Category: Statistics

Int J Legal Med. 2026 May 5. doi: 10.1007/s00414-026-03824-y. Online ahead of print.

ABSTRACT

The primary question in forensic age assessment is whether an individual has reached a legally defined age threshold. Cervical ring apophysis maturation has been proposed as a potential age indicator; however, it has previously been studied only with ionizing imaging. This study aimed to evaluate cervical ring apophysis maturation using magnetic resonance imaging (MRI) and to determine stage-specific probabilities for legally relevant age thresholds.This retrospective cross-sectional study included 1000 individuals (552 females, 448 males) aged 9.64-26.67 years. Maturation of the ring apophysis at C2-C4 was assessed using a five-stage MRI-adapted system. Sex-specific descriptive statistics were calculated. Age-related stage transitions were modeled using multinomial logistic regression, and conditional probabilities were estimated for the 15-, 16-, 18-, and 21-year thresholds. Observer agreement was assessed using weighted kappa.Maturation progressed sequentially from C2 to C4 in both sexes, with a broad transitional zone between stages 3 and 4. In females, median age at stage 4 ranged from 18.5 to 20.2 years in males, approximately 22 years. However, minimal ages for stage 4 were markedly lower (12.5 years in females, 13.1 years in males), and stage 3 persisted into the third decade. At stage 4, the probability of being ≥ 18 years reached 0.96-0.98 in males but only 0.54-0.61 in females. For the ≥ 21-year threshold, probabilities at stage 4 were approximately 0.65-0.70 in males and 0.34-0.40 in females.Cervical ring apophysis maturation on MRI represents a continuous and overlapping biological process. It should therefore be interpreted as a probabilistic indicator for legal thresholds rather than a definitive test of adulthood.

PMID:42084790 | DOI:10.1007/s00414-026-03824-y

Trop Anim Health Prod. 2026 May 5;58(4):249. doi: 10.1007/s11250-026-05031-8.

ABSTRACT

Mastitis is a major cause of economic losses in the dairy industry. The aim of the present study was to examine the overall prevalence of mastitis in Algeria using a systematic review and meta-analysis. The search strategy was performed for relevant literature published from 2002 to 2023 in English and French language. The databases included were PubMed, ScienceDirect, GoogleScholar, Scopus, Springer, Algerian national database i.e., the Scientific Information Database (pnst.cerist.). A total of 4,698 dairy cows were included in the 20 eligible studies for this meta-analysis. The prevalence of mastitis was estimated at 41% [95% CI 32-49%, PI 10-81%]. Cochran’s Q statistic was 405.5 (df = 19, p < 0.001), with I² = 95% and τ² = 0.0385, indicating substantial heterogeneity. The results indicated that there is high heterogeneity among studies for overall analysis. In conclusion, estimating prevalence of mastitis among cattle in Algeria, through meta-analysis (MAs) can provide adequate measures to control mastitis infection, Moreover, effective early diagnosis and proper medication may help our country to reduce incidence of mastitis and economic losses in dairy industry.

PMID:42084754 | DOI:10.1007/s11250-026-05031-8

Unfallchirurgie (Heidelb). 2026 May 5. doi: 10.1007/s00113-026-01708-9. Online ahead of print.

ABSTRACT

BACKGROUND: Knife stab injuries are rare in Germany but are gaining increasing clinical, societal and political relevance. While nationwide crime statistics document a marked rise in knife attacks, there is currently a lack of robust clinical data on hospitalized cases.

OBJECTIVE: The aim of this study was to present the temporal development of such injuries in Stuttgart over the past 10 years.

METHODS: A retrospective, single-center cohort analysis was conducted of all patients hospitalized with knife stab injuries inflicted by third parties at the Klinikum Stuttgart between 2014 and 2024. Included were externally inflicted injuries occurring in Stuttgart; self-inflicted injuries, accidents without external involvement and cases treated exclusively on an outpatient basis were excluded.

