Category: Statistics

J Robot Surg. 2026 May 18;20(1):510. doi: 10.1007/s11701-026-03449-8.

ABSTRACT

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) have emerged as scarless alternatives to conventional open thyroidectomy, offering excellent cosmetic outcomes. However, the comparative perioperative outcomes between these two minimally invasive techniques remain to be systematically evaluated. This meta-analysis aimed to compare the perioperative outcomes of TOETVA and TORT in patients undergoing thyroid surgery.

METHODS: A systematic search was performed in PubMed, Embase, the Cochrane Library, and Web of Science from inception to March 1, 2026, for studies comparing TOETVA and TORT. The primary outcomes included recurrent laryngeal nerve injury, hypoparathyroidism, mental nerve injury, seroma, surgical site infection, and postoperative hemorrhage. The secondary outcome included operation time, length of hospital stay, number of lymph nodes dissected, and postoperative pain score. Pooled weighted mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Study quality was assessed using the ROBINS-I tool.

RESULTS: A total of 5 studies involving 1,080 patients were included (639 in the TOETVA group and 441 in the TORT group). Compared with TOETVA, TORT was associated with significantly longer operation time (MD = -56.74 min, 95% CI [-73.41, -40.07], p < 0.05) but shorter hospital stay (MD = 0.26 days, 95% CI [0.03, 0.49], p < 0.05). The incidence of transient recurrent laryngeal nerve injury was significantly higher in the TOETVA group than in the TORT group (OR = 3.56, 95% CI [1.14, 11.06], p = 0.03). There were no significant differences between the two groups in the number of lymph nodes dissected, the number of metastatic central compartment lymph nodes, the incidence of permanent recurrent laryngeal nerve injury, mental nerve injury, transient or permanent hypoparathyroidism, seroma, surgical site infection, or postoperative hemorrhage.

CONCLUSION: Although TORT is associated with longer operative time, it demonstrates potential advantages in terms of length of hospital stay and neuroprotection.The two procedures are comparable in terms of radicality of lymph node dissection, postoperative pain, and low complication rates. TORT is a safe and effective minimally invasive surgical option with better neural protection, especially suitable for patients prioritizing cosmetic outcomes. Long-term oncological safety still needs to be verified in future multicenter studies with larger samples and longer follow-up durations.

PMID:42144490 | DOI:10.1007/s11701-026-03449-8

Int Urol Nephrol. 2026 May 17. doi: 10.1007/s11255-026-05207-z. Online ahead of print.

ABSTRACT

PURPOSE: The benefits of incremental peritoneal dialysis (IPD) with days off remain controversial. This study aimed to compare the survival rate between IPD with days off and standard-dose peritoneal dialysis (PD).

METHODS: Participants who started continuous peritoneal dialysis (CAPD) between October 1, 2020 and November 30, 2021, in a tertiary hospital in Thailand were enrolled. IPD with two days off (performed 5 days a week) and standard-dose PD (performed every day) were compared using propensity score matching at a 1:1 ratio for baseline characteristics. The primary outcome was 1-year patient survival. One-year PD continuation rate, PD-associated peritonitis rate, admission rate, and weekly Kt/V at 6 weeks, 6 months, and 12 months were analyzed.

RESULTS: The 118 eligible patients (37 IPD and 81 standard-dose PD) were included. After propensity score matching, the groups were compared. One-year patient survival rates were comparable between groups, with no statistically significant difference (94.3% vs. 97.4% in the IPD and standard-dose PD groups, respectively; hazard ratio (HR) 2.15, 95% confidence interval (CI) 0.19-23.75). The 1-year PD continuation, PD-associated peritonitis rate, and admission rate were comparable between groups. Total weekly Kt/V over the 12 months showed no significant change over time.

CONCLUSION: IPD with days off appears to be safe and comparable to standard-dose PD in terms of short-term patient survival.

PMID:42144488 | DOI:10.1007/s11255-026-05207-z

Curr Microbiol. 2026 May 17;83(7):365. doi: 10.1007/s00284-026-04952-9.

