Category: Statistics

Med Image Comput Comput Assist Interv. 2022;13436:207-216. doi: 10.1007/978-3-031-16446-0_20. Epub 2022 Sep 17.

ABSTRACT

We propose LiftReg, a 2D/3D deformable registration approach. LiftReg is a deep registration framework which is trained using sets of digitally reconstructed radiographs (DRR) and computed tomography (CT) image pairs. By using simulated training data, LiftReg can use a high-quality CT-CT image similarity measure, which helps the network to learn a high-quality deformation space. To further improve registration quality and to address the inherent depth ambiguities of very limited angle acquisitions, we propose to use features extracted from the backprojected 2D images and a statistical deformation model. We test our approach on the DirLab lung registration dataset and show that it outperforms an existing learning-based pairwise registration approach.

PMID:42383192 | PMC:PMC13316773 | DOI:10.1007/978-3-031-16446-0_20

Eur Urol Open Sci. 2026 Jun 22;90:42-49. doi: 10.1016/j.euros.2026.06.001. eCollection 2026 Aug.

ABSTRACT

BACKGROUND AND OBJECTIVE: Stress urinary incontinence (SUI) remains a debilitating complication after treatment for prostate cancer or benign prostatic obstruction. While artificial urinary sphincter (AUS) implantation is the gold standard, sling procedures are widely adopted for selected patients. We aimed to analyze long-term trends, perioperative outcomes, and explantation patterns of AUS and sling procedures for male SUI in Germany.

METHODS: We performed a population-based study using the German Nationwide Inpatient Sample (GRAND) from 2005 to 2023. Men undergoing AUS or sling implantation were identified through procedure codes. Primary outcomes were in-hospital morbidity, mortality, and length of stay (LOS). Multivariable regression models were adjusted for age, comorbidities, prior radiotherapy, and year of surgery. Reasons for explantation and reimplantation were also assessed.

KEY FINDINGS AND LIMITATIONS: A total of 24 234 men underwent SUI surgery (AUS: 63%, nonadjustable sling: 32%, and adjustable sling: 4.7%). Median age was 72 yr. AUS implantation remained most frequent, although it declined slightly in recent years. Use of nonadjustable sling peaked in 2012 but decreased thereafter, whereas use of adjustable sling procedures increased steadily. Procedure volumes markedly decreased during COVID-19. Perioperative mortality was <0.1% across groups. Nonadjustable slings were associated with a higher risk of acute urinary retention (odds ratio [OR]: 1.1, p = 0.020) but with a lower risk of wound infection (OR: 0.5, p < 0.001) than AUS. No statistically significant differences were observed between adjustable slings and AUS in terms of perioperative morbidity. LOS was longer in AUS (median 6 d) than in slings (median 5 d; p < 0.001). Two-cuff AUS were associated with longer LOS than single-cuff devices. Explantations occurred most often due to infection or mechanical failure for AUS, and for different reasons for slings. Limitations include reliance on administrative coding without functional or long-term patient-reported outcomes.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Male SUI surgery is safe, with AUS remaining the most frequent procedure in Germany. Adjustable slings represent an expanding option for selected patients.

PMID:42383187 | PMC:PMC13316223 | DOI:10.1016/j.euros.2026.06.001

Environ Epidemiol. 2026 Jun 30;10(4):e501. doi: 10.1097/EE9.0000000000000501. eCollection 2026 Aug.

ABSTRACT

BACKGROUND AND OBJECTIVE: Fractional exhaled nitric oxide (FeNO) is a biomarker of type-2 lung inflammation. Standardized measurement is essential for accurate diagnosis and monitoring. We assess seasonality and environmental determinants of FeNO in individuals with and without chronic respiratory diseases in the general population.

METHODS: This is a cross-sectional study on 412 individuals with chronic respiratory diseases (asthma, chronic bronchitis/chronic obstructive pulmonary disease, rhinitis) and 605 individuals without these conditions. Participants, aged 20-65 years, were recruited in the Gene-Environment Interactions in Respiratory Diseases study in Verona, Italy (2008-2014). Geocoded residential addresses were linked to daily PM₁₀ and air temperature at the time of the clinical examination using previously developed spatiotemporal models. Associations with log-FeNO were analyzed using adjusted linear regression, accounting for seasonality and disease status.

