Category: Statistics

Eur Radiol. 2026 Feb 1. doi: 10.1007/s00330-025-12164-1. Online ahead of print.

ABSTRACT

OBJECTIVES: Microvascular invasion is a strong prognostic factor in hepatocellular carcinomas. The aim of our study was to assess the diagnostic value of mechanical parameters measured with compression MR elastography to detect microvascular invasion in hepatocellular carcinomas.

MATERIALS AND METHODS: In this prospective preoperative MR elastographic study, consecutive patients with hepatocellular carcinomas, scheduled for tumor surgical resection, were included. The tumor parameters assessed with MR elastography were the basal visco-elastic parameters (storage modulus, loss modulus, and phase angle, reflecting elasticity, viscosity and visco-elastic ratio) during expiration and inspiration, and the tumor stiffening slope during compression induced by respiration, reflecting non-linear elasticity. Microvascular invasion was determined with histopathological examination of resected tumors. Diagnostic performance of MR elastography was assessed with area under the receiver operating curve (AUC) analysis.

RESULTS: The final study group consisted of 53 patients with complete surgical resection, MR elastography and histological data, including 31 patients with microvascular invasion. Compression stiffening slope and storage modulus difference between inspiration and expiration were significantly higher in hepatocellular carcinomas without than with microvascular invasion (p < 0.001 and p = 0.03, respectively). Among clinical, morphological and biomechanical imaging features, the MR elastography compression stiffening slope (p = 0.004) and histological WHO differentiation (p = 0.02-0.03) were the only independent determinants of hepatocellular carcinoma microvascular invasion. In contrast to basal biomechanical parameters, the compression stiffening slope had high diagnostic performance for detecting microvascular invasion (AUC_{compression stiffening} = 0.83, p < 0.001).

CONCLUSION: Our results suggest that the compression stiffening slope at MR elastography is useful to diagnose microvascular invasion in patients with hepatocellular carcinomas.

KEY POINTS: Question Because non-invasive imaging markers of hepatocellular microvascular invasion are lacking, the development of new MRI markers is advisable. Findings In our MR elastography study, respiration-induced tumor stiffening, in contrast to basal visco-elastic parameters, had good accuracy for diagnosing hepatocellular carcinoma microvascular invasion. Clinical relevance Our results in patients with hepatocellular carcinomas suggest that the non-invasive measurement of MR elastography tumor compression stiffening slope may assess microvascular invasion.

PMID:41621038 | DOI:10.1007/s00330-025-12164-1

Ambio. 2026 Feb 1. doi: 10.1007/s13280-025-02333-3. Online ahead of print.

ABSTRACT

The recovery of large carnivore populations in Europe often leads to conflicts with the primary sector. Compensation for livestock and agricultural losses is a common mitigation tool, but its impact on tolerance and support for conservation remains unclear. We investigated brown bear damage to apiaries in the Polish Carpathians by surveying beekeepers in areas of bear presence. Using statistical modelling, we examined how emotional and cognitive responses to damage and compensation experiences shape tolerance and behavioural intentions towards bear conservation. We found that experiencing damage and receiving compensation was associated with higher risk perceptions and greater trust in the management administration. Whereas negative intentions were more likely when tolerance was low and fear was high, conservation support was positively associated with tolerance and perceived control. These findings suggest that conservation authorities can improve coexistence by relying on non-lethal strategies that minimize risk, build trust and foster a sense of control.

PMID:41621030 | DOI:10.1007/s13280-025-02333-3

Qual Life Res. 2026 Feb 1;35(3):54. doi: 10.1007/s11136-026-04166-3.

ABSTRACT

PURPOSE: Obstructive Sleep Apnea (OSA) impairs children’s quality of life (QoL), but the impact of air pollution and heat wave on pediatric OSA-related QoL remains unclear. This retrospective cross-sectional study investigated associations between short-term air pollutant (PM_2.5, PM₁₀, SO₂, and NO₂) exposure, heat wave, and QoL in children with OSA, including pollutant lag effects.

