Category: Statistics

Curr Med Sci. 2026 Jul 23. doi: 10.1007/s11596-026-00225-5. Online ahead of print.

ABSTRACT

BACKGROUND: Sepsis is a dysregulated response of the host to infection that can lead to life-threatening organ dysfunction and remains a leading cause of mortality. Early recovery of impaired organ function is crucial for the outcomes of sepsis. Electroacupuncture (EA) is a promising adjunctive therapy for sepsis, but no study has focused on the efficacy of EA for organ dysfunction. This study aimed to investigate the efficacy and safety of EA in improving organ dysfunction among intensive care unit (ICU) patients with sepsis.

METHODS: In this single-center, randomized, sham-controlled clinical trial, an adaptive sample size of 154-500 patients diagnosed with sepsis will be included. Eligible patients will be randomly assigned to receive EA or sham EA treatment at a 1:1 ratio using block randomization. Patients in the two groups will receive 6 consecutive sessions of 30-min EA or sham EA treatment, with the initial acupuncture treatment being completed within 24 h after randomization. The primary outcome is the change in the total score of the Sepsis-Related Sequential Organ Failure Assessment (SOFA) on day 7 after randomization compared with baseline. Secondary outcomes include changes in the SOFA score and related serological outcomes, mortality, ICU-free days, hospital-free days and organ support-free days from baseline to day 28. Statistical analyses will be performed on a full analysis set (FAS) and a per-protocol set (PPS).

DISCUSSION: We expect the findings of this trial to provide evidence that the use of EA as an adjunctive therapy to ICU treatment can promote the recovery of organ function and other outcomes in sepsis patients.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06666946. Registered on 28 October 2024.

PMID:42490017 | DOI:10.1007/s11596-026-00225-5

Hernia. 2026 Jul 23;30(1):300. doi: 10.1007/s10029-026-03716-5.

ABSTRACT

PURPOSE: To compare postoperative pain, hernia-specific Quality of Life, inflammatory response and the long-term hernia-related complaints between self-fixating mesh and limited tack fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

METHODS: This prospective double-blind randomised clinical trial enrolled adult males undergoing elective unilateral TEP repair between April 2018 and December 2020. The patients were randomised in a 1:1 ratio to receive either self-fixating mesh (n = 56) or limited mesh fixation with up to three non-absorbable tacks (n = 56). The primary outcomes studied were postoperative pain (Visual Analogue Scale, VAS) and Quality of Life (Carolina Comfort Scale, CCS), recorded at prespecified intervals up to 3 months. The secondary outcomes included operative time, mesh deployment time, complications, analgesic consumption, length of stay, inflammatory markers (WBC at 48 h; ESR at 3 months) and a predefined long-term follow-up to evaluate late pain, hernia-related discomfort, recurrence, contralateral hernia development, and chronic pain outcomes after at least 5 years of the index surgery.

RESULTS: The operative duration and mesh deployment times were similar in both groups. Mesh deployment time was initially longer with self-fixating mesh in the first chronological quartile, but progressively decreased with experience and was comparable to tack fixation by later quartiles, demonstrating a significant learning-curve effect. Median VAS and CCS scores at all prespecified time points showed no clinically meaningful difference. Analgesic requirements were comparable between groups. Both groups demonstrated a significant postoperative rise in inflammatory markers; however, the magnitude of change was lower in the self-fixating mesh group, with statistically significant differences between groups in ΔWBC and ΔESR. Cord oedema and seroma were the most frequent postoperative surgical site occurrences (SSOs), with similar rates in either group. Only 96 of the 112 patients could be followed up after at least 5 years of the index surgery with an average of 78.5 months follow up. Both groups demonstrated minimal pain and mesh-related discomfort, with no clinically meaningful differences in average VAS or Carolina Comfort Scale scores. The rates of chronic pain (VAS ≥ 3) were low (four in each arm) and comparable between groups. No significant difference was observed in long-term pain-related functional impairment. One recurrence was detected in the self-fixating arm during the study.

