Category: Statistics

BMC Anesthesiol. 2026 May 2. doi: 10.1186/s12871-026-03879-9. Online ahead of print.

ABSTRACT

BACKGROUND: The association between preoperative peripheral nerve block (PNB), major adverse cardiovascular events (MACE), and postoperative length of hospital stay (LOS) in elderly patients who underwent major thoracic and abdominal surgery remains unclear. This study aims to explore the potential mediating effect of MACE on the association between preoperative PNB and postoperative LOS using a statistical mediation framework.

METHODS: In this retrospective cohort study, perioperative data were collected from elderly patients (aged over 65 years) who underwent major thoracic and abdominal surgery. Mediation analysis was employed to examine the relationships between PNB, MACE, and postoperative LOS.

RESULTS: A total of 1915 patients were included in the analysis, with 68.7% (1316/1915) receiving preoperative PNB. Compared to patients who did not receive PNB, those who did had a significantly lower incidence of MACE (P < 0.001) and a shorter postoperative LOS (P < 0.001). The adjusted total and direct associations of PNB with postoperative LOS were – 0.809 days (95% confidence interval [CI], -1.236 to -0.390; P < 0.001) and – 0.661 days (95% CI, -1.077 to -0.250; P = 0.003), respectively. A statistically significant indirect association via MACE was observed (adjusted β=-0.149 days; 95% CI, -0.271 to -0.060; P < 0.001), indicating that 18.1% (95% CI, 6.7% to 41.0%) of the total association was statistically attributable to the indirect pathway through MACE under the model assumptions. A sensitivity analysis excluding postoperative covariates yielded consistent results (proportion mediated: 25.3%).

CONCLUSIONS: Our findings suggest that the observed association between preoperative PNB and reduced postoperative LOS in elderly patients following major thoracic and abdominal surgery may be partly explained by a statistically significant indirect pathway through a reduction in MACE, potentially accounting for approximately 18% of the total effect. These findings are hypothesis-generating and represent statistical associations rather than demonstrated causal mechanisms.

TRIAL REGISTRATION: ChiCTR2400087610; https://www.chictr.org.cn.

PMID:42070039 | DOI:10.1186/s12871-026-03879-9

Am J Cardiovasc Drugs. 2026 May 2. doi: 10.1007/s40256-026-00798-5. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVE: Residual cardiovascular risk persists despite intensive statin therapy in patients with established atherosclerotic cardiovascular disease (CVD). Omega-3 fatty acids, particularly high-dose eicosapentaenoic acid (EPA), have been proposed as adjunctive therapy, yet trial results conflict, likely due to formulation differences. We conducted a formulation-focused meta-analysis to determine whether high-dose EPA-dominant supplementation reduces cardiovascular events and to quantify the impact of mixed EPA/docosahexaenoic acid (DHA) regimens on efficacy.

METHODS: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched MEDLINE, Embase, CENTRAL, and trial registries through May 2025 for randomized controlled trials, including placebo-controlled and open-label designs, of high-dose EPA-dominant omega-3 (≥ 1.8 g/day; ≥ 50% EPA) in adults with established CVD or other high-risk settings. Six trials (n = 42,738; 31-85% male) were eligible. Random-effects models generated pooled risk ratios (RRs), with I² assessing heterogeneity; sensitivity analyses excluded mixed EPA/DHA formulations. Imaging surrogate outcomes were summarized narratively when study modalities were not directly comparable.

RESULTS: EPA-based therapy significantly reduced hospitalizations for unstable angina (RR 0.75, 95% CI 0.66-0.87; I² = 0%). Overall effects on recurrent myocardial infarction and revascularization were not statistically significant, but both became significant after exclusion of STRENGTH, the only mixed EPA/DHA cardiovascular outcomes trial. No significant effect was observed for ischemic stroke, cardiovascular death, or high-sensitivity C-reactive protein (hs-CRP). CHERRY and EVAPORATE both suggested attenuation of plaque progression, but these imaging studies were not pooled because intravascular ultrasound and coronary computed tomography angiography-derived measures were not directly comparable.

CONCLUSION: High-dose EPA-dominant therapy was associated with fewer unstable angina hospitalizations, and formulation appeared to modify clinical benefit. Among blinded, placebo-controlled, cardiovascular outcomes trials, 4 g/day icosapent ethyl is the only formulation independently associated with reduced cardiovascular events. Larger formulation-specific trials are needed to clarify the roles of purified EPA, mixed EPA/DHA regimens, and patient selection.

REGISTRATION: PROSPERO identifier number: CRD420251063069.

PMID:42070013 | DOI:10.1007/s40256-026-00798-5

Oral Radiol. 2026 May 2. doi: 10.1007/s11282-026-00926-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the prevalence of degenerative bony changes of the mandibular condyle and their associations with age, gender, and joint laterality.