METHODS: A retrospective cross-sectional study was conducted at Henan Provincial Children’s Hospital (2021-2023). Eligible participants were ≤ 14-year-old Henan residents with confirmed OSA (OAHI > 1) via polysomnography. QoL was assessed by the OSA-18 Scale. Air pollutant and heat wave data were from national monitoring networks. Generalized Linear Regression Models (GLMs) analyzed continuous QoL outcomes, with sensitivity analyses performed.

RESULTS: 1943 children were included. The statistical analysis results showed that PM_2.5 lag03-lag07; PM₁₀ lag0-lag6, lag01-lag07; SO₂ lag0-lag2, lag01-lag07; NO₂ lag7, lag05-lag07 were statistically correlated with the impact on the QoL of pediatric patients. The maximum effect values OR were 1.042 (95% CI 1.006, 1.079), 1.030 (95% CI 1.016, 1.045), 1.774 (95% CI 1.279, 2.462), and 1.101 (95% CI 1.013, 1.197), respectively. Additionally, heat wave was associated with worse QoL (OR:1.537, 95% CI 1.021, 2.313). Sensitivity analyses confirmed result stability.

CONCLUSIONS: Air pollutants (especially SO₂ and NO₂) and heat waves reduce QoL in children with OSA, highlighting the need for targeted environmental interventions.

PMID:41621022 | DOI:10.1007/s11136-026-04166-3

Orv Hetil. 2026 Feb 1;167(5):180-187. doi: 10.1556/650.2026.33484. Print 2026 Feb 1.

ABSTRACT

INTRODUCTION: The diagnostic work-up of patients presenting to the emergency department with chest pain remains a major clinical and health-economic challenge worldwide. Although most cases are caused by benign, non-cardiopulmonary conditions, the primary goal of emergency care is the timeous, but safe exclusion of life-threatening disorders – mainly acute coronary syndrome and pulmonary embolism. Excessive diagnostic testing increases both healthcare costs and emergency department overcrowding. Preliminary observations suggest that previously unrecognized spinal asymmetry or scoliosis is more prevalent among ambulatory adults presenting with pleuritic or musculoskeletal-type chest pain, potentially predisposing to costosternal or costovertebral subluxation as a mechanical pain generator.

OBJECTIVE: The planned prospective, multicenter study aims to assess the prevalence and clinical significance of spinal asymmetry among ambulatory, low-risk adults presenting with chest pain, and to develop/validate a novel musculoskeletal chest pain clinical prediction model.

METHODS: Primary outcome variables include pulmonary embolism and major cardiac events (non-ST-elevation myocardial infarction, unstable angina). Based on power calculations by Peduzzi et al. (1996), a total of 2,500 patients will provide adequate statistical power to avoid Type II error. Patients will be followed up at 30, 90, and 365 days for complications, recurrent visits, major adverse cardiac events, and mortality. Data will be analyzed using bootstrapping techniques for internal validation of the derived score.

EXPECTED RESULTS: We hypothesize that spinal asymmetry independently correlates with acute musculoskeletal chest pain but does not confer an increased risk of short- or long-term mortality. The newly developed musculoskeletal chest pain clinical prediction model may facilitate early recognition and safe management of musculoskeletal chest pain in the emergency department setting.

CONCLUSION: This study is expected to refine diagnostic algorithms for low-risk chest pain, reduce unnecessary investigations, improve cost-effectiveness, and enhance patient satisfaction. Orv Hetil. 2026; 167(5): 180-187.

PMID:41621021 | DOI:10.1556/650.2026.33484

Discov Oncol. 2026 Feb 1. doi: 10.1007/s12672-026-04459-6. Online ahead of print.

ABSTRACT

BACKGROUND: Trifluridine/Tipiracil (TAS-102) is an effective agent for the late-line treatment of metastatic colorectal cancer (mCRC). Combining TAS-102 with bevacizumab improves outcomes but may increase adverse events. We conducted a real-world, retrospective, exploratory comparison of two dosing schedules (bi-weekly vs. four-weekly) to describe efficacy, safety, and potential molecular and clinical correlates.

