Category: Statistics

BMC Nutr. 2026 May 5. doi: 10.1186/s40795-026-01342-z. Online ahead of print.

ABSTRACT

BACKGROUND: Severe acute pancreatitis (SAP) is a life-threatening condition marked by systemic inflammation, organ failure, and high morbidity. Nutritional support plays a critical role in SAP management, with total enteral nutrition (TEN) and total parenteral nutrition (TPN) being the primary approaches. While TEN maintains gut integrity and may reduce complications, TPN bypasses the gastrointestinal tract and may worsen systemic inflammation. This study aimed to perform an updated systematic review and meta-analysis comparing the efficacy and safety of TEN versus TPN in SAP patients.

METHODS: Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for randomized controlled trials and cohort studies comparing TEN and TPN in SAP. Outcomes included infection rate, organ failure, mortality, necrosis, surgical intervention, hospital stay, and serum markers (amylase, lipase, albumin, IL-6). Quality assessment was done using ROB2 and NOS tools. GRADE methodology was applied to assess evidence certainty.

RESULTS: A total of 23 studies involving 7,674 patients (2,750 TEN and 4,924 TPN) were analyzed. TEN was significantly associated with lower odds of infection (OR = 0.35; 95% CI: 0.18-0.70; p = 0.003), multiple organ failure (OR = 0.41; 95% CI: 0.21-0.78; p = 0.007), and mortality (OR = 0.50; 95% CI: 0.33-0.76; p = 0.001), compared to TPN. The requirement for surgical intervention was also reduced with TEN (OR = 0.26; 95% CI: 0.07-1.00; p = 0.05), although with high heterogeneity and low certainty. No significant differences were observed in pancreatic necrosis (OR = 0.88; p = 0.62) or hospital stay (MD = 1.9 days; p = 0.11). Biochemical markers including serum amylase, lipase, albumin, and IL-6 showed no statistically significant differences between the two groups. GRADE analysis rated the certainty of evidence as moderate for infection and hospital stay, low for organ failure and mortality, and very low for surgical intervention.

CONCLUSION: Our updated meta-analysis demonstrates that total enteral nutrition is associated with significantly better clinical outcomes than total parenteral nutrition in patients with severe acute pancreatitis, particularly in reducing infection, organ failure, and mortality. Although differences in secondary outcomes were not statistically significant, the overall evidence supports TEN as the preferred nutritional approach in SAP management.

PMID:42087204 | DOI:10.1186/s40795-026-01342-z

Crit Care. 2026 May 5. doi: 10.1186/s13054-026-06035-4. Online ahead of print.

ABSTRACT

BACKGROUND: In severe acute kidney injury (AKI), delayed renal replacement therapy (RRT) strategies allow many KDIGO stage-3 patients to avoid dialysis, but excessive postponement in those who ultimately require RRT may worsen outcomes. Early physiologically grounded markers to identify patients likely to need RRT are lacking. We evaluated whether combining early glomerular filtration kinetics and timed urinary urea excretion could improve discrimination of subsequent RRT initiation under a delayed strategy.

METHODS: TUBSAKI is a prospective bicentric ICU cohort including adults with KDIGO stage-3 AKI managed with a protocolized delayed RRT strategy. Blood and 24-hour urine samples were collected at diagnosis (D0) and day 1 (D1). Glomerular filtration dynamics were assessed using kinetic GFR (kGFR), and timed urinary urea excretion was assessed using UUEI. Discrimination for subsequent RRT was assessed using ROC curves and AUC. A combined logistic model (kGFR D0-D1 + UUEI D1) was internally validated by bootstrap, with sensitivity analyses adjusted for SOFA and KDIGO stage-3 oliguria.

RESULTS: Among 110 patients, 31 (28%) required RRT. kGFR D0-D1 showed good discrimination (AUC 0.81 [0.72-0.89]), and UUEI D1 moderate discrimination (AUC 0.74 [0.63-0.82]). The combined model showed an AUC of 0.85 ([0.76-0.91]), optimism-corrected AUC 0.83, and acceptable calibration. Discrimination remained stable after adjustment for SOFA and oliguria. Incremental gain over kGFR alone was modest and not statistically significant.

