Category: Statistics

Front Immunol. 2026 Jul 27;17:1886428. doi: 10.3389/fimmu.2026.1886428. eCollection 2026.

ABSTRACT

OBJECTIVE: This study aims to investigate the impact of different feeding patterns and Mycoplasma pneumoniae (MP) infection on coronary artery lesions (CAL) in children with Kawasaki disease (KD), particularly analyzing whether breastfeeding retains a protective effect against CAL in patients co-infected with MP.

METHODS: A retrospective cohort study was performed, recruiting 388 children diagnosed with KD between January 2020 and January 2025. The participants were categorized into three groups according to feeding status in the first 6 months of life: exclusive breastfeeding (n = 222), partial breastfeeding (n = 76), and formula feeding (n = 90). Of all 388 patients, 88 were MP-positive, and 56 had echocardiography-confirmed CAL. Clinical characteristics and CAL incidence were compared across feeding subgroups. Multivariate logistic regression was applied to assess interaction effects between feeding patterns and MP infection on the risk of CAL development.

RESULTS: Significant intergroup differences were detected in age, proportion of incomplete KD (iKD), and erythrocyte sedimentation rate (ESR) (P < 0.05). The overall CAL incidence was 14.4% (56/388), with no intergroup difference (P = 0.503). Platelet count was identified as an independent risk factor for CAL development (OR = 1.357, 95% CI 1.082-1.702, P = 0.008, per 100 × 10⁹/L increment). Multivariate logistic regression analysis did not reveal a significant interaction between feeding method and MP infection. Within the MP-positive subgroup (n = 88, 14 CAL events), no statistically significant difference in CAL risk was identified between the combined exclusive and partial breastfeeding and formula feeding groups.

CONCLUSION: Among MP-positive KD children in this cohort, we detected no statistically significant inverse association between breastfeeding and CAL risk (OR = 0.906, 95% CI 0.225-3.649). The wide confidence interval reflects considerable statistical uncertainty attributable to the small number of CAL events in this subgroup; therefore, a clinically meaningful protective effect of breastfeeding cannot be ruled out.

PMID:42577342 | PMC:PMC13454092 | DOI:10.3389/fimmu.2026.1886428

Cureus. 2026 Jul 10;18(7):e112426. doi: 10.7759/cureus.112426. eCollection 2026 Jul.

ABSTRACT

Background Hemorrhoidal disease is one of the most common benign anorectal disorders encountered in surgical practice. Although various surgical modalities are available for grade III and IV hemorrhoids, Milligan-Morgan hemorrhoidectomy remains the gold standard treatment. However, postoperative pain is a major complication associated with this procedure. Therefore, hemorrhoidectomy using the harmonic scalpel (HS) has gained attention because of its potential to reduce tissue injury and postoperative pain. Methods This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids who underwent hemorrhoidectomy using the conventional technique (n = 59) or the harmonic scalpel (n = 53) at a tertiary teaching hospital between December 2024 and May 2026. Approval was obtained from the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research (approval number: CSP-MED/24/OCT/110/327), and written informed consent was obtained from all the participants. The study aimed to compare the efficacy of hemorrhoidectomy using the harmonic scalpel with the conventional technique in terms of perioperative outcomes. The primary outcomes included intraoperative bleeding, operating time, and postoperative pain, whereas secondary outcomes included the duration of hospital stay and postoperative urinary retention. Statistical analysis was performed, and a p-value of <0.05 was considered statistically significant. Results A significant reduction in operating time (<0.001), intraoperative blood loss (<0.001), postoperative pain (<0.001), postoperative urinary catheterization (0.018), and hospital stay (<0.001) was noted in the group undergoing hemorrhoidectomy using the harmonic scalpel compared with the conventional group. Conclusion Patients undergoing hemorrhoidectomy using the harmonic scalpel demonstrated a significant reduction in intra- and postoperative complications compared with the conventional group, suggesting greater efficacy in the management of grade III and IV hemorrhoids.

PMID:42577337 | PMC:PMC13453973 | DOI:10.7759/cureus.112426

Front Surg. 2026 Jul 27;13:1885360. doi: 10.3389/fsurg.2026.1885360. eCollection 2026.

ABSTRACT

OBJECTIVE: To compare the clinical efficacy of retrograde vs. antegrade intramedullary nailing(RIN vs. AIN)for extra-articular distal tibial fracture.