ABSTRACT

In this study, optimization of medium components for high cell density culturing of Escherichia coli BL21(DE3) cells expressing the gene coding for the recombinant cellulolytic chimera, CtGH1-L1-CtGH5-F194A was carried out. The chimera comprised an N-terminal β-glucosidase, of glycoside hydrolase family 1, CtGH1 and a C-terminal mutant of an β-1,4-endoglucanase of family GH5, CtGH5-F194A both from Clostridium thermocellum (now known as Acetivibrio thermocellus), fused together with natural linker L1. The growth dynamics of E. coli BL21(DE3) cells was analysed in minimal salt medium (M9) supplemented with glycerol or glucose. The glycerol-supplemented medium provided higher growth (OD₆₀₀ ~5) and lower acetic acid accumulation (0.3 g/L) than that of glucose supplemented medium giving OD₆₀₀ ~4 and acetic acid accumulation of 2.1 g/L. The optimum inoculum size of 5% (v/v) and initial medium pH 7.0 gave the maximum cell growth. The screening of medium components performed by Plackett-Burman design, revealed KH₂PO₄, (NH₄)₂HPO₄ and glycerol as significant variables influencing the cell growth. Response surface methodology (RSM) and central composite design (CCD) utilized for optimization of medium component composition gave final concentrations, KH₂PO₄ (11.22 g/L), (NH₄)₂HPO₄ (5.19 g/L) and glycerol (18.11 g/L) resulting in model predicted value of cell, OD₆₀₀ 7.7. The experimental validation of optimized concentration of medium components displayed cell, OD₆₀₀ of 7.0, fairly matching with the model predicted value. The optimised M9 medium gave 5.3 g_DCW/L with a total protein yield of 12.5 mg/g_DCW displaying 59 U/mg and 44 U/mg β-1,4-endoglucanase and β-glucosidase activity, respectively. Statistical optimization of a defined minimal medium enhanced recombinant protein yield and enzyme activity while reducing the substrate input and acetate accumulation, thereby providing a reproducible and scalable platform for enzyme production. This study establishes the first medium‑optimization framework tailored to E. coli producing a recombinant chimeric enzyme, enabling controlled growth and supporting fed‑batch strategies for high‑cell‑density culturing.

PMID:42144487 | DOI:10.1007/s00284-026-04952-9

Environ Monit Assess. 2026 May 18;198(6):599. doi: 10.1007/s10661-026-15455-2.

ABSTRACT

Surges in gold prices coupled with socio-economic factors have increased small- and medium-scale gold mining in Guyana, which drives the emission of large quantities of mercury (Hg) into the atmosphere. Given the distribution of Hg through the atmosphere, reliable and affordable measurement of concentrations in the air is vital. Moss bags and Hg passive air samplers (MerPAS) were deployed to measure atmospheric Hg around a gold mine in Mahdia, Guyana over a 90-day period as well as a separate 2-day period that encompassed a periodic burn of Hg-gold amalgam (typically 2-h). Mercury in moss and MerPAS were positively correlated over both deployment periods, but Hg concentrations measured during the 2-day event were several-fold higher in both moss and MerPAS compared with the 90-day deployment. Using the 2-day deployment as an estimate of atmospheric Hg, Hg air concentrations around the burning station exceeded 100,000 ng m^-3 averaged over a 48-h period, and moss Hg concentrations were greater than 250,000 ng g^-1 around the burning station, although Hg concentrations in both media decreased rapidly with distance. There was no relationship between Hg in moss and soil Hg at the sampling sites; Hg in soil was instead positively associated with soil organic matter content. Overall, our study shows that Hg concentrations in air at artisanal gold mines in Guyana can exceed international health guidelines of 100,000 ng m^-3 averaged over a 48-h period and that moss provides reliable estimates of relative Hg concentrations in air over both short-term and long-term exposures.

PMID:42144486 | DOI:10.1007/s10661-026-15455-2

J Mol Med (Berl). 2026 May 18;104(1):74. doi: 10.1007/s00109-026-02680-y.

ABSTRACT

Platelets are increasingly recognised as inflammatory mediators that influence leukocyte behaviour, yet their spatial organisation and contribution to psoriatic skin inflammation remain incompletely understood. Here, spatial transcriptomics was used to map platelet-leukocyte niches (PLNi) across inflammatory skin diseases, contrasting psoriasis (PsO) with atopic dermatitis (AD). PLNi were selectively expanded in PsO lesions, where platelet-neutrophil co-localisation defined transcriptionally active regions enriched for stress and inflammatory mediators. PsO and psoriatic arthritis (PsA) shared a convergent cellular profile in which platelet association occurred across immune lineages but was markedly increased in neutrophils, particularly within the epidermis. Epidermal PLNi showed coordinated spatial patterns of dendritic and T cell enrichment, with neutrophil-platelet niches correlating with both. Neutrophil-platelet regions displayed enhanced inflammatory activity and stronger dendritic- and T-cell activation signatures, becoming more frequent with disease severity and pointing to a role for epidermal platelet-neutrophil associations in amplifying psoriatic immune responses. Peripheral multiomic analysis revealed enhanced platelet-neutrophil coupling and increased neutrophil activation in PsA, consistent with the higher systemic inflammatory burden of the arthritic form of the disease. Altogether, these results establish platelet-neutrophil niches as spatial features linked to immune activation in psoriatic disease, with consistent platelet-neutrophil aggregation patterns in circulation. KEY MESSAGES: Platelet-neutrophil niches expand selectively in psoriatic lesions Epidermal niches align with dendritic and T-cell activation programs syndrome Niche prevalence correlates with psoriasis clinical severity Psoriatic arthritis shows systemic platelet-neutrophil coupling Findings outline a platelet-associated inflammatory axis in autoimmunity.

