Category: Statistics

Kidney Int Rep. 2026 Jan 21;11(4):103789. doi: 10.1016/j.ekir.2026.103789. eCollection 2026 Apr.

ABSTRACT

INTRODUCTION: In the AWARD-7 clinical trial participants with type 2 diabetes mellitus (T2D) and moderate-to-severe chronic kidney disease (CKD), a once-weekly treatment with dulaglutide slowed kidney function decline compared with insulin glargine. This post hoc study evaluated dulaglutide’s effect on 6-month changes in plasma concentrations of 21 Joslin Kidney Panel (JKP) proteins, which were previously associated with end-stage kidney disease (ESKD) risk.

METHODS: Plasma concentrations of JKP proteins in participants treated with dulaglutide (n = 124) and insulin glargine (n = 125) were measured using a customized Joslin OLINK proteomic platform. Changes in circulating JKP protein concentrations from baseline to 6 months were determined.

RESULTS: Baseline JKP protein concentrations were similar between groups. After 6 months, 14 JKP proteins increased in the insulin glargine group and decreased in the dulaglutide group with statistically significant between-group differences. The most significant differences were observed for 8 tumor necrosis factor (TNF)-receptors (TNF-R1, -R2, -R3, -R4, -R6B, -R7, -R19L, and -R27), key mediators of inflammatory and apoptotic pathways. In addition, CD160, WFDC2, DLL1, LAYN, SYND1, and EPHA2 were significantly different between treatments, although to a lesser degree, and 7 other proteins remained unaffected. Kidney injury molecule 1 (KIM1), a marker of proximal tubule stress, declined in both groups without significant differences. Treatment effects were more pronounced in participants with lower baseline estimated glomerular filtration rate or higher baseline urinary albumin-to-creatinine ratio, hemoglobin A1c, or body mass index.

CONCLUSION: Six months of dulaglutide treatment significantly lowered concentrations of 14 JKP proteins, particularly those involved in inflammatory and fibrotic pathways. These findings provide insight into biological mechanisms that may underlie the reno-protective effects of dulaglutide.

PMID:41732754 | PMC:PMC12925400 | DOI:10.1016/j.ekir.2026.103789

Int J Cardiol Heart Vasc. 2026 Feb 14;63:101886. doi: 10.1016/j.ijcha.2026.101886. eCollection 2026 Apr.

ABSTRACT

Background: With the growing popularity of amateur endurance sports, including marathon running, it is crucial to recognize transient myocardial changes induced by prolonged physical exertion and to evaluate potential predictors of cardiac fatigue. Methods: A total of 105 runners participating in the 2023 Silesia Marathon (half-marathon, marathon, and ultramarathon) were studied. Transthoracic echocardiography was performed at baseline (1-4 days pre-race), immediately after the race, and 14 days later. Parameters of left and right ventricular function were assessed, including left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LV GLS), right ventricular global longitudinal strain (RV GLS), right ventricular free wall strain (RV FWS), tricuspid annular plane systolic excursion (TAPSE), as well as left and right atrial strain. Regression analyses were conducted to explore demographic- and training-related predictors of exercise-induced functional changes. Results: Immediately post-race, LVEF decreased slightly but remained within the normal range, while LV GLS was significantly reduced in marathon and ultramarathon runners compared with baseline (p = 0.008). RV GLS and RV FWS showed smaller, non-significant declines, and TAPSE demonstrated a non-significant reduction. Atrial strain parameters were transiently decreased but normalized at follow-up. All ventricular and atrial parameters returned to baseline within two weeks, confirming the reversibility of the observed changes. Between-group comparisons revealed no significant differences in cardiac response according to race distance. Regression analyses did not identify consistent predictors of functional decline. Trends suggested that higher weekly training volume may attenuate reductions in LVEF and TAPSE, whereas older age may predispose individuals to a greater decline in TAPSE; however, these associations did not reach statistical significance. Conclusion: Long-distance running induces mild, transient, and reversible changes in ventricular and atrial function in amateur runners. These alterations appear largely independent of race distance and cannot be reliably predicted by simple demographic or training-related indices.

