Category: Statistics

BMC Oral Health. 2026 May 5. doi: 10.1186/s12903-026-08472-7. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this clinical trial was to evaluate and compare the 12-month performance of a contemporary injectable and a conventional paste-type resin composite in Class I cavities using the modified USPHS criteria, supported by SEM analysis.

METHODS: A total of 72 teeth from 34 volunteers were included. Each participant received at least two restorations (one per material); in cases where more eligible cavities were present, additional restorations were performed accordingly. All restorations were performed under rubber dam isolation following conservative Class I cavity preparation, using selective enamel etching and a universal adhesive. All procedures were carried out by the same clinician using a paste-type resin composite (Filtek Z250 Universal Restorative) and an injectable resin composite (G-ænial Universal Injectable). Two calibrated investigators evaluated restorations at baseline, 6, and 12 months using modified USPHS criteria. SEM analysis was conducted on a total of 66 epoxy replicas obtained at baseline, 6, and 12 months from 11 randomly selected participants. Statistical analysis was performed using SPSS (Version 23.0, IBM, NY) with Pearson’s chi-square and Cochran’s Q tests.

RESULTS: Both materials demonstrated comparable and clinically acceptable performance over the 12-month evaluation period according to the modified USPHS criteria, with no statistically significant differences observed at any time point across all criteria, although minor changes were observed in marginal adaptation and color match in a few restorations (p > 0.05). All participants attended the follow-up visits, resulting in a 100% recall and retention rate.

CONCLUSION: The injectable (G-ænial Universal Injectable) and paste-type (Filtek Z250) resin-composites demonstrated comparable and clinically acceptable short-term performance in Class I occlusal restorations, although longer-term follow-up is needed to confirm these findings.

TRIAL REGISTRATION: As trial registration took place after the first participant was enrolled, the study was retrospectively registered at ClinicalTrials.gov on December 21, 2023, with ID: NCT06192667. https://register.

CLINICALTRIALS: gov/prs/beta/studies/S000DTX600000072/recordSummary/.

PMID:42087142 | DOI:10.1186/s12903-026-08472-7

BMC Womens Health. 2026 May 5. doi: 10.1186/s12905-026-04519-7. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the relationship between oxidative stress parameters [total oxidant status (TOS), total antioxidant status (TAS), thiol/disulfide homeostasis, ischemia-modified albumin (IMA)] and serum copper levels in women who use oral contraceptives (OCs) compared to those who do not.

METHODS: This single-center, prospective case-control study included a total of 154 women aged 18 to 45 years (72 OC users and 82 non-users) who presented to the gynecology outpatient clinic of a tertiary care training and research hospital. After obtaining written informed consent, demographic data and information regarding OC use were collected. Venous blood samples were drawn and serum samples were stored at -80 °C until analysis. Serum levels of TOS, TAS, total thiol, native thiol, disulfide, IMA and copper were measured. A p-value of < 0.05 was considered statistically significant.

RESULTS: In OC users, serum levels of copper, TOS, oxidative stress index (OSI), disulfide and IMA were significantly elevated, whereas TAS and native thiol levels were significantly reduced compared to non-users (p < 0.05). Serum copper levels showed a positive correlation with oxidative stress markers and a negative correlation with antioxidant capacity indicators.

CONCLUSIONS: OC use is associated with increased serum copper levels, which in turn have a significant impact on oxidative stress biomarkers. These findings suggest that OC use elevates systemic oxidative stress while compromising antioxidant defense mechanisms. Moreover, elevated copper levels may independently contribute to oxidative stress regardless of OC use.

PMID:42087140 | DOI:10.1186/s12905-026-04519-7

Malar J. 2026 May 5. doi: 10.1186/s12936-026-05923-y. Online ahead of print.

ABSTRACT

BACKGROUND: Sudan is one of the few African countries reporting increasing Plasmodium vivax infections despite the high prevalence of the Duffy-negative phenotype, historically considered protective against this parasite. Emerging molecular evidence challenges this paradigm. The objective of this systematic review and meta-analysis was to synthesize evidence on the prevalence and geographic distribution of P. vivax infection, Duffy antigen polymorphisms, parasite genetic adaptations, and diagnostic limitations in Sudan.

