Category: Statistics

Ann Ital Chir. 2026 Jun 10;97(6):1017-1025. doi: 10.62713/aic.4624.

ABSTRACT

AIM: Postoperative recovery after heart valve surgery is an important topic in the realm of nursing care. This study aimed to evaluate the effect of individualized positioning care on cardiac function recovery and comfort in patients after heart valve surgery.

METHODS: A single-center, retrospective cohort study was conducted, continuously enrolling patients who underwent heart valve surgery at Affiliated Hospital of Xuzhou Medical University from June 2022 to June 2025. A total of 150 patients were included. The patients were divided into a control group (conventional positioning care, n = 76) and an experimental group (individualized positioning care, n = 74) according to the nursing method received. The primary outcome measures were changes in cardiac function indicators, such as left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP) before and after nursing, as well as postoperative comfort scores measured using the Visual Analog Scale for Comfort (VAS-Comfort). Secondary outcomes included postoperative pain scores (Numeric Rating Scale [NRS]), sleep quality (Richards-Campbell Sleep Questionnaire [RCSQ]), pulmonary complications, pressure ulcer incidence, intensive care unit (ICU) length of stay, and postoperative hospital days. Group comparisons were performed using t-test, Mann-Whitney U test, Chi-square test, or Fisher’s exact test. Postoperative NT-proBNP was analyzed using analysis of covariance (ANCOVA), adjusting for baseline levels.

RESULTS: Baseline characteristics were balanced and comparable between the two groups (all p > 0.05). Compared to the control group receiving conventional care, the experimental group receiving individualized positioning care showed more significant improvement in cardiac function: the change in LVEF (ΔLVEF) was significantly higher in the experimental group (0.85 ± 3.98% vs. -3.15 ± 4.20%, p < 0.001); NT-proBNP levels on postoperative day 7 were significantly lower in the experimental group (median: 685.00 pg/mL vs. 1003.50 pg/mL, p < 0.001), and the difference remained statistically significant after adjusting for preoperative values (F = 12.13, p < 0.001). The VAS-Comfort score at 72 h postoperatively was significantly higher in the experimental group (p < 0.001). For secondary outcomes, the experimental group had significantly lower NRS pain scores at 72 h postoperatively (p < 0.001), significantly higher RCSQ sleep scores (69.26 ± 9.87 vs. 59.86 ± 12.02, p < 0.001), a lower incidence of pulmonary complications (9.46% vs. 23.68%, p = 0.019), and significantly shorter ICU stay and postoperative hospital days (both p < 0.001). There were no statistically significant differences between the two groups in the incidence of pressure ulcers or adverse events (p > 0.05).

CONCLUSIONS: Individualized positioning care can significantly promote cardiac function recovery, enhance comfort, and improve clinical outcomes in patients after heart valve surgery without increasing safety risks.

PMID:42304150 | DOI:10.62713/aic.4624

Hypertens Res. 2026 Jun 16. doi: 10.1038/s41440-026-02710-9. Online ahead of print.

ABSTRACT

Management of chronic hypertension in pregnancy remains uncertain, and current guidelines do not address whether the prognostic significance of blood pressure (BP) varies across gestation. To evaluate gestational age-specific associations between maternal BP in the first half of pregnancy and adverse maternal and neonatal outcomes. We conducted a multicenter registry-based cohort study from April 2022 to March 2023 at 65 tertiary referral centers in Japan. A total of 273 women with chronic hypertension and singleton pregnancies were enrolled before 14 weeks’ gestation (median age, 37 years; IQR, 34-40). Systolic and diastolic BP were assessed at three gestational windows (8-9, 10-13, and 14-18 weeks). Aspirin exposure was treated as time-dependent. The primary outcome was a composite of adverse maternal and neonatal events. Cox proportional hazards models and restricted cubic spline analyses were used. Adverse outcomes occurred in 32.6% (89/273). BP-risk associations differed by timing. No association was observed at 8-9 weeks. At 10-13 weeks, risk increased progressively with higher systolic BP, including excess risk in the moderate range (120-134 mmHg) and the highest risk at ≥135 mmHg (HR, 4.11; 95% CI, 1.14-14.82). At 14-18 weeks, a threshold pattern emerged, with increased risk above 140 mmHg (HR, 2.19; 95% CI, 1.40-3.43). Associations were weaker among women who initiated aspirin before 10 weeks, although interaction was not statistically significant. In chronic hypertension, maternal BP during 10-13 weeks of gestation carries heightened prognostic relevance. These findings support gestational age-specific risk assessment and motivate evaluation of early preventive strategies.

