Category: Statistics

Eur J Med Res. 2026 Jan 26. doi: 10.1186/s40001-026-03912-0. Online ahead of print.

ABSTRACT

BACKGROUND: Elevated skin autofluorescence (SAF), a marker of advanced glycation end-products (AGEs), predicts cardiovascular outcomes. However, the predictive value of SAF across diabetes mellitus (DM), chronic kidney disease (CKD), and atherosclerotic cardiovascular disease (ASCVD) remains incompletely compared. This meta-analysis aimed to clarify SAF’s prognostic strength across these populations, highlighting potential mechanisms and therapeutic implications.

METHODS: We performed a systematic search of PubMed, Embase, and Cochrane databases through March 2025, identifying prospective observational studies evaluating associations between SAF and cardiovascular outcomes. Primary endpoints included all-cause mortality, cardiovascular death, cardiovascular disease (CVD), and stroke. Subgroup analyses compared SAF’s predictive value in patients stratified by ESRD status (ESRD vs. non-ESRD), dialysis modality (hemodialysis [HD] vs. peritoneal dialysis [PD]), and diabetes type (type 1 vs. type 2 DM).

RESULTS: Twenty-four studies involving 12,361 participants were included. Elevated SAF significantly predicted increased risks of all-cause mortality (hazard ratio [HR] 1.59; 95% confidence interval [CI] 1.37-1.85, I² = 65.4%), cardiovascular death (HR 1.42; 95% CI 1.07-1.88, I² = 43.9%), CVD events (HR 1.64; 95% CI 1.34-2.03, I² = 78.5%), and stroke (HR 2.33; 95% CI 1.49-3.32, I² = 0.0%). Subgroup analyses demonstrated a significantly stronger association between elevated SAF and CVD events in ESRD patients compared to non-ESRD patients (HR 3.51 vs. 1.56; P for interaction = 0.001). Although not statistically significant, PD patients tended to show a stronger SAF-CVD association than HD patients.

CONCLUSIONS: Elevated SAF predicts increased cardiovascular risk, with notably stronger associations in chronic kidney disease and end-stage renal disease. These findings support the biological relevance of systemic AGE accumulation. However, further prospective validation and decision-analytic studies are required to assess SAF’s incremental predictive value beyond established scores and determine its clinical utility for risk stratification.

PMID:41588485 | DOI:10.1186/s40001-026-03912-0

Arthritis Res Ther. 2026 Jan 26. doi: 10.1186/s13075-026-03737-6. Online ahead of print.

ABSTRACT

BACKGROUND: Although the quality of care related to rheumatoid arthritis (RA) has improved, ensuring high-quality care globally remains a significant challenge. To address this issue, we have introduced a modified Quality of Care Index (QCI) to evaluate variations in RA care services worldwide and analyze the influencing factors.

METHODS: The QCI was derived from a principal component analysis of global incidence, mortality, and prognostic indicators of RA. Joinpoint regression and linear mixed models were employed to analyze the temporal trends of the QCI and its influencing factors.

RESULT: In 2021, the global QCI for RA was 72.09. Among this, the QCI for males was 77.25, while for females it was 71.12. Based on Joinpoint regression, the AAPC of the global RA QCI from 1990 to 2021 was 0.30(0.29-0.31), with 0.22(0.20-0.23) for males and 0.29(0.28-0.30) for females. Based on the LMM model, it was found that age, gender, year, and SDI were all statistically significantly associated with QCI (p < 0.05). Specifically, positive correlations with QCI were observed in the following groups: under 14 years, 20-24 years, 40-54 years, 70-74 years, males, and high-SDI regions. Conversely, negative correlations with QCI were identified in the age groups 15-19 years, 25-39 years, 55-69 years, and 75 years and above.

CONCLUSION: Disparities in RA-related care exist across gender, age, and geographic regions. Further emphasis should be placed on improving care for female RA patients and those in low-SDI regions.

PMID:41588482 | DOI:10.1186/s13075-026-03737-6

Trials. 2026 Jan 26. doi: 10.1186/s13063-026-09451-7. Online ahead of print.

ABSTRACT

BACKGROUND: Prostate cancer is the second most common cancer among men worldwide and is frequently managed with robot-assisted radical prostatectomy (RARP). Standard patient positioning during RARP, specifically the lithotomy and steep Trendelenburg positions with a head-down angle of 25°-45°, can lead to complications such as peripheral nerve injury, elevated intraocular pressure (IOP), dizziness, nausea, and vomiting. This study introduces an alternative “Z-shaped supine position,” aimed at reducing postoperative position-related complications and improving patient comfort.

