Category: Statistics

Int J Neurosci. 2026 Jun 10:1-23. doi: 10.1080/00207454.2026.2687853. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the association of admission neutrophil-to-lymphocyte ratio (NLR) with functional outcomes, intracranial hemorrhage (ICH), and mortality in patients with acute ischemic stroke (AIS).

METHODS: We searched PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Embase from inception until December 17, 2024. Studies examining admission NLR as a predictor for functional outcomes, ICH, and mortality in AIS patients were included. A meta-analysis was performed using pooled odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were conducted based on treatment modality, time of measurement, hemorrhage type, and ethnicity. Heterogeneity was assessed using I² statistics, and publication bias was evaluated using Egger’s test.

RESULTS: Sixty observational studies (33,049 patients), including 59 cohort studies and one cross-sectional study, were included. Higher admission NLR was significantly associated with unfavorable functional outcomes (OR: 1.10, 95% CI: [1.07, 1.14]), ICH (OR: 1.06, 95% CI: [1.03, 1.09]), and mortality (OR: 1.06, 95% CI: [1.04, 1.08]). Subgroup analysis indicated that NLR was associated with poor outcomes in AIS patients receiving mechanical thrombectomy and intravenous thrombolysis.

CONCLUSION: Admission NLR is significantly associated with unfavorable functional outcomes, ICH, and mortality in AIS patients. Its predictive value remained evident in the MT and Asian subgroups; however, the association with unfavorable functional outcomes was not significant in the non-Asian subgroup, and the association with mortality in the IVT subgroup was also not significant. Given its accessibility and cost-effectiveness, NLR holds promise as a routine biomarker for stroke prognosis.

PMID:42267389 | DOI:10.1080/00207454.2026.2687853

Biomol Biomed. 2026 Jun 8. doi: 10.17305/bb.2026.14167. Online ahead of print.

ABSTRACT

Primary membranous nephropathy (pMN) is a principal cause of nephrotic syndrome in adults. The identification of the M-type phospholipase A2 receptor (PLA2R) antigen has significantly advanced non-invasive management; however, the precise clinical relationship between circulating antibody titers and intrarenal antigen deposition continues to be debated. This single-center retrospective study sought to analyze the correlation between clinicopathological parameters, serum anti-PLA2R levels, and glomerular PLA2R tissue expression in pMN. A specific focus was placed on evaluating the diagnostic utility of tissue staining in seronegative patients. A cohort of 49 adult pMN patients, diagnosed via renal biopsy between 2018 and 2025, was evaluated. Serum anti-PLA2R antibodies were quantified using ELISA, while glomerular PLA2R expression and staining intensity (graded 0 to +3) were assessed via immunohistochemistry (IHC) on paraffin-embedded sections. The results demonstrated a notable discordance: the overall serum antibody positivity rate was 49.0%, yet tissue PLA2R expression was detected in 100% of the cohort, encompassing all seronegative cases. A statistically significant difference was observed in the distribution of tissue PLA2R staining intensity based on serum PLA2R status (p=0.002). Conversely, no statistically significant correlation was found between circulating antibody titers and baseline renal function or proteinuria markers (p>0.05). In conclusion, these findings indicate that negative serology does not preclude tissue PLA2R positivity, potentially attributable to mechanisms such as the “kidney-as-a-sink” phenomenon or persistent immunological footprints. This investigation underscores that serum and tissue PLA2R serve as complementary, rather than mutually exclusive, markers. Consequently, renal biopsy with supplementary IHC staining remains a crucial and clinically valuable diagnostic tool, particularly in seronegative cases.

PMID:42267385 | DOI:10.17305/bb.2026.14167

ERJ Open Res. 2026 Jun 8;12(3):01519-2025. doi: 10.1183/23120541.01519-2025. eCollection 2026 May.

ABSTRACT

OBJECTIVE: Small peripheral pulmonary lesions are nowadays preferably diagnosed by navigation bronchoscopy, yet reported diagnostic yields vary across different techniques. Shape-sensing robotic-assisted bronchoscopy (ssRAB), now also available in Europe, combines real-time shape sensing with an actively steerable catheter, potentially improving diagnostic yield. We aimed to compare ssRAB combined with cone-beam computed tomography (CBCT) imaging (ssRAB+CBCT) against our current standard, CBCT-based navigation bronchoscopy (CBCT-NB) alone.

METHODS: We conducted a single-centre, propensity score-matched analysis comparing patients undergoing ssRAB+CBCT with patients undergoing CBCT-NB for the diagnosis of small peripheral pulmonary lesions. Matching was performed on known lesion characteristics influencing yield. Primary outcome was strict diagnostic yield. Secondary outcomes included diagnostic accuracy at follow-up, safety and procedure-related metrics.