METHODS: This review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO (CRD42025127714). The reports of P. vivax infection in Sudan focusing on host Duffy status and the parasite genetic variability from 2005 to 2025 were identified through systematic searches of PubMed, Web of Science, Scopus, and EMBASE with predefined Boolean search operators. To determine the risk of bias, the Joanna Briggs Institute prevalence study checklist was employed. To obtain a pooled prevalence estimate in Duffy-negative individuals, a random-effects meta-analysis (DerSimonian-Laird estimator) was conducted. Heterogeneity was assessed using Cochran’s Q test and the I² statistic, while publication bias was evaluated using funnel plots and Egger’s regression test.

RESULTS: A total of sixteen studies conducted between 2005 and 2025, including 5,753 participants from various regions of Sudan, were included. P. vivax infection was reported in both Duffy-positive and Duffy-negative individuals. Meta-analysis of five studies reporting host Duffy antigen status showed a pooled prevalence of P. vivax infection of 11.7% (95% CI 7.2-17.3%) among Duffy-negative individuals. The studies showed moderate heterogeneity (I² = 56%). Substantial genetic diversity was observed in the P. vivax Duffy Binding Protein (PvDBP), including multiple haplotypes and both Malagasy-type and Cambodian-type gene duplications. Most studies were assessed as having low to moderate risk of bias, and funnel plot inspection did not suggest substantial publication bias, although interpretation is limited by the small number of studies.

CONCLUSIONS: This systematic review and meta-analysis provide evidence that P. vivax infection occurs among Duffy-negative individuals in Sudan, challenging the long-standing assumption of complete Duffy-mediated protection. The observed parasite genetic diversity highlights adaptive mechanisms that may facilitate infection in Duffy-negative hosts. Strengthening molecular surveillance and integrating host-parasite genomic data into national malaria control programs will be critical to inform malaria elimination strategies and vaccine development in Africa.

PMID:42087123 | DOI:10.1186/s12936-026-05923-y

BMC Oral Health. 2026 May 6. doi: 10.1186/s12903-026-08436-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Zygomatic implant placement is a challenging surgical procedure, as the implants are inserted with limited accessibility and visibility. The aim of this study was to compare the accuracy of completely limiting versus partially limiting computer-generated 3D surgical guides for zygomatic implant placement in patients with atrophic maxillae.

MATERIALS AND METHODS: This prospective randomized controlled study included participants with atrophic posterior maxilla indicated for zygomatic implant (ZI) placement. The participants were randomly allocated to one of two groups. Group I received ZI using completely limiting 3D computer-guided surgical templates, while Group II underwent ZI placement using partially limiting 3D computer-guided surgical templates. The primary outcome variable was the accuracy of implant placement, which was assessed by measuring linear deviations at the implant coronal and apical points, as well as angular deviations. The secondary outcome was the duration of the operative time.

RESULTS: This study evaluated 12 zygomatic implants (6 per group) in 6 patients (mean age: 56.9 ± 7.57 years). Baseline demographics and clinical features were well-balanced between groups, with comparable age and sex distributions. There were no statistically significant differences in linear or angular deviations between the groups, except for a statistically significant greater apical deviation in the midsagittal plane for Group II (p = 0.015). Group II had a significantly shorter mean operative time (21.17 ± 2.14 min) than Group I (27 ± 2.37 min) (p = 0.01). No dropouts or postoperative complications (e.g., infection, peri-implantitis, or sinus-related issues) have occurred.

CONCLUSIONS: Within the limitations of the sample size of this study, the partially limiting surgical guide could provide a successful and less invasive treatment modality for zygomatic implant placement, as it significantly reduces the surgical time with comparable overall accuracy. However, the completely limiting guide demonstrates superior control at the critical apical implant position.

TRIAL REGISTRATION: ClinicalTrials.org (NCT06227351) 2024-02-05.