RESULTS: There was a significant increase in hospitalized patients with stab injuries with a peak in 2021. Overall, this corresponds to an increase of approximately 100% over 10 years (10% per year). During the coronavirus disease 2019 (COVID-19) pandemic, around 70% more cases occurred compared to other years. The monthly distribution showed significant peaks in April, August and December. The clustering on Sundays and Mondays indicates an elevated risk during weekend nights. A total of 92% of affected individuals were male, with a mean age of 31.1 years.

CONCLUSION: Hospitalized patients with knife stab injuries in Stuttgart significantly increased between 2014 and 2024, particularly during the COVID-19 years. The majority of the affected individuals were young men. The results confirm the clinical perception of an increasing number of severe knife stab injuries requiring hospital treatment in the Klinikum Stuttgart.

PMID:42084748 | DOI:10.1007/s00113-026-01708-9

Environ Geochem Health. 2026 May 5;48(7):333. doi: 10.1007/s10653-026-03217-5.

ABSTRACT

Stream sediments, as long-term sinks for potentially toxic elements (PTEs), provide valuable insights into both natural and anthropogenic contamination. This study presents a comprehensive assessment of PTE contamination, ecological risk, and human health implications across Odisha, eastern India- a region characterized by complex Precambrian geology, intensive agriculture, mining, and industrialization. Concentrations of ten PTEs (Cr, Cd, As, Ni, Cu, Zn, Co, Mn, V, and W) from 28,111 locations collected under the Geological Survey of India NGCM program indicate moderate to very high contamination across the state, with pronounced hotspots in mineralized and industrial belts. Multivariate analyses, including principal component analysis and hierarchical clustering, reveal dominant lithogenic control over Cr, Mn, Ni, Co, Cu, Zn, and V, while anthropogenic enrichment of As, Cd, and W is linked to mining, industrial emissions, and agricultural activities. Non-negative matrix factorization corroborates these source apportionment results. Pollution indices, including enrichment factor, geo-accumulation index, pollution load index, and potential ecological risk index, indicate moderate to high ecological risk in several regions. Human health risk assessment shows that 69.05% of locations exhibit high non-carcinogenic risk (HI > 1) for children, whereas adults show non-carcinogenic and carcinogenic risks in < 0.5% and > 65% of locations, respectively, primarily associated with Cr, Cd, and As. Sobol sensitivity analysis demonstrates that concentration variability predominantly governs carcinogenic risk estimates. Additionally, a machine learning-based framework is developed to classify risk and non-risk zones for both adults and children. This integrated approach provides critical insights for public health protection, targeted remediation, and sustainable land-use planning.

PMID:42084746 | DOI:10.1007/s10653-026-03217-5

Mol Biol Rep. 2026 May 5;53(1):714. doi: 10.1007/s11033-026-11903-x.

ABSTRACT

BACKGROUND: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and end-stage kidney failure worldwide. Genetic factors contribute to inter-individual and population-specific susceptibility to DKD. Data from South Indian populations are limited, highlighting the need for region-specific genetic association studies in DKD.

METHODS AND RESULTS: This case-control study included 125 South Indian individuals: 60 patients with diabetes and proteinuria (DKD), 34 patients with diabetes without kidney disease, and 31 healthy controls. Genomic DNA was isolated and nine variants were genotyped using amplification refractory mutation system polymerase chain reaction (ARMS-PCR). Variant frequencies were compared among groups. In-silico pathogenicity prediction tools and Odds ratio (OR) with 95% confidence intervals (CIs) were estimated using multivariable logistic regression analyses were used to assess the association between genetic variants and DKD risk. Data visualization was performed using R statistical software. Among the nine variants analyzed, the TRPC6 rs36111323 (G > A; p.A404V) was independently associated with DKD (OR = 2.76; 95% CI = 1.04-7.34; p = 0.0418). This variant was more frequent in patients with DKD compared with diabetic patients without nephropathy and healthy controls. Pathogenicity prediction analyses supported a potentially deleterious effect of the variant.

CONCLUSIONS: The TRPC6 rs36111323 variant appears to be associated with increased susceptibility to diabetic kidney disease in a South Indian population, suggesting a population-specific genetic risk factor. Validation in larger cohorts and functional studies is warranted to clarify its role and potential application in precision nephrology.

