Category: Statistics

Commun Med (Lond). 2026 Apr 20;6(1):233. doi: 10.1038/s43856-026-01578-7.

ABSTRACT

BACKGROUND: Developmental plasticity refers to biological adaptations, most often prenatally, to environmental cues. These can help organisms adapt to similar postnatal environments, with health benefits if prenatal and postnatal conditions match. While associations between various prenatal exposures and adverse offspring health have been documented, the interaction between prenatal and postnatal conditions remains less understood. We address this gap by examining whether pre- and postnatal drought exposures interact in their impact on cognitive performance, as early-life nutrition is a critical factor for cognitive development.

METHODS: Standardized math and reading scores from 11-16 year-olds in rural India (N = 2,032,917) from the 2007-2018 Annual Status of Education Report (a cross-sectional cognitive assessment household survey) were combined with University of Delaware Terrestrial Precipitation data. Given the high reliance on rainfed agriculture in the setting, rainfall levels below the 20th percentile of the district-specific long-term mean served as a proxy for nutritional adversities in a quasi-experimental study setup.

RESULTS: We show that early-life droughts adversely impact cognitive function. We find positive interaction terms between prenatal and postnatal drought exposures, suggesting that children already exposed to droughts prenatally are better equipped for postnatal droughts.

CONCLUSIONS: The findings of this study align with the predictions around phenotypic plasticity, i.e., that prenatal conditions prepare organisms for similar postnatal challenges. However, given the increasing unpredictability of the climate, such alignments cannot be planned or anticipated, implying frequent mismatches between prenatal and postnatal conditions.

PMID:42010115 | DOI:10.1038/s43856-026-01578-7

J Clin Psychol Med Settings. 2026 Apr 20. doi: 10.1007/s10880-026-10151-2. Online ahead of print.

ABSTRACT

It is unknown whether youth with abdominal pain-related disorders of gut-brain interaction (AP-DGBI) and clinically elevated pain intensity, functional disability, and anxiety (“high-risk”) respond differentially to the Aim to Decrease Anxiety and Pain Treatment (ADAPT), an evidence-based cognitive behavioral therapy program, compared to youth with fewer risk factors (“low-risk”). This secondary analysis included youth aged 9-14 with AP-DGBI recruited from outpatient gastroenterology clinics and randomized to receive ADAPT plus treatment as usual (TAU) or TAU-alone. Baseline risk status was determined using an established grading system derived from validated measures. Differences in post-treatment (~ 8 weeks) pain intensity, functional disability, and anxiety were examined using a multivariate analysis of covariance model with an interaction of risk-status-by-treatment-allocation. Data from 79 youth were analyzed; 29 (36.7%) were high-risk. Risk status (F(3, 72) = 3.30, Wilks’ Λ = 0.879, p = 0.025) predicted higher post-treatment pain intensity (estimated marginal mean difference high versus low risk 1.47 [95% Confidence Interval (CI) 0.44, 2.50]) and functional disability (5.71 [95% CI 1.38, 10.05]), but not anxiety. Accounting for risk status, ADAPT did not affect post-treatment outcomes and no risk-by-treatment-interaction emerged. Risk status predicted post-treatment outcomes for youth with AP-DGBI. Clinical implications include screening of psychosocial risk factors.

PMID:42010055 | DOI:10.1007/s10880-026-10151-2

Clin Transl Oncol. 2026 Apr 20. doi: 10.1007/s12094-026-04349-x. Online ahead of print.

ABSTRACT

BACKGROUND: Medicines awaiting price and reimbursement (P&R) decisions represent a delicate situation in the Spanish NHS. The interval between marketing authorisation (MA) and PR averages 616 days, leaving patients without standard access to EU-approved treatments for almost 2 years, despite their eventual availability. While early access before MA is regulated, no framework exists for the period between MA and PR. Responsibility for funding falls to hospitals or autonomous regions, with no harmonised criteria, leading to inequities in access.

OBJECTIVES: To describe our access model to medicines in special situations (MSS), and to evaluate the clinical and regulatory implications of this procedure.

