Category: Statistics

JAMA Netw Open. 2026 Feb 2;9(2):e2559344. doi: 10.1001/jamanetworkopen.2025.59344.

ABSTRACT

IMPORTANCE: Childhood obesity has been independently associated with exposure to gestational diabetes and prenatal depression. Although these conditions frequently co-occur and may share biological pathways, their combined association with childhood obesity remains unknown.

OBJECTIVE: To examine whether exposure to prenatal depression and gestational diabetes is separately and jointly associated with childhood obesity.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study of births from 2011 to 2021 used data from Kaiser Permanente Northern California, an integrated health care system. Individuals receiving prenatal care were universally screened for depression and gestational diabetes and their children’s height and weight were monitored until age 10 years. Data analysis was performed from June 2024 to December 2025.

EXPOSURES: Gestational diabetes diagnosis and prenatal depression diagnosis and severity obtained from medical records.

MAIN OUTCOMES AND MEASURES: The primary outcome was childhood obesity, defined as Centers for Disease Control and Prevention body mass index z scores greater than or equal to the 95th percentile stratified by child age in years. Modified Poisson regression with robust SEs estimated risk ratios (RRs) for prenatal depression and gestational diabetes separately and jointly, adjusting for the birthing parent’s age, race and ethnicity, neighborhood deprivation, parity, and prenatal alcohol and tobacco use. Effect modification was assessed separately by statistical interactions and stratified models.

RESULTS: In this cohort study of 203 333 birthing parent-child pairs (mean [SD] age of birthing parents at the time of delivery, 30.8 [5.3] years; 104 214 male children [51.3%]), rates of childhood obesity increased with child’s age, from 14.6% (29 198 of 199 329 children) at age 2.0 to 4.9 years, to 16.5% (19 155 of 116 398 children) at age 5.0 to 7.9 years, and 21.8% (9798 of 44 894 children) at age 8.0 to 10.0 years. Prenatal depression was minimally associated with obesity (RR, 1.07 [95% CI, 1.04-1.10] for children aged 2.0-4.9 years; RR, 1.08 [95% CI, 1.04-1.12] for children aged 5.0-7.9 years; RR, 1.05 [95% CI, 1.00-1.11] for children aged 8.0-10.0 years). Gestational diabetes demonstrated larger effect estimates (RR, 1.29 [95% CI, 1.25-1.34] for children aged 2.0-4.9 years; RR, 1.45 [95% CI, 1.40-1.51] for children aged 5.0-7.9 years; RR, 1.39 [95% CI, 1.31-1.46] for children aged 8.0-10.0 years). Joint exposure to gestational diabetes and depression conferred the highest RRs compared with having neither exposure (RR, 1.33 [95% CI, 1.23-1.44] for children aged 2.0-4.9 years; RR, 1.54 [95% CI, 1.41-1.69] for children aged 5.0-7.9 years; RR, 1.43 [95% CI, 1.25-1.64] for children aged 8.0-10.0 years), with no evidence of interaction (P for interaction >0.10). After additionally adjusting for prepregnancy body mass index, joint results were attenuated, although the association for the 5.0 to 7.9 years age group remained especially robust.

CONCLUSIONS AND RELEVANCE: In this cohort study, both prenatal depression and gestational diabetes were associated with childhood obesity risk, with larger effect sizes observed for gestational diabetes. Children exposed to both conditions had the greatest risk, although associations appeared additive rather than synergistic. These findings underscore the need for universal prenatal screening and risk stratification, along with targeted interventions for children exposed to these conditions.

PMID:41706453 | DOI:10.1001/jamanetworkopen.2025.59344

Urol Pract. 2026 Feb 18:101097UPJ0000000000000988. doi: 10.1097/UPJ.0000000000000988. Online ahead of print.

ABSTRACT

INTRODUCTION: We share our 10-year experience with transitioning from MRI-fusion transrectal (TR) to MRI-fusion transperineal (TP) prostate biopsy and the increased costs and time associated with this transition, particularly from the pathology perspective.

METHODS: Our prospectively maintained MRI-fusion prostate biopsy database was queried. Demographic and clinical data were captured. The cost difference between processing TR and TP biopsies was calculated. Scenarios to decrease cost and time were explored. R-software was used for statistical analyses.

RESULTS: Over 10 years, 2,370 prostate biopsies were performed (1,719 TR, 651 TP). TP biopsy became the preferred method in 2023. The overall cancer detection rates (CDR) and clinically significant CDR (csCDR) for TR biopsy were 55.4% (952/1,719) and 35.4% (609/1,719), respectively. For TP, it was 62.8% (409/651) and 41.8% (272/651), respectively. This was a significant difference in CDR and csCDR (p<0.01). The estimated increased annual cost for TP biopsy from a pathology processing standpoint was $136,662, and the estimated time increase per year was 1,332.5 hours. We constructed 4 scenarios with cost and time reductions as high as $282,750 and 2730 hours per year, respectively.