RESULTS: FeNO levels were higher in subjects with respiratory diseases during the warm season, even after adjusting for pollen exposures; a milder seasonal pattern was observed in subjects without chronic respiratory diseases (P for interaction = 0.001). A 10 μg/m³ increase in mean PM₁₀ concentration at lag 0-1 (day of FeNO measurement and day before) was associated with a 3% higher FeNO concentration (Ratio of Geometric Means, RGM: 1.03, 95% confidence interval: 1.00, 1.06) after adjusting for seasonality.

CONCLUSION: FeNO is a sensitive biomarker of environmental exposures. Overlooking seasonality and environmental factors might impact clinical decision-making in chronic respiratory diseases.

PMID:42383180 | PMC:PMC13318099 | DOI:10.1097/EE9.0000000000000501

Future Healthc J. 2026 Jun 3;13(3):100542. doi: 10.1016/j.fhj.2026.100542. eCollection 2026 Sep.

ABSTRACT

BACKGROUND: Legislative moves to legalise assisted dying in the UK have renewed discussion on future clinicians’ preparedness for new potential responsibilities. This study examined medical students’ ethical attitudes, legal understanding and curricular exposure.

METHODS: VOICE was a national cross-sectional survey of UK and Ireland medical students in 2025 (n = 896). The questionnaire assessed ethical views, confidence, legal knowledge and teaching exposure. Descriptive statistics, thematic analysis and multivariable logistic regression explored predictors of ethical agreement, curriculum coverage and legal knowledge.

RESULTS: Most students (64.5%) believed that assisted dying can be ethically justified, yet legal knowledge was limited; only 7.6% correctly identified all eligibility criteria. Nearly 70% reported minimal curricular coverage. Formal teaching was associated with higher confidence and greater ethical agreement. Regional variation and concerns about coercion and inequalities were common.

CONCLUSION: Students show broad ethical support but have very limited confidence, legal understanding and curricular preparation, highlighting the need for structured education.

PMID:42383174 | PMC:PMC13315502 | DOI:10.1016/j.fhj.2026.100542

Gynecol Oncol Rep. 2026 Jun 11;66:102135. doi: 10.1016/j.gore.2026.102135. eCollection 2026 Aug.

ABSTRACT

OBJECTIVE: Updated ACOG guidelines recommend a combined approach of transvaginal ultrasound (TVUS) and endometrial sampling for evaluation of most postmenopausal bleeding (PMB). Although prior studies investigating the reliability of TVUS suggest that non-endometrioid endometrial cancer subtypes present with thinner endometrium, some included cases with incomplete endometrial visualization. We therefore evaluated endometrial thickness (ET) by cancer subtype while controlling for incomplete endometrial visualization.

METHODS: We performed a retrospective cohort study of patients with PMB who underwent TVUS followed by tissue-confirmed endometrial cancer at three academic centers (2013-2022). Cancers were classified as endometrioid or non-endometrioid (serous, clear cell, carcinosarcoma, undifferentiated). Fibroid presence, endometrial visualization, and race/ethnicity were recorded. Patients with incomplete endometrial visualization were excluded from endometrial thickness analysis. Appropriate nonparametric statistical comparisons were performed.

RESULTS: Among 171 analysis-eligible patients (121 endometrioid, 50 non-endometrioid), non-endometrioid cancers were more common among non-Hispanic Black (53%) than non-Hispanic White (20%) or Hispanic patients (25%). Patients with non-endometrioid cancers were more likely to have incompletely visualized endometria (34% vs 9.1%, p < 0.01). Among patients with complete visualization, mean ET did not differ between endometrioid and non-endometrioid cancers (16.9 vs 19.5 mm) or by race/ethnicity. ET ≤4 mm occurred in 5.6% of cancers with fully visualized endometria, without differences between subtypes.

CONCLUSION: When endometrium was fully visualized, non-endometrioid cancers did not present with thinner ET than endometrioid cancers, and a 4 mm cutoff may miss 5.6% of cancers. Incomplete visualization, more common in non-endometrioid disease, may lead to additional missed diagnoses, supporting universal endometrial sampling for PMB.

PMID:42383153 | PMC:PMC13315767 | DOI:10.1016/j.gore.2026.102135

Clin Neuropsychiatry. 2026 Jun;23(3):232-242. doi: 10.36131/cnfioritieditore20260302.

ABSTRACT

OBJECTIVE: psoriasis is a chronic immune-mediated disease that significantly impacts patients’ health-related quality of life (HRQOL). While effective treatments exist, the burden of psoriasis on HRQOL and the factors influencing it remain underexplored in Vietnam. To assess HRQOL and its associated factors among patients with psoriasis vulgaris in a tertiary hospital in Vietnam.