METHODS: We conducted a 2-year retrospective review of MSS access requests. Our tertiary hospital uses a transparent pathway: clinicians submit a consultation to Clinical Pharmacology and Hospital Pharmacy; departments issue independent reports to Hospital Administration, which decides, considering individual justification, clinical need, early access, and treatment benefit.

RESULTS: A total of 295 request were received, and 78 involved products pending PR decision. Of them, 73 (93.6%) were granted local access. Subsequently, PR status changed to regular access in 64.1% of these requests (50/78), ensuring early access for 62.8% of patients (49/78). Onco-haematological patients granted early access showed an overall disease control rate of 63%, with a median survival of 16 months.

CONCLUSIONS: Until legislation regulates access to medicines awaiting reimbursement, or decision times are reduced, implementing robust local procedures is essential to guarantee fair and equitable MSS access, particularly for patients requiring treatment before national PR resolution.

PMID:42010054 | DOI:10.1007/s12094-026-04349-x

J Robot Surg. 2026 Apr 21;20(1):438. doi: 10.1007/s11701-026-03391-9.

NO ABSTRACT

PMID:42010040 | DOI:10.1007/s11701-026-03391-9

Intern Emerg Med. 2026 Apr 20. doi: 10.1007/s11739-026-04348-4. Online ahead of print.

ABSTRACT

Chronic type B aortic syndrome (cTBAS) is a rare condition characterized by persistent dissection, intramural hematoma or penetrating ulcer within the thoracic descending or thoraco-abdominal aorta. In cTBAS, pathological aortic remodeling leads to a high burden of morbidity and mortality. Guidelines recommend medical treatment with anti-impulse (AI) and lipid-lowering (LL) drugs to improve outcomes, but underlying evidence is sparse, trials are lacking, and feasibility is unknown. We performed a retrospective observational study on consecutive patients with cTBAS followed in a medical clinic from 2021 to 2025, while receiving dual AI/LL therapy with guideline-compliant targets. Response to medical therapy and occurrence of major aortic events (MAEs) were recorded. Thirty-five patients with cTBAS (23 with aortic dissection, 10 with intramural hematoma, and 2 with penetrating aortic ulcer) were followed for a median of 28 months. A MAE occurred in 11 (31%) patients. Demographic and clinical characteristics including systolic/diastolic blood pressure (SBP/DBP), heart rate and lipid levels at baseline were similar in patients who did or did not develop MAEs. During follow-up, patients without MAEs had significant reductions in SBP (P = 0.005), total and LDL cholesterol (P = 0.002, P < 0.001), and increased achievement of SBP < 130 mmHg (P = 0.046), and LDL cholesterol < 70 or < 55 mg/dL (P < 0.001, P = 0.003). All variables were statistically unchanged in patients who developed MAEs. On-target SBP at 6 months and LDL cholesterol at 12 months were associated with protection from MAEs (hazard ratio 0.19, P = 0.014, and 0.15, P = 0.004, respectively). In conclusion, results provide proof-of-concept that in cTBAS, strict dual AI/LL medical therapy is feasible and associated with favorable outcomes.

PMID:42010024 | DOI:10.1007/s11739-026-04348-4

Stress Biol. 2026 Apr 21;6(1):31. doi: 10.1007/s44154-026-00303-7.

ABSTRACT

Heat stress (HS) negatively affects cattle welfare, productivity, and sustainability, with marked differences between heat-tolerant breeds such as Nellore and heat-susceptible breeds such as Angus. In this study, an untargeted UHPLC-Orbitrap-MS metabolomic approach was used to investigate breed-specific differences in the blood metabolome associated with HS. Blood samples were collected from the same Nellore and Angus steers during peak HS exposure and after recovery, allowing both inter-breed and within-animal longitudinal comparisons. Multivariate analyses revealed a clear metabolic divergence between breeds during the challenge period, involving metabolites related to amino acid metabolism, lipid remodeling, energy pathways, and steroid metabolism. Longitudinal analyses accounting for repeated measures showed pronounced breed-specific metabolic responses. Nellore cattle displayed extensive and statistically robust metabolic changes across phases, with 114 metabolites remaining significant after false discovery rate (FDR) correction, including amino acids and peptides, nucleotide derivatives, carbohydrates, acyl-carnitines, steroids, and tetrapyrrole-related compounds. In contrast, Angus cattle showed only a limited number of FDR-significant metabolites, indicating a less consistent systemic response to HS. Pathway analysis identified porphyrin, purine, and pyrimidine metabolism as key pathways modulated by HS, particularly in Nellore cattle. Overall, these results suggest that heat tolerance is associated with coordinated metabolic adaptations rather than isolated metabolite changes. Further studies on larger cohorts are needed to validate the functional relevance of these findings.