PMID:42144473 | DOI:10.1007/s00109-026-02680-y

Eur Spine J. 2026 May 18. doi: 10.1007/s00586-026-09981-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether preoperative spinal angiography with endovascular embolization followed by microsurgical resection is technically feasible and safe for hypervascular spinal tumors, and to examine how cervical, thoracic, and lumbar vascular anatomy influences feasibility.

METHODS: We retrospectively reviewed 25 patients treated from 2017 to 2025 at two centers (14 men, 11 women; mean age 53 years) with hypervascular tumors involving the cervical (n = 3), thoracic (n = 15), lumbar and sacral (n = 7) spine. All underwent preoperative angiography (DSA)-embolization (within the same procedure if technically possible). We recorded whether embolization could be safely performed and any embolization-related complications; we also graded angiographic devascularization (devascularization grade, DG) and operative estimated blood loss (EBL). Selective or super-selective embolization was performed when arterial anatomy allowed safe catheterization, and surgery followed within 24-48 h.

RESULTS: Embolization was feasible in 23/25 patients (92%): thoracic 15/15 (100%), lumbar 6/6 (100%), sacral 1/1 (100%), and cervical 1/3 (33%). Two cervical RCC (renal cell carcinoma) metastases were not embolized because multiple short feeders shared trunks with radiculomedullary (spinal cord-supplying) arteries, precluding safe super-selective access. Among embolized cases, super-selective feeder occlusion was performed in 5/23 (21.7%) and segmental-vessel embolization in 18/23 (78.3%) using precipitating hydrophobic injectable liquid (PHIL), coils, and n-butyl cyanoacrylate (NBCA). High-grade devascularization (DG2-3) was achieved in all embolized cases, and completion angiography showed no or minimal residual tumor blush. There were no permanent embolization-related neurological deficits (0/23); one transient ischemic event occurred (1/23, 4.3%; vertebrobasilar ischemia in a C2 aneurysmal bone cyst) with full recovery. Mean estimated blood loss was 650 mL (median 600; range 400-800 mL. Differences in mean EBL between subsets of RCC and non-RCC tumors were statistically unsignificant, Correlations between DG and EBL was not identified.

CONCLUSION: A coordinated endovascular-surgical pathway achieved high embolization feasibility with no permanent embolization-related neurological complications, and no postoperative neurological deterioration in this cohort. Feasibility limitations were concentrated in the cervical spine, where short, shared feeders involving spinal cord-supplying arteries can preclude safe embolization. Limitations include retrospective design, small cohort with few cervical cases, and heterogeneous tumors/embolic agents; prospective studies with standardized devascularization and functional outcome metrics are warranted.

PMID:42144462 | DOI:10.1007/s00586-026-09981-3

Eur J Pediatr. 2026 May 18;185(6):404. doi: 10.1007/s00431-026-07084-1.

