Category: Statistics

BMC Med Educ. 2026 Jul 4. doi: 10.1186/s12909-026-09683-w. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare professionals’ knowledge and training are important contributors to adequate medical care for headache disorders. Since most headaches are treated in primary care, undergraduate medical education represents an important stage for strengthening headache-related knowledge and clinical preparedness. This study aimed to evaluate headache education among final-year medical students in Türkiye.

METHODS: This cross-sectional, web-based survey study was conducted among final-year medical students from ten medical faculties in Türkiye between June and December 2022. A 32-item questionnaire developed by the authors was used to assess headache-related educational exposure, self-reported preparedness, and theoretical knowledge. Thirteen knowledge-based questions were used to calculate the total knowledge score. Descriptive statistics, group comparisons, and Spearman correlation analysis were performed.

RESULTS: A total of 523 final-year medical students participated. The mean knowledge score was 9.14 ± 1.87 out of 13. Although 94.8% reported receiving headache education, only 46.5% had received outpatient clinic-based training, 11.7% had attended a headache subspecialty clinic, and 9.6% were familiar with the national headache guideline. Participants who had received didactic headache education scored higher than those who had not (9.18 vs. 8.37; mean difference 0.81, 95% CI 0.09 to 1.54; p = 0.019), as did those who had received outpatient clinic-based training (9.38 vs. 8.93; mean difference 0.45, 95% CI 0.13 to 0.77; p = 0.009) and those who had received structured instruction on headache history-taking (9.30 vs. 8.58; mean difference 0.72, 95% CI 0.34 to 1.11; p = 0.001). Higher total headache-related lesson time was weakly but significantly correlated with higher knowledge scores (Spearman’s rho = 0.12, 95% CI 0.04 to 0.21; p = 0.005). Most participants reported feeling insufficiently prepared to treat pregnant women with migraine, as well as pediatric and geriatric patients with migraine.

CONCLUSIONS: The findings suggest that undergraduate headache education in Türkiye may benefit from further curricular strengthening, particularly through structured teaching, clinical exposure, and improved familiarity with headache management guidelines. Further studies using validated tools and longitudinal designs are needed to evaluate the educational and clinical impact of such interventions.

PMID:42401888 | DOI:10.1186/s12909-026-09683-w

Cardiovasc Diabetol. 2026 Jul 4. doi: 10.1186/s12933-026-03208-x. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) and non-alcoholic fatty liver disease (NAFLD) are closely linked to insulin resistance and elevated cardiovascular risk, triglyceride-glucose (TyG)-related indices, the atherogenic index of plasma (AIP), and the cardiometabolic index (CMI) have emerged as practical surrogate markers for cardiometabolic risk assessment in these populations. However, it remains unclear whether the associations of these indices with adverse cardiovascular events remain consistent when transitioning from the NAFLD to the newly defined MASLD framework, and a comprehensive comparison of these indices across both diagnostic criteria is lacking.

METHODS: This study included 4693/3266, 74,173/67,864, and 7823/10,576 individuals with MASLD/NAFLD from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKB), and China Pudong cohort, respectively. Multivariate Cox proportional hazards models, restricted cubic spline analyses, and time-dependent receiver operating characteristic curves were employed to assess associations. Linear regression models evaluated relationships between TyG-related indices and cortical/subcortical structural volumes. Mediation analyses examined the role of oxidative stress, phenotypic aging, and inflammatory markers.