MATERIALS AND METHODS: CBCT scans of 112 temporomandibular joints of 56 clinically symptomatic patients were included based on predefined inclusion and exclusion criteria. Degenerative changes, including erosion, flattening, osteophytes, subchondral sclerosis, and subcortical pseudocysts, were assessed for their presence, frequency, and demographic associations using the Chi-square test, McNemar test, Spearman’s correlation analysis, and Cohen’s kappa statistics.

RESULTS: Erosion was the most prevalent finding (84.8%) and frequently coexisted with flattening. Subcortical pseudocyst showed a positive association with increasing age (p < 0.05), osteophytes were more commonly observed in males (p < 0.01), and subchondral sclerosis occurred more frequently on the left side (p < 0.05).

CONCLUSION: Symptomatic TMJs demonstrated at least one degenerative change, where Erosion was the most prevalent, and subcortical pseudocyst was the least common degenerative change in the mandibular condyle. Age, gender, and joint side showed associations with specific changes.

PMID:42070001 | DOI:10.1007/s11282-026-00926-6

J Bone Miner Metab. 2026 May 2. doi: 10.1007/s00774-026-01731-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Proximal femoral fractures are highly prevalent in Japan, with over 200,000 cases annually and a rising trend. Fracture liaison service (FLS) interventions improve osteoporosis treatment initiation and reduce refracture rates. The content of FLS interventions varies by institution, and the effectiveness of our intervention remains unclear. The aim of this study was to evaluate the effectiveness of our FLS intervention in preventing fragility fractures within 1 year after proximal femoral fracture surgery.

MATERIALS AND METHODS: A retrospective case-control study was performed on patients aged ≥ 50 undergoing surgery for proximal femoral fracture between February 2021 and January 2024. Patients were divided into non-FLS (pre-August 2022) and FLS groups. Data including demographics, comorbidities, fracture type, medication initiation, and refracture occurrence within 1 year were extracted. Statistical analyses involved Mann-Whitney U, χ2 tests, and Cox proportional hazards modeling.

RESULTS: Among 521 eligible patients, osteoporosis medication initiation within 3 months improved from 14% in the non-FLS group to 100% in the FLS group (p < 0.05). Time to medication initiation decreased from 20 to 12 days (p < 0.05). The refracture rate was significantly lower in the FLS group (1.8% vs. 5.7%, p < 0.05). Multivariate analysis showed FLS intervention significantly reduced refracture risk (HR 0.32, 95% CI 0.12-0.89, p = 0.03) and robust in sensitivity analyses for cognition, walking ability, and discharge destination.

CONCLUSIONS: FLS intervention effectively reduced fragility fractures within 1 year postoperatively by enhancing early osteoporosis treatment initiation. Continued FLS programs and long-term follow-up are recommended to sustain benefits.

PMID:42069997 | DOI:10.1007/s00774-026-01731-1

Int Urol Nephrol. 2026 May 2. doi: 10.1007/s11255-026-05163-8. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate finerenone-associated adverse events (AEs) and to investigate the association between finerenone use and renal injury via data mining of the Food and Drug Administration Adverse Event Reporting System (FAERS).

METHODS: To minimize statistical bias, the data extraction period was set from database inception (2004) to provide a stable background for disproportionality analysis. Four disproportionality algorithms (ROR, PRR, BCPNN, and MGPS) and stricter case-screening methods were employed to improve analytical precision. Additionally, a clinical priority evaluation was conducted to rank clinical risks and surveillance levels for these AEs. Supplementary analysis was performed to assess the relationship between finerenone and renal injury, as well as associated risk factors.

RESULTS: A total of 1316 finerenone-related reports were identified. 30 AEs were detected as significantly positive signals, with most being related to renal function (15 PTs, 50%), blood pressure (5 PTs, 16.67%), and blood potassium (4 PTs, 13.33%). Among them, blood glucose increased, blood creatine increased, and flank pain were new potential AEs. Acute kidney injury, hyperkalemia, renal impairment, glomerular filtration rate decreased, blood creatinineincreased, blood potassium increased, and hyponatremia exhibited moderate clinical priority levels and warrant further study. Signals reflecting renal injury were detected in patients regardless of baseline nephropathy. Male sex, taking more than 3 drugs, and using amlodipine may be risk factors for finerenone-related nephrotoxicity.

CONCLUSIONS: These results highlight new finerenone-related AEs, provide ranked guidance for pharmacovigilance through clinical priority evaluation, and clarify factors that influence renal injury, providing guidance for individualized treatment and improved drug safety.