ABSTRACT

The diagnosis of Clostridioides difficile infection (CDI) in children is challenging due to high rates of asymptomatic colonization and the limited ability of available assays to differentiate colonization from true infection. The relative utility of polymerase chain reaction (PCR) versus stool toxin A/B detection by enzyme immunoassay (EIA) remains uncertain in pediatric practice. This study aimed to evaluate whether stool toxin A/B detection adds incremental clinical value among children with gastrointestinal multiplex PCR positivity for C. difficile toxin genes (tcdA/tcdB) by comparing risk factors, treatment decisions, and outcomes according to toxin status. This retrospective observational study included 103 pediatric patients (< 18 years) with PCR positive for C. difficile toxin genes (tcdA/tcdB) results at a tertiary children’s hospital between October 2022 and April 2025. Patients were categorized into three groups: stool toxin A/B not evaluated, stool toxin A/B negative, and stool toxin A/B positive. Demographics, risk factors, clinical characteristics, laboratory findings, treatment decisions, and outcomes were compared across stool toxin A/B groups. Of the 103 patients, 26 (25.2%) had no stool toxin A/B, 63 (61.2%) were stool toxin A/B negative, and 14 (13.6%) were stool toxin A/B positive. More than half of the cohort (54.3%) received CDI treatment, with no significant difference in treatment initiation rates among stool toxin A/B groups. The risk factors-including underlying disease (e.g., malignancies, inflammatory bowel disease, and immunodeficiencies), recent hospitalization, antibiotic exposure, and proton pump inhibitor (PPI) or enteral tube use-were similarly distributed. Clinical severity, laboratory parameters, imaging findings, recurrence, complications (1.0%), ICU admission (4.9%), and mortality (3.9%) did not differ significantly between stool toxin A/B positive and negative patients. Although a statistically significant difference in diarrhea severity was observed across groups, this was driven by the toxin-not-evaluated group. Importantly, stool toxin A/B positivity did not correlate with clinical severity, underlying risk factors, laboratory abnormalities, or outcomes.

CONCLUSION: In this pediatric cohort, stool toxin A/B detection did not provide additional clinical value beyond PCR positivity for C. difficile toxin genes (tcdA/tcdB). PCR alone, when interpreted in the context of compatible symptoms and epidemiological risk factors, may be sufficient to guide treatment decisions for suspected pediatric CDI. Given the limited incremental value of stool toxin A/B testing, optimized diagnostic algorithms and further multicenter pediatric studies are warranted.

WHAT IS KNOWN: • Pediatric CDI diagnosis is complicated by high asymptomatic colonization; PCR for C. difficile toxin genes (tcdA/tcdB) is sensitive but cannot distinguish colonization from infection. • Stool toxin A/B EIAs are more specific but less sensitive, and guidelines often recommend multistep algorithms.

WHAT IS NEW: • In our cohort of pediatric patients with PCR positivity for C. difficile toxin genes (tcdA/tcdB), stool toxin A/B status was not associated with clinical severity, risk factors, laboratory findings, outcomes, or treatment initiation. • When clinical features are compatible, PCR positivity for C. difficile toxin genes (tcdA/tcdB) alone may be sufficient to guide treatment, with limited incremental value of stool toxin A/B testing.

PMID:42144455 | DOI:10.1007/s00431-026-07084-1

Sci Rep. 2026 May 17. doi: 10.1038/s41598-026-53149-4. Online ahead of print.

ABSTRACT

During pregnancy, mental health conditions are a major health concern across the globe. Common mental disorders have complex effects on the health of the mother and fetus, as well as long-lasting social and economic repercussions. Hence, this study aimed to assess the worldwide pooled prevalence and risk factors of common mental disorders in pregnant women. We searched published papers using major databases, including Embase, PubMed, PsycINFO, Web of Science, Google Scholar, and HINARI, for studies on the prevalence and risk factors of common mental disorders published up to January 2024. The research teams used the Newcastle-Ottawa Quality Assessment Scale to assess the quality of each study. Two independent researchers screened and extracted the data. The analysis conducted using STATA statistical software version 11. The global estimated pooled prevalence and risk factors of common mental disorders in pregnant women were assessed using a random effect model. The heterogeneity of the included studies was evaluated using the I² statistic. The researchers assessed the publication bias using the funnel plot and Egger’s statistical test. The studies comprised eighteen studies with 17,380 pregnant women. The global pooled prevalence of common mental disorders in pregnant women was 31.59% (95% CI: 23.74-39.43). Subgroup analysis estimated the prevalence of common mental disorders in Africa (30.30%; 95% CI: 20.95-39.65), Asia (22.96%; 95% CI: 13.12-32.78), and South America (40.30%; 95% CI: 23.92-59.15). The risk factors considered included a family history of mental illness, chronic medical conditions, intimate partner violence, unplanned pregnancy, emotional violence, and a history of abortion. However, only intimate partner violence (POR = 2.63; 95% CI: 1.12, 6.17) was found to be significantly associated with common mental disorders among pregnant women. This study reveals a high global burden of common mental disorders among pregnant women, with regional variations. Intimate partner violence was found to be a significant risk factor. To mitigate its impact, integrating routine mental health screening and intimate partner violence prevention should be made into maternal healthcare services.

PMID:42144451 | DOI:10.1038/s41598-026-53149-4

EJNMMI Phys. 2026 May 17. doi: 10.1186/s40658-026-00887-z. Online ahead of print.