RESULTS: Most IR-related indices demonstrated nonlinear, predominantly J-shaped associations with cardiovascular disease (CVD) and related mortality, especially within the UKB. TyG-WC optimally predicted 3-year CVD mortality in MASLD/NAFLD across UKB and NHANES, as well as ischemic stroke (IS) in UKB-MASLD. TyG-WHTR was the strongest predictor for CVD mortality in the Pudong cohort and myocardial infarction (MI) in UKB-MASLD. Notably, elevated TyG-WHTR was consistently associated with heightened risks across all endpoints: CVD mortality (NAFLD: UKB: HR 1.60, 95%CI 1.38-1.84, NHANES: 1.90, 1.34-2.70, Pudong: 1.24, 1.10-1.40; MASLD: UKB: 1.59, 1.38-1.82, NHANES: 1.86, 1.36-2.54, Pudong: 1.70, 1.43-2.03), MI (NAFLD: 1.20, 1.09-1.33; MASLD: 1.22, 1.11-1.34), and IS (NAFLD: 1.41, 1.24-1.61; MASLD: 1.39, 1.23-1.57). Structural neuroimaging analyses revealed significant negative correlations between TyG-WC/TyG-WHTR and subcortical volumes (P < 1 × 10^-4). Mediation analyses indicated that oxidative stress, phenotypic aging, and inflammatory markers collectively accounted for 1.4-27% of the observed associations.

CONCLUSIONS: Insulin Resistance-Related Indices demonstrate robust clinical utility in predicting CVD and mortality in NAFLD/MASLD across three distinct cohorts, with oxidative stress, inflammatory activation, and accelerated aging serving as potential mechanistic pathways.

PMID:42401883 | DOI:10.1186/s12933-026-03208-x

BMC Pregnancy Childbirth. 2026 Jul 4. doi: 10.1186/s12884-026-09595-z. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical cerclage reduces the risk of preterm birth, but factors associated with its success may not be uniform. Among singleton pregnancies with ultrasound- or physical examination-indicated cerclage (no history-based indication), we examined whether factors associated with delivery differ by gestational-age threshold.

METHODS: This single-center historical cohort included 114 women undergoing cerclage between May 2020 and December 2025: ultrasound-indicated with cervical length 10 to < 20 mm (Group 1, n = 41) or < 10 mm (Group 2, n = 32), and physical examination-indicated cervical dilatation (Group 3, n = 41). All cerclages used the McDonald technique with polypropylene monofilament suture. The primary outcome was gestational age at delivery, assessed at ≥ 34, < 32, and < 28 weeks. Firth penalized multivariable logistic regression evaluated study group, maternal age, and gestational age at cerclage as primary covariates; post-cerclage cervical length was analyzed separately as a secondary post-treatment-adjusted variable. All models were exploratory, and p values were nominal.

RESULTS: In these exploratory models, factors associated with delivery differed across thresholds. For delivery ≥ 34 weeks, gestational age at cerclage was the only covariate independently associated with the outcome (aOR 1.28 per week, 95% CI 1.04 to 1.59; p = 0.021). For delivery before 32 weeks (aOR 2.96, 95% CI 1.08 to 8.66; p = 0.034) and before 28 weeks (aOR 9.36, 95% CI 1.98 to 91.11; p = 0.003), physical examination-indicated cerclage was the only covariate that reached significance; 11 of the 14 deliveries before 28 weeks occurred in this group, so this estimate is imprecise and near-separating. The numerically higher rate of delivery ≥ 34 weeks in Group 2 than Group 1 (78.1% vs. 70.7%) was not statistically significant. Apparent discrimination was moderate (AUC 0.69 to 0.77), without internal validation.

CONCLUSIONS: In this exploratory single-center cohort, the factors associated with delivery varied with the gestational-age threshold examined. Near term, later gestational age at cerclage was associated with delivery ≥ 34 weeks; at earlier thresholds, physical examination-indicated cerclage identified a higher-risk group for very and extreme preterm delivery, although these estimates were imprecise and partly confounded by indication severity and co-interventions. Findings should be interpreted as hypothesis-generating and require confirmation in larger prospective studies.

PMID:42401881 | DOI:10.1186/s12884-026-09595-z

BMC Med Inform Decis Mak. 2026 Jul 4. doi: 10.1186/s12911-026-03661-4. Online ahead of print.