PMID:41732747 | PMC:PMC12924757 | DOI:10.1016/j.ijcha.2026.101886

Phys Imaging Radiat Oncol. 2026 Feb 11;37:100923. doi: 10.1016/j.phro.2026.100923. eCollection 2026 Jan.

ABSTRACT

BACKGROUND AND PURPOSE: Adaptive radiotherapy (ART) manages anatomical variations through real-time plan adjustments. Herein, we aimed to evaluate the efficacy of ART in improving target coverage and reducing organ-at-risk (OAR) irradiation doses in cervical cancer.

MATERIALS AND METHODS: A prospective single-arm study enrolled 15 patients with cervical cancer. Participants received definitive chemoradiotherapy (45-50 Gy/25Fractions) using cone-beam computed tomography-guided online ART workflow. Endpoints included geometric miss volume (target volume underdosed), planning target volume (PTV) coverage (V_100%), OAR sparing (generalized equivalent uniform dose [gEUD] and normal tissue complication probability [NTCP]), and dose homogeneity/conformity parameters (coefficient of variation [CV], Paddick Index [PI]). Mixed-effects models compared ART and simulated image-guided radiotherapy (IGRT) plans, with Wilcoxon signed-rank and Mann-Whitney U tests for statistical analysis.

RESULTS: Among 375 adaptive sessions, ART outperformed IGRT, reduced geometric miss volume by 85.1% (0.28 cm³ vs. 1.88 cm³; P < 0.001) and achieved V_100% ≥ 99% in 99.2% of fractions (vs. 75.0% with IGRT; P < 0.001). ART improved PTV dose homogeneity (median CV: -0.29% vs. 3.89%; P < 0.001) and conformity (median PI: 0.75 vs. 0.60; P < 0.001). Additionally, ART reduced rectum gEUD by 4.39% (P < 0.001) and NTCP by 52.27% (P < 0.001), with similar benefits for other OARs (P < 0.001). ART maintained robustness against intrafractional anatomical changes, with minimal target coverage loss and stable OAR doses despite bladder/rectum volume fluctuations. Patients exhibited 100% complete response and mild acute side effects (no grade ≥ 3 enteritis; no cystitis).

CONCLUSIONS: Online ART with 3-mm isotropic margins is feasibile for cervical cancer, achieved high target coverage while reduced OAR doses and NTCP.

PMID:41732733 | PMC:PMC12925179 | DOI:10.1016/j.phro.2026.100923

PeerJ. 2026 Feb 19;14:e20779. doi: 10.7717/peerj.20779. eCollection 2026.

ABSTRACT

BACKGROUND: Mexico has high levels of adolescent obesity (40.4%), with an increase from 17.6 to 18.1% between 2020 and 2023. Technological advancement and early access to electronic devices and video games after the COVID-19 pandemic, along with morbid lifestyles, contribute to this problem.

OBJECTIVE: To determine the association between video game use, lifestyle, and obesity in adolescents.

METHODS: A cross-sectional, analytical study was conducted. Subjects with and without video game use and percentiles >5 and <95 were included. Those with metabolic, hormonal, neurological, and autoimmune diseases were excluded. Questionnaires were administered regarding lifestyle and video game use. A multiple binary logistic regression model including the variables male sex, morbid lifestyle, video game use, and physical inactivity was developed, yielding exponential B coefficients, 95% CI, and p-values.

RESULTS: Of 272 subjects, males predominated with 51.8%, and obesity of 75.7%. The use of video games and morbid lifestyle showed an OR 10.67 (95% CI [5.33-20.58]) and 3.55 (95% CI [1.99-6.36]), respectively. In the adjusted model, the use of video games and physical inactivity obtained an exponential of B of 6.89 (95% CI [3.17-14.94]) and B of 3.12 (95% CI [1.49-6.50]).

