Category: Statistics

Syst Rev. 2026 Mar 3. doi: 10.1186/s13643-026-03129-6. Online ahead of print.

ABSTRACT

BACKGROUND: In ptotic/macromastic breasts, nipple-sparing mastectomy (NSM) risks ischemic complications. Staging with nipple repositioning (mastopexy or breast reduction) may improve perfusion, but uncertainty remains regarding safety and optimal timing.

METHODS: PRISMA guidelines will be followed. The database search will be conducted using MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.org targeting studies from inception to search date. Meta-analysis will be performed using Review Manager 5.4 software; forest plots will be used for two-arm studies to calculate pooled risk ratios, heterogeneity using I² statistics, and p-value for overall effect.

DISCUSSION: Due to the conflicting studies regarding the optimal timing and safety of nipple-repositioning before NSM, a systematic review and meta-analysis is required to provide more definitive evidence-based recommendations regarding the optimal timing and safety of this staged approach. Limitations may include the predominance of observational studies, heterogeneity in intervals, and inconsistent reporting that may limit the certainty of our conclusions.

SYSTEMATIC REVIEW REGISTRATION: ROSPERO CRD42024513738.

PMID:41776684 | DOI:10.1186/s13643-026-03129-6

Parasit Vectors. 2026 Mar 3. doi: 10.1186/s13071-026-07317-0. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate and compare the diagnostic performance of the Midi Parasep^® Solvent Free (SF) system and the Ritchie method for detecting helminths and protozoa in clinical stool samples. It also assessed the most suitable concentration technique for different laboratory contexts on the basis of parasitic burden and epidemiological factors.

METHODS: A retrospective comparative study was performed with 100 helminth-positive samples from the Drassanes Vall d’Hebron Microbiology Laboratory (Barcelona, Spain). Samples were previously identified using the Ritchie technique and were reprocessed using the Midi Parasep^® SF system. All samples were examined by expert microscopists and in accordance with World Health Organization protocols and quality standards. Bivariate analysis was performed using the Z-test or Fisher’s exact test, as appropriate, and differences were considered statistically significant at P < 0.05.

RESULTS: The Ritchie method detected 139 parasitic aetiologies, whereas Midi Parasep^® SF identified 85, yielding an overall concordance of 61.15%. While protozoan detection showed 100% concordance between both methods, the correlation for helminths was significantly lower (54.6%; P < 0.001). Midi Parasep^® SF exhibited reduced sensitivity, particularly for larger helminths (e.g., Strongyloides stercoralis, Schistosoma intercalatum) and samples with low parasitic burden. In addition, the Alcorfix^TM fixative agent caused morphological alterations in some helminth eggs and larvae. Midi Parasep^® SF offers operational advantages and hazard reduction; however, the Ritchie method is more sensitive for helminth detection.

CONCLUSIONS: The choice of concentration technique should be guided by the clinical context. Midi Parasep^® SF is efficient for protozoa and suitable for routine use in high-throughput settings. Conversely, the Ritchie method is preferable when helminth infection is highly suspected, particularly in migrant or travel medicine populations. Moreover, other diagnostic techniques, such as serological assays, could contribute to a more accurate diagnosis, thereby guiding the selection of the most appropriate concentration technique.

PMID:41776678 | DOI:10.1186/s13071-026-07317-0

Trop Med Health. 2026 Mar 4. doi: 10.1186/s41182-026-00937-3. Online ahead of print.

ABSTRACT

BACKGROUND: While global estimates of SARS-CoV-2-infected mortality predominantly focus on in-hospital deaths, post-discharge mortality remains an overlooked contributor to the total disease burden, especially in low- and middle-income countries such as Bangladesh. This study aimed to estimate the 30-day post-discharge mortality rate among adult (≥ 18 years) patients with severe acute respiratory infection (SARI) who were SARS-CoV-2-infected and to identify factors associated with these deaths.

METHODS: From March 2020-December 2023, we enrolled hospitalised adult meeting the World Health Organization defiend SARI case defination across nine tertiary care hospitals in Bangladesh. We followed-up with patients or their family members 30-day post-discharge to ascertain survival status. We calculated the proportion of post-discharge deaths among SARS-CoV-2-infected patients and compared the demographic and clinical characteristics of decedents versus survivors. Data were summarised using descriptive statistics, t-test, Fisher’s exact test, and Chi-square tests. We used multivariable Cox’s regression models to calculate the adjusted hazard ratio (aHR) to identify factors associated with SARS-CoV-2-infected adult patient’s deaths during 30-day post-discharge period.