METHODS: This retrospective matched case-control study included 42 patients treated between April 2020 and April 2024-21 with RIN and 21 with AIN. Patients were matched by age and sex. Perioperative parameters, radiographic reduction quality, malunion rate, time to weight-bearing, functional outcomes (Baird-Jackson and AOFAS scores), and complications were assessed. Pain at the knee and ankle was also recorded. All patients were followed for at least 12 months. A post hoc power analysis was performed based on key outcome variables. Binary outcomes were analyzed using conditional logistic regression accounting for the matched design, with sensitivity analyses adjusting for fracture type and fibular fracture. A post-hoc power analysis based on discordant pairs was performed.

RESULTS: Both groups had comparable baseline characteristics. RIN resulted in significantly lower intraoperative blood loss (34.38 ± 2.27 mL vs.49.38 ± 7.00 mL, P < 0.05), shorter hospital stays (8.00 ± 2.07 days vs.11.00 ± 2.10 days, P < 0.05), earlier weight-bearing (11.86 ± 0.96 days vs.12.76 ± 1.04 days, P < 0.05). The RIN group showed a numerically higher rate of excellent fracture reduction (90.5% vs. 76.2%), though this difference was not statistically significant in the matched-pair analysis (OR = 3.50, 95% CI: 0.73-16.85, P = 0.119). post-hoc power analysis indicated that this non-significant finding likely reflected insufficient power (<10%) due to a limited number of discordant pairs. Functional scores improved significantly over time in both groups, with no inter-group differences at any time point. The incidence of anterior knee pain was significantly lower in the RIN group (9.5% vs. 47.6%, OR = 0.10, 95% CI: 0.01-0.82, P = 0.032), whereas malunion rates and other complications were comparable.

CONCLUSION: Both RIN and AIN provide reliable fixation and satisfactory functional outcomes for extra-articular distal tibial fracture. RIN significantly reduces the incidence of anterior knee pain compared to AIN, a finding supported by adequate statistical power. RIN also reduces intraoperative blood loss and shortens hospital stay. The observed numerical advantage in excellent reduction requires further confirmation in larger, appropriately powered studies. RIN may be the preferred approach in selected patients, especially those with high functional demands or preexisting anterior knee pathology.

PMID:42577333 | PMC:PMC13454167 | DOI:10.3389/fsurg.2026.1885360

Front Sports Act Living. 2026 Jul 27;8:1830689. doi: 10.3389/fspor.2026.1830689. eCollection 2026.

ABSTRACT

INTRODUCTION: Competitive freestyle swimming performance depends on the interaction between stroke rate (SR) and stroke length (SL), yet this relationship has generally been examined using linear approaches. This study investigated the nonlinear biomechanical interaction between SR and SL to identify the conditions associated with maximal swimming velocity.

METHODS: Data were collected from fifty highly trained freestyle swimmers performing maximal-effort 50-m sprint trials. Swimming velocity was analyzed using polynomial regression, response-surface methodology, stationary-point analysis, and Hessian determinant testing to identify and verify optimal biomechanical interaction.

RESULTS: The nonlinear interaction model explained 68% of the variance in swimming velocity and improved predictive performance by 20% compared with the linear model. Response-surface optimization identified a constrained biomechanical interaction corridor rather than a single optimal combination of SR and SL. Stationary-point analysis, confirmed by the Hessian determinant, demonstrated that this region represented a statistically significant local maximum, providing evidence that swimming velocity is governed by nonlinear rather than purely additive relationships between SR and SL.

DISCUSSION: The findings demonstrate the value of integrating nonlinear regression, response-surface methodology, and mathematical optimization to characterize swimming biomechanics. The proposed analytical framework offers a reproducible approach for optimizing biomechanical performance and has practical applications in training prescription, performance monitoring, and future real-time coaching systems.

PMID:42577324 | PMC:PMC13454069 | DOI:10.3389/fspor.2026.1830689

Front Neurol. 2026 Jul 27;17:1906794. doi: 10.3389/fneur.2026.1906794. eCollection 2026.

ABSTRACT

BACKGROUND: Traumatic brachial plexus injury (BPI) is a severe condition whose epidemiological characteristics exhibit regional and temporal variation, potentially affecting its diagnosis and treatment.

