinomial logistic regression and Wilcoxon rank sum test were performed by using the SPSS-26 and R-Studio.

RESULTS: The sample comprised 55.61% males and 44.38% females. Approximately 44.7% of participants reported cardiovascular condition. Prolonged heat exposure was significantly associated with increased cardiovascular risk (OR = 1.29, 95% CI: 1.09-1.79, p = 0.010). Heat related stress in urban areas was strongly associated with adverse outcomes (OR = 3.67, 95% CI: 2.23-6.80, p < 0.001). Awareness of heat related campaigns was associated with lower cardiovascular risk (OR = 0.54, 95% CI: 0.31-0.81, p = 0.01).

CONCLUSION: Cardiovascular health is associated with urban heat exposure. Socioeconomic factors may modify this relationship. Improved education, healthcare system and targeted health policies are needed to reduce the impact.

PMID:42241742 | DOI:10.1016/j.hrtlng.2026.102861

Drug Metab Dispos. 2026 May 12;54(6):100322. doi: 10.1016/j.dmd.2026.100322. Online ahead of print.

ABSTRACT

Tree shrews (Tupaia belangeri) are nonprimate animal species available for use in biomedical studies. Because the molecular and enzymatic properties of their cytochromes P450 (P450s or CYPs) are similar to human P450s, tree shrews are a promising animal model for preclinical studies. However, in tree shrews, the properties of dextromethorphan O-demethylation, a marker reaction for human CYP2D6, have not yet been fully elucidated. In this study, we characterized dextromethorphan O-demethylation in tree shrews. We observed biphasic Michaelis-Menten kinetics for dextromethorphan O-demethylation mediated by tree shrew liver microsomes. However, in the narrow dextromethorphan concentration range 0.69-17 μM, monophasic kinetics were observed. Of the 11 recombinant tree shrew P450s analyzed, CYP2A13, CYP2Cs (CYP2C18, CYP2C76a, and CYP2C76b), and CYP2D8a showed dextromethorphan O-demethylation activity; of these, tree shrew CYP2D8a showed the highest activity (22 nmol/min per nmol P450). The quantification of tree shrew CYP2D8a protein by immunoblotting showed levels ranging from 2.3 to 9.2 pmol/mg protein in liver microsomes from 5 tree shrews. The intrinsic clearance of the high-affinity component of dextromethorphan O-demethylation was significantly correlated (r = 0.95, P < .01) with the hepatic protein content of tree shrew CYP2D8a. The intrinsic clearance of the low-affinity component of dextromethorphan O-demethylation was tentatively correlated with both tree shrew CYP2A13 and CYP2C activities, although the correlations did not reach statistical significance. These results suggest that CYP2D8a is the primary enzyme responsible for dextromethorphan O-demethylation in tree shrews. SIGNIFICANCE STATEMENT: We observed biphasic kinetics of dextromethorphan O-demethylation in tree shrew liver microsomes and the activities of recombinant CYP2A13, CYP2C18, CYP2C76a, CYP2C76b, and CYP2D8a. The intrinsic clearance of the high-affinity component was significantly correlated with CYP2D8a protein content. The intrinsic clearance of the low-affinity component was tentatively correlated with both CYP2A13 and CYP2C activities, but the correlations were not statistically significant. These results suggest that CYP2D8a is the primary enzyme responsible for dextromethorphan O-demethylation in tree shrews.

PMID:42241735 | DOI:10.1016/j.dmd.2026.100322

JACC Adv. 2026 Jun 4;5(7):102858. doi: 10.1016/j.jacadv.2026.102858. Online ahead of print.

ABSTRACT

BACKGROUND: Anxiety disorders are common in pediatric heart disease (PHD), including congenital, arrhythmic, and acquired heart disease. The standard screening tool, Screen for Child Anxiety Related Emotional Disorders (SCARED), is too lengthy to complete in a busy pediatric cardiology clinic.

OBJECTIVES: This study assessed the concurrent validity of a briefer tool, Pediatric-Reported Outcomes Measurement Information System Pediatric Anxiety (PROMIS-Anx), relative to SCARED in children with PHD.

METHODS: Children, aged 7.5 to <18 years, with PHD and their caregivers both completed PROMIS-Anx and SCARED between January 2020 and August 2022 during cardiology clinic visits. Association of PROMIS-Anx and SCARED scores were analyzed using Spearman correlation coefficient (r_s), and a cut point was developed for PROMIS-Anx in children and their caregivers using Youden index.