PMID:42087122 | DOI:10.1186/s12903-026-08436-x

BMC Womens Health. 2026 May 5. doi: 10.1186/s12905-026-04506-y. Online ahead of print.

ABSTRACT

BACKGROUND: Depressive symptoms during pregnancy and the postpartum period have been extensively studied; however, evidence regarding mental health in the preconception period remains limited. Women preparing for pregnancy undergo physiological changes, lifestyle adjustments, and psychosocial transitions, and emotional vulnerability may be heightened by reproductive stressors, including infertility. Nevertheless, population-based studies examining depressive symptoms and their associated lifestyle and reproductive factors during the preconception period remain scarce.

METHODS: This cross-sectional study included 14,004 women aged 20-45 years who participated in the Seoul Metropolitan Preconception Health Management Program between 2019 and 2021. Depressive symptoms were assessed using the Korean-validated Hospital Anxiety and Depression Scale-Depression subscale (HADS-D), with scores ≥ 11 indicating elevated risk. Sociodemographic, lifestyle, nutritional, menstrual, and reproductive factors were assessed. A multivariable logistic regression model was used to identify factors independently associated with depressive symptoms.

RESULTS: Among the participants, 1,102 women (8.5%) exhibited elevated depressive symptoms. In a multivariable logistic regression model, depressive symptoms were independently associated with current smoking, passive smoking exposure, insomnia, binge eating, irregular menstruation, severe dysmenorrhea, infertility history, and previous pregnancy. Insomnia, binge eating, current smoking, and severe dysmenorrhea were each associated with more than twofold higher odds of depressive symptoms. In contrast, regular physical activity showed a clear dose-response association, with increasing physical activity level associated with progressively lower odds of depressive symptoms, whereas greater dysmenorrhea severity was associated with progressively higher proportions screening positive for depressive symptoms. Folic acid supplementation was also independently associated with reduced odds of depressive symptoms.

CONCLUSIONS: Depressive symptoms were relatively common among women preparing for pregnancy and were closely associated with modifiable lifestyle factors, including smoking, sleep problems, and eating behaviors, as well as reproductive-related factors such as dysmenorrhea and infertility. These findings underscore the need to integrate systematic mental health screening and targeted lifestyle and reproductive health interventions into routine preconception and infertility care to improve women’s psychological well-being and support healthier future pregnancies.

PMID:42087119 | DOI:10.1186/s12905-026-04506-y

Clin Neurol Neurosurg. 2026 Apr 30;267:109445. doi: 10.1016/j.clineuro.2026.109445. Online ahead of print.

ABSTRACT

INTRODUCTION: Antiseizure Medications (ASMs) can be beneficial for many patients with epilepsy; however, some individuals with medication-resistant epilepsy (MRE) may not experience effective seizure control. Although effective alternative diets and non-pharmacological interventions have received much attention, there are limited studies in this regard. Therefore, this study was conducted to investigate the efficacy of probiotic intervention on children with MRE.

METHODS: This prospective, triple-blind, randomized clinical trial study was conducted on 62 pediatric patients with MRE who were referred to the Children’s Medical Center (the main referral center for children with epilepsy) and diagnosed by an epileptologist. Patients were randomly divided into two equally distributed groups: intervention (31 patients) with daily probiotic intake and control (31 Patients) with placebo intake. Patients were followed up at intervals of 45 days, 3 months, and 6 months regarding the number of seizures as the primary outcome, and the times and dose of anticonvulsants taken by the patient as secondary outcomes.

RESULTS: In the probiotic group, 20 patients (64.5%) experienced a decrease in seizure frequency following the intervention, while 11 patients (35.5%) showed no change in their seizure frequency. This outcome was statistically significant when compared to the placebo intervention group (P = 0.007). A statistically significant relationship was found between probiotic consumption and the patient’s seizure frequency after starting probiotics in patients with normal neuroimaging results (P = 0.007). Probiotic administration had a statistically significant effect only on reducing the dose of Phenobarbital. This study found that probiotic use was associated with a reduction in the number of seizures in patients with MRE. Because antiseizure medication (ASM) adjustments were not protocolized and certain confounders were not fully controlled, the causative nature of the association between probiotic use and seizure reduction cannot be ascertained.