CONCLUSION: The postoperative pain scores, hernia-specific quality-of-life outcomes, and early and late complication rates, including recurrence, with the use of self-fixating mesh were comparable to those observed with limited tack fixation in TEP repair. Although inflammatory markers increased postoperatively in both groups, the magnitude of the inflammatory response was modestly lower in the self-fixating mesh group. Mesh deployment time was initially longer with self-fixating mesh but decreased significantly with experience and became comparable to tack fixation, indicating a short and clinically acceptable learning curve. These findings support self-fixating mesh as a safe and atraumatic alternative fixation strategy in TEP repair with comparable short-term and long-term pain, quality of life, and recurrence rates.

PMID:42490014 | DOI:10.1007/s10029-026-03716-5

Adv Ther. 2026 Jul 23. doi: 10.1007/s12325-026-03695-0. Online ahead of print.

ABSTRACT

INTRODUCTION: In the absence of head-to-head trial data, a matching-adjusted indirect comparison (MAIC) was conducted to compare the effectiveness, with respect to overall survival (OS) and progression-free survival (PFS), of PET-guided BrECADD versus PET-guided ABVD, BEACOPP, and eBEACOPP in advanced Hodgkin lymphoma.

METHODS: Individual patient data (IPD) from patients in HD21 and aggregate data from the SWOG S0816, RATHL, HD9, and Mondello 2020 studies were utilized. Potential effect modifiers and prognostic variables for advanced Hodgkin lymphoma were identified via literature review, clinician input, and statistical analysis. As there was no common arm between HD21 and the comparator trials, unanchored MAICs were conducted. Data from patients in HD21 were weighted to align with published aggregate characteristics of the comparator trials.

RESULTS: BrECADD was associated with significantly improved PFS and OS compared with PET-guided ABVD among patients aged 18-60 (SWOG S0816; PFS HR: 0.24, 95% CI 0.16, 0.35, p < 0.001; OS HR: 0.30, 95% CI 0.14, 0.63, p = 0.004) and patients aged 18 to 75 (RATHL; PFS HR: 0.24, 95% CI 0.16, 0.36, p < 0.001; OS HR: 0.47, 95% CI 0.25, 0.89, p = 0.01). In the comparison of BrECADD versus BEACOPP (per the Mondello et al. 2020 study cohort), there was a trend in PFS improvement [HR = 0.58 (95% CI 0.29, 1.19), p = 0.194)] in favor of BrECADD in adults aged 18-75 years of age. Additionally, a trend was observed among patients aged 66-75, favoring BrECADD for freedom from treatment failure [HR = 0.63 (95% CI 0.28, 1.44), p = 0.260] when compared to BEACOPP (HD9).

CONCLUSION: These findings provide robust evidence and further support for the use of BrECADD in adult patients with advanced Hodgkin lymphoma.

PMID:42490007 | DOI:10.1007/s12325-026-03695-0

Updates Surg. 2026 Jul 23. doi: 10.1007/s13304-026-02767-8. Online ahead of print.

ABSTRACT

Iatrogenic chylothorax is generally attributed to injury to the main thoracic duct and its tributaries. However, the current anatomic classification of the thoracic duct primarily focuses on the morphology and outlet of the main duct. Using thoracic ductography, this study aimed to identify the presence of a large-caliber transverse branch of the thoracic duct and to evaluate its role as a cause of chylothorax. This retrospective study included 25 patients who underwent thoracic ductography for chylous leakage between May 2020 and May 2025. Thoracic duct branching patterns and leakage sites were correlated with surgical history, and clinical outcomes following lymphatic embolization were analyzed. A single thoracic duct was identified in 52% of patients, whereas 48% had at least one large-caliber transverse branch crossing the mediastinum at the carinal or upper tracheal level. All patients (n = 12) who developed chylothorax after surgery at the mediastinum had a transverse branch, which was confirmed as the source of lymphatic leakage in 100% of these cases. In contrast, leaks following surgery at the left mediastinal border originated from the main thoracic duct. There was statistically significant lower pretreatment daily drainage volume in patients with transverse branch injury than in those with main duct injury (p = 0.048). Large-caliber transverse branches of the thoracic duct may be more prevalent than previously recognized and represent a frequent cause of iatrogenic chylothorax when injured. Improved awareness of this anatomic variant may generate hypotheses for future preventive strategies during mediastinal procedures.