PMID:42069979 | DOI:10.1007/s11255-026-05163-8

Arch Orthop Trauma Surg. 2026 May 2;146(1):169. doi: 10.1007/s00402-026-06299-z.

ABSTRACT

BACKGROUND: Pediatric femoral neck fractures require stable fixation to avoid complications. It remains unclear whether fixation with the Proximal Humeral Internal Locking System (PHILOS) can serve as an alternative to cannulated screw fixation. The purpose of this study was to compare the biomechanical properties of PHILOS and cannulated screws for stabilizing unstable pediatric femoral neck fractures using a synthetic bone model.

MATERIALS AND METHODS: Twelve fourth-generation synthetic composite femurs were randomly assigned to screw fixation (Group S) or PHILOS fixation (Group P) (n = 6 each). A standardized vertically oriented Delbet type II osteotomy was created in all specimens. Group S was fixed with three 6.5-mm cannulated screws, whereas Group P received a PHILOS plate with 3.5-mm locking screws. Each specimen underwent a standardized loading protocol using a universal testing machine. Axial stiffness, cyclic displacement, ultimate failure load, and failure modes were recorded and statistically compared between groups.

RESULTS: No statistically significant difference was found in axial stiffness between Group P (746 ± 300 N/mm) and Group S (753 ± 256 N/mm) (p = 1.000). Displacement after cyclic loading was significantly greater in Group P (1.42 ± 0.3 mm) compared with Group S (0.57 ± 0.2 mm) (p = 0.004). The ultimate failure load was higher in Group S (2378 ± 513 N) than it was in Group P (1652 ± 206 N) (p = 0.025). Upon reaching ultimate load, all specimens in both groups failed at the femoral head region due to femoral head broken.

CONCLUSIONS: The adult PHILOS plate with 3.5-mm locking screws demonstrated inferior biomechanical stability compared with three 6.5-mm cannulated screws in this synthetic composite femur model.

LEVEL OF EVIDENCE: Controlled laboratory study.

PMID:42069974 | DOI:10.1007/s00402-026-06299-z

Arch Orthop Trauma Surg. 2026 May 2;146(1):171. doi: 10.1007/s00402-026-06325-0.

ABSTRACT

INTRODUCTION: Limb salvage centers have increased in number over time, but lack standardized defining criteria. This systematic review aimed to assess organizational features of limb salvage centers and determine whether orthoplastic centers, in comparison to vascular limb salvage centers, represent a distinct care model that may benefit from standardization.

METHODS: We conducted a systematic review of publications related to limb salvage centers by searching MEDLINE, Embase, Web of Science, and Cochrane databases from their inception through 2024. We quantified binary data extraction as a reporting score of 26 organizational features across six structural care domains for limb salvage centers, based on a validated quality measurement framework. Organizational features differentiating distinct center types were identified to establish a quality framework for orthoplastic centers. Statistical comparisons between center types were performed using appropriate tests (p < 0.05).

RESULTS: Of 118 included studies, orthoplastic (n = 43) and vascular (n = 48) centers represented 77% of all studies. Recent increases in orthoplastic publications show substantial variability in organizational features. Orthoplastic center literature more frequently reported plastic surgery consultation criteria (p < 0.001), surgical outcomes (p < 0.001), and centralized network integration (p ≤ 0.006), highlighting acute reconstructive approaches. Vascular center studies documented significantly more organizational team features (p < 0.001) and quality systems (p = 0.033), reflecting established care frameworks for chronic disease management. Six organizational features characterized orthoplastic centers with > 70% prevalence, providing a benchmark framework with standardization priorities.

CONCLUSION: Orthoplastic limb salvage centers demonstrate distinct care paradigms that benefit from standardization. Our findings suggest structural benchmarks to support the need for standardized development of orthoplastic limb salvage centers.

PMID:42069968 | DOI:10.1007/s00402-026-06325-0

Eur Radiol. 2026 May 2. doi: 10.1007/s00330-026-12577-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop a semi-automated method to segment “black hole” lesions on post-gadolinium 2D T1-weighted images (GdT1) in multiple sclerosis (MS) that follows radiological intensity rules and perform multi-center validation.

MATERIALS AND METHODS: Multi-center spin-echo GdT1 images and accompanying proton-density (PD)/T2-weighted images and manual T2 lesion masks of the REFLEXION study (NCT00813709) of suspected/early MS were used. Briefly, the proposed method segments cortical gray matter (GM) to derive a T1-weighted intensity threshold, which is applied inside co-registered T2 lesion masks to segment black hole lesion voxels. It was optimized on a training set (N = 40, 57.5% female, mean age 31.4 ± 8.7 (standard deviation) years), and 274 patients formed the test set (61.3% female, age 31.8 ± 8.4 years). Performance was quantified by the Dice similarity coefficient (DSC) and the intraclass correlation coefficient (ICC) for absolute agreement with manual segmentations. Lesion-wise sensitivity and specificity were calculated.