METHODS: A retrospective multicenter study was conducted across a regional healthcare network comprising 16 tertiary and 3 secondary hospitals. A total of 683 patients with traumatic BPI treated between January 2017 and December 2022 were enrolled, of whom 665 were included in the final analysis. Demographic and clinical data were extracted from the electronic medical record system. Limb function was assessed at final follow-up using the Louisiana State University Medical Center (LSUMC) grading system, and statistical analyses were performed using SPSS version 22.0.

RESULTS: Of the 665 patients, 480 were male and 185 were female, with a mean age of 41.65 years. The proportion of female patients increased significantly from 15.6% in 2017 to 34.1% in 2022. Among traffic-related injuries (45.86%), e-bike accidents were the most common mechanism (27.82%), surpassing motorcycle accidents (13.23%). Closed injuries accounted for 90.98% of cases, Fractures were present in 51.43% of patients, with clavicular fractures having the highest surgical rate (98.82%). Surgery within 3 months achieved a recovery rate of 78.5%, which was significantly higher than that of delayed surgery (p < 0.001). Among surgical patients, isolated infraclavicular injuries had the highest recovery rate (82.35%), while C5-T1 injuries had the lowest (49.33%). Neurolysis yielded the highest recovery rate (79.17%).

CONCLUSION: The epidemiology of BPI in Guangxi has shifted markedly, with notable age differences between male and female patients and e-bike accidents emerging as the dominant mechanism. Early intervention and individualized surgery remain critical determinants of favorable outcomes.

PMID:42577314 | PMC:PMC13453835 | DOI:10.3389/fneur.2026.1906794

Clin Transl Sci. 2026 Aug;19(8):e70694. doi: 10.1111/cts.70694.

ABSTRACT

Phase 2a trials in tuberculosis patients traditionally assess early bactericidal activity over two weeks, often using the time-to-positivity biomarker, followed by a phase 2b study typically lasting 8-week with time-to-event of culture conversion as the endpoint. This study investigated different machine learning models to predict the time-to-event of 2-month culture conversion in the REMoxTB trial with phase 2a time-to-positivity biomarker data and the impact of different phase 2a study lengths. Time-to-positivity at baseline and up to 14 days or 28 days after two moxifloxacin-containing regimens and one control regimen were analyzed using nonlinear mixed-effects modeling. The final models were used to predict individual baseline time-to-positivity and time-to-positivity differences between 0 and 14 days or 0 and 28 days. The individual predictions served as features in the following machine learning analysis. Statistical metrics and Kaplan-Meier plots informed model selection. Bi-exponential and exponential decay models described the 14-day and 28-day time-to-positivity data, respectively. In the machine learning analysis, baseline time-to-positivity and/or time-to-positivity differences were ranked as the most important features in all models. Statistical metrics and Kaplan-Meier plots indicated a good fit to culture conversion at 8 weeks using 4-week phase 2a information with a C-support vector classification model. Four-week time-to-positivity phase 2a data provided more information compared to the 2-week time-to-positivity data for the prediction of culture conversion. The workflow demonstrated the potential of machine learning to predict the time-to-event of phase 2b culture conversion up to 8 weeks using time-to-positivity phase 2a biomarker information in a clinical trial assessed with pharmacometric analysis.

PMID:42576151 | DOI:10.1111/cts.70694

Stat Med. 2026 Aug;45(18-19):e70691. doi: 10.1002/sim.70691.

ABSTRACT

Health risk behaviors, including smoking, poor nutrition, alcohol misuse, and physical inactivity (SNAP), are leading contributors to chronic disease burden and healthcare costs worldwide. Their prevalence is shaped not only by individual demographic characteristics but also by contextual factors such as socioeconomic and occupational environments. We develop a Bayesian topic-informed dynamic mixture model to analyze SNAP behaviors using data from the Italian health and behavioral surveillance system PASSI. Free-text occupational descriptions are integrated through structural topic modeling to define latent occupational groups that inform the mixture weights of a multivariate ordered probit model. Covariate effects are allowed to vary across occupational clusters and evolve over time. To enhance interpretability and facilitate variable selection, we incorporate non-local spike-and-slab priors on regression coefficients. We further develop a tailored online learning strategy based on sequential Monte Carlo, enabling efficient updating of inference as new surveillance data become available. The proposed approach provides a flexible and interpretable framework for monitoring how occupational contexts modulate the impact of socio-demographic factors on multiple health risk behaviors over time, supporting targeted public health interventions. More broadly, the methodology is applicable to other longitudinal health surveillance and clinical settings where complex contextual information is available in textual form.

