Category: Statistics

J Neurosurg Anesthesiol. 2026 Jun 19. doi: 10.1097/ANA.0000000000001128. Online ahead of print.

ABSTRACT

Hemodynamic stability and timely neurological assessment are critical components of anesthetic management in intracranial neurosurgery. This systematic review and meta-analysis were prospectively registered in PROSPERO (CRD420251274560, registered December 28, 2025) and evaluated the efficacy and hemodynamic stability of remimazolam versus propofol as hypnotic agents in patients undergoing these procedures. PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing remimazolam with propofol in patients undergoing intracranial neurosurgical procedures. The outcomes evaluated were heart rate (HR), mean arterial pressure (MAP), hypotension incidence, recovery characteristics, and adverse events. We computed mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. We included 7 RCTs, comprising 770 patients. Remimazolam was associated with a significantly shorter recovery time compared with propofol (MD: -1.74 min; 95% CI: -3.40 to -0.08; P=0.040; I2=48.7%). There were no significant differences between groups in anesthesia duration (MD: -3.31 min; 95% CI: -9.40 to 2.78; P=0.286; I2=0%), HR (MD: -1.79 bpm; 95% CI: -8.97 to 5.39; P=0.625; I2=97.5%), MAP (MD: -2.54 mm Hg; 95% CI: -6.09 to 1.00; P=0.160; I²=29.5%), and incidence of hypotension (RR: 0.56; 95% CI: 0.26-1.22; P=0.143; I2=72.4%). In conclusion, in patients undergoing intracranial neurosurgery, remimazolam use was associated with shorter recovery time and a hemodynamic profile similar to that of propofol.

PMID:42312365 | DOI:10.1097/ANA.0000000000001128

Trop Doct. 2026 Jun 18:494755261459846. doi: 10.1177/00494755261459846. Online ahead of print.

ABSTRACT

BackgroundAccurate and timely Gram stain interpretation of positively flagged blood culture bottles is crucial for early detection of bloodstream infections and initiation of empirical therapy. However, resin and charcoal particles in culture media may interfere with smear clarity.MethodsA prospective study was conducted on 100 positive blood culture samples. Four smear preparation techniques – conventional, water wash, blood film, and drop and rest – were applied. These were assessed for diagnostic agreement with final culture results and graded for resin/charcoal interference. Kappa (κ) statistics measured concordance.ResultsThe blood film method showed the highest agreement with culture Gram stains (63%, κ = 0.26), followed by conventional (62%, κ = 0.24), drop and rest (61%, κ = 0.22), and water wash (59%, κ = 0.18). It also had the least particle interference and the most deposit-free smears (29/100).ConclusionThe blood film method offers superior diagnostic clarity and is recommended.

PMID:42312347 | DOI:10.1177/00494755261459846

Glob Health Action. 2026 Dec;19(1):2686564. doi: 10.1080/16549716.2026.2686564. Epub 2026 Jun 18.

ABSTRACT

BACKGROUND: Cesarean section is a lifesaving obstetric intervention when medically indicated; however, its utilization remains unequal across sub-Saharan Africa (SSA). Although the World Health Organization recommends cesarean section rates of 10-15%, access remains insufficient in many low-resource settings and excessive in others. Understanding geographic patterns and drivers is essential for maternal health planning.

OBJECTIVE(S): To examine the spatial variation and determinants of cesarean section delivery across SSA.

METHODS: We conducted a cross-sectional analysis using Demographic and Health Survey data (2015-2024) from 201,481 weighted samples across 28 SSA countries. Spatial autocorrelation and hotspot patterns were assessed using Global Moran’s I and Getis-Ord Gi* statistics. Spatial regression models, including ordinary least squares, spatial lag, spatial error, geographically weighted regression, and multiscale geographically weighted regression, were fitted. Model performance was compared using corrected Akaike Information Criterion and adjusted R².