PMID:42084711 | DOI:10.1007/s11033-026-11903-x

Clin Rheumatol. 2026 May 5. doi: 10.1007/s10067-026-08135-6. Online ahead of print.

ABSTRACT

BACKGROUND: Gout is one of the most common inflammatory arthritides and represents a growing health burden worldwide. This study compares the disease burden of gout and its attributable risk factors between China and European Union (EU) countries from 1990 to 2023 using data from the Global Burden of Disease Study 2023 (GBD 2023). In addition, the study evaluates potential causal relationships between key risk factors and gout and projects future trends in disease burden.

METHODS: Using GBD 2023 data, we analyzed the epidemiology of gout in China and EU countries. Analyses included descriptive statistics and age- and sex-specific comparisons. Joinpoint regression models were used to calculate annual percentage changes (APC) and average annual percentage changes (AAPC) to assess long-term trends. An autoregressive integrated moving average (ARIMA) model was applied to project gout burden trends in China and EU countries from 2024 to 2040. In addition, a two-sample Mendelian randomization (MR) approach was used to investigate the potential causal relationship between key risk factors and gout at the genetic level.

RESULTS: In 2023, China’s age-standardized incidence rate (ASIR), prevalence rate (ASPR), and disability-adjusted life year rate (ASDR) for gout were 151.27/100,000, 809.69/100,000, and 25.14/100,000, respectively, all higher than in 1990. In comparison, EU countries showed lower levels for these indicators in both 1990 and 2023. Joinpoint regression analysis demonstrated an overall increasing trend in gout burden in both China and the EU between 1990 and 2023, although China experienced a brief decline in APC between 1990 and 1994. The burden of gout was higher among males than among females. Projections suggest that ASIR, ASPR, and ASDR will continue to increase in both China and European countries between 2024 and 2040. Mendelian randomization analysis further indicated a significant positive causal relationship between body mass index (BMI) and gout.

CONCLUSION: This study combines GBD 2023 epidemiological data with Mendelian randomization analysis to characterize trends in the burden of gout in China and EU countries. The findings show a continuing increase in gout burden over time, particularly in China. The identified causal association between elevated BMI and gout highlights the importance of addressing modifiable metabolic risk factors to help reduce the future burden of gout. Key Points • An increasing burden of gout could be observed in China and the European Union from 1990 to 2023. • A higher age-standardized burden of gout was observed in China than in the European Union. • Future projections indicate that the burden of gout will continue to increase through 2040. • A causal association between elevated body mass index and gout risk was supported by Mendelian randomization analysis.

PMID:42084706 | DOI:10.1007/s10067-026-08135-6

Eur J Clin Microbiol Infect Dis. 2026 May 5. doi: 10.1007/s10096-026-05494-5. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to describe the evolution of cefoperazone-sulbactam consumption in Romania between 2011 and 2024. The use of this fixed-dose combination is not recommended by the World Health Organisation as it may result in selection of antimicrobial resistance.

METHODS: This retrospective study analyzed the data on antibiotic consumption collected by the National Center for Surveillance and Control of Communicable Diseases which is based on data provided by the National Health Insurance Fund and the IQVIA-Multinational Integrated Data Analysis System. Antibiotic sales were converted into defined daily doses (DDDs) per 1,000 inhabitants per day.

RESULTS: The consumption of cefoperazone-sulbactam in Romania between 2011 and 2024 ranged from 0.016 to 0.021 DDD per 1000 inhabitants per day, with an average of 0.019 DDD per 1000 inhabitants per day. When adjusted for population, the RO1 macroregion registered the highest average consumption (0.033 DDDs per 1000 inhabitants per day). One-way ANOVA on DDD per 1,000 inhabitants per day data suggested that there were no statistically significant differences between macroregions (F = 2.78, p = 0.054). Although differences are observed in the mean values, they can be explained by counties with abnormally high consumption.