CONCLUSIONS: The importance of family physician intervention on obesogenic factors in adolescents and their families to reduce the risk of harmful behaviours by promoting physical activity and a healthy lifestyle.

PMID:41732729 | PMC:PMC12925410 | DOI:10.7717/peerj.20779

PeerJ. 2026 Feb 19;14:e20554. doi: 10.7717/peerj.20554. eCollection 2026.

ABSTRACT

The way people perceive health risks is often assumed to influence how they adopt precautionary measures. However, people’s assessment of a given phenomenon’s risk may vary over time, and the relationship between perceived risk and compliance with protective measures may be dynamic and bi-directional. We measured the perceived risk of COVID-19 and compliance with infection control measures for a large representative sample at four time-points during the first year of the COVID-19 pandemic in Norway. We employed a cross-lagged panel analysis to investigate both the cross-sectional and the temporal association between perceived risk and compliance. We found cross-sectional associations between perceived risk and compliance at one of the time points. There were no temporal associations between risk at one time-point and compliance at the subsequent time-point. Neither was compliance associated with risk at the subsequent time-point. The results suggest that the relationship between perceived risk and compliance with COVID-19 infection control measures is negligible and stable over time. A multiverse analysis showed that the absence of a relationship between perceived risk and compliance was robust to different operationalizations of perceived risk. This highlights the need for a nuanced understanding of how risk perceptions impact behavior during a pandemic.

PMID:41732725 | PMC:PMC12925416 | DOI:10.7717/peerj.20554

Crit Care. 2026 Feb 23. doi: 10.1186/s13054-026-05867-4. Online ahead of print.

ABSTRACT

BACKGROUND: The role of Enterococcus spp. and the need for specific anti-Enterococcus therapy in Intensive Care Unit (ICU) patients with peritonitis remain debated.

METHODS: We conducted a retrospective multicentre cohort study including all consecutive adults admitted to the ICUs of four hospitals in western France with peritonitis between 2020 and 2022. Outcomes were compared according to Enterococcus spp. isolation and, among Enterococcus-positive cases, according to early administration (< 48 h) of active antimicrobial therapy. Propensity-weighted Cox models were used to estimate 90-day survival.

RESULTS: Among 392 patients, Enterococcus spp. were isolated in 161 (41.1%). Enterococcus-positive patients were older and more frequently had postoperative and diffuse peritonitis. ICU mortality rates were 29.8% vs 28.1% in patients with and without Enterococcus infection (p = 0.805). In multivariable analysis, postoperative peritonitis (aOR 2.56 [1.67-3.95], p < 0.001), diffuse peritonitis (aOR 1.78 [1.10-2.89], p = 0.020) and solid organ transplantation (aOR 5.82 [1.18-28.76]; p = 0.031) were independently associated with Enterococcus isolation. Among the 155 patients with documented Enterococcus peritonitis and available antimicrobial treatment data, 95 (61%) received early active therapy. Early anti-Enterococcus treatment was not associated with improved 90-day survival either in the raw population (HR 0.71 [95% CI 0.39-1.27]; p = 0.241) or after weighted Cox regression (HR 0.66 [95% CI 0.37-1.18]; p = 0.160).

CONCLUSIONS: Enterococcus spp. isolation appears common in ICU peritonitis but not independently associated with higher mortality. Early targeted antimicrobial therapy was not associated with a statistically significant improvement in outcomes.

PMID:41731517 | DOI:10.1186/s13054-026-05867-4

BMC Med. 2026 Feb 24. doi: 10.1186/s12916-026-04700-7. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults (> 65 years) residing in long-term care facilities (LTCFs) are at elevated risk of severe outcomes from respiratory infections. Infections often remain undetected or present atypically in this population, leading to underdiagnosis. Our study aimed to estimate the respiratory virus infection burden, independent of symptom presentation, among older adults in Swedish LTCFs in the post-pandemic period (2021-2024).