RESULTS: A total of 131 patients with 183 biopsied lesions were included in the ssRAB+CBCT arm. Median lesion size was 12 mm (interquartile range 8-18 mm). Propensity score matching with lesions from our reference CBCT-NB cohort was successful in 150 out of 183 lesions. The diagnostic yield at the lesion level was 73% for the ssRAB+CBCT arm and 70% for the CBCT-NB arm; the mean difference of 3.3% (95% CI -6.9-13.5%) was not statistically significant (p=0.521). The diagnostic yield at the patient level for the ssRAB+CBCT arm was 82%.

CONCLUSION: ssRAB+CBCT has a diagnostic yield similar to that of our highly optimised CBCT-NB programme, and was below the study’s powering assumption of a 15% increase in diagnostic yield. There was a suggestion of benefit in small nodules with a negative bronchus sign. The unique features of ssRAB mean that it holds promise, but larger studies are warranted to clarify its position and optimal case selection, compared with other navigation bronchoscopy technologies, its clinical impact and its cost-effectiveness.

PMID:42267382 | PMC:PMC13244196 | DOI:10.1183/23120541.01519-2025

ERJ Open Res. 2026 Jun 8;12(3):01086-2025. doi: 10.1183/23120541.01086-2025. eCollection 2026 May.

ABSTRACT

INTRODUCTION: Prolonged waiting times significantly limited access to our respiratory physiotherapy service for cough control therapy. In response, we developed a virtual physiotherapy group intervention for individuals with chronic cough (ViP-Cough) to improve accessibility. This article describes the uptake and potential benefits of this novel approach.

METHODS: A service evaluation was carried out utilising a retrospective observational cohort study design involving patients with chronic cough referred to a single-centre respiratory physiotherapy service. All referrals were assessed by a specialist physiotherapist and offered access to ViP-Cough, a single-session virtual group intervention comprising: 1) education and lifestyle advice; 2) cough control strategies; and 3) breathing pattern retraining and vocal hygiene. Patients completed outcome measures at baseline and 4 weeks post-intervention, including numerical rating scales (NRS) for cough severity, frequency and impact on daily activities (0-10; higher scores indicating worse outcomes), and confidence in self-management (0-10; higher scores indicating better outcomes). Descriptive statistics and paired samples t-tests were used for analysis.

RESULTS: Of the 194 patients referred (median age 61 years; 79% female), 70% reported cough duration >5 years. Of those screened, 155 (80%) opted in; 116 attended, and 106 completed all assessments. Significant improvements were observed in cough severity (mean difference (95% CI) -1.26 (-0.82- -1.70), p<0.001), frequency (-1.19 (-0.79- -1.60), p<0.001), impact on daily life (-1.16 (-0.23- -1.61), p<0.001) and confidence in self-management (+2.16 (1.64-2.68), p<0.001).

CONCLUSION: ViP-Cough is a promising, scalable and low-cost approach to delivering nonpharmacological cough therapy. These preliminary findings support further evaluation in a randomised controlled trial.

PMID:42267377 | PMC:PMC13244200 | DOI:10.1183/23120541.01086-2025

ERJ Open Res. 2026 Jun 8;12(3):01300-2025. doi: 10.1183/23120541.01300-2025. eCollection 2026 May.

ABSTRACT

BACKGROUND: Pleural mesothelioma (PM) is a fatal asbestos-related cancer with a poor and often uncertain prognosis. This study validates the histological proliferation marker Ki67 and evaluates whether its integration into the two-tier tumour grading system can improve prognostication in epithelioid PM.

METHODS: Patients with epithelioid PM were recruited from two longitudinal cohort studies from 2010-2023. Diagnostic biopsies were analysed by three pulmonary pathologists. Cox regression determined the relationship between covariables and outcomes. Pearson correlation assessed the association between Ki67 and two-tier grade. A prognostic model combining Ki67 and tumour grade was internally validated using bootstrapping.

RESULTS: 98 patients were recruited. Ki67 was strongly predictive of overall survival (OS) and progression-free survival (PFS) and correlated with two-tier tumour grade. 30% was the optimal cut-off, with Ki67 more strongly predictive of OS (hazard ratio (HR) 2.37, 95% CI 1.51-3.71) and PFS (HR 2.09, 1.35-3.23) than two-tier grade (HR 1.83, 1.13-2.97 and HR 1.70, 1.08-2.66, respectively). Combining Ki67 and two-tier grade improved prediction of OS and PFS compared with two-tier grade alone. Ki67 stratified patients within each tumour grade, with median survival in the lowest risk group (low Ki67, low grade) of 660.5 days (IQR 329-1297) and 300 days (IQR 124-366) in the highest risk group (high Ki67, high grade).