PMID:42304127 | DOI:10.1038/s41440-026-02710-9

Pediatr Res. 2026 Jun 16. doi: 10.1038/s41390-026-05184-0. Online ahead of print.

ABSTRACT

BACKGROUND: Infants undergoing therapeutic hypothermia (TH) due to neonatal encephalopathy often require sedation and pain medication. Dexmedetomidine may be a good alternative to morphine as it provides both sedation and analgesia. However, the safety and pharmacokinetics (PK) of dexmedetomidine in this population are not well established.

METHODS: In this Phase II, multicenter, open-label, randomized, safety and PK trial, 48 infants undergoing TH for encephalopathy were randomized to receive dexmedetomidine (25) or morphine (23) using standardized doses. PK parameters of dexmedetomidine in this population were calculated using a nonlinear mixed effects modeling using NONMEM^® 7.5 software.

RESULTS: There were no statistically significant differences between groups in baseline characteristics, hospitalization outcomes and adverse events. A total of 315 dexmedetomidine PK samples using a 1-compartment model with first-order elimination analysis were analyzed. Median clearance and volume of distribution were 0.51 L/kg/h and 0.25 L/kg. Weight, post-menstrual age, maximum liver enzymes, and encephalopathy severity influenced dexmedetomidine PK.

CONCLUSION: The incidence of adverse events and hospitalization outcomes in infants randomized to dexmedetomidine or morphine during hypothermia were similar. Using population PK to model dexmedetomidine, lower clearance and volume of distribution parameters were found in infants undergoing hypothermia compared to previously published parameters in non-cooled infants.

IMPACT: Infants undergoing therapeutic hypothermia for encephalopathy often require drugs to treat pain and for sedation in the intensive care unit. Dexmedetomidine may be a better alternative to opiates since it provides sedation, analgesia, and prevents shivering but does not suppress ventilation. In this randomized, unmasked, safety and PK trial we found no significant differences in short term hospital outcomes and incidence of adverse events in infants receiving dexmedetomidine when compared to infants receiving morphine. The pharmacokinetics of dexmedetomidine in this at-risk population was further established.

PMID:42304121 | DOI:10.1038/s41390-026-05184-0

Sci Rep. 2026 Jun 17. doi: 10.1038/s41598-026-57623-x. Online ahead of print.

ABSTRACT

Prenatal exposure to environmental pollutants, particularly heavy metals and pesticides, is a major public health concern because of its potential association with fetal growth and development. These toxicants can cross the placental barrier and accumulate in fetal tissues. Meconium, the first neonatal feces, is a well-established biomarker of cumulative fetal exposure during late pregnancy. However, evidence regarding sex-specific associations between prenatal pollutant exposure and neonatal outcomes remains limited, particularly in low- and middle-income countries. A cross-sectional study was conducted among 123 full-term newborns in Syria between August and September 2025, including 68 from Damascus and 55 from Latakia. Meconium samples were collected within the first hours after birth, prior to feeding, using sterile contamination-free procedures. Samples were stored at – 20 °C and transported under controlled cold-chain conditions to accredited laboratories. Heavy metals (Pb, Hg, Cd, As, Cr, Ni, Mn, Cu, Se, Tl, Sb) were quantified using atomic absorption spectrophotometry following microwave-assisted acid digestion. Pesticides (diazinon, chlorpyrifos, malathion, DDT/DDE, permethrin) were extracted using organic solvents and analyzed using high-performance liquid chromatography. Statistical analyses were performed using SPSS version 23.0, including sex-stratified multivariate regression models adjusted for maternal and neonatal covariates. All target pollutants were detected in meconium samples, indicating widespread prenatal exposure. Considerable inter-individual variability in pollutant concentrations was observed across all analytes. Sex-specific associations were identified between pollutant levels and neonatal outcomes. Among male newborns, mercury was negatively associated with birth weight, whereas nickel showed a positive association. Diazinon exposure was associated with reduced head circumference. Among female newborns, lead, thallium, and DDT/DDE showed associations with birth weight. In addition, DDT/DDE was associated with head circumference and birth length, whereas permethrin was associated with shorter birth length. Descriptive regional variation in pollutant concentrations was observed between Damascus and Latakia, although these differences were not the primary focus of the present analysis. This study identified widespread prenatal exposure to multiple environmental pollutants and observed sex-specific associations with neonatal outcomes. Meconium biomonitoring represents a useful approach for assessing cumulative fetal exposure during late pregnancy. Given the observational cross-sectional design, these findings should be interpreted cautiously. Some pesticide-related findings require confirmation using more selective analytical methods. Further prospective studies are needed to confirm these associations and better understand the biological mechanisms underlying sex-specific susceptibility.