CONCLUSIONS: Early glomerular filtration kinetics and urinary urea excretion were associated with subsequent RRT initiation under a delayed strategy. The incremental clinical value of UUEI remained limited in this cohort, and external validation is required before clinical use.

PMID:42087193 | DOI:10.1186/s13054-026-06035-4

BMC Med Inform Decis Mak. 2026 May 6;26(1):160. doi: 10.1186/s12911-026-03350-2.

NO ABSTRACT

PMID:42087181 | DOI:10.1186/s12911-026-03350-2

BMC Sports Sci Med Rehabil. 2026 May 6. doi: 10.1186/s13102-026-01711-y. Online ahead of print.

ABSTRACT

BACKGROUND: Team-level defensive efficiency is a central determinant of success in professional football, yet defenders’ physical and motor profiles are rarely examined in relation to ecological defensive outcomes, particularly in under-researched professional leagues. This study investigated anthropometric and motor-fitness signatures of defensive efficiency among professional football defenders in the Nigeria Premier Football League (NPFL) using multivariate profiling methods.

METHODS: An observational ecological study was conducted among 36 professional defenders from Enugu Rangers International FC across three competitive seasons (2021/22-2023/24). Standardised anthropometric and motor-fitness assessments (agility, vertical-jump power, reaction time, balance, and coordination) were obtained during pre-season testing. Team-level defensive efficiency was derived from predefined ecological defensive indicators obtained from official league statistics, including goals conceded per match, defensive success index, points per goal conceded, and goal-prevention rate. Analyses included Spearman correlations, Kruskal-Wallis tests with eta-squared effect sizes (η²_H), principal component analysis (PCA), and k-means clustering; no individual-level regression was undertaken.

RESULTS: GA/PLD was relatively stable between full seasons (0.79 in 2021/22; 0.87 in 2023/24), whereas DSI and PPGC improved (0.68→0.74; 1.87→2.06), with GPR and GD/PLD also increasing (0.27→0.38; 0.29→0.53), indicating that comparable goals conceded yielded more favourable results. Defenders showed substantial muscularity (mean BMI 25.7 kg/m²; muscle mass 41.2 kg) and good motor fitness (agility 11.0 s). Anthropometric variables were strongly coupled, and BMI and jump classifications showed large effects on muscle mass, body fat, and jump power. PCA yielded three components explaining 72.5% of variance (body size/composition; agility-balance-coordination; power vs. adiposity), and k-means clustering identified three defender archetypes that differed most clearly in agility, separating heavier, slower stoppers from leaner, faster coverage profiles and balanced hybrids.

CONCLUSION: This ecological profiling study shows that, within a single NPFL club, professional defenders cluster into distinct anthropometric and motor-fitness archetypes-ranging from heavier high-mass stoppers to leaner, more agile mobile coverage defenders-while team-level indicators suggest increasingly efficient conversion of broadly stable goals conceded into better results and goal difference. These patterns do not establish individual causal effects but illustrate how multivariate profiling can support role allocation, interpretation of body-size and power metrics, and context-sensitive conditioning in data-limited professional environments. Inferences remain exploratory and are constrained by single-club sampling, lack of player-level event data, and unquantified cluster stability.

PMID:42087177 | DOI:10.1186/s13102-026-01711-y

Genome Biol. 2026 May 5. doi: 10.1186/s13059-026-04086-y. Online ahead of print.

ABSTRACT

RNA velocity has recently emerged as a key tool in the analysis of single-cell transcriptomic data, yet connecting RNA velocity analyses to underlying regulatory processes has proved challenging. Here, we propose CRAK-Velo, a semi-mechanistic model that integrates chromatin accessibility data in the estimation of RNA velocities. CRAK-Velo provides biologically consistent estimates of developmental flows and enables accurate cell-type deconvolution, while additionally shining light on regulatory processes at the level of interactions between genes and chromatin regions.