RESULTS: Among 7,816 patients enrolled [mean age 47 years (± 47.7), 62% male], 1,280 (16.4%) were SARS-CoV-2-infected. Of them, 126 (9.8%) died during their hospital stay. Among the 1154 patients discharged alive, 1,108 (96%) were successfully followed up, and 111 (10%) died within 30 days post-discharge. The most frequently reported symptoms among post-discharge decedents included difficulty breathing (105; 94.6%), body ache (55; 49.6%), headache (44; 39.6%), with over half (59; 53.1%) having at least one pre-existing condition. Post-discharge mortality was approximately fourfold higher among prematurely discharged patients (aHR: 4.13; 95% CI 1.52-11.23), nearly fourfold higher in those with difficulty breathing (aHR: 3.69; 95% CI 1.62-8.43), and more than threefold higher among patients with kidney disease (aHR: 3.35; 95% CI 1.34-8.38) compared with their counterparts.

CONCLUSIONS: Nearly one in five adult patients with SARS-CoV-2-infected SARI in Bangladesh died either during hospitalisation or within 30-day of post-discharge, with almost half of these deaths occurring after discharge. Study findings underscore the urgent need to strengthen discharge planning, such as developing and implementing standardised discharge guidelines, prioritising high-risk patients such as premature discharge for targeted post-discharge follow-up, and implementing structured post-discharge care interventions to reduce preventable mortality in resource-limited settings.

PMID:41776628 | DOI:10.1186/s41182-026-00937-3

Reprod Biol Endocrinol. 2026 Mar 3. doi: 10.1186/s12958-026-01539-8. Online ahead of print.

NO ABSTRACT

PMID:41776626 | DOI:10.1186/s12958-026-01539-8

Eur J Med Res. 2026 Mar 4. doi: 10.1186/s40001-026-04021-8. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical observations indicate a correlation between frailty and lower urinary tract symptoms (LUTS) in men. We further investigated this relationship via data from two extensive population-based studies.

METHODS: We performed a cross-sectional study via the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). Participants lacking exposure variables, outcome variables, and important covariates were not included. The frailty index (FI) was used to evaluate frailty. In CHARLS, LUTS is defined as a previous diagnosis of benign prostatic hyperplasia. In NHANES, the presence of LUTS was defined as 2 or more symptoms, including hesitancy, incomplete emptying and/or nocturia. After taking into account the covariates (demography, chronic diseases, and unhealthy lifestyles), multivariable logistic regression was employed to examine the association between frailty and LUTS. Furthermore, subgroup analysis was conducted to investigate the influence of covariables on the association between frailty and LUTS. The mediating role of depression was ultimately examined.

RESULTS: Finally, our study included 1735 participants from NHANES and 5008 participants from CHARLS. The NHANES findings indicated a positive connection between frailty and LUTS [OR 1.97, 95% CI (1.53, 2.55)] after controlling for all the variables. The link persisted when FI was set as a categorical variable [Q3, 1.78 (1.05, 3.02); Q4, 2.95 (1.76, 4.93)]. The CHARLS findings indicated a positive connection between frailty and LUTS [1.64 (1.21, 2.23)] after controlling for all variables. The connection persisted when FI was designated as a categorical variable [Q2, 1.73 (1.31, 2.28); Q3, 2.15 (1.64, 2.83); Q4, 3.11 (2.36, 4.09)]. Depression partly mediated the relationship between frailty and LUTS (18.20% in NHANES; 19.63% in CHARLS).

CONCLUSIONS: A high FI was correlated with a greater risk of LUTS in both the US and Chinese men. The relationship between frailty and LUTS was partly explained by depression.

PMID:41776600 | DOI:10.1186/s40001-026-04021-8

BMC Med. 2026 Mar 4. doi: 10.1186/s12916-026-04754-7. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) disease and chronic obstructive pulmonary disease (COPD) are associated with major adverse cardiovascular events (MACE). Whether COPD further increases MACE risk within CKM populations, and whether this potential risk is modifiable through inhaled corticosteroids (ICS), is unknown. Within CKM populations, we investigated the relationship between (1) COPD and subsequent MACE, and (2) amongst concurrent CKM-COPD populations, we investigated the relationship between ICS and subsequent MACE.

METHODS: We used Clinical Practice Research Datalink (CPRD) Aurum, Hospital Episode Statistics and Office of National Statistics data, between January 1st, 2010, and March 29th, 2021. We created five discrete cohorts: chronic kidney disease (CKD), type-II diabetes mellitus (T2DM), obesity, MACE history, and older adults (aged ≥ 65 years old [“Age65 + “]). CKD, T2DM, obesity, and Age65 + cohorts were MACE-naïve at the time of inclusion. Aim (1) exposures were (a) COPD, (b) incident COPD, and (c) being at risk of COPD without diagnosis (defined as age ≥ 40 years old, smoking history, no evidence of asthma, and frequent respiratory infections requiring antibiotics). Aim (2) exposure was ICS prescription (control group: long-acting bronchodilators). The outcome was MACE (acute coronary syndrome, arrhythmia, heart failure, ischaemic stroke, or cardiovascular-specific mortality). We implemented Cox proportional hazards models.