ABSTRACT

BACKGROUND: Prognostic prediction following gastric cancer surgery plays a pivotal role in postoperative management, helping to optimize therapeutic strategies and improve patient survival. Standard clinicopathological indicators, including tumor differentiation and lymph node metastasis, continue to serve as the basis for outcome evaluation; however, they do not adequately represent the host’s systemic inflammatory response and immunonutritional status, both of which significantly affect tumor progression and postoperative recovery. Systemic inflammatory markers, such as the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR), have emerged as reliable, noninvasive prognostic indicators. However, the complex and nonlinear interactions among inflammatory, clinical, and demographic variables pose a limitation for traditional statistical methods.

METHODS: This study proposes a novel deep learning framework that integrates three major components: Gradient-Boosted Decision Tree, Tree-Driven Encoder (TDE), and one-dimensional Convolutional Neural Network (1D-CNN) for postoperative prognostic prediction in gastric cancer. The GBDT module captures intricate dependencies among clinical and inflammatory variables, the TDE transforms tree-based structures into unified binary embeddings, and the 1D-CNN component learns high-level feature representations from these embeddings to predict postoperative prognosis. The model’s performance was evaluated using cross-validation and compared with various traditional machine learning algorithms and advanced deep learning architectures for tabular data.

RESULTS: Experimental findings demonstrate that the proposed hybrid framework consistently outperforms both traditional and general deep learning models in predicting postoperative prognosis. By combining tree-based feature structuring with deep representation learning, the model effectively captures nonlinear and hierarchical relationships among systemic inflammatory markers and clinicopathological features. This approach achieves high predictive accuracy, robustness, and generalization capability, particularly in identifying high-risk patients characterized by elevated inflammatory activity. Moreover, the model exhibited stable performance across multiple random seeds and data partitions, confirming its reproducibility and reliability under different experimental conditions.

CONCLUSIONS: This study presents a data-driven and interpretable deep learning framework for postoperative prognostic prediction in gastric cancer. By integrating the strengths of gradient-boosted tree modeling and deep neural representation learning, the proposed model provides a more comprehensive understanding of the interplay among inflammation, nutrition, and tumor biology, supporting personalized treatment planning and evidence-based clinical decision-making. Future research will focus on external validation using independent cohorts, real-time clinical application, and enhancing model explainability to facilitate clinical adoption.

PMID:42401875 | DOI:10.1186/s12911-026-03661-4

BMC Womens Health. 2026 Jul 4. doi: 10.1186/s12905-026-04657-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Across sub-Saharan Africa, and Nigeria in particular, young women and adolescent girls aged 15 to 24 continue to face a disproportionate risk of HIV – and a large part of that risk comes down to unprotected sex. Knowing about HIV is widely assumed to lead to safer behaviour, yet the evidence that knowledge actually translates into condom use is far from straightforward. This study takes a closer look at that relationship, comparing comprehensive HIV knowledge and condom non-use among unmarried adolescent girls and young women (AGYW) in Nigeria across three points in time.

METHODS: We drew on data from the Nigeria Demographic and Health Surveys conducted in 2008, 2013, and 2018. Condom non-use at last sexual intercourse – a standard DHS indicator – served as our measure of risky sexual behaviour. The analysis focused on sexually active unmarried women in two age groups: adolescent girls aged 15 to 19, and young women aged 20 to 24. We excluded participants with missing or unclear responses for the outcome variable or key covariates. Weighted descriptive statistics and survey-weighted binary logistic regression models were run separately for each age group and survey year, with all analyses accounting for the clustered, stratified sampling design of the NDHS. Stata 16.1 was used throughout.

RESULTS: HIV knowledge improved over the study period, particularly among young women in the older age group, while trends in condom use followed a less predictable pattern. Among adolescent girls, comprehensive HIV knowledge was not meaningfully linked to condom use in 2008, but that association became statistically significant by 2013 and held through 2018. Importantly, though, condom non-use actually rose in 2018 even as knowledge levels reached their highest point – a clear sign that knowing is not the same as doing. Socioeconomic status and region of residence were both significantly associated with condom use.