CONCLUSION: Transitioning to an MRI-fusion TP prostate biopsy has resulted in higher overall CDR and csCDR rates, but also significantly higher costs and time spent. Possible designs may exist that could yield significant cost and time savings per annum.

PMID:41706435 | DOI:10.1097/UPJ.0000000000000988

J Vector Borne Dis. 2026 Feb 7. doi: 10.4103/jvbd.jvbd_211_24. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: The aim of this study was to identify the risk factors associated with mortality in patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF) through the application of machine learning models and to evaluate their predictive performance.

METHODS: The study included patients with a definitive diagnosis who were admitted to the Department of Infectious Diseases and Clinical Microbiology of Tokat State Hospital between February 1, 2011 and October 1, 2022 with suspicion of CCHF. Five models, namely XGboost, Logistic regression, Random Forest, LightGBM, and Gradient Boosting Classifier, were constructed using machine learning algorithms to predict mortality in CCHF patients. The performance of these models was subsequently evaluated.

RESULTS: A total of 1,881 cases of suspected CCHF were admitted to the hospital, of which 891 were confirmed, resulting in a fatality rate of 3.3%. In the study, the receiver operating characteristic (ROC) analysis was performed to predict the risk of mortality in CCHF patients with the XGboost, logistic regression, and Gradient Boosting Classifier models. The area under the curve (AUC) results were 0.849, 0.919, and 0.853, respectively. In the evaluation of the relative importance of the features of these models, platelet count, neutrophil-to-lymphocyte ratio (NLR), and neutrophil count were identified as being among the top five.

INTERPRETATION CONCLUSION: Statistically significant predictive models were created using machine learning techniques, specifically XGboost, logistic regression, and Gradient Boosting Classifier. The results of our analysis suggest that platelet count, NLR and neutrophil count are the most effective parameters for predicting mortality.

PMID:41706434 | DOI:10.4103/jvbd.jvbd_211_24

J Vector Borne Dis. 2026 Feb 7. doi: 10.4103/jvbd.jvbd_223_25. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: CD5L (CD5 antigen-like) is a secreted glycoprotein involved in immune regulation, macrophage polarization, and lipid metabolism. While its role in inflammatory and bacterial diseases has been described, its function in viral infections such as dengue virus (DENV) infection remains unclear. This study aimed to evaluate serum CD5L levels in dengue-infected individuals and investigate its association with serological markers and disease severity. A cross-sectional study involving dengue-positive and dengue-negative individuals was conducted to compare serum CD5L concentrations and assess correlations with NS1, IgM, IgG status, and disease severity.

METHODS: Serum samples were collected from confirmed dengue-positive patients and dengue-negative controls. CD5L concentrations were quantified using enzyme-linked immunosorbent assay (ELISA) and analyzed according to serological profiles (NS1, IgM, and IgG). Two-group comparisons were performed using the Mann-Whitney U test, and multiple groups were analyzed using the Kruskal-Wallis test with Dunn’s post hoc test. A P-value < 0.05 was considered statistically significant.

RESULTS: CD5L levels were significantly elevated in dengue-positive individuals compared to dengue-negative controls (P < 0.05), with the highest levels observed in IgG-positive only individuals (P < 0.01). No significant differences were seen in NS1-positive only or IgM-positive only groups, suggesting that CD5L upregulation is associated with IgG seropositivity rather than acute-phase markers. Similarly, CD5L levels did not significantly differ among individuals with combined serological markers (NS1 & IgM-positive, NS1 & IgG-positive, IgM & IgG-positive). Among IgG-positive only individuals, CD5L levels were significantly higher in non-severe dengue cases compared to severe dengue cases (P < 0.05). No significant differences were observed in CD5L levels between severe and non-severe NS1-positive only or IgM-positive only individuals. These findings suggest a potential association between increased CD5L and later stages of dengue virus infection with less severe outcomes.

INTERPRETATION CONCLUSION: This study highlights CD5L’s potential role in dengue pathogenesis, particularly its association with IgG seropositivity and non-severe disease. Further research is needed to clarify its mechanisms and evaluate its potential as a biomarker or therapeutic target in dengue virus infection.

PMID:41706431 | DOI:10.4103/jvbd.jvbd_223_25

J Vector Borne Dis. 2026 Feb 7. doi: 10.4103/jvbd.jvbd_270_25. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: Dengue fever remains a major global public health threat, responsible for millions of infections annually across tropical and subtropical regions. Despite extensive modeling efforts, most existing studies focus exclusively on mosquito-mediated transmission and overlook additional non-vectorial pathways that may influence outbreak persistence.