CONCLUSION: Ki67 is a valid surrogate for tumour grade with an optimal cut-off at 30%. Integrating Ki67 into the two-tier grading system enhances prognostic accuracy, improves outcome prediction and would reduce uncertainty for patients and clinicians.

PMID:42267369 | PMC:PMC13244189 | DOI:10.1183/23120541.01300-2025

Health Syst (Basingstoke). 2025 Oct 21;15(2):91-110. doi: 10.1080/20476965.2025.2570686. eCollection 2026.

ABSTRACT

Effectiveness of health systems is achieved through universal coverage, while efficiency is reached by minimizing the cost of delivery. This study presents a novel analysis for designing national health systems, considering workforce, equipment, global costs and accessibility in different geographical contexts. Designed to be a medium- and long-term strategic planning tool, our model offers a practical solution by assessing projected health infrastructure and resources and evaluates health requirements using data from the OECD, the World Bank, OpenStreetMap, and national health statistics. Applied to Brazil, Finland, and France, the analysis is in line with UN Sustainable Development Goal 3.8 and the WHO’s Human Resources for Health strategy. The findings suggest that regions with dispersed populations, such as central-western Brazil and northern Finland, would benefit from small hospitals, clinics and health centers. Brazil should hire more health professionals, purchase more radiotherapy equipment and invest $7.95 billion in logistics to reduce patient travel times, particularly for the 1,222 municipalities most affected by low accessibility. Finland would benefit from additional hospital beds and CT scanners, while France could benefit from a more centralized health care model, with municipalities providing all levels of care. France should also invest more in nursing staff and mammography equipment.

PMID:42267360 | PMC:PMC13244518 | DOI:10.1080/20476965.2025.2570686

Front Vet Sci. 2026 May 25;13:1832869. doi: 10.3389/fvets.2026.1832869. eCollection 2026.

ABSTRACT

Animal production in extensive livestock systems faces significant health and welfare challenges due to variable environments, diverse climatic conditions, and practical constraints that limit close animal monitoring. By “extensive livestock systems”, we refer to production systems characterized by large herd sizes, open-range grazing, and limited direct animal supervision, typical of beef cattle, sheep, and goat farming in rangeland environments. Conventional approaches, including visual inspection and periodic veterinary assessment, often provide incomplete and delayed insights into animal health status, limiting timely intervention for infectious and metabolic diseases. Recent advances in wearable sensors, imaging technologies, genomic testing, omics profiling, and environmental monitoring offer new opportunities for continuous, data-driven surveillance of livestock. However, when applied in isolation, these modalities capture only partial aspects of the complex biological and environmental processes that influence animal health and disease progression. Multimodal monitoring integrates these diverse data streams to provide a more comprehensive and dynamic representation of animal health. This enables earlier detection of disease risk, improved welfare outcomes, and enhanced support for veterinary and on-farm decision-making. Ultimately, such integration empowers farmers to achieve earlier and more precise interventions, reduce veterinary costs, and improve overall animal welfare and productivity in extensive systems. This review synthesizes current approaches to multimodal monitoring in extensive livestock systems, explores data integration strategies, and evaluates key challenges for practical implementation, including cost, scalability, and data interoperability. We conclude by outlining future research directions that prioritize feasibility, affordability, and farmer-centered design to facilitate real-world adoption.

PMID:42267351 | PMC:PMC13243129 | DOI:10.3389/fvets.2026.1832869

Front Vet Sci. 2026 May 25;13:1707807. doi: 10.3389/fvets.2026.1707807. eCollection 2026.

ABSTRACT

INTRODUCTION: This pilot study aimed to compare sonographic findings at thoracic sites used to detect pneumothorax in canine cadavers.

METHODS: Intubated frozen-thawed cadavers without pre-existing sonographic evidence of pneumothorax were included. Control, unilateral and bilateral pneumothorax groups were created, with the latter induced by infusion of air (3 mL/kg) under ultrasound guidance. Four blinded sonographers (two experts and two novices) evaluated positive-pressure-ventilated (PPV) cadavers placed in sternal recumbency. Lung sliding and B-lines were assessed at the chest tube site (CTS) and caudo-dorsal border (CDB), while the abnormal abdominal curtain sign (AACS) was evaluated along the abdominal curtain sign (ACS). When absence of lung sliding was noted, operators searched for a lung-point (LP). Presence or absence of pneumothorax was recorded for the CTS, CDB, AACS, combined CTS + LP, and CDB + AACS + LP (Modified PLUS). Post-study right and left horizontal beam radiography was used as the reference standard to quantify pneumothorax volume by a board-certified radiologist. Results were analyzed by Fisher’s exact test with a statistical significance set at p < 0.05.