CONCLUSION: Comprehensive HIV knowledge among unmarried AGYW in Nigeria has grown, but it has not reliably translated into condom use. This gap between what young women know and what they are able to do points to barriers that go well beyond information – structural, social, and economic forces that shape the choices available to them. Closing that gap will require interventions that take those realities seriously.

PMID:42401873 | DOI:10.1186/s12905-026-04657-y

BMC Surg. 2026 Jul 4. doi: 10.1186/s12893-026-04021-9. Online ahead of print.

ABSTRACT

BACKGROUND: Reconstruction of segment 5 and/or segment 8 anterior sector veins ≥ 5 mm is widely recommended in adult right lobe living donor liver transplantation (LDLT) to prevent venous congestion. Whether this approach is universally required, or whether selective ligation guided by intraoperative findings is acceptable in lower-risk recipients, remains unresolved.

METHODS: This single-centre retrospective cohort study included adult recipients who underwent right lobe LDLT without inclusion of the middle hepatic vein at a high-volume transplant centre (approximately 150 adult LDLTs per year) between November 2021 and May 2025. Eligible patients had intraoperatively measured segment 5 and/or segment 8 veins ≥ 5 mm. Venous management was determined intraoperatively and was not randomized: reconstruction was preferred in recipients judged at higher risk of congestion, and all recipients with graft-to-recipient weight ratio (GRWR) < 0.8 were managed in the reconstruction group. The primary endpoints were postoperative day 7 (POD7) international normalized ratio (INR), total bilirubin, and ascites volume. Multivariable adjustment was prespecified for postoperative ascites only, adjusting for ligation status, MELD score, and GRWR. Prespecified sensitivity analysis restricted to GRWR ≥ 0.8 was performed. Partial Olthoff early allograft dysfunction (EAD) and approximate ILTS-iLDLT small-for-size syndrome (SFSS) were assessed as secondary analyses.

RESULTS: A total of 170 recipients were included (16 selective ligation; 154 reconstruction). Baseline variables did not differ statistically, but all 20 recipients with GRWR < 0.8 were in the reconstruction group. POD7 outcomes were comparable: INR 1.24 vs. 1.27 (p = 0.80), bilirubin 1.46 vs. 1.70 mg/dL (p = 0.35), ascites 1100 vs. 1250 mL (p = 0.89). In multivariable analysis (n = 91), selective ligation was not independently associated with ascites (β = 0.202; 95% CI – 0.359 to + 0.764; p = 0.476); MELD was the only significant predictor (p = 0.024). The GRWR ≥ 0.8 sensitivity analysis confirmed these findings. Partial Olthoff EAD was 25.0% vs. 15.7% (p = 0.42); approximate SFSS was 27.3% vs. 24.7% (p = 1.00). Post-hoc power for the ascites comparison was 80% only for Cohen’s d ≥ 0.90, far larger than the observed d = 0.02.

CONCLUSIONS: In carefully selected recipients with adequate graft volume and favourable intraoperative findings, selective ligation of segment 5 and/or 8 veins ≥ 5 mm was not associated with worse early graft function in this cohort. Given the small ligation group, non-randomized allocation, and substantial missing data, these preliminary results are consistent with the feasibility of selective ligation in a selected lower-risk subgroup but cannot establish its safety, clinical applicability, or equivalence to reconstruction. Prospective, adequately powered, multicentre validation is required before any change in current clinical practice can be considered.

CLINICAL TRIAL NUMBER: not applicable.

PMID:42401871 | DOI:10.1186/s12893-026-04021-9

Eur Eat Disord Rev. 2026 Jul 4. doi: 10.1002/erv.70147. Online ahead of print.