METHODS: This study addresses this gap by developing the first fractional-order dengue transmission model that simultaneously integrates human-to-human, mosquito-to-mosquito, human-to-mosquito, and mosquito-to-human transmission routes. The Caputo fractional derivative is applied to capture memory effects and nonlocal temporal behavior inherent in real epidemic processes.

RESULTS: Analytical results demonstrate that the model exhibits backward bifurcation when the mosquito-to-mosquito reproduction number exceeds unity, implying that dengue may persist even when the basic reproduction number falls below one. Numerical simulations reveal that fractional-order dynamics slow epidemic decay, delay infection peaks, and prolong outbreak duration compared with classical integer-order models. These findings indicate that memory effects significantly influence disease persistence and the effectiveness of control measures.

INTERPRETATION CONCLUSION: By bridging an important gap in dengue modeling, this framework highlights the combined epidemiological impact of multi-route transmission and fractional dynamics. The results provide insight into designing integrated and sustainable dengue control strategies that account for vectorial, non-vectorial, and memory-dependent transmission processes.

PMID:41706429 | DOI:10.4103/jvbd.jvbd_270_25

Dig Dis Sci. 2026 Feb 18. doi: 10.1007/s10620-026-09765-1. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used to treat pancreaticobiliary diseases, but can be technically challenging, leading to occasional unsuccessful attempts. While repeat ERCP is one option in these cases, data on the effectiveness and safety of this practice remain limited. Thus, we conducted a systematic review and meta-analysis to assess outcomes of repeat ERCP after initial unsuccessful attempt.

METHODS: MEDLINE, Embase, and CENTRAL were searched on February 28, 2025. We included randomized trials and observational studies reporting on outcomes of repeat ERCP following an initial unsuccessful attempt, with the primary outcome being technical success of cannulation, and secondary outcomes including adverse events (AEs). Random-effects models were used to pool data, and heterogeneity was assessed through the I² statistic.

RESULTS: A total of 22 studies involving 1514 patients with a median age of 62 years were included. The majority of studies were conducted at a single center (86.4%), where the most common indication for repeat ERCP was choledocholithiasis (41.2%), followed by malignant biliary obstruction (29.0%). The pooled technical success rate of repeat ERCP was 83.6% (95% CI 78.6-88.1%, I² = 76.4%). The pooled AE overall rate was 7.3% (95% CI 5.2-9.6%, I² = 27.5%), with pancreatitis being the most frequent and with this overall AE rate being statistically comparable to that associated with patients’ index ERCPs.

CONCLUSIONS: Our meta-analysis demonstrated encouraging success rates with repeat ERCP after initial failure, with acceptably low AE rates, highlighting its role as a primary option in cases of initial unsuccessful ERCP.

PMID:41706406 | DOI:10.1007/s10620-026-09765-1

Appl Biochem Biotechnol. 2026 Feb 18. doi: 10.1007/s12010-026-05608-x. Online ahead of print.

ABSTRACT

Direct purification of a protein from the culture medium is usually the simplest and most cost-effective method, so maximizing extracellular yield is one of the most important goals in protein supply. Although L-asparaginase is not naturally secreted into the extracellular medium through conventional cellular secretory pathways in Escherichia coli, some proteins were previously shown to be released from periplasm of E. coli into medium depending on culture medium and aeration efficiency. Here, extracellular release of L-asparaginase into the culture medium by the E. coli ATCC 11303 was demonstrated and found to be strongly dependent on medium composition, aeration effectiveness, and their interaction. Employing the RSM-CCD (response surface methodology- central composite design), the impacts of four independent factors (shaking speed, maltose, tryptone, and L-asparagine concentrations) on extracellular L-asparaginase activity were also investigated. Optimization of the culture medium led to a significant increase in extracellular L-asparaginase activity, closely matching the predicted values and confirming the robustness of the model. Although further studies appear necessary, this investigation highlights the practical importance of aeration and culture medium composition in extracellular release of L-asparaginase.

PMID:41706403 | DOI:10.1007/s12010-026-05608-x

Odontology. 2026 Feb 18. doi: 10.1007/s10266-026-01345-z. Online ahead of print.