RESULTS: COPD was associated with MACE amongst all cohorts, but was comparatively weak in the MACE history cohort (cohort total; adjusted hazard ratio [95% confidence interval]): CKD (N = 573,626; 1.29 [1.26, 1.32]), T2DM (N = 649,506; 1.30 [1.26, 1.35], obesity (N = 225,273; 1.41 [1.34, 1.48]), MACE history (N = 507,889; 1.04 [1.02, 1.06]), and Age65 + (N = 592,123, 1.59 [1.52, 1.66]). Incident COPD was associated with subsequent MACE in CKD only (1.28 [1.13, 1.45]). Being at risk of COPD was associated with subsequent MACE in CKD (1.18 [1.07, 1.30]), MACE history (1.16 [1.08, 1.25]), and Age65 + (1.28 [1.13, 1.46]). ICS prescription was not associated with subsequent MACE in any concurrent CKM-COPD cohort.

CONCLUSIONS: COPD was an independent risk factor for MACE in CKM populations. ICS did not attenuate MACE amongst CKM-COPD groups. Incident COPD was associated with MACE in CKD, and being at risk of COPD was associated with MACE in CKD, MACE history, and Age65 + cohorts.

PMID:41776594 | DOI:10.1186/s12916-026-04754-7

Biol Sex Differ. 2026 Mar 3. doi: 10.1186/s13293-026-00865-1. Online ahead of print.

ABSTRACT

BACKGROUND: Parkinson’s disease (PD) is a neurodegenerative disorder with established sex differences in incidence and progression. Epidemiological evidence suggests nicotine may confer protection against PD, but its mechanisms, particularly regarding sex-specific effects, remain unclear. This study investigated the neuroprotective mechanisms of nicotine in a rotenone-induced PD rat model, with a specific focus on evaluating sex-dependent modulation across behavioral, pathological, and gut-related outcomes.

METHODS: Male and female Sprague-Dawley rats were administered rotenone (2 mg/kg/day, s.c.) for four weeks to induce PD. Nicotine (0.5 mg/kg/day, s.c.) was administered 30 min after rotenone. Motor function was assessed using rotarod and CatWalk XT gait analysis. Neuropathology in the substantia nigra was evaluated via immunofluorescence for α-synuclein and tyrosine hydroxylase (TH). Gut pathology was analyzed through colon histopathology (H&E staining) and ELISA for IL-6 and α-synuclein. Gut microbiota composition was assessed by 16 S rDNA sequencing, and serum metabolomics was performed using UPLC-MS/MS. Data were analyzed by two-way ANOVA with Tukey’s post-hoc test.

RESULTS: Nicotine significantly attenuated rotenone-induced motor impairments: males showed a superior response in balance-related parameters, while females exhibited enhanced efficacy in dynamic gait metrics. Pathologically, nicotine reduced nigral α-synuclein accumulation and TH depletion in both sexes, with males showing greater α-synuclein accumulation following rotenone exposure. Crucially, nicotine exclusively ameliorated colon histopathology, reduced plasma α-synuclein, and suppressed colon IL-6 in females, while attenuating intestinal α-synuclein accumulation in both sexes. Microbiota analysis revealed sex-divergent taxonomic shifts with nicotine treatment. Metabolomics showed significantly more extensive metabolic reprogramming in females, particularly affecting indole derivatives. Pearson correlations revealed significant sex-specific associations between altered serum indole derivatives and gut microbiota genera.

CONCLUSIONS: Nicotine exerts neuroprotection in PD through sex-dependent modulation of multiple pathological pathways, primarily involving the gut-microbiota-metabolite axis. Females benefit from enhanced gastrointestinal protection and metabolic reprogramming, while males show preferential motor balance restoration. These findings underscore the critical importance of sex-stratified therapeutic strategies for PD.

PMID:41776571 | DOI:10.1186/s13293-026-00865-1

J Orthop Surg Res. 2026 Mar 3;21(1):169. doi: 10.1186/s13018-025-06209-w.

ABSTRACT

BACKGROUND: Patient comorbidities and medication intake impact on the mortality rate in revision surgery for periprosthetic joint infection (PJI) of the lower limb. The present study collected data from patients who underwent revision surgery for PJI of total hip arthroplasty (THA) or total knee arthroplasty (TKA). Data regarding comorbidities and medication intake for each patient were collected to investigate whether comorbidities and medication intake influence in-hospital mortality in patients who underwent revision surgery for PJI of a THA or TKA.