CONCLUSION: Educational and training activities focused on the outlier counties are necessary to raise awareness about the risk of increased selection of antimicrobial resistance. In line with the rejection of the reclassification proposal of cefoperazone-sulbactam in the updated 2025 WHO AWaRe classification of antibiotics, new government policies to ensure the discontinuation of cefoperazone-sulbactam use in Romania are needed.

PMID:42084702 | DOI:10.1007/s10096-026-05494-5

Eur J Clin Microbiol Infect Dis. 2026 May 5. doi: 10.1007/s10096-026-05529-x. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the causal effect of ceftazidime/avibactam (C/A) combination therapy versus monotherapy on mortality and clinical success in patients with KPC-producing Klebsiella pneumoniae (KPC-Kp) infections in intensive care unit.

METHODS: This multi-centre, retrospective observational study (2021-2023) included adults with KPC-Kp bloodstream infections or pneumonia treated with C/A-based regimens. We employed a counterfactual framework using inverse probability of treatment weighting (IPTW) to estimate the average treatment effect on 30-day mortality. Clinical success was further assessed using Desirability of Outcome Ranking (DOOR) analysis and partial credit scoring based on patient-perspective scenarios.

RESULTS: Among 123 included patients, 77 (62.6%) received monotherapy and 46 (37.4%) received combination therapy. The combination group presented with significantly higher baseline severity, including higher APACHE II scores and rates of septic shock. In the IPTW-adjusted analysis, 30-day survival was 73.8% (95% CI: 56-92%) with combination therapy compared with 60.8% (95% CI: 46.8-77%) with monotherapy. The survival probability ratio was 1.21 (95% CI: 0.80-1.45), indicating no statistically significant survival benefit. The DOOR analysis showed a 54.7% (95% CI: 48.9%-60.4%) probability of a more favourable outcome with combination therapy, which was not statistically significant. Mean partial credit scores did not differ significantly across scenarios prioritizing survival or adverse event avoidance.

CONCLUSIONS: In this cohort, C/A-based combination therapy did not provide a significant survival advantage or an improved clinical desirability ranking compared with monotherapy, after adjusting for confounding factors.

PMID:42084701 | DOI:10.1007/s10096-026-05529-x

J Cereb Blood Flow Metab. 2026 May 5:271678X261444895. doi: 10.1177/0271678X261444895. Online ahead of print.

ABSTRACT

Cyclooxygenase-1 (COX-1), an essential enzyme in the synthesis of pro-inflammatory prostanoids from arachidonic acid, is widely expressed in the brain, primarily in microglia. Previous studies from our laboratory found that the novel positron emission tomography (PET) radioligand [¹¹C]PS13 has excellent in vivo selectivity for constitutively expressed COX-1 in human brain. This study sought to further evaluate the effects of age and sex on levels of constitutive COX-1 expression in the brains of 56 healthy volunteers. COX-1 density in the brain measured by [¹¹C]PS13 PET showed a significant positive correlation with age in the whole brain, as well as in regions with the highest COX-1 expression, such as the hippocampus, lateral occipital cortex, and pericentral cortex. No significant sex differences were observed in any regions. Consistent findings were observed regardless of partial volume correction (PVC), while overall statistical significance was enhanced with PVC. In conclusion, the present study found that constitutive COX-1 binding in the brain, which is associated with microglial density, increased with age with no significant sex differences. The physiological roles of COX-1 in these regions and its potential contributions to the aging process remain largely unknown, and further investigation is warranted. Clinical trial registration information: NCT03324646; NCT04396873 in ClinicalTrials.gov.

PMID:42083927 | DOI:10.1177/0271678X261444895

J Comp Eff Res. 2026 May 5:e260074. doi: 10.57264/cer-2026-0074. Online ahead of print.

ABSTRACT

In this update, we review a framework for identifying and mitigating information bias in electronic health records and administrative claims data, highlighting practical recommendations for study design, variable definition, and statistical analysis. We also discuss a perspective on emerging privacy-preserving technologies – synthetic data and federated networks – that enable secure cross-border data access while maintaining patient privacy.

PMID:42083917 | DOI:10.57264/cer-2026-0074