PMID:42489999 | DOI:10.1007/s13304-026-02767-8

Brain Imaging Behav. 2026 Jul 23;20(4):112. doi: 10.1007/s11682-026-01181-3.

ABSTRACT

Growth-associated protein 43 (GAP-43), a synaptic protein involved in neuronal plasticity, has emerged as a potential biomarker for Alzheimer’s disease (AD) and mild cognitive impairment (MCI), with elevated levels linked to synaptic dysfunction. This dysfunction, in turn, has been associated with reduced cerebral glucose metabolism, which further exacerbates cognitive decline and accelerates disease progression. However, the link between CSF GAP-43 and cerebral glucose metabolism, measured by FDG-PET, remains less understood. This study aimed to investigate the relationship between CSF GAP-43 levels, cerebral glucose metabolism, and cognitive performance across different stages of cognitive impairment, specifically in individuals with AD (n = 83), MCI (n = 370), and cognitively normal (CN; n = 215). Cognitive function was assessed using the ADAS-Cog 13 scale, CSF GAP-43 levels were measured via ELISA, and cerebral glucose metabolism was analyzed with FDG-PET. The results showed that CSF GAP-43 levels were significantly elevated in the AD group compared to the CN and MCI groups (p < 0.001). In the MCI group, there was a modest but statistically significant negative association between CSF GAP-43 levels and cerebral glucose metabolism (β = -0.126, FDR p = 0.003), whereas this association was not significant in the CN (β = -0.031, FDR p = 0.612) or AD groups (β = 0.157, FDR p = 0.584). Mediation analysis, adjusted for age, sex, education, and APOE ε4 carrier status, showed that FDG-PET cerebral glucose metabolism partly and statistically mediated the association between CSF GAP-43 and cognitive performance only in the MCI group (β = 0.047, FDR-adjusted p = 0.009). These findings indicate that higher CSF GAP-43 was associated with lower cerebral glucose metabolism, which in turn was associated with worse cognitive performance in MCI. However, because of limitations, cross-sectional design, and modest magnitude of the effects, these results should be interpreted as statistical associations rather than evidence that CSF GAP-43 impairs glucose metabolism or cognition.

PMID:42489996 | DOI:10.1007/s11682-026-01181-3

Environ Sci Pollut Res Int. 2026 Jul 23. doi: 10.1007/s11356-026-37999-z. Online ahead of print.

ABSTRACT

The manufacturing process of normal concrete is highly responsible for producing carbon dioxide, resulting in a larger carbon footprint, thus leading to the need for alternative materials to be used in the construction industry. The current research focuses on analyzing the impact and effect of the addition of fly ash (FA) and rice husk ash (RHA) as partial substitution of ordinary Portland cement (OPC) in high-performance self-compacting concrete (SCC). The study evaluates the fresh properties (slump flow, L-box, and V-funnel), mechanical properties (compressive, split tensile, and flexural strength), and durability properties (water absorption, acid, sulfate, and saline water resistance). A Response Surface Methodology (RSM) based Box-Behnken design was employed to analyze the influence of OPC, FA, and RHA proportions and to optimize mix performance. According to the findings, the most efficient ternary combination (OPC 75%, FA 15%, and RHA 10%) obtained better performance with compressive strength of 52.6 MPa, split tensile strength of 4.7 MPa, and flexural strength of 6.1 MPa at 90 days. Additionally, from Life Cycle Assessment (LCA), there was a decrease in carbon dioxide emissions by 119.25 kg/m³, as well as reductions in energy, water use in comparison to control mix of SCC. The use of ternary blend with the optimized combination resulted in a cost reduction of 9.3%compared to the control mix. These results indicate the substantial possibilities of FA-RHA composite SCC in promoting sustainability and sustainable development, thus providing a solution to support circular economy approaches and minimize environmental impacts in contemporary construction projects.