PMID:42576150 | DOI:10.1002/sim.70691

J Int Med Res. 2026 Aug;54(8):3000605261476168. doi: 10.1177/03000605261476168. Epub 2026 Aug 10.

ABSTRACT

ObjectiveTo analyze the characteristics and risk factors of blood-borne occupational exposures among healthcare workers at Shaoxing Second Hospital from 2020 to 2025 and to inform targeted prevention and control strategies.MethodsA retrospective analysis was performed on 252 blood-borne occupational exposure events reported from January 2020 to December 2025. Occupational distribution, occurrence patterns, exposure routes, high-risk operations, pathogens, and postexposure prophylaxis data were statistically analyzed.ResultsThe annual standardized incidence of blood-borne occupational exposures increased year by year. Nurses and staff with <5 years of service were the highest-risk groups. Sharp instrument injuries accounted for 92.46% of exposures. Hepatitis B virus was the dominant known pathogen (25.78%), whereas the hepatitis B virus postexposure prophylaxis rate was only 21.21%.ConclusionsThese findings indicate that healthcare workers at this hospital exhibit distinct high-risk features for blood-borne occupational exposures. To mitigate occupational exposure risks, a systematic and precise prevention program, hierarchical management of high-risk groups, and regular hepatitis B virus immune monitoring are recommended.

PMID:42576147 | DOI:10.1177/03000605261476168

Orbit. 2026 Aug 10:1-7. doi: 10.1080/01676830.2026.2714930. Online ahead of print.

ABSTRACT

PURPOSE: To characterize nuclear expression of Yes-associated protein 1 (YAP1), a key effector of the Hippo pathway, in lacrimal gland adenoid cystic carcinoma (LG ACC) and explore potential associations with clinicopathologic features and clinical outcomes.

METHODS: A retrospective, multi-institutional study of 24 LG ACC specimens was performed. Immunohistochemistry (IHC) was used to assess nuclear YAP1 expression. Staining intensity and percentage expression were combined into a composite NY-SCORE. Exploratory analyses evaluated relationships between YAP1 expression scores, clinicopathologic features, and clinical outcomes.

RESULTS: Nuclear YAP1 expression was observed in all 24 LG ACC cases: 6 tumors showed moderate staining (NY-SCORE 5-6), 18 tumors showed high staining (NY-SCORE 7-8), and none were low-scoring. Exploratory analyses did not demonstrate statistically significant associations between YAP1 expression and clinicopathologic features or clinical outcomes.

CONCLUSIONS: Nuclear YAP1 expression was consistently present in LG ACC tissue, suggesting that YAP1 nuclear localization is a common feature of this malignancy and supports future investigation of Hippo pathway activation in LG ACC. While YAP1 expression did not distinguish clinicopathologic risk or outcomes in this cohort, its uniform presence provides a foundation for future studies evaluating its biological role and potential therapeutic relevance.

PMID:42576145 | DOI:10.1080/01676830.2026.2714930

Biol Trace Elem Res. 2026 Aug 11. doi: 10.1007/s12011-026-05270-8. Online ahead of print.

ABSTRACT

Blood lead levels were associated with increased mortality in cancer patients, with mediation analyses suggesting a partial role of oxidative stress and inflammation, and heterogeneity across cancer types linked to Hallmark pathway activity. We analyzed 2,689 cancer patients from NHANES (1999-2016) using Cox regression, restricted cubic spline, and mediation analyses. Over 22,151.5 person-years, 983 deaths occurred. Compared with the lowest quartile, the highest blood lead quartile was associated with increased all-cause mortality (HR = 2.44; 95% CI: 1.79-3.34) and cancer mortality (HR = 2.34; 95% CI: 1.20-4.46). Lipid-adjusted inflammation indicators-including uric acid-to-high-density lipoprotein ratio (UHR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammatory response index (SIRI)-mediated 4.51-5.72% of the association, supporting partial mediation through oxidative stress and inflammation. The effect varied by cancer type and correlated with TCGA Hallmark pathway activities, including KRAS signaling (ρ = -0.95) and xenobiotic metabolism (ρ = 0.79), suggesting that molecular context modulates lead toxicity.

PMID:42576141 | DOI:10.1007/s12011-026-05270-8