PMID:42010023 | DOI:10.1007/s44154-026-00303-7

Ann Biomed Eng. 2026 Apr 20. doi: 10.1007/s10439-026-04120-x. Online ahead of print.

ABSTRACT

PURPOSE: Postsurgical adhesion remains a significant clinical challenge. Seprafilm^® is widely used as a barrier to reduce adhesion formation, however its efficacy may be inconsistent. Recombinant human proteoglycan-4 (rhPRG4), a surface-active, anti-inflammatory glycoprotein found in synovial fluid inhibits cell and protein adhesion. This study investigated whether coating Seprafilm with rhPRG4 could enhance its anti-adhesive potential.

METHODS: Macrophages (J774), human fibroblast-like synoviocytes (HFLS), and melanoma (A375) cells were cultured on tissue culture wells treated with rhPRG4 or bovine submaxillary mucin (BSM) to determine optimal seeding density. Seprafilm sheets were coated with rhPRG4 or BSM (0.78-200 µg/mL). Cell adhesion was quantified using CellTiter-Glo^® while non-adherent macrophages were assessed for viability and re-adhesion. Migration was tested with the Oris^™ Universal Cell Migration assay and oxidative stress with MitoSOX^™ Red staining. ANOVA with multiple comparisons was used for statistical analysis.

RESULTS: Seprafilm alone promoted HFLS and macrophage adhesion, whereas application of rhPRG4 significantly reduced adherence compared to both control and BSM coated surfaces. The combination of rhPRG4 with Seprafilm showed the greatest reduction in adhesion without compromising viability or re-adherence. Seprafilm alone increased macrophage migration and ROS production, while rhPRG4 coated surfaces alone or in combination with Seprafilm suppressed both.

CONCLUSION: Coating Seprafilm with rhPRG4 enhances its anti-adhesive properties by reducing adhesion, migration, and oxidative stress in vitro. These findings suggest rhPRG4 may improve the biological performance of adhesion barriers by suppressing early cellular infiltration and inflammatory activation. Anti-adhesive bioactive surface modifications may advance postsurgical adhesion prevention and wound healing.

PMID:42010021 | DOI:10.1007/s10439-026-04120-x

Neurocrit Care. 2026 Apr 20. doi: 10.1007/s12028-026-02527-x. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal management of small-to-moderate volume (≤ 50 mL) basal ganglia spontaneous intracerebral hemorrhage (ICH) is controversial. This meta-analysis aimed to compare the efficacy and safety of stereotactic drainage treatment (SDT) with conservative medical treatment (CMT) in this patient population.

METHODS: We queried major databases up to October 2025 for studies comparing SDT versus CMT for basal ganglia ICH ≤ 50 mL. The primary endpoint was good functional recovery (modified Rankin Scale score 0-2). Subgroup analyses were performed on the basis of cohort-mean hematoma volume (< 25 mL vs. 25-50 mL) and follow-up duration.

RESULTS: Eleven studies involving 1634 participants were analyzed. Compared with CMT, SDT was associated with a higher proportion of favorable functional outcome up to 12 months (P < 0.001). Subgroup analysis showed consistent functional benefits across both volume strata (< 25 mL and 25-50 mL), with significant superiority emerging from 3 months onwards (all P < 0.001). Mortality did not differ significantly between groups (P = 0.05). SDT also accelerated hematoma resolution and reduced hospital stay (all P < 0.05) without increasing infection (P = 0.17) or rebleeding risks (P = 0.19).