RESULTS: Optimization resulted in: (1) GM selection as minimally 0.8 total WM plus GM partial volume, masked by MNI cortex; (2) normalized mutual information-driven linear co-registration of T2 to GdT1 images, interpolating T2 lesion masks using trilinear interpolation and 0.6 threshold; (3) mean intensity inside GM mask used as upper intensity threshold. The optimized method had acceptable spatial accuracy (DSC: 0.39 ± 0.26) and good volumetric accuracy (ICC: 0.84, 95% CI [0.72, 0.90]. Lesion-wise sensitivity was 0.91 ± 0.19, and lesion-wise specificity was 0.62 ± 0.22.

CONCLUSION: The proposed method to semi-automatically segment black holes from post-gadolinium T1-weighted images shows acceptable performance. As a potential aid to radiologists, the method is not recommended to be used entirely without human intervention.

KEY POINTS: Question T1-hypointense “black hole” lesions reflect disease severity in multiple sclerosis but are not routinely quantified due to a lack of reliable analysis methods. Findings A rule-based semi-automated method for GdT1 “black hole” lesion segmentation was developed and optimized, and then validated in a large unseen multi-center test set. Clinical relevance This method adds quantitative information about GdT1 “black hole” lesions to the radiological assessment of multiple sclerosis disease severity, when false positives are manually removed. This can enhance the characterization of individual patients and advance the understanding of the disease.

PMID:42069957 | DOI:10.1007/s00330-026-12577-6

Sci Rep. 2026 May 2. doi: 10.1038/s41598-026-50886-4. Online ahead of print.

ABSTRACT

Ranked Set Sampling (RSS) is known for its efficiency in parameter estimation, especially when ranking is more feasible than actual measurement. This study introduces a novel memory type estimator for RSS based on Hybrid Exponentially Weighted Moving Averages (HEWMA), using two auxiliary variables. The estimator aims to enhance efficiency by integrating current and past information along with secondary auxiliary data. Analytical expressions for the bias and mean square error (MSE) are derived, and the corresponding sample coefficients are obtained to simplify HEWMA weight calculations. A simulation study is conducted to evaluate the estimator under various conditions, including different sample sizes, distributional shapes (normal and skewed Weibull), and varying correlation levels among study and auxiliary variables. Results indicate that the proposed estimator consistently yields the highest relative efficiency (RE) compared to conventional and memory estimators using one or multiple auxiliary variables. Additionally, the estimator is applied to two real-world mortality datasets from the USA, involving deaths from tobacco- and alcohol-related cancers. Despite challenges such as zero values and small sample sizes, the estimator maintains superior performance. Overall, the proposed estimator offers an improvement in estimation performance for RSS, particularly in settings where auxiliary variables are available and memory type estimators are applicable.

PMID:42069952 | DOI:10.1038/s41598-026-50886-4

Sci Rep. 2026 May 2. doi: 10.1038/s41598-026-51535-6. Online ahead of print.

ABSTRACT

Federated learning (FL) has become a highly promising paradigm for privacy-preserving distributed model training by enabling edge devices to train without sharing raw data. But in practice, edge environments are both non-stationary and asymmetric, with varying data distributions due to shifts in user behaviour, sensing conditions, and overall environmental dynamics. This causes concept drift (sudden, gradual, and recurrent), leading to poor model performance, slower convergence, and predictive bias. Current approaches to FL are not combined to tackle problems of drift adaptation, differential privacy (DP) and resource efficiency (FedAvg, DP-FedAvg). To address these constraints, we present FedDriftGuard. This Federated learning layer unifies client-level drift detection, drift-adaptive aggregation, and adaptable differential privacy into a single, FLE architecture-compatible system. The proposed DP-DriftNet model implements attention-based time encoding to capture changing data patterns and drift-directed feature weighting to allow greater flexibility in the presence of distributional changes. A drift-optimal privacy scheduler allocates noise probabilistically, subject to a limited privacy budget, thereby enforcing an appropriate privacy-utility trade-off without cancelling formal DP guarantees. Also, update sparsification, compression and periodic transmission techniques are used to reduce communication overhead. Decades of experimentation on real-world and synthetic drift datasets have shown that FedDriftGuard outperforms baseline FL techniques, achieving accuracy and F1-score gains of 9-14% and 11-17%, respectively, with adaptation latency 28% shorter and communication cost 20-35% lower. Such findings are statistically significant and confirm the soundness of the suggested method. FedDriftGuard offers effective, scalable privacy-preserving learning in adaptable, edge-drifting environments.

PMID:42069950 | DOI:10.1038/s41598-026-51535-6