PMID:42304096 | DOI:10.1038/s41598-026-57623-x

Nat Comput Sci. 2026 Jun 16. doi: 10.1038/s43588-026-01002-z. Online ahead of print.

ABSTRACT

Gene-environment interaction (G×E) analyses play a crucial role in advancing genetic discovery, addressing missing heritability, and facilitating precision medicine. However, existing G×E methods are mostly designed for cross-sectional data, limiting the utility of longitudinal data. Here we propose SAGELD, a scalable and accurate genome-wide G×E method for longitudinal traits that controls for sample relatedness in large-scale datasets. SAGELD uses matrix projection to construct test statistics and the SPA_GRM framework to efficiently control for sample relatedness, achieving 10- to 10,000-fold speedups over existing methods while maintaining greater power than cross-sectional analyses. We evaluated SAGELD through extensive simulations and UK Biobank analyses. Using age and body mass index as environmental exposures, we identified 74 loci with genetic × age interactions and 5 loci with genetic × adiposity interactions in the pooled analysis of longitudinal primary care data and cross-sectional assessment data. These results highlight the advantages of leveraging longitudinal data in G×E analyses.

PMID:42304093 | DOI:10.1038/s43588-026-01002-z

Commun Biol. 2026 Jun 16. doi: 10.1038/s42003-026-10451-1. Online ahead of print.

ABSTRACT

Cell-cell communication (CCC) contributes to bacterial survival and adaptability. Gram-positive bacteria employ secreted peptides to coordinate CCC. While the molecular pathways activated by these peptides are well studied, little is known about how individual cells contribute to initiating the signaling response. To address this question, we used microdroplet arrays to examine the major human pathogen Streptococcus pneumoniae and its TprA/PhrA regulator/peptide CCC system, which promotes colonization and virulence. We measured phrA promoter activity in wild-type (WT) cells and in a phrA deletion mutant, using populations seeded before signaling began. As signaling emerged, we observed heterogeneity in S. pneumoniae signaling within and across microdroplets. Addition of exogenous PhrA increased both the magnitude of signal and the percentage of signaling cells, yet it did not reduce the heterogeneity of signal. When examining whether PhrA peptide produced from WT cells was shared with ΔphrA cells, we found a preference for self-signaling over signaling to neighboring cells. Overall, we developed a platform to quantify cell-cell signaling at the single-cell level and determined that at early stages TprA/PhrA signaling is highly heterogeneous and primarily targets producing cells. We propose that this heterogeneity and its amplification through autoinduction may confer a fitness advantage to the population.

PMID:42304065 | DOI:10.1038/s42003-026-10451-1

Sci Rep. 2026 Jun 16. doi: 10.1038/s41598-026-58469-z. Online ahead of print.

ABSTRACT

To identify psychosocial factors associated with medication adherence among elderly patients with chronic diseases, guided by the Integrated Theory of Health Behavior Change (ITHBC). A cross-sectional survey was conducted among 1,138 community-dwelling adults aged sixty years or older who were receiving long-term treatment for chronic diseases. A structured questionnaire was administered that incorporated validated instruments including the Adherence to Refills and Medications Scale (ARMS), the Medication Literacy Knowledge-Attitudes-Practices (KAP) Scale, the Beliefs about Medicines Questionnaire (BMQ), the Self-efficacy for Appropriate Medication Use Scale (SEAMS), and the Social Support Rating Scale (SSRS). Descriptive statistics, group comparisons, and binary logistic regression were used to examine the psychosocial factors associated with medication adherence. A total of 1,102 valid responses were obtained, yielding a response rate of 96.84%. Among the participants, 46.64% demonstrated good medication adherence. Guided by the ITHBC framework, psychosocial variables were categorized into intention-, capability-, and context-related domains. Logistic regression analysis showed that higher self-efficacy (OR = 0.874, p < 0.001) and higher medication literacy (OR = 0.980, p = 0.020) were associated with lower odds of poor medication adherence, whereas stronger medication concern beliefs (OR = 1.128, p = 0.008) and a history of adverse drug reactions (OR = 0.596, p = 0.035) were associated with poorer adherence. Compared with older adults living with a spouse, those living alone (OR = 3.848, p = 0.003) and those living with children (OR = 3.404, p = 0.004) showed significantly higher odds of poor medication adherence. Medication adherence among older adults with chronic diseases was associated with medication literacy, self-efficacy, social support, and medication beliefs. The ITHBC provided a useful framework for understanding these psychosocial determinants. The findings highlight the importance of multidimensional adherence-support interventions integrating medication education, psychosocial support, and self-management enhancement for older adults with chronic diseases.