RESULTS: Among 144 child/caregiver pairs, anxiety was present in 36.0% of children by SCARED. Scores on SCARED and PROMIS-Anx were higher in females, adolescents, and those with known behavioral health disorders, but were not associated with cardiac disease severity, race, or ethnicity. SCARED and PROMIS-Anx scores were highly correlated in children (r_s = 0.76, P < 0.001), and slightly less so in caregivers (r_s = 0.58, P < 0.001), both reaching statistical significance. A PROMIS-Anx score of >30 was identified as a threshold for significant anxiety symptoms based on SCARED.

CONCLUSIONS: PROMIS-Anx scores correlate with SCARED across the range of scores, particularly when completed by the child. Routine screening for anxiety in cardiology clinic, with a brief tool such as PROMIS-Anx, can promote earlier identification and treatment of anxiety in children with PHD.

PMID:42241734 | DOI:10.1016/j.jacadv.2026.102858

J Pediatr Urol. 2026 May 20;22(5):106039. doi: 10.1016/j.jpurol.2026.106039. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Antibiotic resistance is a challenge in contemporary world. Urethroplasty for hypospadias is one of the most common urological surgeries performed around the world, yet, there is still no consensus on the use of antibiotics pre- and post-operatively. Our objective was to analyze the effectiveness of antibiotic prophylaxis and therapy before, during, and after hypospadias repair in children.

METHODS: A prospective randomized trial was carried out including patients with coronal hypospadias who underwent urethroplasty performed by one surgeon. Urethral catheters were used in all cases for 10 days. Study participants were randomly assigned in a 1:1:1 ratio to receive a single intraoperative administration of antibiotics (Group I); an intraoperative antibiotic prophylaxis and antibiotic therapy for 10 days until the removal of urethral catheter (Group II); no antibiotic administration (Group III). Randomization was performed using computer-generated permuted blocks with randomly varying block sizes, prepared by an independent statistician. The results were analyzed using the analysis of variance (ANOVA). The following criteria were compared: postoperative functional complications, such as: urethral fistula, stenosis, diverticulum; wound infection symptoms: hyperemia of surgical site, pain during palpation, and symptomatic urinary tract infection.

RESULTS: A total of 300 patients were included in the study. Two patients (2%) in Group I, two patients (2%) in Group II, and four patients (4%) in Group III had urethral fistulas, requiring surgery 6 months after primary repair, yet without statistical difference between groups. We found no significant difference in frequency of symptomatic UTIs between three groups (p = 0.182).

CONCLUSION: There is no effect of antibiotic prophylaxis and therapy on the frequency of postoperative surgical and infectious complications after urethroplasty for coronal hypospadias repair in children.

PMID:42241729 | DOI:10.1016/j.jpurol.2026.106039

ANZ J Surg. 2026 Jun 4. doi: 10.1111/ans.70728. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite established ethical principles, a critical synthesis of how informed consent deficiencies, leading to costly malpractice lawsuits in elective orthopedic surgery, relate to medico-legal outcomes, documentation pitfalls, and team roles is lacking. This scoping review aimed to investigate the status of obtaining informed consent by the treatment team in elective orthopedic surgeries and the related legal consequences.

METHODS: Following the Arksey & O’Malley framework update by Levac et al., we conducted a comprehensive search across PubMed, Scopus, Web of Science databases, and the Google Scholar search engine. Studies focusing on informed consent, legal factors, and the treatment team in elective orthopedic procedures were included in this review. Data were charted and analyzed using thematic analysis for qualitative synthesis, supplemented by quantitative summary statistics.

RESULTS: Qualitative analysis identified four themes: documentation patterns, legal factors, cultural considerations, and risk mitigation strategies. Findings showed frequent documentation gaps (13%-32% of forms lacked specific complications). Nerve injury was the most common cause of lawsuits (46%-56%). In lumbar fusion, 24% of claims cited failure to obtain consent. US compensation averaged $871 093, vastly exceeding European figures. Patient recall of complications was poor (22.5%) but improved to 48% with written aids.

CONCLUSION: The informed consent process in elective orthopedics faces systematic challenges, including inconsistent documentation, high litigation risk, and inadequate patient understanding. To reduce legal exposure and promote safety, implementing evidence-based, procedure-specific consent forms, interdisciplinary team training, and culturally competent communication is recommended. Addressing these requires coordinated policy reform at institutional and educational levels.

PMID:42241726 | DOI:10.1111/ans.70728

Intern Med J. 2026 Jun 4. doi: 10.1111/imj.70457. Online ahead of print.

