Category: Statistics

J Ethnobiol Ethnomed. 2026 Jun 16. doi: 10.1186/s13002-026-00917-1. Online ahead of print.

ABSTRACT

BACKGROUND: Bryophytes are ecologically and socioeconomically important but remain largely understudied from an ethnobotanical perspective, particularly in Africa. This study provides the first assessment of traditional knowledge, uses, perceived threats, and conservation strategies for bryophytes in Benin Republic.

METHODS: Ethnobotanical data were collected through semi-structured interviews (n = 637), free-listing, and participatory ranking among fifteen sociolinguistic groups across the three climatic zones of Benin (humid, sub-humid, and semi-arid). Descriptive and inferential statistics were used to assess (i) bryophyte knowledge, (ii) use patterns, (iii) socio-demographic factors associated with knowledge of bryophytes, (iv) perceived threats, and (v) proposed conservation measures.

RESULTS: Sixteen species were cited, of which twelve had documented traditional uses. Vernacular classifications relied mainly on habitat-based descriptors, while medicinal uses were predominant. Philonotis africana (Müll. Hal.) Rehmann ex Paris, Index Bryol. emerged as the most widely known and culturally important species, whereas other taxa showed marked geographic and cultural specificity. Knowledge of bryophytes varied significantly with ethnicity, age, occupation, and education, with elders, traditional healers, and few ethnic groups holding the richest knowledge. Species diversity and uses declined from the humid to the semi-arid zone, consistent with the ecological apparency hypothesis. Deforestation and agricultural expansion were identified as the main threats. Proposed conservation measures emphasized protected areas, reduced forest clearing, and preservation of humid microhabitats.

CONCLUSIONS: Overall, this study provides important baseline on bryophytes in Benin and essential insights towards their sustainable management. Further studies should be conducted on Philonotis Africana, especially regarding its medicinal and environmental benefits.

PMID:42304201 | DOI:10.1186/s13002-026-00917-1

BMC Public Health. 2026 Jun 16. doi: 10.1186/s12889-026-27764-9. Online ahead of print.

ABSTRACT

BACKGROUND: Retirement is a major life transition that affects psychological well-being and coping. This study evaluated the effect of a health promotion program grounded in an ecological framework on retirement adjustment, psychological well-being, and coping strategies among Iranian retirees.

METHODS: A randomized controlled trial was conducted with 178 retirees from retirement centers affiliated with the Departments of Education and the Oil Industry in Fars province, southern Iran. Participants were systematically selected and randomly assigned to intervention (n = 90) and control (n = 88) groups using stratified block randomization. The intervention comprised a multicomponent program including blended learning (face-to-face sessions and mobile-based delivery via WhatsApp) and support from family and organizations. Educational strategies were guided by the PRECEDE-PROCEED model and Lazarus’ transactional model of stress and coping. Data were collected at baseline, three months, and six months post-intervention using the Retirement Adjustment Scale, Ryff Psychological Well-Being Scale, and Ways of Coping Questionnaire. Statistical analyses included repeated measures ANOVA, MANCOVA (adjusting for baseline scores), and independent samples t-tests.

RESULTS: Groups did not differ significantly at baseline. Over time, the intervention group showed improvements in retirement adjustment, total psychological well-being, subjective well-being, psychological well-being dimension, ways of coping, and problem-focused coping (P < 0.001). Emotion-focused coping showed no significant change. Significant time-by-group interaction effects were observed for all these variables (P < 0.001).

CONCLUSION: An ecological, theory-driven health promotion program improved well-being, coping skills, and adjustment in retirees. Multilevel interventions addressing individual, family, and organizational levels may support healthy aging and successful retirement.

TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) with a code of IRCT20180516039690N2, registered 16th September 2022.

PMID:42304185 | DOI:10.1186/s12889-026-27764-9

Diabetol Metab Syndr. 2026 Jun 16. doi: 10.1186/s13098-026-02210-3. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, the prevalence of early-onset hypertension is high, with a high risk of premature mortality. Consequently, this research intended to ascertain the association of early-onset diabetes mellitus (DM) with early-onset hypertension and premature all-cause mortality.