METHODS: The present study follows the STROBE Statement. Our institutional databases were searched using the OPS (operation and procedure codes) 5-823 and 5-821 in combination with the ICD (International Statistical Classification of Diseases and Related Health Problems) codes T84.5, T84.7 or T84.8. All patients with hip or knee implant infections who underwent revision surgery were retrospectively retrieved and included in the present study.

RESULTS: Data from 346 patients were collected (181 THAs and 165 TKAs). Patients with renal insufficiency demonstrated a statistically significant greater risk of in-hospital mortality (95% CI 0.0131 to 0.1132), as did patients with a history of malignancy (95% CI 0.1478 to 0.7497), and patients with dementia (95% CI 0.0398 to 0.3791). Nicotine and alcohol abuse, diabetes mellitus, arterial hypertension, hereditary thrombophilia, hereditary haemorrhages, cerebrovascular diseases, coronary heart diseases, chronic obstructive pulmonary disease osteoporosis, liver cirrhosis, rheumatoid arthritis, acute dental infection did not influence in the in-hospital mortality rate in patients who underwent revision surgery for PJI of a THA or TKA. Patient medication therapy did not impact the risk of in-hospital mortality in PJI.

CONCLUSION: Patients undergoing revision surgery for PJI after total hip and knee arthroplasty show an increased in-hospital mortality in the presence of the following comorbidities: dementia, renal insufficiency, and history of malignancy. Based on the present results, further infection prevention and geriatric co-management strategies should be evaluated for patients undergoing revision arthroplasty of the hip and knee for PJI.

PMID:41776540 | DOI:10.1186/s13018-025-06209-w

BMC Oral Health. 2026 Mar 3. doi: 10.1186/s12903-026-07743-7. Online ahead of print.

ABSTRACT

STATEMENT OF THE PROBLEM: The clinical performance of ceramic crowns is influenced by overall marginal adaptation. A recently introduced advanced lithium disilicate ceramic requires further evidence compared to conventional lithium disilicate in terms of vertical marginal fit.

PURPOSE OF THE STUDY: To assess the vertical marginal fit of crowns constructed from advanced and conventional lithium disilicate materials.

MATERIALS AND METHODS: Ten (n = 10) ceramic crowns were constructed and randomly assigned to two groups: Group (T) with CEREC Tessera crowns (n = 5) and Group (E) with IPS e.max CAD crowns (n = 5). Vertical marginal fit was evaluated using a stereomicroscope at 10X magnification both before and after cementation, with twenty equidistant measurement points recorded for each crown. Each crown was cemented to its corresponding natural molar tooth using Totalcem resin cement. Mann-Whitney U test was used to compare the two material groups. Wilcoxon signed-rank test was used to compare between vertical marginal fit before and after cementation (P ≤ 0.05).

RESULTS: The overall vertical marginal fit between the two groups showed no significant difference, whether before or after cementation. However, both groups exhibited a statistically significant decrease in vertical marginal fit after cementation.

CONCLUSION: Advanced lithium disilicate shows advantageous properties concerning mean marginal gap values exhibiting comparable performance to IPS e.max CAD.

CLINICAL IMPLICATIONS: CEREC Tessera demonstrated marginal fit values within clinically acceptable limits, supporting its reliability as a novel chairside material suitable for use in restorative dentistry.

PMID:41776528 | DOI:10.1186/s12903-026-07743-7

BMC Nurs. 2026 Mar 3. doi: 10.1186/s12912-026-04508-z. Online ahead of print.

ABSTRACT

AIM: To determine the association between urinary incontinence and primary caregiver burden (ZBI) in individuals aged ≥ 80, and to assess additional clinical and sociodemographic contributors.

METHODS: In this cross-sectional study at Elazığ City Hospital (Oct-Nov 2025), 311 patient-caregiver dyads were evaluated using interviews and chart review. UI was assessed with ICIQ-SF and burden with the ZBI. We used descriptive statistics, Spearman correlation, and multiple linear regression (outcome: total ZBI).

RESULTS: Mean patient age was 84.6 years; UI prevalence was 53.1% (n = 165). Mean caregiver ZBI = 47.08 ± 19.77. ZBI correlated strongly with ICIQ-SF (r = 0.536; p < 0.001). The regression model explained 31.5% of ZBI variance (F = 19.932, p < 0.001; adj R2 = 0.299); UI (B = 14.776; β = 0.374; p < 0.001) and BMI (B = 1.055; β = 0.194; p < 0.001) were the only significant predictors.

CONCLUSIONS: In geriatric patients, UI independently and substantially increases caregiver burden and may adversely affect quality of care. Prioritized strategies to reduce caregiver burden should include effective UI management, psychosocial support for caregivers, and control of modifiable risk factors such as obesity and falls.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41776504 | DOI:10.1186/s12912-026-04508-z