RESULTS: Mild pneumothorax was present in 10/16 hemithoraces, scant pneumothorax in 3/16, and no pneumothorax in 3/16. Combined accuracy, sensitivity, and specificity of all operators was 22% (9-40), 4% (0-20), 100% (54-100) for both CTS and CTS + LP; 53% (35-71), 42% (23-63), 100% (54-100) for CDB; 31% (16-50), 15% (4-35), 100% (54-100) for AACS; and 56% (38-74), 46% (27-67), 100%(54-100) for Modified PLUS, respectively. There was a significant difference in identification of pneumothorax between the CTS and CDB (p = 0.00027), and CTS and Modified PLUS (p = 0.0012) and between CTS + LP and Modified PLUS for all operator comparisons (p = 0.00012).

DISCUSSION: The site assessed (CDB vs. CTS) for lung sliding and the sonographic signs (AACS, lung sliding) evaluated with different POCUS protocols can influence the accuracy of diagnosing pneumothorax in PPV canine cadavers placed in sternal recumbency.

PMID:42267350 | PMC:PMC13244080 | DOI:10.3389/fvets.2026.1707807

Front Dent. 2026 Jan 25;23:2. doi: 10.18502/fid.v23i2.20886. eCollection 2026.

ABSTRACT

Objectives: Radicular cyst (RC) and odontogenic keratocyst (OKC) are among the most commonly identified cysts in both the maxilla and mandible. With the advancements in 3D imaging techniques such as cone-beam computed tomography (CBCT), there is an opportunity to thoroughly examine the boundaries of these lesions and quantify the grayscale of CBCT images, known as the grayscale value (GSV). This study investigated the reliability of CBCT GSV in distinguishing between RC and OKC. Materials and Methods: A total of 60 specimens with confirmed pathological diagnoses of RC and OKC were meticulously selected. Before surgical biopsy of each lesion, CBCT images were obtained and analyzed using Romexis version 2.9.2 software to compute the mean GSV of each lesion. Statistical analysis was then conducted using SPSS version 1.0.0.1406, and a linear, backward regression model was used to analyze the differences in GSV between lesion categories (alpha=0.05). Results: Upon extracting the mean GSV of the selected sections of each type of lesion, no statistically significant difference was observed between the mean GSVs of the two lesion categories (P>0.05). Conclusion: The present findings regarding lack of a significant difference in the mean GSV between RC and OKC were substantial, and suggest that the GSV may not be a reliable index for differentiating these cystic lesions from each other, a conclusion that could potentially impact future diagnostic practices.

PMID:42267314 | PMC:PMC13245654 | DOI:10.18502/fid.v23i2.20886

JGH Open. 2026 Jun 7;10(6):e70430. doi: 10.1002/jgh3.70430. eCollection 2026 Jun.

ABSTRACT

AIMS: Chronic pancreatitis (CP) is a progressive inflammatory condition with insidious and nonspecific symptoms; however, data on its clinical and computed tomography (CT) based characteristics in Vietnam remain limited. This study aimed to characterize the clinical features and contrast-enhanced CT findings of Vietnamese patients with CP and to assess the association between clinical manifestations and morphological severity using the Cambridge classification.

METHODS AND RESULTS: We conducted a cross-sectional study of patients diagnosed with CP at a tertiary hospital in Ho Chi Minh City, Vietnam. Demographics, risk factors, clinical symptoms, and CT imaging characteristics were recorded. Morphologic severity was graded using the Cambridge system. A total of 160 patients were included; 85.6% were male, with a median age of 50 years. Alcohol-related disease was the predominant etiology (62.5%). Notably, 24.4% had disease onset before 35 years of age, and 33.1% had no prior history of acute pancreatitis. Abdominal pain was the most common symptom (87.5%), followed by weight loss and diabetes mellitus. CT imaging demonstrated advanced structural abnormalities, with pancreatic calcifications in 85.0% of patients, ductal dilatation in 73.1%, and 92.5% classified as Cambridge grade 4. Within this predominantly advanced-stage cohort, no statistically significant association was detected between clinical manifestations and CT-based morphological severity.

CONCLUSION: In this tertiary-center CT-based cohort from Vietnam, CP was characterized by heterogeneous clinical manifestations and predominantly advanced CT abnormalities. The absence of a detectable symptom-severity association in this advanced-stage cohort supports the need for more comprehensive diagnostic approaches to enable earlier recognition of CP.

PMID:42267313 | PMC:PMC13243886 | DOI:10.1002/jgh3.70430