RESULTS: Cesarean section delivery showed significant spatial clustering (Moran’s I = 0.18, z = 43.3, p < 0.01). Hotspot areas were identified in Uganda, Rwanda, Burundi, Kenya, Tanzania, Malawi, South Africa, Lesotho, Gabon, Ghana, and Senegal, while cold spots were observed in Ethiopia, Madagascar, Angola, Nigeria, Guinea, Cote d’Ivoire, Sierra Leone, Liberia, and Mauritania. Previous cesarean delivery, maternal age ≥35 years, pregnancy spacing behavior, and health insurance coverage were significant spatial predictors.

CONCLUSION: Cesarean section utilization in SSA exhibits substantial geographic inequality driven by context-specific determinants. Spatially targeted maternal health policies, improved referral systems, and equitable financing mechanisms are needed to optimize access to medically indicated cesarean delivery while minimizing unnecessary procedures.

PMID:42312320 | DOI:10.1080/16549716.2026.2686564

Int J Chron Obstruct Pulmon Dis. 2026 Jun 12;21:616277. doi: 10.2147/COPD.S616277. eCollection 2026.

ABSTRACT

INTRODUCTION: Patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often suffer from malnutrition, and traditional assessment methods struggle to fully capture muscle loss. The value of total pectoralis major area (tPMA) measured by CT remains to be determined. This study aimed to investigate the relationship between tPMA and malnutrition in patients with AECOPD and its diagnostic value.

METHODS: A total of 123 patients with AECOPD were enrolled (35 in the malnutrition group and 88 in the non-malnutrition group). Clinical and imaging parameters were compared between the two groups. Logistic regression analysis was used to assess the independent association between tPMA and malnutrition, and ROC curves were employed to evaluate its diagnostic performance when used alone or in combination with albumin (ALB) or total protein (TP). Spearman correlation analysis was used to examine the relationship between tPMA and other nutritional and disease severity indicators.

RESULTS: tPMA levels were significantly lower in the malnourished group than in the non-malnourished group (P < 0.01). tPMA was a protective factor against malnutrition in patients with AECOPD (OR = 0.998, P < 0.001); this association remained statistically significant after adjusting for confounding factors (P < 0.05). The AUC of tPMA for the standalone diagnosis of malnutrition was 0.770; when combined with ALB or TP, the AUC increased to 0.901 and 0.916, respectively (P < 0.05). tPMA was positively correlated with nutritional indicators and negatively correlated with the NRS2002 and CAT (P < 0.05).

DISCUSSION: tPMA is an independent associated factor against malnutrition in patients with AECOPD; when combined with ALB or TP, it significantly improves diagnostic performance and can serve as an objective adjunctive assessment indicator.

PMID:42312314 | PMC:PMC13271148 | DOI:10.2147/COPD.S616277

Front Glob Womens Health. 2026 Jun 2;7:1750182. doi: 10.3389/fgwh.2026.1750182. eCollection 2026.

ABSTRACT

INTRODUCTION: Since Acute Coronary Syndrome (ACS) death rates remain a challenge underscoring the importance of socioeconomic factors, the aim of the study was to explore the trend in incidence, mortality, and mortality-to-incidence ratio (MIR) of ACS and Myocardial Infarction (MI) among women in Serbia, middle income country, from 2006 to 2022, as well possible association with the Human Development Index (HDI), Social Demographic Index (SDI), and Years of Life Lost (YLL).

METHODOLOGY: The research was conducted according to the principles of a descriptive epidemiological study, using data extracted from publicly accessible yearbooks, registry and reports (count, and age-standardized rates). Statistical analysis was performed using Joinpoint Regression analysis with the Joinpoint Regression Program version 5.4.

RESULTS AND DISCUSSION: There were a significant declining trend of MI incidence (APC -2.1, p = 0.005) and mortality rates (APC -7.8, p < 0.001); ACS incidence did not change significantly, while ACS mortality decreased (APC -6.8, p < 0.05). There was significant association between trend of ACS and MI incidence, mortality and MIR at women in Serbia, and increasing trend of HDI and SDI. The constant decline in YLL followed, but the number of lost years remains high (APC -5.9, p < 0.001).