METHODS: This research utilized NHANES data from six cycles between 2007 and 2018. Weighted logistic regression was employed to explore the association between early-onset DM and early-onset hypertension, while weighted Cox regression was adopted to analyze the association between early-onset DM and premature all-cause mortality. Kaplan-Meier survival curves were leveraged to elucidate the trends in survival probability over time between individuals with and without DM. Subgroup analysis was implemented to ascertain potentially vulnerable populations who were at high risk of early-onset hypertension and premature all-cause mortality.

RESULTS: In the analysis of the association between early-onset hypertension and early-onset DM, 22,053 participants were included, with a positive rate of 1.17% for early-onset hypertension. In the analysis of the association between early-onset DM and premature all-cause mortality, 23,434 participants were included, with a premature all-cause mortality rate of 5.79%. Weighted logistic regression showed that early-onset DM was significantly associated with early-onset hypertension (OR = 4.252, 95% CI: 3.326, 5.437). Weighted Cox regression indicated that early-onset DM was significantly associated with premature all-cause mortality (HR = 3.017, 95% CI: 2.296, 3.963). Subgroup analysis suggested significant interaction effects of poverty income ratio (PIR) and drinking status on the association between early-onset DM and early-onset hypertension. A significant interaction between PIR and the association between early-onset DM and premature all-cause mortality was noted.

CONCLUSION: Early-onset DM is associated with a higher prevalence of early-onset hypertension and premature all-cause mortality in the study population.This finding provides crucial theoretical support for understanding the accelerated progression of the disease in younger populations, and further guides the development of early, proactive, and multidimensional intervention strategies.

PMID:42304179 | DOI:10.1186/s13098-026-02210-3

Ann Ital Chir. 2026 May 18;97(6):1060-1068. doi: 10.62713/aic.4480.

ABSTRACT

AIM: Inguinal hernia repair is among the most common surgical procedures worldwide, and the approach is evolving towards minimally invasive techniques such as laparoscopic transabdominal preperitoneal (TAPP) repair. However, open tension-free repairs remain essential in specific clinical contexts. This study aimed to compare perioperative outcomes, postoperative recovery, complication rates, and medical costs between small-incision tension-free mesh repair combined with scrotal drainage and laparoscopic TAPP repair, providing evidence-based guidance for surgical selection in diverse practice environments.

METHODS: A retrospective cohort study was conducted at Yanbian University Hospital between June 2018 and February 2023. A total of 323 consecutive patients were enrolled. Group A included 107 patients who underwent small-incision tension-free mesh repair combined with scrotal drainage, and Group B included 216 patients who underwent TAPP. Baseline demographics were compared to ensure group equivalence. Intraoperative parameters (blood loss, operative time), postoperative recovery indicators (time to first flatus, ambulation initiation, pain resolution), length of hospital stay, medical costs, complication rates, and recurrence within six months were assessed using appropriate statistical tests (p < 0.05 indicated significance).

RESULTS: No significant differences in baseline characteristics were detected between the two groups (p > 0.05). Compared with TAPP (Group B), small-incision tension-free mesh repair with scrotal drainage (Group A) was associated with greater intraoperative blood loss (p < 0.001) but a shorter operative time (p < 0.001). Postoperatively, Group A had longer hospital stays and delayed recovery of gastrointestinal function (time to first flatus), ambulation, and pain resolution (all p < 0.001). Total hospitalization costs were significantly lower in Group A than in Group B (p < 0.001). The mean duration of drain placement in Group A was 2.03 ± 0.65 days. Chronic groin pain occurred in 8.4% vs. 4.6% (p > 0.05) of patients, and hernia recurrence rates were 1.9% vs. 1.4% (p > 0.05) for Groups A and B, respectively. Incisional infection was more frequent in Group A (3.7%) than in Group B (0%, p < 0.05).

CONCLUSIONS: Both small-incision tension-free mesh repair with scrotal drainage and TAPP are safe and effective when performed by experienced surgeons within standardized perioperative protocols. The small-incision approach is particularly suitable for elderly patients and those with comorbidities limiting tolerance to general anaesthesia, as well as for resource-constrained settings. Targeted drain placement effectively prevents postoperative seroma formation but may also increase local tissue trauma, prolong postoperative discomfort, delay mobilization, and increase the risk of superficial wound infection.