ABSTRACT

This systematic review aimed to explore the potential effects of mucoadhesive tablets (MATs) on the pain and ulcer size outcomes in patients with recurrent aphthous stomatitis (RAS). A systematic search of EMBASE, PubMed, ScienceDirect, and Web of Science was conducted. Randomized controlled trials (RCTs) comparing MATs with placebo were included. Risk of bias was assessed using the RoB 2 tool, and certainty of evidence was evaluated with GRADE. Outcomes were pooled using random-effects meta-analysis and expressed as mean differences (MD) with 95% confidence intervals (CI). Four RCTs were included in the qualitative review and only three of them were included in the quantitative analysis. For ulcer diameter, MATs demonstrated a statistically significant reduction at day 5 (MD -1.97 mm, 95% CI -3.88 to -0.05; p = 0.044; I² = 78.4%) and day 7 (MD -1.19 mm, 95% CI -1.86 to -0.53; p = 0.0005; I² = 0%). No significant difference was observed at day 3 (MD -1.63 mm, 95% CI -3.99 to 0.74; p = 0.178; I² = 85.9%). For pain intensity, significant short-term reductions were observed at day 2 (MD -1.69, 95% CI -2.46 to -0.93; p < 0.0001), day 3 (MD -2.63, 95% CI -3.93 to -1.32; p < 0.0001), day 4 (MD -2.82, 95% CI -3.83 to -1.81; p < 0.0001), and day 6 (MD -1.22, 95% CI -1.96 to -0.48; p = 0.0012). MATs were associated with short-term improvements in pain and ulcer size in RAS, although results varied across formulations and time points and were influenced by moderate heterogeneity. These findings should therefore be interpreted as preliminary, highlighting the need for larger, longer-term trials with standardized outcome measures.

PMID:41706378 | DOI:10.1007/s10266-026-01345-z

Neurol Ther. 2026 Feb 18. doi: 10.1007/s40120-026-00891-6. Online ahead of print.

ABSTRACT

INTRODUCTION: The spinocerebellar ataxia composite score (SCACOMS) comprises items from the functional Scale for the Assessment and Rating of Ataxia (f-SARA) and the Clinician Global Impression of Change (CGI-C). In the derivation of SCACOMS, weights reflecting 1-year responsiveness were assigned to each item using partial least squares (PLS) regression modeling. The current objective was to incorporate patient-feedback into the SCACOMS item weights, examine corresponding responsiveness of the composite scale, and discuss potential implications for future use.

METHODS: Item weights derived by PLS regression were compared to each item’s relative importance as assigned by 16 patients with SCA during semi-structured interviews. SCACOMS item weights were adjusted using the following combinations: (1) 50/50 weighted combination of PLS and patient weights and (2) reducing the weight of CGI-C to 20% and averaging individual item weights obtained from each perspective. The 1-year mean to standard deviation ratios (MSDRs) for the resulting reweighted scales were compared, with larger MSDRs indicating greatest sensitivity to disease progression.

RESULTS: The PLS-derived SCACOMS had the highest MSDR (0.99). When item weights were averaged across the two sources, the resulting MSDR was 0.91. When the weight of CGI-C was set to 20%, reflecting patient preferences for higher weights on the discrete symptoms, the MSDR was 0.79.

CONCLUSIONS: This study took a novel approach to enhance the face validity of SCACOMS by incorporating patient feedback into the statistically optimized item weights. The result is the merging of objectively derived item weightings (reflecting optimal scale responsiveness) with patient-assigned relevance. While this update may increase the patient centricity of a composite measure, this comes at the expense of reduced sensitivity. This potential trade-off in sensitivity to detect change should be evaluated in the context of the composite measure’s intended use.

PMID:41706362 | DOI:10.1007/s40120-026-00891-6

Sleep Breath. 2026 Feb 18;30(1):55. doi: 10.1007/s11325-026-03591-5.

ABSTRACT

BACKGROUND: Investigation of Restless Legs Syndrome (RLS) in patients with poliomyelitis sequelae (PS) and the effect of RLS on pain, fatigue, sleep and quality of life (QoL).

METHOD: We investigated the presence of RLS in patients with PS who consecutively applied to the neurology outpatient clinic and did not have secondary causes of RLS. Gender, age, side affected by PS, leg muscle strength and length, International RLS Study Group criteria, Pittsburgh Sleep Quality Index questionnaire, Fatigue Severity Scale, SF-36 Form scores were recorded. After receiving a diagnosis of RLS, patients completed the RLS Severity Rating Scale (RLS-SWS) questionnaire.

RESULTS: We identified RLS in 12 (37.5%) of the 32 patients included in the study. There were no differences in demographic characteristics. The leg lengths in the patients with RLS (PwRLS) were significantly shorter (p < 0.001). PwRLS had shorter sleep duration, longer latency, and worse sleep quality and fatigue severity scores (p < 0.001). The pain score was found to be statistically significantly higher in the PwRLS group (p = 0.007). There were no differences in other QoL areas. In the PwRLS study, the RLS-SWS score was positively correlated with sleep latency, sleep quality, and pain and fatigue scores. It was also negatively correlated with sleep duration (p < 0.001).

CONCLUSION: These findings demonstrate that RLS, which has an effective treatment, is a prevalent condition among PS patients that worsens sleep quality and increases pain. Clinicians should screen PS patients who complain of leg pain and/or sleep disturbances for RLS and provide appropriate treatment.

PMID:41706359 | DOI:10.1007/s11325-026-03591-5