CONCLUSION: Consistently high mortality rates from ACS and MI among women in Serbia may be attributed to the complex phases of socioeconomic transformation the country has experienced, characterised by high exposure to risk factors and insufficient health promotion and prevention strategies. Urgently prioritising cost-effective, multidisciplinary prevention strategies for women, adapted to local contexts and aligned with health and other Sustainable Development Goals, is critical to reducing global disparities in cardiovascular outcomes.

PMID:42312312 | PMC:PMC13269274 | DOI:10.3389/fgwh.2026.1750182

Front Glob Womens Health. 2026 Jun 2;7:1775422. doi: 10.3389/fgwh.2026.1775422. eCollection 2026.

ABSTRACT

OBJECTIVE: To evaluate the influence of partnership status on the perception of menopausal symptoms and quality of life in women undergoing hormone replacement therapy (HRT).

METHODS: The study included 60 menopausal women aged 40-85 years with significant climacteric symptoms. Participants were divided into two groups according to relationship status: women living in a stable partnership (n = 30) and women without a partner for at least one year (n = 30). Menopausal symptoms and quality of life were assessed using the Menopause Rating Scale (MRS) and the Manchester Short Assessment of Quality of Life (MANSA). All participants received combined HRT. Assessments were performed at baseline and after three months of therapy. Changes in symptom severity (ΔMRS) and quality of life (ΔMANSA) were analyzed, and Pearson correlation coefficients with corresponding p-values were used to assess relationships between variables.

RESULTS: HRT was associated with improvement in menopausal symptoms and quality of life in both groups. However, women living in a partnership showed a greater reduction in MRS scores and a greater increase in MANSA scores compared to women without a partner. After three months of HRT, statistically significant correlations (p < 0.05) between hormonal levels (estradiol, FSH), menopausal symptoms, and quality of life were observed exclusively in partnered women.

CONCLUSION: HRT improves menopausal symptoms and quality of life; however, partnership status appears to play a moderating role. A stable partnership may facilitate the integration of psychobiological processes of hormonal changes and contribute to improved subjective adaptation to menopause.

PMID:42312311 | PMC:PMC13269051 | DOI:10.3389/fgwh.2026.1775422

Liver Cancer. 2026 Apr 16. doi: 10.1159/000551935. Online ahead of print.

ABSTRACT

INTRODUCTION: The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains dismal. Although systemic therapy is the standard of care, its effectiveness is limited. This study aimed to compare the efficacy and safety of transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) combined with systemic therapy versus systemic therapy alone in patients with HCC and PVTT.

METHODS: We retrospectively analyzed 478 patients newly diagnosed with HCC and PVTT between January 2021 and December 2024. Propensity score matching (PSM) was used to balance baseline characteristics. Outcomes compared between the combination therapy group (TACE/HAIC plus targeted therapy and immunotherapy, n = 374) and the systemic therapy group (n = 104) included overall survival (OS), progression-free survival (PFS), tumor response, and adverse events.

RESULTS: After PSM (184 vs. 102 patients), the combination therapy group showed significantly longer median OS (15.7 vs. 5.9 months; hazard ratio [HR] = 0.524, 95% confidence interval [CI]: 0.391-0.702; p < 0.001) and PFS (7.0 vs. 3.6 months, HR = 0.732, 95% CI: 0.558-0.959; p = 0.024). The disease control rate was also higher in the combination therapy group (43.5% vs. 27.5%, p = 0.007). Subgroup analyses revealed pronounced survival benefits in patients with Vp4 PVTT and those with Child-Pugh B liver function. Although adverse events were more frequent in the combination therapy group, the incidence of grade 3-4 toxicities was generally comparable between the two groups.

CONCLUSION: In HCC patients with PVTT, combining TACE or HAIC with systemic therapy significantly improves survival outcomes compared to systemic therapy alone, with acceptable safety. This multimodal approach offers a promising treatment strategy, particularly for patients with advanced PVTT or impaired liver function.

PMID:42312291 | PMC:PMC13271749 | DOI:10.1159/000551935

Int J Biomed Imaging. 2026 Jun 16;2026:4763936. doi: 10.1155/ijbi/4763936. eCollection 2026.