PMID:42085751 | DOI:10.1016/j.clineuro.2026.109445

Epidemics. 2026 Apr 22;55:100911. doi: 10.1016/j.epidem.2026.100911. Online ahead of print.

ABSTRACT

Susceptible-Exposed-Infectious-Recovered (SEIR) models with inter-individual variation in susceptibility or exposure to infection were proposed early in the COVID-19 pandemic as a potential element of the mathematical/statistical toolset available to policy development. In comparison with other models employed at the time, those designed to fully estimate the effects of such heterogeneity tended to predict small epidemic waves and hence require less containment to achieve the same outcomes. However, these models never made it to mainstream COVID-19 policy making due to lack of prior validation of their inference capabilities. Here we report the results of the first systematic investigation of this matter in idealized scenarios created with synthetic data. We simulate datasets using the model with strategically chosen parameter values, and then conduct maximum likelihood estimation to assess how well we can retrieve the assumed parameter values. Parameter uncertainties were found to markedly reduce when concurrently fitting multiple epidemics with shared parameters, suggesting a general methodological approach that can be further developed to tackle real-world questions.

PMID:42085746 | DOI:10.1016/j.epidem.2026.100911

Atherosclerosis. 2026 May 1;417:120773. doi: 10.1016/j.atherosclerosis.2026.120773. Online ahead of print.

ABSTRACT

AIMS: This study aims to explore the relationship between aortic aneurysm and dissection (AAD) and cognitive impairment, with an emphasis on uncovering the potential biological mechanisms.

METHODS: Utilizing the UK Biobank database, a matched cohort study was performed to assess the association between AAD and the risk of Alzheimer’s disease. Cognitive function was evaluated in a β-aminopropionitrile (BAPN)-induced AAD mouse model through a series of behavioral assays. Drug-target Mendelian randomization analysis was conducted to identify candidate genes implicated in this association. Expression levels of PRDX6 were examined in brain tissues from Alzheimer’s disease patients using datasets from the Gene Expression Omnibus (GEO), as well as in aortic tissues and blood samples obtained from both AAD patients and AAD model mice. Correlative analyses between PRDX6 and pro-inflammatory cytokines (IL-1β and TNF-α) were performed in mouse hippocampal tissues of the mouse model. Additionally, in vitro experiments employing SH-SY5Y cells were carried out to investigate the functional role of PRDX6 in modulating synaptic protein expression and inflammatory responses.

RESULTS: Competing risk regression analysis indicated that AAD is significantly associated with an increased incidence of cognitive impairment. Behavioral testing revealed that AAD model mice exhibited deficits in cognitive performance. Mendelian randomization prioritized PRDX6 was prioritized as a candidate gene of interest. Elevated PRDX6 expression was observed in brain tissues from Alzheimer’s disease patients. Both AAD patients and AAD model mice demonstrated markedly increased PRDX6 levels in aortic tissues and circulating blood; notably, PRDX6 expression was also upregulated in the hippocampus of AAD mice. In the hippocampus, PRDX6 expression positively correlated with levels of IL-1β and TNF-α expression in AAD mice. In SH-SY5Y cells, silencing of PRDX6 resulted in increased expression of synaptic proteins, reduced pro-inflammatory cytokine production, and decreased apoptosis, whereas overexpression of PRDX6 elicited inverse effects.

CONCLUSIONS: The present findings establish a significant association between AAD and heightened risk of cognitive impairment. PRDX6 has been identified as a potential mediator in this relationship, and PRDX6-related neuroinflammation is proposed as a plausible mechanistic pathway linking AAD to cognitive dysfunction.

PMID:42085745 | DOI:10.1016/j.atherosclerosis.2026.120773

Neuroimage Clin. 2026 Apr 29;50:103999. doi: 10.1016/j.nicl.2026.103999. Online ahead of print.