ABSTRACT

BACKGROUND: Polymyalgia rheumatica is the commonest inflammatory condition affecting adults over 50 years of age, however it has been under-researched and management varies in everyday clinical practice.

AIM: This national survey of rheumatologists and trainees managing polymyalgia rheumatica (PMR) in Australia sought to determine current diagnostic and management approaches and establish a baseline for future development of a disease-specific clinical care standard.

METHODS: Following ethics approval, an online survey was circulated to the membership of the Australian Rheumatology Association. Relevant demographic information about respondents was collected, along with answers to multiple-choice questions on the clinical presentation, diagnosis, management and prognosis of PMR. Free-text responses were also permitted at the end of each section. The survey remained open between 25 March 2022 and 11 November 2022. Data analysis involved descriptive statistics for multiple-choice questions and thematic analysis for free-text responses.

RESULTS: Seventy-nine clinicians completed the survey, of whom the majority were qualified rheumatologists who regularly managed patients with PMR. Most respondents relied upon clinical diagnosis, but some did not recognise peripheral joint involvement or normal inflammatory markers as possible features of PMR. Access to imaging investigations like ¹⁸F-fluorodeoxyglucose positron emission tomography combined with computed tomography was limited but desirable in circumstances of diagnostic uncertainty. Management predominantly involved glucocorticoid monotherapy; however, long-term outcomes were diverse and almost every clinician had prescribed a conventional synthetic DMARD for steroid-sparing purposes. The use of adjunctive physical therapy was inconsistent.

CONCLUSION: Variability remains in the diagnosis and management of PMR among Australian clinicians, with gaps in recognition of atypical presentations, imaging access and incorporation of physical therapy, ultimately supporting the need for standardised, evidence-based clinical care guidelines.

PMID:42241712 | DOI:10.1111/imj.70457

Obstet Gynecol. 2026 Jun 4. doi: 10.1097/AOG.0000000000006344. Online ahead of print.

ABSTRACT

OBJECTIVE: To synthesize evidence on the benefit-risk profile of antenatal corticosteroid (ACS) exposure in twin pregnancies and to explore effect modification by gestational age at birth and study design.

DATA SOURCES: PubMed, Embase, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (from inception to October 2025) were searched using terms for twin pregnancy or multiple gestation and antenatal corticosteroids (eg, betamethasone, dexamethasone).

METHODS OF STUDY SELECTION: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PROSPERO CRD420251275650), we included randomized controlled trials (RCTs) and observational studies comparing ACS exposure with no ACS in twin pregnancies and reporting neonatal outcomes. Observational studies were eligible only if they reported adjusted effect estimates accounting for relevant confounders. Primary outcomes were neonatal mortality and neonatal hypoglycemia; key secondary outcomes included neonatal intensive care unit (NICU) or special care unit admission and major respiratory outcomes. Risk of bias was assessed with version 2 of the Cochrane Risk of Bias tool and Risk of Bias in Non-randomized Studies of Interventions.

TABULATION, INTEGRATION, AND RESULTS: Random-effects meta-analyses were conducted to estimate risk ratios (RRs) with 95% CIs. Heterogeneity was assessed with the I2 statistic, and small-study effects were evaluated when feasible. Prespecified subgroup analyses examined gestational age (less than 34 weeks vs 34 or more weeks) and study design. Sixteen studies (18,367 neonates, 8,723 ACS exposed) were included. Overall, the certainty of evidence was moderate to low. Exposure to ACS was not significantly associated with a reduction in neonatal mortality (RR 0.77, 95% CI, 0.59-1.01). Antenatal corticosteroid was not associated with a reduction in respiratory distress syndrome (RDS) overall (RR 1.11, 95% CI, 0.81-1.52), and gestational age-stratified analyses were nonsignificant; however, analyses restricted to RCTs suggested a higher risk of RDS among ACS-exposed neonates (P<.001). Exposure to ACS was associated with increased supplemental oxygen requirement (RR 1.72, 95% CI, 1.07-2.74), neonatal hypoglycemia (RR 1.80, 95% CI, 1.30-2.51), and NICU or special care unit admission (RR 1.33, 95% CI, 1.07-1.64), with consistent hypoglycemia effects across gestational ages.

CONCLUSION: In twin pregnancies, ACS exposure was not consistently associated with improved neonatal outcomes, with no overall reduction in RDS and neonatal mortality. Associations with increased risks of hypoglycemia, oxygen requirement, and NICU or special care unit admission were observed. Given the moderate-to-low certainty of the available evidence, these findings should be interpreted cautiously.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD420251275650.

PMID:42241699 | DOI:10.1097/AOG.0000000000006344