ABSTRACT

BACKGROUND: Brain tumour detection and analysis using medical imaging requires the extraction of both local spatial features and global contextual representations. Although convolutional neural networks (CNNs) excel at capturing local spatial patterns and Transformer-based architectures model long-range dependencies effectively, the optimal architectural paradigm for clinical deployment remains unresolved. This systematic review and meta-analysis evaluates hybrid CNN-Transformer architectures for brain tumour detection, focusing on the integration of local and global feature learning, diagnostic accuracy and computational efficiency. The roles of generative adversarial networks (GANs) for addressing data scarcity and multimodal imaging fusion for diagnostic completeness are also critically examined.

METHODS: A systematic search was conducted across IEEE Xplore, PubMed, Scopus and Google Scholar for studies published between January 2021 and May 2025. From 1876 initially identified articles, 94 met the prespecified inclusion criteria following quality assessment using the QUADAS-2 and ROBINS-I frameworks. A random-effects meta-analysis of diagnostic accuracy was performed using the DerSimonian-Laird estimator, with statistical heterogeneity quantified using I² and publication bias assessed using funnel plot asymmetry and Egger’s test. Computational efficiency was standardised to GigaFLOPs using a reference input of 240 × 240 × 155 voxels (BraTS benchmark), with FLOP estimates derived from primary publications where available and bounded by theoretical complexity formulas otherwise, with estimated values explicitly distinguished throughout.

RESULTS: Across all 94 included studies, the pooled diagnostic accuracy was 93.5% (95% CI: 92.7%-94.4%); however, confirmed publication bias (Egger’s p = 0.043) indicates this represents an upper-bound approximation rather than an unbiased population estimate. Because subgroup study counts were insufficient for formal random-effects pooling (CNN-only: n = 3; Transformer-only: n = 2; CNN-Transformer hybrid: n = 4; minimum recommended n = 10 per subgroup), no subgroup meta-analysis was performed. Instead, descriptive mean accuracies are reported as hypothesis-generating observations only: CNN-only models 91.7%, Transformer-only models 93.6% and CNN-Transformer hybrid models 94.6%. These figures must not be interpreted as pooled meta-analytic estimates; they reflect mean observed accuracy across a small number of included studies and are reported solely to illustrate directional trends consistent with the mechanistic rationale for hybridisation. Substantial heterogeneity was observed (I² = 78.3%; p < 0.001). Three integration paradigms were identified: sequential (45% of models; 93.8% accuracy; 1.8 GFLOPs), parallel (32%; 94.3%; 2.8 GFLOPs) and hierarchical (23%; 94.9%; 3.5 GFLOPs). Parallel architectures demonstrated optimal clinical viability, balancing accuracy with a mean inference time of 2.1 s. GAN-based augmentation improved rare tumour class detection by 7%-10%, with conditional GANs outperforming vanilla architectures. Multimodal MRI + PET fusion achieved 94.2% accuracy at 2.8 GFLOPs, whereas triple-modality integration yielded marginal additional gains (95.1%) at substantially elevated computational cost (9.1 GFLOPs). Notably, 65% of included studies used the BraTS benchmark exclusively, and hybrid model accuracy declined from 94.6% on high-grade gliomas to 88.3% on low-grade gliomas, with hybrid architectures exhibiting 2.3× greater susceptibility to Gaussian noise than CNN-only equivalents, limitations that constrain generalisation to real-world clinical settings.

CONCLUSIONS: Descriptive comparison of mean observed accuracies based on study counts is insufficient for confirmatory meta-analysis, suggesting hybrid CNN-Transformer architectures may offer diagnostic accuracy advantages over CNN- and Transformer-only approaches; this observation is hypothesis-generating only and requires validation in a larger, more balanced evidence base. Among integration strategies, parallel architectures demonstrated the most favourable accuracy efficiency balance in the reviewed evidence. GANs and multimodal imaging function as essential architectural enablers, addressing data scarcity and diagnostic incompleteness, respectively. Significant challenges remain in computational efficiency, noise robustness and generalisation to rare tumour subtypes, representing priority directions for future research.

PMID:42312286 | PMC:PMC13270495 | DOI:10.1155/ijbi/4763936

J Indian Assoc Pediatr Surg. 2026 May-Jun;31(3):406-417. doi: 10.4103/jiaps.jiaps_288_25. Epub 2026 May 5.