PMID:42087173 | DOI:10.1186/s13059-026-04086-y

Confl Health. 2026 May 5. doi: 10.1186/s13031-026-00795-0. Online ahead of print.

ABSTRACT

BACKGROUND: Timely prehospital care is essential in preventing trauma‑related deaths in conflict settings, yet civilian systems often lack the capacity for rapid stabilization and evacuation. Trauma Stabilization Points (TSPs), adapted from military models, have been introduced in Gaza to provide forward‑deployed triage and stabilization. This study describes patient characteristics, clinical presentations, interventions, and outcomes at a TSP operating in Khan Younis, Gaza, in 2024 during the ongoing war.

METHODS: We conducted a retrospective cross‑sectional analysis of routinely collected patient‑level data from a TSP operated by the Palestinian Red Crescent Society with support from the WHO and an international emergency medical team. All patients presenting between 12 February and 28 April 2024 were included. Descriptive statistics and logistic regression assessed associations between patient characteristics, injury severity, interventions, and referral outcomes.

RESULTS: 1,928 patients were entered into the dataset. Non‑traumatic conditions accounted for 53% of attendances, while 47% were trauma‑related. Most patients (94.8%) were stable, as defined by the Interagency Integrated Triage Tool (IITT) on arrival. A total of 3482 interventions were recorded, dominated by basic care (86%). Overall, 80.6% of patients were discharged, 19.3% referred to still-functioning hospitals, and 0.1% died at the TSP. Clinical instability, fractures, and penetrating injuries were significantly associated with referral, while basic interventions (e.g., wound suturing, antipyretics) predicted discharge.

CONCLUSIONS: Despite operating in a high‑intensity conflict, the TSP primarily functioned as a triage and primary‑care access point rather than a trauma‑focused facility. The dominance of on-site treatment and same-day discharge suggest the TSP offloaded some non-urgent patients from overwhelmed hospitals and likely contributed to reducing consumption of limited ambulance resources.

PMID:42087157 | DOI:10.1186/s13031-026-00795-0

BMC Surg. 2026 May 6. doi: 10.1186/s12893-026-03813-3. Online ahead of print.

ABSTRACT

BACKGROUND: Perforated peptic ulcer is a critical emergency disease requiring surgery, and postoperative intra-abdominal abscess (IAA), an organ/space surgical site infection (SSI), is a common complication. Intraoperative irrigation is a common IAA prevention approach; however, scientific evidence supporting its effectiveness is lacking. We aimed to investigate the association between intraoperative irrigation volume and IAA using multicentre data.

METHODS: This multicentre retrospective cohort study was conducted between January 2011 and December 2023. The study included patients aged ≥ 18 years who underwent laparotomy or laparoscopy for perforated peptic ulcer, defined as perforation of a gastric or duodenal ulcer. The primary and secondary outcomes were IAA incidence and superficial incisional SSI, respectively, and their association with the intraoperative irrigation volume was determined through multivariable logistic regression analyses.

RESULTS: The study included 478 patients with a median age of 66 years (interquartile range [IQR]: 54-75 years), 344 (72.0%) of whom were males. The median irrigation volume was 7.0 (IQR: 5-10) L. Among the 478 patients, IAA and superficial incisional SSI occurred in 52 (10.9%) and 71 (14.9%), respectively. The irrigation volume and the outcomes exhibited no significant association (for IAA: adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI] = 0.97-1.11, p = 0.25; for superficial incisional SSI: AOR = 1.07, 95% CI = 1.00-1.14, p = 0.053).

CONCLUSIONS: There was no statistically significant association between increased intraoperative irrigation volume and a decreased incidence of postoperative IAA formation. These findings suggest that alternative strategies, rather than uncontrolled high-volume irrigation, are required for IAA prevention.

PMID:42087153 | DOI:10.1186/s12893-026-03813-3

Environ Health. 2026 May 6. doi: 10.1186/s12940-026-01304-9. Online ahead of print.