PMID:42304063 | DOI:10.1038/s41598-026-58469-z

Sci Rep. 2026 Jun 16. doi: 10.1038/s41598-026-57900-9. Online ahead of print.

ABSTRACT

The domain shift problem induced by variable working conditions severely constrains the cross-domain generalization capability of data-driven fault diagnosis models. Existing methods lack collaborative modeling of the multi-scale time-frequency characteristics of vibration signals at the feature extraction level. They also neglect the constraint guidance of fault physical mechanisms on the feature alignment process at the domain adaptation level. To address these deficiencies, this paper proposes a physics-guided cross-domain adaptation framework-a Hierarchical Hybrid Transformer network with Contrastive Learning (PgHHT-CL). The framework comprises three key designs. At the feature encoding level, a hierarchical hybrid Transformer encoder is constructed. It achieves collaborative extraction of transient impulse components and periodic modulation components in vibration signals through gated interactive fusion of local convolutional branches and global self-attention branches across multiple abstraction levels. At the domain adaptation level, a physics-guided cross-domain contrastive learning strategy leverages the order-invariance relationship between fault characteristic frequencies and rotational frequency from bearing dynamics prior knowledge to constrain the construction of cross-domain positive and negative sample pairs. The feature alignment process is thereby required to satisfy physical consistency beyond statistical distribution matching. At the training optimization level, a joint optimization objective integrates classification loss, cross-domain contrastive loss, and physical consistency loss, with a progressive weight adjustment strategy to ensure stable convergence of multi-task learning. Extensive cross-condition transfer experiments on two public bearing datasets from Case Western Reserve University and Paderborn University show that PgHHT-CL achieves average diagnostic accuracies of 94.94 ± 0.32% and 90.26 ± 0.50%, respectively, attaining the highest mean accuracy across all 18 transfer tasks among the representative state-of-the-art baselines selected for comparison. The framework also exhibits notable robustness under large domain shift and strong noise conditions. Ablation experiments and feature visualization analyses further validate the effectiveness and physical interpretability of the physics-guided strategy and hierarchical hybrid architecture.

PMID:42304057 | DOI:10.1038/s41598-026-57900-9

Sci Rep. 2026 Jun 16. doi: 10.1038/s41598-026-58191-w. Online ahead of print.

ABSTRACT

Heart failure (HF) is a prevalent, progressive syndrome, and a leading cause of hospitalization, mortality, and healthcare expenditure worldwide, especially among older adults. This study aimed to assess the long-term burden of mortality, rehospitalizations and their composite among HF patients and to identify independent predictors of these outcomes. A population-based retrospective cohort study was conducted across all hospitals in the province of L’Aquila, Italy, including all residents discharged alive after an index HF hospitalization between 1 January 2014 and 31 December 2022, with follow-up through 31 December 2023. Kaplan-Meier analysis estimated event rates at 30 days, 90 days, 1 year, 5 years and 9 years. Predictors of the 5-year composite outcome (death or rehospitalization) and rehospitalization frequency were analyzed using multivariable Cox regression and negative binomial models. A total of 5,883 patients were included. By 5 years, 69.4% had experienced the composite outcome, increasing to 85.4% by 9 years. Nearly half of the rehospitalizations occurred in the first year. Older age, male sex, longer initial hospital stay, and earlier discharge year were associated with poorer outcomes. HF poses a long-term burden, highlighting the need for ongoing care, in which nurses are central to improve outcomes and care quality.

PMID:42304054 | DOI:10.1038/s41598-026-58191-w

Sci Rep. 2026 Jun 16. doi: 10.1038/s41598-026-55097-5. Online ahead of print.

ABSTRACT

Recent advances in molecular tools have changed how researchers approach selective neural modulation, especially in rodent models where germline modifications and viral vector delivery are readily optimized. However, these tools have not advanced as rapidly for nonhuman primates, despite critical need for translational gene therapy models. A key barrier is targeting specific neuronal populations in the larger primate brain with cell-type and circuit specificity. Dopaminergic neurons pose a particular challenge due to their inaccessible ventral midbrain location, where local injection non-selectively targets all dopaminergic neurons. This work provides NHP researchers with a comparison of retrograde viral vectors, highlighting one which achieves efficient dopaminergic neuron transduction, establishing a foundation for combining vectors with cell-type-specific enhancers for basic and translational applications.

PMID:42304030 | DOI:10.1038/s41598-026-55097-5