METHODS: We analyzed patients with mCRC who were treated with TAS-102 in combination with bevacizumab as late-line therapy from January 2020 to February 2023. Regimen assignment followed physician-patient shared decision-making based on clinical factors and local practice changes after emerging evidence, not randomization. Endpoints included progression-free survival (PFS), overall survival (OS), adverse events (AEs). Analyses were exploratory and hypothesis-generating, with multivariable Cox models for selected covariates.

RESULTS: A total of 92 patients were enrolled in this study. Median PFS was 3.2 months (bi-weekly) vs. 3.7 months (four-weekly), and median OS was 10.0 vs. 9.3 months, with no statistically significant differences. KRAS mutation was associated with inferior OS (7.7 vs. 11.8 months; P = 0.018), whereas TP53 was not. Eastern Cooperative Oncology Group performance status (ECOG-PS) = 2 independently predicted shorter PFS and OS; prior bevacizumab exposure correlated with shorter PFS but not OS. Common adverse events in patients were neutropenia (63.0%), leukopenia (67.0%), anemia (44.6%), malaise (55.4%), nausea (45.7%), anorexia (31.5%), and diarrhea (23.9%).

CONCLUSION: In this retrospective, real-world study, the two regimens demonstrated comparable disease control, and the bi-weekly regimen appeared to be better tolerated, representing a reasonable potential alternative. Nevertheless, these findings should be interpreted as exploratory, and future prospective studies are warranted.

PMID:41621001 | DOI:10.1007/s12672-026-04459-6

Orv Hetil. 2026 Feb 1;167(5):171-179. doi: 10.1556/650.2026.33450. Print 2026 Feb 1.

ABSTRACT

INTRODUCTION: Surface-guided radiotherapy is an increasingly widely used technique that can monitor patient body surface movement in real time in a non-invasive manner.

OBJECTIVE: To evaluate the setup accuracy of surface-guided radiotherapy in lung stereotactic body radiotherapy compared to conventional cone-beam CT-based positioning.

METHOD: A retrospective single-center analysis was performed on 12 patients treated with lung surface-guided radiotherapy between 2022 and 2025. 6 patients were positioned using surface guidance with cone beam CT verification, while 6 were treated using cone-beam CT alone. Table couch corrections in three translational (vertical, longitudinal, lateral) and three rotational axes (pitch, roll, rotation) were recorded. Group differences were analyzed using the independent-samples Mann-Whitney U-test.

RESULTS: The resultant 3D translational displacement was significantly lower in the surface-guided group (median: 0.40 cm) compared to the control group (0.63 cm; p = 0.002). Among individual translational components, only the vertical axis showed a significant reduction in the surface-guided group (p<0.001), while longitudinal and lateral shifts did not differ significantly (p>0.05). In contrast, the resultant 3D rotational displacement was higher with surface-guided radiotherapy (median: 2.19° vs. 1.13°; p = 0.013). None of the individual rotational axes (pitch, roll, rotation) showed statistically significant differences (p>0.05).

DISCUSSION: These findings are consistent with previous literature demonstrating that surface guidance improves translational accuracy in thoracic radiotherapy, particularly in the vertical direction. The slightly increased rotational deviations observed in the surface-guided group may be attributed to the absence of a 6D treatment couch, as the system primarily optimizes translational alignment. Given the small sample size, further multicenter studies with larger cohorts and different surface guidance platforms are warranted.

CONCLUSION: Surface-guided radiotherapy enhances positioning accuracy in lung sterotactic radiotherapy, mainly by reducing translational displacements. However, optimal control of rotational errors may require the integration of 6D couch capabilities or dedicated rotational correction techniques. Orv Hetil. 2026; 167(5): 171-179.

PMID:41620991 | DOI:10.1556/650.2026.33450

Curr Med Res Opin. 2026 Feb 1:1-11. doi: 10.1080/03007995.2026.2621287. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVE: Disordered mineral metabolism is associated with adverse outcomes in dialysis populations, but its prognostic significance in non-dialysis CKD is less well defined. This study evaluated elevated serum alkaline phosphatase (ALP) and hyperphosphatemia as predictors of mortality and renal outcomes in non-dialysis CKD.