ABSTRACT

BACKGROUND: While Wilms tumor (WT) is primarily associated with mutations in WT1, CTNNB1 and WTX genes, these alterations account for only ~30% of cases, suggesting a broader, unexplored genetic landscape.

OBJECTIVE: The objective of this study was to comprehensively characterize novel genetic variants in WT through whole-genome sequencing analysis of paired tumor and normal renal tissues.

MATERIALS AND METHODS: Somatic exonic variants (paired, malignant, and normal renal tissues) in the whole genome of the study cohort were filtered for exonic regions, annotated using multiple prediction tools (SIFT, MutationTaster, Combined Annotation Dependent Depletion [CADD]), and analyzed for functional relevance using cBioPortal and STRING databases.

RESULTS: Seventy-one variants in 16 genes were consistently present across the study cohort. Statistically, KRT18, CNN2, MUC16, MUC19, and FCGBP harbor 74.6% (53/71) of the variations identified. Six genes (MAST2, MUC19, KRT3, MUC16, FCGBP, and ANKRD36) were predicted to have a “high” likelihood of being involved in cancer. Twenty-three variants pertaining to KRT18, CNN2, WDR89, MTCH2, DDX11, GXYLT1, and ANKRD36 had a CADD score >20, with 10 KRT18 variants having DANN scores ≥0.75. Significant clustering of variants in “hotspot-exons” pertaining to KRT18 (exon 1), CNN2 (exon 7), and MUC16 (exons 23 and 56) was observed. The implicated genes were found to interact with multiple pathways involved in cell cycle regulation, apoptosis, immune signaling, and developmental processes.

CONCLUSIONS: This study significantly expands WT’s genetic landscape by identifying 71 variants across 16 genes, including several genes with established roles in other cancers (MUC16, KRT18, FCGBP) that have not been previously implicated in WT, as well as genes with limited prior cancer associations. The identification of mutation hotspots and WT-specific gene associations provides new insights into WT development and potential therapeutic targets. These findings warrant further functional studies to validate their role in WT pathogenesis and potential as diagnostic or therapeutic targets.

PMID:42312281 | PMC:PMC13271734 | DOI:10.4103/jiaps.jiaps_288_25

J Indian Assoc Pediatr Surg. 2026 May-Jun;31(3):363-368. doi: 10.4103/jiaps.jiaps_180_25. Epub 2026 May 5.

ABSTRACT

INTRODUCTION: Multiple functional scoring systems exist to evaluate bowel and urinary outcomes in patients with anorectal malformations (ARM). However, their correlation with patient-reported quality of life (QoL) remains uncertain. This study aimed to assess the predictive value of these functional scores in determining long-term QoL among adolescents and adults with ARM.

MATERIALS AND METHODS: We conducted a cross-sectional study including patients aged ≥12 years who had undergone definitive surgical correction for ARM, irrespective of age at operation. Functional outcomes were evaluated using the Kelly, Rintala, Holschneider, pediatric incontinence/constipation score (PICS), lower urinary tract symptoms, and Bowel function score (BFS) systems. QoL was assessed using a self-reported 1-10 numerical scale, where higher scores indicated better perceived well-being. Correlations between functional outcomes and QoL were analyzed statistically.

RESULTS: Twenty-three patients (17 females, 6 males) with a mean age of 15.96 ± 4.65 years were assessed. The majority (74%) had low-type ARM. The Kelly and BFS scores demonstrated the strongest correlation with each other (P < 0.001). However, none of the functional scoring systems showed a significant correlation with patient-reported QoL.

CONCLUSIONS: Functional scoring systems, while useful for objective outcome assessment, do not reliably predict long-term QoL in ARM survivors, particularly those with low malformations. Patient-reported QoL appears to be shaped by broader influences, including psychosocial adaptation, coping mechanisms, cultural perceptions, and response shift. These findings highlight the need for validated QoL instruments and multicenter studies incorporating both functional and psychosocial domains.

PMID:42312250 | PMC:PMC13271698 | DOI:10.4103/jiaps.jiaps_180_25