ABSTRACT

OBJECTIVE: Knowledge of family functioning (FF) for those with eating disorders (EDs) is driven by research with females, resulting in an overly gendered perception of FF. The current study: (1) descriptively examined FF among male adolescents with EDs, (2) compared FF among males with anorexia nervosa-restricting subtype (AN-R), AN-binge/purge subtype (AN-BP), and avoidant/restrictive food intake disorder (ARFID), and (3) compared FF between males and females with these EDs.

METHOD: Participants were 175 males and 175 females who completed the Family Assessment Device (FAD).

RESULTS: Males scored above the clinical cutoffs on most FAD subscales. No differences in FF were found among males across ED diagnoses. Significant differences were found between males and females with AN-R on four FAD subscales (affective involvement [OR = 4.70], affective responsiveness [OR = 2.52], communication [OR = 2.78], and general functioning [OR = 2.22]), with males reporting worse FF (all ps < 0.03). Differences between males and females with AN-BP or ARFID were not large enough to meet statistical significance.

CONCLUSIONS: This study increases understanding of FF in EDs from a more diverse standpoint. Male adolescents with EDs experience poor FF. Qualitative studies could clarify possible reasons behind poor FF for adolescent males with EDs and help to identify specific targets for treatment.

PMID:42400951 | DOI:10.1002/erv.70147

Cancer Immunol Immunother. 2026 Jul 4. doi: 10.1007/s00262-026-04411-1. Online ahead of print.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV), particularly high-risk types such as HPV16, is associated with several malignancies, including cervical cancer. Existing therapeutic vaccines targeting HPV oncoproteins E6 and E7 show limited immunogenicity and high production costs. Self-amplifying mRNA (saRNA) vaccines offer a promising alternative by enabling robust antigen expression at low doses. This study evaluated the immunogenicity and antitumor efficacy of a novel saRNA vaccine, JJ-saRNA-HPV01, targeting HPV16 E6/E7 in a preclinical mouse model.

METHODS: JJ-saRNA-HPV01, encoding an HPV16 E6-linker-E7 fusion protein, was encapsulated in lipid nanoparticles (LNP). Physicochemical properties (size, PDI, encapsulation efficiency, and zeta potential) were characterized, and in vitro expression was confirmed in 293 T cells by Western blot. Female C57BL/6 mice were immunized intramuscularly with single or double doses (0.1-5 μg). Immune responses were assessed by IFN-γ ELISpot, CD8⁺CD69⁺ T-cell activation, and tumor-infiltrating lymphocyte analysis. Antitumor efficacy was evaluated in TC-1 tumor-bearing mice, with prophylactic and long-term protection tested by tumor challenge and re-challenge. Statistical tests included one-way and two-way ANOVA with multiple comparisons and Kaplan-Meier survival analysis with Mantel-Cox test.

RESULTS: JJ-saRNA-HPV01 elicited potent, dose-dependent, E7-specific CD8⁺ T-cell responses in the mouse model. In therapeutic TC-1 models, both 0.1 and 1 µg doses markedly inhibited tumor growth (TGI = 93.0 and 95.7%) and improved survival (p < 0.001), with the 1 µg dose achieving complete regression and 91% survival. Prophylactic vaccination provided 100% protection and cured mice rejected tumor re-challenge, confirming durable E7-specific memory. Mechanistically, vaccination increased intratumoral CD8⁺ infiltration with limited CD4⁺ recruitment, elevated IFN-γ⁺ effector T-cell frequencies (p < 0.001), and reduced PD-1 expression on tumor-infiltrating lymphocytes by 33-55% (p < 0.05), indicating partial reversal of T-cell exhaustion and establishment of a more immunoactive tumor microenvironment.