ABSTRACT

PURPOSE: Lesion segmentation is important in targeted radionuclide therapy dosimetry. In this study, we proposed a novel 2D multi-modal Segment Anything Model (mmSAM) for lesion segmentation in whole-body multi-tracer PET/CT images.

METHODS: The AutoPET 2024 dataset, including ¹⁸F-PSMA (369 subjects), ¹⁸F-FDG (170 subjects) and ⁶⁸Ga-PSMA (170 subjects) PET/CT images and their corresponding tumor masks, was used in this study. The ¹⁸F-PSMA PET/CT dataset was used as the primary dataset and was divided into 233: 36: 100 for training, validation and testing the mmSAM, using both PET and CT input. The transferability of the primary model was evaluated on 100 patients on other 2 datasets, without and with fine-tuning using 70 cases of ¹⁸F-FDG and ⁶⁸Ga-PSMA respectively. Standard single modal 2D SAM with only PET input, 3D nnUNet with two-channel PET/CT input and the thresholding-based method were also implemented for comparison. Mean Dice, the 95th percentile Hausdorff distance (mean HD95), mean standardized uptake value (mean |SUV_mean| error), metabolic tumor volume (mean |MTV| error), true positive rate (TPR), positive predictive value (PPV), and false discovery rate (FDR) were computed for all tumors. Statistical significance among different segmentation methods was evaluated using the Wilcoxon test.

RESULTS: mmSAM achieved the best performance as compared to other segmentation methods for the primary ¹⁸F-PSMA dataset (mean Dice/HD95/|SUV_mean| error/|MTV| error/TPR/PPV/FDR = 0.76/1.92 mm/5.10%/14.60%/100%/96.51%/3.49%, all p < 0.05), without fine-tuning (mean Dice/HD95/|SUV_mean| error/|MTV| error/TPR/PPV/FDR = 0.61/2.28 mm/ 15.83%/27.71%/100%/78.91%/21.09% for ¹⁸F-FDG; 0.77/1.33 mm/5.55%/17.96%/100% /97.78%/2.22% for ⁶⁸Ga-PSMA, p < 0.05), as well as with fine-tuning (mean Dice/HD95/|SUV_mean| error/|MTV| error/TPR/PPV/FDR = 0.65/1.81 mm/6.62%/13.93%/100%/ 80.50%/19.50% for ¹⁸F-FDG; 0.81/1.15 mm/4.62%/14.30%/100%/99.30%/0.70% for ⁶⁸Ga-PSMA, p < 0.05) on the cross-tracer datasets.

CONCLUSION: The proposed mmSAM is promising for lesion segmentation in multi-tracer oncologic PET/CT images. Fine-tuning significantly enhances segmentation accuracy for cross-tracer studies.

PMID:42144442 | DOI:10.1186/s40658-026-00887-z

Skeletal Radiol. 2026 May 18. doi: 10.1007/s00256-026-05252-w. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess current trends and impacts of hybrid (HYB) and work from home (WFH) practice models on the musculoskeletal (MSK) radiology workforce and explore implications for recruitment and the future of the subspecialty.

MATERIALS AND METHODS: A 38-question voluntary, anonymous survey was distributed to the Society of Skeletal Radiology (SSR) membership (n = 1060). Descriptive statistics and chi-squared test were performed to analyze demographics, trends, and preferences for HYB-WFH practice models. Thematic analysis of open-ended responses identified perceptions and impacts of HYB-WFH.

RESULTS: The survey response rate was 30% (314 respondents). Most (89%) work in practices that support HYB-WFH. Most (84%) felt HYB-WFH was extremely (54%) or somewhat important (30%) but would not consider the job if it meant reduced compensation (56%) or higher productivity requirements (52%). HYB was the most desired work model (84%), followed by WFH (13%) and in-person (4%). Preference for HYB-WFH was associated with geographic residence, job location (urban/suburban/rural), and commute time (p < 0.05), but not age, gender, dependents, caregiver status, or career stage. Perceived benefits included improved work-life balance, job satisfaction, and productivity, with possible tradeoffs in career development, collegiality, and trainee education. Among 59% planning to change jobs in the next 5 years, motivating factors included workload (66%), compensation (54%), and HYB-WFH (39%). Most preferred HYB for their next job.

CONCLUSION: HYB-WFH practice models are strongly desired by the MSK workforce, regardless of age, gender, and life and career situation. Embracing HYB-WFH trends is key to supporting workforce sustainability and adapting to an evolving job market.

PMID:42144439 | DOI:10.1007/s00256-026-05252-w