METHODS: In this prospective cohort study, patients from a tertiary renal clinic were followed for >12 months. Elevated ALP was defined as >105 U/L in females or >130 U/L in males; hyperphosphatemia as phosphate >4.5 mg/dL. The primary outcome was mortality, and the secondary outcome was a composite endpoint (ESKD progression, dialysis initiation, or doubling of serum creatinine). Kaplan-Meier, log-rank, and Cox regression analyses were performed (STATA; p <.05).

RESULTS: Among 360 patients (mean age 53.7 ± 13.9 years; follow-up 14 ± 4.2 months), elevated ALP was present in 31.7% and was associated with higher mortality (24.6% vs 8.9%, p <.001) and composite events (45.6% vs 33.9%, p = .03). Hyperphosphatemia occurred in 38.1% and was associated with increased mortality (21.2% vs 9.4%, p = 0.002) and composite outcomes (57.4% vs 25.6%, p <.001). Elevated ALP independently predicted mortality (HR = 2.37; 95% CI = 1.36-4.15; p = .002) but not composite outcomes. Hyperphosphatemia predicted both mortality (HR = 2.59; 95% CI = 1.47-4.57; p = .001) and composite events (HR = 2.55; 95% CI = 1.80-3.60; p <.001). Subgroup analyses demonstrated the highest mortality risk among patients with concurrent elevations in ALP and serum phosphate.

CONCLUSIONS: Elevated ALP independently predicted mortality, while hyperphosphatemia predicted both mortality and CKD progression. Monitoring these biomarkers may improve risk stratification and guide future interventional studies.

PMID:41620976 | DOI:10.1080/03007995.2026.2621287

Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi. 2026 Feb;42(2):129-139.

ABSTRACT

Objective To investigate the effect of N-acetylglucosamine transferase 4 (GalNAc-T4) on the mitochondrial autophagy in H9c2 cell injury model induced by hypoxia/reoxygenation (H/R) in high glucose (HG) environment, and its regulatory mechanism on extracellular signal regulated kinase 1/2 (ERK1/2) signaling pathway. Methods The cell experiments were divided into five groups. Control group (Control): Cells were transfected with pc-NC cells. HG group: 50 mmol/L glucose was added to the culture medium, and cells were transfected with pc-NC. HG+H/R group: In addition to the HG treatment, cells were subjected to a low oxygen environment for 6 hours, followed by transfection with the pc-NC vector. Overexpression group (pc): Cells were transfected with the pc while undergoing HG+H/R treatment. ERK1/2 agonist epidermal growth factor (EGF) group: Cells were treated with HG+H/R and transfected with the pc, supplemented with 20 ng/mL EGF in the culture medium. The proliferation activity, apoptosis rate, mitochondrial membrane potential, the levels of reactive oxygen species (ROS), iron ions, and mitochondrial autophagy in each group of cells were detected. The expressions of GalNAc-T4, ERK1/2, phosphorylated ERK1/2 (p-ERK1/2), translocase of outer mitochondrial membrane 20 (TOM20), translocase of inner mitochondrial membrane 23 (TIM23), B cell lymphoma 2 (Bcl2), and Bcl2 associated X protein (BAX) were detected in cells. Results Overexpression of GalNAc-T4 significantly increased the proliferation activity, the mitochondrial membrane potential, and the expression of TOM20, TIM23, and Bcl2 in H9c2 cells in HG+H/R group, and decreased the cell apoptosis rate, the levels of ROS and iron ion. Meanwhile, it inhibited the mitochondrial autophagy and downregulated the expression of p-ERK1/2/ERK1/2 and BAX in cells. EGF partially reversed the protective effect of the overexpression of GalNAc-T4 on cardiomyocytes, and the differences were statistically significant. Conclusion Overexpression of GalNAc-T4 could significantly improve the mitochondrial dysfunction in H9c2 cells undergoing hypoxia/reoxygenation under high glucose conditions, inhibit oxidative stress and excessive mitochondrial autophagy, and reduce the apoptosis rate of cardiomyocytes. This may be related to its ability to block the activation of ERK1/2 signaling pathway.