ABSTRACT

Over 100,000 people were exposed to arsenic-contaminated drinking water in Antofagasta, Chile from 1958-1970. Individuals born during this high exposure period have elevated rates of cancer, lung and cardiovascular disease, and hypertension. However, the mechanisms of long-term arsenic toxicity remain unclear. We investigated whether early-life arsenic exposure was associated with altered glucocorticoid levels in adulthood. This study included 114 individuals born in Antofagasta during the high exposure period and 118 individuals born in other Chilean cities with lower exposure. Arsenic exposure metrics were constructed based on residential histories and included: concentration at birth, peak and highest 5-year average between ages 0-10 years, and highest lifetime 5-year average, and lifetime cumulative exposure. Morning plasma cortisol concentrations were measured using a cell-based bioassay. Individuals in the highest quartile of highest lifetime 5-year average of arsenic exposure had approximately 11% lower mean log cortisol levels than those in the lowest quartile of exposure (β = -0.116; 95% CI: -0.229, -0.003). In sex-stratified analyses, associations were stronger among female participants. For example, female participants in the highest quartile of cumulative exposure had 22.0% lower cortisol levels compared to those in the lowest quartile (β = -0.248; 95% CI: -0.444, -0.053) and the test for interaction by sex was statistically significant (p = 0.036). This study is the first to show that early-life arsenic exposure may suppress HPA axis activity decades after exposure has ceased. These findings support endocrine disruption as a potential mechanism underlying long-term health effects of arsenic and highlight early development as a critical exposure window.

PMID:42087152 | DOI:10.1186/s12940-026-01304-9

BMC Endocr Disord. 2026 May 6. doi: 10.1186/s12902-026-02301-2. Online ahead of print.

ABSTRACT

IMPORTANCE: Accurate risk prediction is essential for targeted prevention of type 2 diabetes mellitus (T2DM). However, the global applicability and methodological rigor of existing prediction models remain uncertain.

OBJECTIVE: To systematically review and meta-analyze the geographic distribution, methodological quality, and predictive performance of all published T2DM risk prediction models.

DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, and VIP were searched from inception to December 2025 (eAppendix S1 in the Supplement).

STUDY SELECTION: Studies that developed or validated a multivariable prediction model for incident T2DM in general adult populations and reported at least one performance measure.

DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias using the PROBAST tool. A random-effects meta-analysis was used to pool C-statistics. Heterogeneity was explored via subgroup analyses and meta-regression. The study followed TRIPOD-SRMA and PRISMA reporting guidelines.

MAIN OUTCOMES AND MEASURES: The primary outcome was the geographic origin of models. Secondary outcomes included pooled measures of discrimination (C-statistic/AUC) stratified by region and an overall assessment of methodological quality (PROBAST).

RESULTS: A total of 65 studies comprising 97 distinct prediction models were included (eTable 1). Geographic distribution was highly skewed, with 70.1% of models developed in Asian populations (China: 47.4%; Japan: 13.4%; South Korea: 9.3%), while only 7.2% originated from the US and 4.1% from Europe. Logistic regression was used in 97.9% of models. External validation was performed for only 21 models (21.6%). According to PROBAST, 91.8% of models were at high risk of bias (eTable 2), primarily due to inadequate handling of missing data, lack of external validation, and poor calibration reporting. Meta-analysis revealed wide variation in discrimination by geographic region (eTable 7). US-based models achieved the highest pooled AUC (0.97; 95% CI, 0.94-0.99), but this finding is likely influenced by overfitting, small sample bias, and publication bias (see Discussion). European models showed a pooled AUC of 0.84 (0.81-0.87), while Chinese models showed the lowest performance (AUC, 0.79; 0.76-0.82). Due to very high heterogeneity (I² > 80% in most regions), these pooled estimates should be interpreted as descriptive summaries rather than precise estimates of true regional performance. Performance was lowest in prediabetic cohorts (AUC, 0.72; 0.68-0.76); however, this finding is preliminary due to the limited number of models and high heterogeneity. Funnel plot asymmetry suggested potential publication bias (Egger’s test p=0.03); The most frequently included predictors were age (69.1%), body mass index (64.9%), family history of diabetes (44.3%), and waist circumference (39.2%) (eFigure 4 and eTable 3).