METHOD: a cross-sectional study was conducted from March to December 2023, including 149 patients with psoriasis vulgaris. HRQOL was evaluated using the EQ-5D-5L tool, and disease severity was assessed with the Psoriasis Area and Severity Index (PASI). Data analysis included descriptive statistics, chi-square tests, and stepwise multivariate Tobit regression to identify factors associated with the EQ-5D index.

RESULTS: the mean EQ-5D index was 0.85 (SD = 0.17), with patients reporting the fewest problems in mobility (88.6% no issues) and self-care (81.2% no issues). However, pain/discomfort (68.5%) and anxiety/depression (36.2%) were significant concerns. The EQ-5D index declined with increasing PASI scores (mild: 0.87, severe: 0.68, p < 0.01). Factors negatively associated with HRQOL included older age (Coef. = -0.003, p = 0.026), severe redness (Coef. = -0.199, p = 0.001), and pain symptoms (Coef. = -0.108, p = 0.031). Male sex was independently associated with higher HRQOL (Coef. = 0.084, p = 0.015). Fraizeron treatment was positively associated with higher HRQOL (Coef. = 0.164, p = 0.048).

CONCLUSIONS: psoriasis substantially impacts HRQOL, particularly through pain and emotional burden. Older age, severe redness, and pain symptoms were associated with poorer HRQOL, whereas male sex and Fraizeron treatment were associated with higher HRQOL. Comprehensive management strategies addressing both physical symptoms and psychological well-being may help improve HRQOL.

PMID:42383145 | PMC:PMC13316888 | DOI:10.36131/cnfioritieditore20260302

Mayo Clin Proc Innov Qual Outcomes. 2026 Jun 23;10(4):100734. doi: 10.1016/j.mayocpiqo.2026.100734. eCollection 2026 Aug.

ABSTRACT

OBJECTIVE: To address the limited recognition of structural causes of lower-limb pain and the lack of real-world data on entheseal pathology, we evaluated ultrasound-detected entheseal and tendinous abnormalities in an unselected outpatient population, highlighting the underuse of musculoskeletal ultrasound (MSK US) in early diagnostic assessment despite the frequent misclassification of these conditions as nonspecific soft-tissue or degenerative disorders.

PATIENTS AND METHODS: We conducted a retrospective analysis of 667 consecutive adults undergoing standardized MSK US for lower-limb pain in a general ambulatory orthopedic clinic. Fourteen predefined entheseal and tendinous sites across the hip, knee, and ankle-foot regions were evaluated using Outcome Measures in Rheumatology criteria. Prevalence, anatomical distribution, bilaterality, and clinical predictors were assessed using descriptive statistics and multivariable logistic regression.

RESULTS: Ultrasound-confirmed enthesopathy or tendinopathy was present in 152 of 667 patients (22.8%). Lesions most frequently involved the gluteus medius tendon and plantar fascia (5.5% each, n=37), followed by the semimembranosus (2.8%, n=19), patellar (2.6%, n=17), and Achilles tendons (4.2%, n=28). Abnormalities were predominantly unilateral (<10% bilateral). Increasing age was the only independent predictor of entheseal pathology (adjusted OR 1.26 per 10-year increase; 95% CI, 1.08-1.47). Sex, body mass index, diabetes, and rheumatologic disease were not relatively associated with pathology.

CONCLUSION: Entheseal and tendinous abnormalities are common among symptomatic adults in everyday outpatient practice. Systematic integration of MSK US as a first-line assessment tool could improve diagnostic precision and enable targeted management strategies. These findings provide population-relevant evidence to inform musculoskeletal care pathways and health system decision-making.

PMID:42383140 | PMC:PMC13316613 | DOI:10.1016/j.mayocpiqo.2026.100734

Indian J Sex Transm Dis AIDS. 2026 Jan-Jun;47(1):16-21. doi: 10.4103/ijstd.ijstd_94_25. Epub 2026 May 19.

ABSTRACT

BACKGROUND: Syphilis is a sexually transmitted disease that varies in presentation according to the stage of the disease. Susceptibility to penicillin contributed to the near elimination of the disease during the 1990s to 2000 period. Recently, there have been reports of the re-emergence of syphilis from all parts of the world.

AIM: To study the clinical presentation and trends of syphilis.

MATERIALS AND METHODS: A retrospective study was conducted from January 2013 to December 2024. All clinically and/or serologically diagnosed cases of syphilis were included in the study. Medical records of all the patients attending the sexually transmitted infection clinic were analyzed concerning age, sex, clinical presentation, and laboratory investigations. Statistical analysis was done using mean, median, and proportion.