ABSTRACT

Although the classical language cortex significantly contributes to post-stroke aphasia (PSA), non-language-specific cortex, such as the cerebellum, is increasingly implicated in language. However, the specific contributions of its subregions to PSA, particularly regarding distinct language dimensions, remain unclear. Given fluency as a core dimension, we investigated the functional and structural integrity of cerebellar language-related subregions to clarify their distinct roles in fluent (FA) versus non-fluent aphasia (nonFA). We enrolled a primary cohort of 81 PSA patients (46 nonFA, 35 FA), and 77 healthy controls (HCs), alongside an independent external validation cohort (Aphasia Recovery Cohort [ARC]; 23 nonFA, 22 FA). Using individualized functional connectivity (FC) and volumetric analyses based on the Multi-Domain Task Battery (MDTB) atlas, we found that nonFA patients exhibited significantly decreased FC between the classical language network (LN) and language-related cerebellar subregions (right MDTB 8 and 9; R_MDTB8/9-LN FC), alongside reduced right Crus II volume. Correlation analysis revealed that these neuroimaging indicators were positively associated with language scores in nonFA, while no such relationships were observed in FA. Furthermore, mediation analysis indicated that right Crus II volume statistically accounted for the observed association between R_MDTB8/9-LN FC and overall Aphasia Quotient (AQ). As the key findings were replicated in the ARC, our results provide compelling evidence that the functional connectivity strength and structural integrity of specific cerebellar subregions contribute to language fluency. Our findings support expanding models of PSA beyond cortical regions and suggest that cerebellar-targeted strategies may improve language rehabilitation outcomes.

PMID:42085725 | DOI:10.1016/j.nicl.2026.103999

J Infect Public Health. 2026 Apr 29;19(6):103238. doi: 10.1016/j.jiph.2026.103238. Online ahead of print.

ABSTRACT

BACKGROUND: Despite global elimination goals, measles remains a persistent regional health challenge in the Association of Southeast Asian Nations (ASEAN). This systematic review and meta-analysis characterized the distribution of cases and deaths during ASEAN measles outbreaks (2015-2025) and computed pooled proportions of cases stratified by age, vaccination history, migration status, and indigenous group membership.

METHODS: In this systematic review and meta-analysis (PROSPERO CRD420251149627), we searched Scopus, Medline, Embase, and Google Scholar through January 15, 2026, for studies on measles outbreaks in ASEAN (2015-2025) that stratified cases by age, vaccination history, or marginalized groups. A modified Joanna Briggs Institute/ROBINS-E tool was used to assess the risk of bias. Pooled proportions were calculated using random-effects generalized linear mixed models (GLMM). Heterogeneity and small-study effects were evaluated using I² statistics and Luis Furuya-Kanamori (LFK) indices, respectively.

FINDINGS: Across 11 studies (15,679 cases), measles disproportionately affected children under five (n = 10,867). Vaccination history reporting was near-complete in children but negligible in adults (0·22%, 95% CI: 0·00-73·41%). Among cases with known history, 73·20% (95% CI: 59·37-83·61%) were unvaccinated. Age-ineligible infants (<9 months) comprised half the unvaccinated burden (49·98%, 95% CI: 24·85-75·13%). Among vaccinated cases, 74·84% (95% CI: 44·48-91·70%) were not fully vaccinated. Significant heterogeneity was observed throughout (I² ≥ 89·0%). Risk of bias was generally low. Transmission was also documented among migrant and indigenous subpopulations.

INTERPRETATION: ASEAN measles outbreaks are driven by immunity gaps in unvaccinated children, partially vaccinated individuals, and age-ineligible infants. Achieving and sustaining regional measles elimination requires closing coverage gaps and addressing systemic drop-outs between doses. Future strategies must prioritize lifecycle immunity, including enforcement of the 2nd dose of measles containing vaccine (MCV2) and potential adult boosters, digitized vaccine registries, and cross-border collaboration.

PMID:42085724 | DOI:10.1016/j.jiph.2026.103238