PMID:42489975 | DOI:10.1007/s11356-026-37999-z

J Thromb Thrombolysis. 2026 Jul 23. doi: 10.1007/s11239-026-03361-w. Online ahead of print.

ABSTRACT

Severe sepsis-associated thrombocytopenia creates a difficult clinical trade-off between thrombosis prevention and bleeding risk, yet evidence to guide pharmacological prophylaxis when platelet counts are 30,000-50,000/µL remains limited. We conducted a target trial emulation using the MIMIC-IV database, classifying eligible adults with sepsis upon first intensive care unit admission based on whether a predominantly unfractionated heparin (UFH)-based prophylaxis strategy was administered within a 24-hour grace period after platelet counts initially entered this range. Among 938 eligible patients (189 prophylaxis strategy, 749 control strategy), venous thromboembolism (VTE) occurred in 14 and 86 patients, respectively. In the inverse probability-weighted Cox analysis, early administration of this UFH-based prophylaxis was associated with a lower 28-day VTE hazard (adjusted hazard ratio 0.51, 95% confidence interval 0.28-0.92; P = 0.025), though this association was attenuated in certain prespecified sensitivity analyses. Electronic health record-derived major bleeding occurred in 22 and 95 patients, respectively, and no statistically higher hazard was observed under the prophylactic strategy (adjusted hazard ratio 0.74, 95% confidence interval 0.46-1.20; P = 0.220). These findings suggest that early administration of a predominantly UFH-based prophylactic strategy may be associated with a lower VTE risk, without a statistically higher hazard of the electronic health record-derived major bleeding endpoint. Given the observational design, this efficacy signal remains hypothesis-generating rather than definitive and warrants prospective validation.

PMID:42489962 | DOI:10.1007/s11239-026-03361-w

Brain Topogr. 2026 Jul 23;39(5):83. doi: 10.1007/s10548-026-01237-z.

ABSTRACT

Understanding how the brains structural architecture supports task-evoked functional activity is a fundamental goal of neuroscience. However, most predictive models rely on single-scale structural features, overlooking the brains intrinsically hierarchical organization. Here, we introduce the Collaborative Graph Attention Multi-Task Network (CoGA-MTN), a deep learning framework that integrates multi-scale structural features to jointly predict task-based functional connectivity (FC) and identify potential disease-related network alterations. CoGA-MTN employs a dual-branch graph attention network to extract complementary global statistical and local topological features from structural MRI, and a cross-modal task-coordinated learning mechanism that enables task-conditioned FC prediction alongside multi-disease classification. Validated on the Consortium for Neuropsychiatric Phenomics dataset (152 participants, three tasks, four diagnostic groups), CoGA-MTN outperforms single-scale baselines in task-conditioned FC prediction (PCC = 0.657 ± 0.02) and achieves macro F1 scores of 0.68-0.75 across three psychiatric disorders. Crucially, the model reconstructs a stable whole-brain connectivity architecture that is conserved across tasks, while simultaneously revealing diagnosis-related discrepancies that are consistent with established pathophysiological models. By modeling psychiatric conditions within a normative structure-function framework, this work provides a unified approach for characterizing the relationships between multi-scale brain structure, dynamic function, and psychopathology.

PMID:42489954 | DOI:10.1007/s10548-026-01237-z

Environ Monit Assess. 2026 Jul 23;198(8):867. doi: 10.1007/s10661-026-15716-0.