METHODS: We leveraged capillary blood samples and coupled national registry data from 1622 LTCF residents (median age = 87). A multiplex platform was used to quantify antigen-specific IgG and IgM responses to RSV (pre-/post-F, strain A-specific G-protein), influenza-A (H1N1 and H3N2 HA), influenza-B (HA) and SARS-CoV-2 (spike). Linear mixed-effects models were used to demonstrate the dynamics of antibody levels over time, adjusted for age, sex and comorbidities.

RESULTS: RSV-specific antibody responses peaked in spring 2022 (p < 0.001), suggesting an impact of relaxed COVID-19-related restrictions on RSV exposure at LTCFs. RSV-specific antibodies subsequently declined over time until an increase during autumn 2023 (p < 0.001). Geographic variation in pre-F antibody levels suggested localised RSV outbreaks. The total estimated RSV burden at LTCFs was markedly higher than official reports of the Swedish Public Health Agency. Influenza antibody dynamics reflected seasonal trends and were strongly influenced by annual vaccination. A random forest classifier incorporating serological profiles with demographics, location and comorbidities significantly outperformed a model without serological data (AUC-ROC = 0.67 vs. 0.58), although discriminatory performance remained modest. Higher levels of RSV pre-F antibodies in autumn 2021 were associated with increased one-year mortality in logistic regression (OR = 1.43, p = 0.024). Exploratory survival analysis indicated a trend that elevated levels of RSV pre-F antibodies during low population immunity may confer a transiently elevated early hazard of death, although this did not reach statistical significance (HR = 4.50, p = 0.087).

CONCLUSIONS: We observed substantial respiratory virus circulation among older adults in Swedish LTCFs and show that RSV burden is under-reported. The results highlight a need for further research into the role of RSV pre-F antibody levels in preventing severe outcomes, potentially via vaccination of LTCF residents. Our scalable serological surveillance system is a valuable approach to detect respiratory infections in LTCFs, independent of symptom presentation or healthcare-seeking behaviour.

PMID:41731510 | DOI:10.1186/s12916-026-04700-7

BMC Womens Health. 2026 Feb 24. doi: 10.1186/s12905-026-04347-9. Online ahead of print.

NO ABSTRACT

PMID:41731481 | DOI:10.1186/s12905-026-04347-9

BMC Musculoskelet Disord. 2026 Feb 23. doi: 10.1186/s12891-026-09544-z. Online ahead of print.

ABSTRACT

BACKGROUND: The proximal femur is a common site for benign bone tumors and tumor-like lesions, which often lead to pathological fractures and structural instability. However, these lesions are highly heterogeneous, and in some cases, conventional internal fixation cannot adequately meet surgical requirements. Currently, there is no consensus on the optimal surgical strategy for such conditions. This study aimed to evaluate whether a lesion-categorization-based surgical approach could improve postoperative functional recovery and to explore the feasibility of joint-preserving treatment in cases with severe structural destruction.

METHODS: A retrospective analysis was conducted on 100 patients who underwent surgical treatment for benign tumors of the proximal femur between 2020 and 2024. Tumors were classified based on lesion location, size, extent of femoral head destruction, and the presence of deformities. Surgical strategies were selected according to this classification. Postoperative function was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system. A Bayesian linear regression model and intergroup comparisons were employed to evaluate the impact of the classification on clinical outcomes.

RESULT: In this study, a modified surgical strategy was proposed to categorize benign proximal femoral bone lesions into five types, with corresponding surgical strategies developed for each type. Type 1 and 2 lesions were characterized by mild cortical involvement and relatively stable structures suitable for curettage, bone grafting, with or without internal fixation. Type 3-5 showed progressive bone loss and deformity requiring limited internal fixation combined with external fixation (LIFEF), corrective osteotomy, or endoprosthetic replacement (EPR). The cohort had a mean age of 37.3 years (range 17-69) and a mean follow-up duration of 25.0 ± 14.9 months (range 3-54 months). The MSTS-93 score at the final follow-up was 26.1 ± 1.0. Bayesian analysis revealed statistically credible differences in postoperative MSTS scores among the three groups: Type 1, Type 2, and “Other types” (Types 3-5). The overall complication rate was 5%, including mild limping, transient pain, and mild avascular necrosis.