CONCLUSIONS: SDT was associated with improved long-term functional recovery compared with CMT in cohorts with small-to-moderate basal ganglia ICH. Safety outcomes showed no statistically significant differences between groups. Large, multicenter randomized trials with standardized protocols are needed to confirm SDT’s efficacy and safety and to refine patient selection.

PMID:42010003 | DOI:10.1007/s12028-026-02527-x

Mol Psychiatry. 2026 Apr 20. doi: 10.1038/s41380-026-03563-x. Online ahead of print.

ABSTRACT

Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting 2% of the global population. Beyond core symptoms such as social communication deficits and repetitive behaviors, individuals with ASD are at increased risk of cardiometabolic comorbidities, including obesity, diabetes, and cardiovascular disease. Here, we investigate the shared genetic architecture between ASD and cardiometabolic traits using large genome-wide association studies datasets and advanced statistical approaches: the bivariate causal mixture (MiXeR) model and pleiotropy-informed conditional false discovery rate (pleioFDR). Our results show significant polygenic overlap between ASD and several cardiometabolic phenotypes, despite almost negligible genetic correlation between the traits. Specifically, we observed positive genetic correlations within the shared component for ASD and metabolic traits, such as body mass index (rg=0.03), type 2 diabetes (rg=0.23), and total cholesterol (rg=0.78). In contrast, negative correlations emerged between ASD and cardiovascular traits, including diastolic and systolic blood pressure (rg = -0,22, for both), pulse pressure (rg = -0.25), and coronary artery disease (rg = -0.90). Finally, we identified 100 shared loci between ASD and cardiometabolic traits, mapping to 124 genes and suggesting shared biological mechanisms underlying these phenotypes and pointing to potential therapeutic targets. Shared loci between ASD and metabolic traits predominantly showed concordant effects, whereas those overlapping with cardiovascular traits-particularly blood pressure-related traits-tended to exhibit discordant effects. Together, these findings deepen our understanding of the biological connections between ASD and cardiometabolic comorbidities and may help inform more personalized strategies for managing ASD and its associated long-term health risks.

PMID:42009985 | DOI:10.1038/s41380-026-03563-x

Aesthetic Plast Surg. 2026 Apr 20. doi: 10.1007/s00266-026-05675-9. Online ahead of print.

ABSTRACT

BACKGROUND: Prepectoral breast reconstruction using acellular dermal matrices (ADMs) or micro-polyurethane foam-covered breast implants have emerged as commonly used surgical techniques. Although the use of both ADMs and micro-polyurethane foam-covered implants in prepectoral breast reconstruction are widely described in literature, comparative data remains limited.

OBJECTIVES: Our goal was to compare the short-term and medium-term clinical outcomes as well as the patient-reported outcomes in patients undergoing direct-to-implant (DTI) prepectoral breast reconstruction using ADM versus micro-polyurethane foam-covered implants.

METHODS: A retrospective matched cohort study was conducted on 64 patients (32 ADM-wrapped and 32 micro-polyurethane foam-covered breast implants). Patients were matched based on prior surgery, adjuvant radiotherapy, and implant volume. Demographic and oncological characteristics, surgical variables, short- and medium-term outcomes, and patient-reported outcomes were compared between the two groups.

RESULTS: The micro-polyurethane group had significantly older patients (median age 53 vs. 47 years; p = 0.036). Periprosthetic fluid collection (31% vs. 3%; p = 0.006) and need for percutaneous fluid aspiration (38% vs. 9%; p = 0.016) occurred significantly more often in the ADM group. The indication for further surgery was also higher with ADM (47% vs. 19%; p = 0.031). Patient satisfaction showed a non-significant trend favoring micro-polyurethane implants in satisfaction with outcome domain (mean: 89 vs. 82; p = 0.060).

CONCLUSIONS: Both ADM-assisted reconstructions and micro-polyurethane implants demonstrated high performance in the short and medium term, and they were associated to high patient satisfaction with reconstruction. However, micro-polyurethane implants were associated with fewer periprosthetic fluid collections and a lower need for percutaneous fluid aspirations compared to the ADM group. These findings suggest a potential advantage in terms of reduced postoperative complications.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42009925 | DOI:10.1007/s00266-026-05675-9