ABSTRACT

In the Delhi National Capital Region (NCR), post-monsoon or winter air pollution is a significant environmental stressor on nearby agricultural systems. The current study analyzed the possible effects of particulate matter (PM) and ozone (O₃) pollution on wheat and mustard yield losses during October-February coinciding with the post-monsoon cropping season, as well as the spatial characteristics of these pollutants throughout the agricultural airshed centered around Delhi. Pollution exceedance frequency, severe pollution episode analysis, PM_2.5/PM₁₀ ratios, O₃ exposure indices, spatial gradient analysis, principal component analysis (PCA) and cluster analysis, and crop stress risk assessment were used to analyze daily PM_2.5, PM₁₀, O₃, and NO₂ data (2022-2025) from Central Pollution Control Board monitoring stations situated within about 150 km of Delhi. The findings showed severe winter particulate pollution throughout the entire airshed, with frequent occurrences of severe PM_2.5 pollution at stations affected by transportation and peri-urban areas. Particulate pollution was found to be the primary cause of regional atmospheric variability using PCA and cluster analyses. The values of the Crop Stress Index (CSI) varied from 54.35 in Palwal to 122.89 in Bahadurgarh for winter crops of this airshed. Potential yield-loss risks for rabi wheat in Bahadurgarh, Rohat and Sonipat could be up to 15, 14.25 and 11.4% while that of mustard could be potentially reduced by 12, 11.4 and 10.54%, respectively. Overall, the study shows that wintertime air pollution in the Delhi NCR area is a regional-scale agro-environmental stressor that may have an impact on the growth, physiology, and productivity of wheat and mustard throughout the Delhi’s agricultural airshed.

PMID:42489950 | DOI:10.1007/s10661-026-15716-0

Clin Oral Investig. 2026 Jul 23;30(8):355. doi: 10.1007/s00784-026-07040-1.

ABSTRACT

OBJECTIVES: The NLRP3 inflammasome amplifies inflammation and may contribute to the destruction of tooth-supporting tissues in periodontitis. This study evaluated the expression of inflammasome markers (NLRP3, AIM2, IL-1β, TNF-α, CASP1, IL-10, TLR2, and TLR4) and the epigenetic patterns of NLRP3 and IL-1β in primary gingival fibroblasts from healthy individuals and patients with Grade C periodontitis (PerioC).

MATERIALS AND METHODS: Cells were exposed to Aggregatibacter actinomycetemcomitans Protein Extract (AaPE) (5 µg/ml) for 1.5 h. After the experimental period, total RNA and DNA were collected and extracted. Total RNA was isolated and gene expressions of TLR2, TLR4, NLRP3, CASP1, AIM2, IL-10, IL-1β and TNF-α were analyzed via qPCR. DNA methylation and hydroxymethylation patterns of the IL-1β and NLRP3 genes were evaluated. Statistical analyses were performed considering a significance level of 5%.

RESULTS: Fibroblasts from PerioC exhibited higher AIM2 levels before and after stimulation compared to healthy individuals (p < 0.05). Conversely, IL-10 expression was lower in PerioC before AaPE incubation (p < 0.05). NLRP3 expression increased post-stimulation in healthy cells but remained unchanged in PerioC. IL-1β expression was consistently lower in PerioC in both conditions. The NLRP3 gene showed reduced methylation after AaPE exposure only in healthy fibroblasts, resulting in lower methylation levels compared to PerioC (p < 0.05).

CONCLUSIONS: PerioC fibroblasts exhibited dysregulated inflammasome-related gene expression and a distinct epigenetic response to AaPE, suggesting altered local immune regulation at the transcriptional level.

CLINICAL RELEVANCE: Patients with severe and rapidly progressing periodontitis exhibit an altered inflammasome-related gene expression and epigenetic response to bacterial stimulation. The reduced transcriptional responsiveness of inflammatory mediators and distinct DNA methylation profile observed in PerioC cells may contribute to ineffective host defense and persistent periodontal tissue destruction.

PMID:42489943 | DOI:10.1007/s00784-026-07040-1