PMID:41620966

Alcohol Clin Exp Res (Hoboken). 2026 Feb;50(2):e70225. doi: 10.1111/acer.70225.

ABSTRACT

BACKGROUND: Despite potentially harmful consequences, people routinely encounter alcohol adverts designed to increase consumption of alcohol in preference to safer alternatives. However, individuals differ in the degree to which such adverts elicit preferential alcohol consumption. This study builds upon and extends prior research by testing hypotheses concerning the impact of biased processing during advert viewing on subsequent alcohol craving and consumption.

METHOD: Sixty-eight undergraduate students viewed beer and soft drink adverts. In some viewing blocks, beer and soft drink adverts played simultaneously to assess participants’ attentional bias to beer adverts. In others, participants were asked to choose which type of advert to view, which assessed bias in volitional viewing choice. Participants subsequently rated their craving for beer before completing a taste test designed to yield a behavioral measure of preferential beer consumption.

RESULTS: Attentional bias to alcohol adverts predicted beer craving and preferential beer consumption. The association between attentional bias and preferential beer consumption was mediated by beer craving. An equivalent pattern of prediction was observed when using the viewing choice bias measure as the predictor. Importantly, when variation in either bias measure was statistically controlled for, the other continued to predict preferential beer consumption in a manner that was mediated by beer craving.

CONCLUSIONS: Two types of processing bias during advert viewing-viewing preference and attentional bias-were independently associated with subsequent preferential alcohol consumption. In both cases, these associations were accounted for by alcohol craving. The theoretical and applied implications of this are discussed.

PMID:41620957 | DOI:10.1111/acer.70225

JMIR Med Educ. 2026 Jan 30. doi: 10.2196/83779. Online ahead of print.

ABSTRACT

BACKGROUND: Structured educational programs for physicians in healthy longevity medicine (HLM) remain scarce. No published data yet document the impact of longevity-focused medical education on physicians. This study assesses the ramification of the HLM curriculum, certified by the American Council for Continuing Medical Education (ACCME), on physicians’ confidence in knowledge of HLM and clinical practice.

OBJECTIVE: This study aimed to evaluate the impact of accredited HLM education on physicians’ confidence in knowledge, and practice patterns, examining self-reported integration of HLM principles, professional attitudes, and career trajectories to determine the translational value of structured curricula in the emerging medical discipline.

METHODS: A cross-sectional online survey was conducted between March and April 2024 among physicians who had completed accredited HLM courses between January 2023 and February 2024. Invitations were sent globally to 590 eligible physicians; trainees and students were excluded. A total of 113 respondents completed the survey and were included in the analysis. The survey assessed self-reported changes in clinical implementation, confidence in HLM-related knowledge, and professional attitudes following course completion. Descriptive statistics and logistic regression analyses were performed (p < .05, 95% CIs).

RESULTS: Respondents represented 42 nationalities and were primarily trained in family medicine (27.4%) and internal medicine (15.93%). Overall, 96.5% reported increased confidence in HLM-related knowledge, with 47.8% indicating substantial improvement. More than half (55.8%) reported integrating HLM principles into routine patient assessments, and 80.5% reported more frequent discussions related to healthspan-focused care. Additionally, 23% initiated aging biomarker testing, 48.7% increased testing frequency, 52.2% reported a shift in their perspective on aging, and 73.5% anticipated full integration of HLM into mainstream medicine. Physicians practicing in specialized care demonstrated higher odds of reporting increased confidence in HLM knowledge compared with those in primary and preventive care (OR 4.46, 95% CI 1.55-12.79, p = .005).

CONCLUSIONS: Accredited education in HLM is associated with enhanced confidence in HLM knowledge, increased clinical engagement with HLM practices, and a shift in aging-related care paradigms. These findings underscore the critical role of structured HLM curricula in bridging the translational gap between geroscience and everyday medical practice. Nevertheless, systemic healthcare barriers impede widespread implementation, warranting policy-level strategies to support healthspan-oriented education and care models.

PMID:41620952 | DOI:10.2196/83779