RESULTS: A total of 260 cases with syphilis were enrolled. The male-to-female ratio was 5.53:1. The most common stage of presentation was latent syphilis (45.6%). The most common age group affected was 21-30 years. Out of the total cases, 2.7% of cases were pregnant females, 14.18% were human immunodeficiency virus (HIV) positive, and 95 cases were men who have sex with men cases. Only two cases of congenital syphilis were detected.

CONCLUSION: A resurgence of syphilis cases has been observed in the last 3 years, with latent syphilis contributing to the majority of cases. Possible factors attributed to this surge include promiscuous sexual behavior, HIV coinfection, male having sex with male, and early adolescent sexual exposure. The sudden rise in latent syphilis cases is a warning sign of resurgence in India, as it signifies the persistence of syphilis in the subclinical phase in the community.

PMID:42383134 | PMC:PMC13318344 | DOI:10.4103/ijstd.ijstd_94_25

Sci Rep. 2026 Jun 30. doi: 10.1038/s41598-026-58207-5. Online ahead of print.

ABSTRACT

Traditional Bayesian network structure learning requires explicit trade-offs among structural complexity, statistical fit, and decision reliability. This study proposes BAPS (Budgeted Acyclicity with Phase-transition Spectral diagnostics), a framework that reformulates structure learning as a budget-controlled optimization problem in which a global edge budget limits the number of selected candidate edges and thereby regulates model capacity. A relaxed QUBO formulation with post-hoc DAG projection explores likelihood-improving structures while recovering feasible directed acyclic graphs; in benchmark experiments, the repair process reduces SHD by 20.6%, 14.9%, and 8.3% on Asia, Insurance, and Barley, indicating improved structural agreement while enforcing feasibility. Spectral diagnostics based on algebraic connectivity serve as descriptive structural indicators for flagging budget regions where repair burden may escalate. A dual-layer credibility framework quantifies uncertainty from parameter and observational sources; credibility interval width contracts by 69-73% under increasing Dirichlet concentration and remains empirically stable in sparse-data conditions where resampling-based methods become unstable due to zero-frequency effects. Across benchmark networks, BAPS achieves the highest BIC gain while maintaining broadly comparable held-out predictive performance relative to established baselines. Overall, BAPS provides a unified framework integrating edge-budget capacity control, structural diagnostics, feasibility repair, and credibility assessment for Bayesian network learning in complex diagnostic environments.

PMID:42380384 | DOI:10.1038/s41598-026-58207-5

Int Microbiol. 2026 Jul 1. doi: 10.1007/s10123-026-00822-3. Online ahead of print.

ABSTRACT

Pseudomonas aeruginosa is a multidrug-resistant pathogen, highly prevalent in ICU patients and is a rising concern globally. Multidrug resistance (MDR) and virulence of P. aeruginosa has been a major reason linked to the high rates of mortality in both developed and non-developed countries. The study focused specifically on main structural outer membrane proteins mainly oprI and oprL due to their significant role on both virulence and MDR by assessing their MDR from the isolates collected from various healthcare settings in Lahore, Pakistan. A total of 65 isolated were collected from different tertiary care hospitals of Lahore, Punjab. All isolates were identified and characterized using conventional methods. MDR patterns were assessed through disk diffusion method in accordance with CLSI 2024 guidelines. Detection of virulence genes (oprI and oprL) was performed using PCR amplification. Statistical and in silico analysis was performed to analyse the prevalence of P. aeruginosa and identification of potential vaccine targets provide alternative treatment strategies against infections caused by it. Out of all 65 isolates, total of 52 isolates was reportedly positive with P. aeruginosa and showed 100% resistance to β-lactams with high susceptibility to cephalosporins and fluoroquinolones. Multidrug resistance was reported in 70% isolates of P. aeruginosa. All isolates (100%) harbored the oprL gene while the oprI gene was detected in 85.5% of isolates. In silico characterization revealed strong binding B and T cell epitopes with 100% conservancy as potential multi-epitope candidates that warrant further in vivo and in vitro validation to overcome deadly infections caused by P. aeruginosa. In conclusion, MDR and virulence gene characterization by both molecular and computational methods will aid in developing multi-epitope vaccine candidate that can be tested in vitro and in vivo to overcome MDR and rising mortality rates in Pakistan.

PMID:42380383 | DOI:10.1007/s10123-026-00822-3