METHODS: This single-center, randomized controlled trial will recruit 78 patients scheduled for RARP. Participants will be randomly assigned to either the standard RARP position group or the Z-shaped supine position group. The Z-shaped supine position involves 10°-15° hip flexion, 5°-10° knee flexion, and 20°-30° leg abduction, combined with a 20°-25° Trendelenburg tilt. This position is supported by an integrated shoulder and neck brace. Outcomes include the incidence of peripheral nerve injuries (primary outcome), intraoperative IOP, skin contact pressure, deep vein thrombosis, postoperative pain, and pressure injury. Assessments will be conducted preoperatively, intraoperatively, and postoperatively at multiple time points. Statistical analyses will include an intention-to-treat (ITT) approach and comparisons between the two groups.

DISCUSSION: This study aims to validate the Z-shaped supine position as a safer alternative to standard positioning during RARP, with a focus on reducing perioperative complications while maintaining both functional and surgical outcomes.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300072954. Registered on 28 June, 2023.

PMID:41588472 | DOI:10.1186/s13063-026-09451-7

J Ethnobiol Ethnomed. 2026 Jan 26. doi: 10.1186/s13002-026-00853-0. Online ahead of print.

ABSTRACT

This paper explores the erosion of foraging-related ethnobotanical knowledge in three coastal Mediterranean areas: Gozo Island (Malta), Kasos Island (Greece), and the Castagniccia region of Corsica Island (France). Based on recent ethnobotanical fieldwork between the summer of 2023 and the spring of 2025 in the three study areas, we document the few remaining wild vegetable uses in each region and contextualise the absence of robust LEK linked to plant foraging within broader socio-environmental changes. Our findings show that land abandonment, mass migration, desertification, and the rise of seasonal tourism have contributed to the disintegration of Local Ecological Knowledge (LEK). These forces have severed communities from everyday land-based practices, transforming vibrant ethnobotanical traditions into fragmented memories. We argue that LEK, particularly foraging knowledge, cannot survive in the absence of continuous interaction with the landscape, and that the revival of such practices requires more than nostalgic return, demanding a reconnection with local agro-ecological systems.

PMID:41588471 | DOI:10.1186/s13002-026-00853-0

Trials. 2026 Jan 26. doi: 10.1186/s13063-026-09476-y. Online ahead of print.

ABSTRACT

BACKGROUND: Peripheral nerve injuries (PNI) commonly result in multiple dysfunctions in clinical practice. Repetitive peripheral magnetic stimulation (rPMS) and repetitive transcranial magnetic stimulation (rTMS) are non-invasive interventions for neuromodulation. Their benefits have been reported respectively in PNI rehabilitation, but little is known about their combined effect. Combined central-peripheral interventions were found to have better improvements than central- or peripheral-only intervention in numerous studies. Hence, we conducted a randomized controlled trial to assess the effect of rPMS combined with rTMS on postoperative median nerve injury (PMNI) and explore its mechanism.

METHODS: In this prospective, single-center, randomized clinical trial, we will enroll 60 participants with PMNI and randomize them into four groups (conventional intervention group, rPMS + sham rTMS group, sham rPMS + rTMS group, and rPMS + rTMS group) at a 1:1:1:1 ratio. All participants will undergo interventions for 12 weeks and be assessed at 0, 6, and 12 weeks during the treatment. Measurements will include grip strength, side pinch, Semmes-Weinstein monofilament test (SW), two-point discrimination test (2PD), Purdue pegboard test (PPT), motor conduction velocity test (MCV), and sensory conduction velocity test (SCV). Moreover, functional near-infrared spectroscopy (fNIRS) will be used to explore brain mechanisms. Statistical analysis will be performed using SPSS software with the significance level set at p < 0.05.

DISCUSSION: The results of this study will develop innovative magnetic stimulation techniques for the rehabilitation of PMNI.

TRIAL REGISTRATION: This study prospective protocol was approved by the Medical Ethics Committee of Shanghai Jing’an District Central Hospital (ethical approval number 202437, study protocol version 1.0). The trial was prospectively registered at the Chinese Clinical Trial Registry on December 16, 2024, with the name “Effects of Repetitive Transcranial Magnetic Stimulation Combined with Repetitive Peripheral Magnetic Stimulation on Complete Postoperative Median Nerve Injury: Protocol of A Randomized Control Study” (registration number ChiCTR2400094038).

PMID:41588466 | DOI:10.1186/s13063-026-09476-y

BMC Psychol. 2026 Jan 26. doi: 10.1186/s40359-026-04020-8. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was conducted to examine the effect of smombie (attention distraction and alienation from the environment due to smartphone use) and phubbing (ignoring others by being preoccupied with one’s phone during face-to-face interactions) levels on adolescents’ psychological well-being.