CONCLUSIONS: JJ-saRNA-HPV01 induces potent antitumor immunity at low doses (0.1-1 μg), by promoting T-cell infiltration, enhancing IFN-γ secretion, and downregulating PD-1 expression. Its dual prophylactic/therapeutic efficacy, dose-sparing advantage, and long-term protection support clinical translation in HPV-associated cancers, particularly in resource-limited settings. Future studies should focus on improving E6 immunogenicity and evaluation in combination with immune checkpoint inhibitors.

PMID:42400858 | DOI:10.1007/s00262-026-04411-1

Bull Math Biol. 2026 Jul 4;88(7):134. doi: 10.1007/s11538-026-01690-8.

ABSTRACT

Vaccination programs have helped reduce case numbers and the death toll of COVID-19 significantly over the past few years. The spread and control of COVID-19 have been studied by means of ODE-based compartmental models in a number of studies. However, studies on the different benefits of vaccines, other than blocking infections, remain a paucity. In this study, we developed an ODE-based compartmental model with a separate disease progression path for vaccinated individuals. Key parameters were defined to account for the different facets of vaccine effectiveness: (1) blocking infections; (2) decreasing transmission; (3) expediting recovery; (4) reducing severe morbidity; and (5) preventing disease mortality. Sensitivity analyses and numerical simulations on the reproduction number, number of infections, reduction in peak infections, and cumulative disease-induced deaths provided important insights into the impact of different aspects of vaccine effectiveness on disease control. Specifically, vaccine benefits that reduce disease spread or accelerate recovery have a more substantial impact on the overall population (both vaccinated and unvaccinated individuals) than do vaccine benefits that reduce severe infections or death. The latter type of vaccines does not exhibit a considerable impact on the overall epidemic at the population level, but has a major impact only on the vaccinated individuals. In conclusion, infection burden can be reduced drastically with vaccines that have high potential in blocking infections, decreasing infectivity, and expediting recovery.

PMID:42400854 | DOI:10.1007/s11538-026-01690-8

Eur J Orthop Surg Traumatol. 2026 Jul 4;36(1):272. doi: 10.1007/s00590-026-04863-2.

ABSTRACT

BACKGROUND: Rotator cuff tears are common after traumatic anterior shoulder dislocation in patients aged ≥ 40 years, yet evidence on outcomes following open Latarjet with concomitant rotator cuff repair (RCR) remains limited. We compared long-term outcomes after open Latarjet with versus without concomitant RCR.

METHODS: Retrospective comparative cohort study of patients aged ≥ 40 years undergoing primary open Latarjet. Patients were grouped as Latarjet with concomitant repair of a repairable (Goutallier ≤ 2; irreparable tears excluded) full-thickness rotator cuff tear (RCR) versus Latarjet without cuff repair (No-RCR). Outcomes included recurrence, complications and reoperations, pain (VAS), validated functional scores (Rowe, Walch-Duplay, Constant, SSV), return to sport, and radiographic graft position and arthropathy.

RESULTS: Seventy-one patients were included at a mean follow-up of 10.7 ± 5.3 years (No-RCR n = 49; RCR n = 22). Recurrent dislocation occurred in 2/49 (4%) No-RCR and 2/22 (9%) RCR patients, both RCR recurrences progressed to reverse shoulder arthroplasty. Overall complication rates (31% vs. 27%, p = 0.51) and reoperation rates (8% vs. 14%, p = 0.17) were not significantly different. Persistent pain and/or stiffness was more frequent following RCR (59% vs. 17%, p = 0.001) and return to sport was lower (50% vs. 82%, p = 0.037), while functional scores and radiographic arthropathy were otherwise comparable.

CONCLUSION: In patients aged ≥ 40 years, open Latarjet with concomitant repair of a repairable full-thickness cuff tear provides durable stabilization and similar long-term scores to Latarjet alone, but residual pain/stiffness and reduced return to sport are more common after concomitant cuff repair.

LEVEL OF EVIDENCE: Level III; retrospective comparative study.

PMID:42400821 | DOI:10.1007/s00590-026-04863-2