CONCLUSIONS AND RELEVANCE: T2DM prediction models exhibit striking geographic inequity and poor methodological quality, with over 90% at high risk of bias. The substantial variation in performance by region and the lack of external validation critically limit their global clinical utility. These findings underscore an urgent need for rigorous external validation in diverse populations and de novo model development in under-represented regions, guided by PROBAST and TRIPOD standards.

TRIAL REGISTRATION: Not applicable.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42087146 | DOI:10.1186/s12902-026-02301-2

BMC Endocr Disord. 2026 May 5. doi: 10.1186/s12902-026-02302-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Prader-Willi syndrome (PWS) is a rare imprinting disorder characterized by typical dysmorphic features, lack of satiety, infantile hypotonia, and later morbid obesity with complications, short stature, hypogonadotropic hypogonadism, skeletal and psychiatric problems. From the literature, it is well known that patients with PWS have a more favorable metabolic pattern than healthy controls.

AIM: The aim of the study is to assess the metabolic profile of PWS patients followed at an Expert Center for Rare Endocrine Diseases compared with healthy controls and to look for relations between components of the metabolic syndrome (MetS), adipokines, and the compartments of body composition (BC-lean and fat mass).

PATIENTS AND METHODS: The current study is a cross-sectional evaluation of 25 patients with Prader-Willi syndrome (mean age 11.3 ± 8.2 years), with a total of 183.6 patient-years of regular follow-up (from the first visit to the center to the data collection cutoff date), compared with 24 age-, sex-, and BMI-matched healthy controls (mean age 11.3 ± 3.9 years). Each participant underwent anthropometric measurements, physical examination, biochemical and hormonal blood sampling, and whole-body DXA scan. Statistical analysis (SPSS 15.0 statistical package, Chicago, IL, USA) was performed to assess the relations between the metrics in the PWS group compared with controls.

RESULTS: Patients with PWS showed a better profile of glucose homeostasis with significantly lower serum insulin concentration and calculated HOMA-IR index compared with the controls (p < 0.05). Taking into consideration age, sex, and body mass index (BMI) in the PWS group, the analysis showed strong positive correlations between waist circumference (WC) and systolic blood pressure (SBP) (r = 0.864, p < 0.001), and WC and diastolic blood pressure (DBP) (r = 0.534, p = 0.033). Partial correlation analysis with respect to age, sex, and pubertal development found significant positive WC correlations with insulin (r = 0.796, p = 0.006), HOMA-IR (r = 0.697, p = 0.025), LDL-cholesterol (r = 0.735, p = 0.002), uric acid (r = 0.735, p = 0.002), CRP (r = 0.600, p = 0.023), and leptin (r = 0.730, p = 0.005). Strong negative correlations existed between WC and SHBG (r = -0.772, p = 0.002) and HMW adiponectin (r = -0.998, p = 0.044). Additionally, a negative correlation of HMW adiponectin and SBP was demonstrated. 88% of the patients were treated with recombinant human growth hormone (rhGH). Bone mineral density adjusted for height (BMD/height) was significantly lower in patients with PWS (p < 0.05) compared with healthy controls. The analysis did not reveal significant relationships between BC compartments and metabolic and auxological parameters in the PWS group.

CONCLUSION: Our study confirms that patients with PWS have a favorable metabolic profile compared with healthy controls matched by age, sex, and BMI. Syndromic participants who manifest greater accumulation of abdominal adipose tissue have a higher risk of hemodynamic changes and metabolic disturbances predictive of the development of cardiovascular diseases (CVD) in adulthood. WC could serve as a predictive marker for detecting higher metabolic risk in this syndromic group of patients, and both WC and HMW adiponectin for hypertension. In the future, on this basis, we could possibly implement both of these metrics in clinical practice.

PMID:42087144 | DOI:10.1186/s12902-026-02302-1