METHOD: This descriptive cross-sectional study was conducted with 626 adolescents living in Turkey between June-September 2025. Data was collected via an online survey administered through Google Forms. The data collection tools used were the Smombie Scale for Adolescents, the General Phubbing Scale, and the Psychological Well-Being Scale. R programming language 4.1.3, G*Power 3.1, and SPSS-22 programs were used in the analysis of the study.

RESULTS: According to hierarchical regression analysis results, smombie level explained 15.7% of the variance in psychological well-being (R² = 0.157; F(1,624) = 117.64, p < 0.001) and was found to be negatively associated with psychological well-being (β = – 0.398; 95% CI [- 0.475, – 0.329]). With the addition of phubbing level, the total variance explained by the model increased to 22.3% (R² = 0.223; F(2,623) = 90.70, p < 0.001). In this model, both smombie (β = – 0.171; 95% CI [- 0.266, – 0.079]) and phubbing (β = – 0.344; 95% CI [- 0.224, – 0.130]) levels showed statistically significant and negative relationships with psychological well-being; with phubbing being a stronger predictor.

CONCLUSION: This study demonstrates that smombie and phubbing behaviors in adolescents are negatively associated with psychological well-being. The cross-sectional design of this study limits causal inferences. Therefore, future research should employ a longitudinal design to determine the direction of these relationships and their effects over time.

PMID:41588448 | DOI:10.1186/s40359-026-04020-8

Eur J Med Res. 2026 Jan 27. doi: 10.1186/s40001-025-03829-0. Online ahead of print.

ABSTRACT

BACKGROUND: Genetic factors play an important role in metabolic disease susceptibility. Apolipoproteins E (APOE) and A1 (APOA1) are key regulators of lipid metabolism and have been individually associated with dyslipidemia and type 2 diabetes mellitus (T2DM).

OBJECTIVE: This study aimed to examine the individual and combined associations of APOE (rs429358, rs7412) and APOA1 (rs5069) gene polymorphisms with obesity and T2DM.

METHODS: A case-control study was conducted including 350 participants categorized into four groups: controls (n = 100), euglycemic obese individuals (n = 100), obese individuals with T2DM (n = 100), and non-obese individuals with T2DM (n = 50). Biochemical parameters, including lipid profiles and glycemic indices, were assessed. Genotyping was performed using TaqMan^® SNP genotyping assays.

RESULTS: Metabolic disturbances and dyslipidemia were observed across all patient groups, with the most pronounced abnormalities in obese individuals with T2DM. The APOE ε4 allele and ε4/ε4 genotype were significantly associated with obese T2DM compared with controls and euglycemic obese subjects. The APOA1 rs5069 A allele and AA genotype were associated with both obesity and T2DM. Spearman correlation analysis revealed a positive co-occurrence of APOE and APOA1 genotypes in euglycemic obese (ρ = 0.264, p = 0.008) and obese T2DM (ρ = 0.347, p < 0.001) groups, but not in non-obese T2DM individuals. However, in multivariate logistic regression models adjusted for age, sex, and BMI, the APOE × APOA1 interaction term did not reach statistical significance (p = 0.138).

CONCLUSION: APOE ε4 and APOA1 rs5069 A alleles were independently associated with obesity-related T2DM. Although these variants demonstrated correlated distribution patterns in obese individuals, the formal gene-gene interaction on T2DM risk was not statistically significant after multivariable adjustment. These findings suggest that obesity may represent a metabolic context in which combined genetic associations are more evident, warranting further investigation in larger and well-powered cohorts.

PMID:41588446 | DOI:10.1186/s40001-025-03829-0

Arch Public Health. 2026 Jan 26. doi: 10.1186/s13690-026-01842-1. Online ahead of print.

NO ABSTRACT

PMID:41588445 | DOI:10.1186/s13690-026-01842-1

J Orthop Surg Res. 2026 Jan 26. doi: 10.1186/s13018-025-06633-y. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the clinical and radiographic results of a novel partial unicondylar arthroplasty (PUCA) using a three-dimensional-printed (3DP) porous tantalum prosthesis for treating focal osteochondral defects (FOCD) of the femoral condyle, in comparison with unicompartmental knee arthroplasty (UKA).