CONCLUSIONS: The lesion-categorization-based surgical strategy provides a practical and effective framework for managing benign tumors of the proximal femur. This approach optimizes postoperative functional recovery, supports joint preservation where feasible, and may serve as a reference for standardized surgical decision-making.

LEVEL OF EVIDENCE: IV; Retrospective observational study.

PMID:41731472 | DOI:10.1186/s12891-026-09544-z

BMC Pregnancy Childbirth. 2026 Feb 23. doi: 10.1186/s12884-026-08818-7. Online ahead of print.

ABSTRACT

BACKGROUND: Gestational diabetes mellitus (GDM) may be associated with occult abnormalities in choroidal microcirculation.This study utilizes ultra-widefield swept-source OCTA (SS-OCTA) and introduces the three-dimensional choroidal vascularity index (3D-CVI) as a volumetric quantitative parameter to systematically characterize the choroidal microcirculatory characteristics in GDM.

METHODS: This cross-sectional study utilized SS-OCTA with a 24 × 20 mm scan range. A 3 × 3 grid (9 regions) was applied to assess an effective area of interest measuring 17 × 17 mm. Built-in automated algorithms quantified choriocapillaris plexus vascular density (CCP VD), 3D-CVI, and choroidal thickness (CT). Statistical analyses included one-way ANOVA and general linear models, with Pearson/Spearman correlation for association analysis.

RESULTS: 138 women were enrolled (n = 46/group), comprising the GDM, pregnant controls (PC), and non-pregnant controls (NC), with mean ages of 31.98 ± 4.43, 30.74 ± 3.66, and 31.00 ± 4.26 years.Significant differences were observed in macular grid CCP VD among the three groups (46.26 ± 1.41%, 46.28 ± 1.43%, and 45.41 ± 1.85%; P = 0.012), after adjusting for age and axial length(AL), at Age = 35.38 years, GDM was higher than both PC and NC (P = 0.005,P < 0.001), and PC was higher than NC (P = 0.033). In pregnancy, GDM showed significantly higher macular grid CCP VD than PC at longer AL (AL = 23.98 mm, P = 0.015). For 3D-CVI, significant differences were found in the macular grid (40.37 ± 3.30%,41.50 ± 3.23%,41.96 ± 2.70%,P = 0.043)/nasal-superior(39.59 ± 2.90%,40.65 ± 2.69%,41.43 ± 2.71%;P = 0.007);After adjustment, GDM remained lower than NC at the mean age level(macular grid: P = 0.047; nasal-superior: P = 0.012), while GDM and PC showed no significant difference.No significant differences were found in CT across regions (all P > 0.05).Correlation analysis showed inverse associations of age with mean CCP VD, 3D-CVI, and CT (r = – 0.56/-0.49/-0.47,all P < 0.05). Gestational age was negatively correlated with CCP VD and CT (r = – 0.46/-0.23,all P < 0.05). AL, mean ocular perfusion pressure, fasting plasma glucose, and glycated hemoglobin showed no significant correlations ( all P > 0.05).

CONCLUSIONS: Macular grid CCP-VD increased overall in pregnancy versus NC.In pregnancy, GDM exceeded PC at higher age or AL.3D-CVI differed only in macular grid and nasal-superior, lower in GDM than NC yet not from PC.Given the structural differences between mild-to-moderate GDM and PC may be subtle.3D-CVI may serve as an auxiliary indicator for regional choroidal remodeling, and combined with CCP, it can comprehensively assess the choroidal pathophysiology in GDM.Longitudinal gestation-to-postpartum follow-up is needed.

PMID:41731441 | DOI:10.1186/s12884-026-08818-7