METHODS: This exploratory-retrospective matched-cohort consecutively enrolled study involved 17 patients: 8 in Group A (PUCA with 3DP porous tantalum prosthesis) from a larger trial and 9 in Group B (UKA), matched by age, gender, and BMI. Participants, aged 18-60, had femoral condylar FOCD with complete clinical and imaging data; exclusions included knee instability and incomplete data. Follow-ups were at 6 weeks, 3, 6, 12 months, and annually. The primary outcome was the Hospital for Special Surgery (HSS) knee score, with secondary outcomes including visual analogue scale (VAS), time to full-weight-bearing walking (FWBK), knee injury and osteoarthritis outcome score (KOOS), Lysholm scores and range of motion (ROM). Prosthesis stability and Kellgren-Lawrence (KL) grading were assessed via radiograph, and postoperative complications were compared. Statistical analyses included the Mann-Whitney U test, independent-samples t test, and Fisher’s Exact test.

RESULTS: All patients averaged 49.6 years old at surgery with a mean follow-up of 49.6 months. No demographic or complication differences were found between groups, and no revisions were needed. Preoperative scores were similar (P > 0.05). Postoperatively, Group A demonstrated significantly greater improvements in KL grades (1.5 ± 0.5 vs. 2.5 ± 0.5, P = 0.006), VAS (1.3 ± 0.5 vs. 2.5 ± 0.5, P = 0.002), HSS (92.3 ± 1.8 vs. 87.4 ± 1.6, P = 0.000), KOOS (90.9 ± 1.6 vs. 88.3 ± 1.9, P = 0.009), Lysholm (91.4 ± 2.4 vs. 88.5 ± 1.9, P = 0.019), and ROM (133.1° ± 6.5° vs. 115.6° ± 4.0°, P = 0.000), except for FWBK (4.9 ± 0.8 vs. 5.3 ± 0.5 weeks, P = 0.189). However, only the difference in ROM met the minimum clinically important difference. All postoperative scores, except for ROM and KL, showed statistically significant improvement compared with preoperative values in both groups radiographs at final follow-up showed stable prostheses in both groups with no signs of loosening. The statistical power for postoperative HSS was 1.0 (G*Power, effect size = 2.89).

CONCLUSION: This initial study is the first to apply personalized PUCA with 3DP porous tantalum prostheses for FOCD, demonstrating promising early outcomes compared with UKA, such as delayed progression of osteoarthritis, effective pain relief, and improved knee function and quality of life. PUCA notably preserves more native tissue and adapts to individual defects, making it clinically feasible by offering a potentially better option for future FOCD management.

PMID:41588442 | DOI:10.1186/s13018-025-06633-y

Infect Dis Poverty. 2026 Jan 27;15(1):15. doi: 10.1186/s40249-026-01412-1.

ABSTRACT

BACKGROUND: Dengue remains a major public health challenge, particularly in endemic areas like Puerto Rico, where its economic burden is substantial. This study aimed to update the economic burden of dengue in Puerto Rico using recent data from patients, hospitals, and insurance companies, providing a clearer picture of the current situation. We estimated the total number of dengue cases with fever who sought care by adjusting for underreporting through a robust statistical framework linking island-wide passive surveillance data to sentinel acute febrile illness surveillance.

METHODS: We obtained cost data from hospitals and conducted interviews with a random sample of people diagnosed with dengue (n = 101) from December 2021-November 2022, collecting detailed information on direct medical costs, non-medical costs, and indirect costs. We analyzed median, epidemic and long-term dengue incidence patterns from 2010-2023. We conducted a cost-of-illness analysis using Bayesian multiplier methods to adjust for underreporting, followed by a bottom-up costing approach during a typical median incidence year and an epidemic year to illustrate the current economic burden of dengue in Puerto Rico.

RESULTS: In the median incidence year (2014), from 597 reported dengue cases we estimated 4500 [95% credible interval (95% CrI): 3700-5400] outpatient and 3900 (95% CrI: 3200-4700) hospitalized cases. During an epidemic year (2010), these figures rose substantially from the reported 10,359 dengue cases to an estimated 77,300 (95% CrI: 64,600-93,200) outpatient and 67,300 (95% CrI: 56,100-81,700) hospitalized cases. The median cost per hospitalized dengue case was 5200 USD for children and USD 6800 for adults, while outpatient costs were 2300 USD for children and 2700 USD for adults. Direct medical costs and indirect costs constituted the largest share of total costs. The total economic burden was 1.1 billion USD (95% CrI: 785 million-1.6 billion) during the epidemic year, compared to 62.7 million USD (95% CrI: 45.9-95.4 million) in the median incidence year.

CONCLUSIONS: These findings highlight the considerable financial strain of dengue, particularly during epidemics, and underscore the urgent need for enhanced resource allocation, effective prevention strategies, and policy interventions to mitigate the economic impact of future outbreaks.

PMID:41588438 | DOI:10.1186/s40249-026-01412-1