PMID:42304161 | DOI:10.62713/aic.4480

Ann Ital Chir. 2026 May 27;97(6):1112-1119. doi: 10.62713/aic.4527.

ABSTRACT

AIM: To compare the correlation between three-dimensional stereophotography (3D-SPG) and visual analogue scale (VAS) in the evaluation of periorbital swelling after upper blepharoplasty, and to provide a basis for postoperative swelling monitoring and recovery evaluation.

METHODS: This retrospective study included 39 patients who underwent upper blepharoplasty between December 2024 and April 2025. On postoperative days 1, 7, 14, and 28, 3D-SPG was used to measure objective morphological volume and double-eyelid fold width, while periorbital swelling experienced by the patients was assessed using a visual analogue scale. Changes in objective morphological volume and VAS scores from their baseline levels were calculated. Repeated measures analysis of variance was used to assess changes over time, and Pearson correlation analysis was used to evaluate the correlation between objective morphological volume and VAS scores. Standardized response mean (SRM) was calculated to compare the responsiveness of the two parameters.

RESULTS: During the postoperative 28-day period, the double-eyelid fold width, VAS score, and objective morphological volume decreased significantly over time (all p < 0.001). There was a significant positive correlation between the objective morphological volume and VAS score in the early postoperative period (d1-d7) (left eye: d1 r = 0.467, p = 0.003; d7 r = 0.546, p < 0.001; right eye: d1 r = 0.449, p = 0.004; d7 r = 0.497, p = 0.001). At late postoperative days (d14-d28), the correlation weakened and became not statistically significant (left eye: d14 r = 0.098, p = 0.555; d28 r = 0.175, p = 0.286; right eye: d14 r = 0.254, p = 0.119; d28 r = 0.113, p = 0.494). Sensitivity analysis showed that both parameters demonstrated high responsiveness in the early intervals (d1-d7 and d7-d14). However, 3D-SPG maintained consistently higher responsiveness throughout the observation period (SRM = 3.406-5.007), whereas VAS showed a decline in responsiveness in the late interval (d14-d28), potentially due to a floor effect (SRM = 0.902-1.355).

CONCLUSIONS: Both 3D-SPG and VAS demonstrate distinct performance characteristics across postoperative stages. 3D-SPG provides objective, quantitative volumetric data, while VAS captures patient-perceived symptoms. These findings suggest that both methods assess different dimensions of postoperative swelling. However, further studies are needed to determine whether their combined use offers additional clinical benefit.

PMID:42304158 | DOI:10.62713/aic.4527

Ann Ital Chir. 2026 May 27;97(6):1120-1126. doi: 10.62713/aic.4318.

ABSTRACT

AIM: Splenic flexure resection (SFR) is a technically demanding procedure due to the region’s complex vascular anatomy and limited colonic mobility. The orientation of the colonic anastomosis-either isoperistaltic or anisoperistaltic-represents a critical yet understudied technical factor that may influence operative complexity and postoperative recovery. This study aimed to compare short-term outcomes between these two anastomotic configurations.

METHODS: We conducted a retrospective cohort study at a tertiary colorectal center, including consecutive patients who underwent elective SFR for colon cancer between January 2023 and December 2024 (n = 53). Patients were stratified according to the orientation of the side-to-side anastomosis: isoperistaltic (ISO, n = 32) or anisoperistaltic (ANISO, n = 21). Demographic, oncologic, surgical, and postoperative variables were analyzed. Primary endpoints were operative time, gastrointestinal recovery (time to first flatus and first stool), and length of hospital stay. Secondary endpoints included estimated blood loss, conversion rate, 30-day complications, inflammatory markers, analgesic use, costs, and quality of life assessed using the Gastrointestinal Quality of Life Index (GIQLI).

RESULTS: Baseline demographics were largely comparable between groups, although patients in the ANISO group were significantly older (71.4 ± 6.0 vs. 67.8 ± 4.4 years; p = 0.023) and had a slightly lower body mass index (BMI) (25.4 ± 1.4 vs. 26.5 ± 2.3 kg/m²; p = 0.049). Operative time was significantly shorter in the ANISO group (126.5 ± 13.8 vs. 154.8 ± 23.4 minutes; p < 0.001). Gastrointestinal recovery was faster following anisoperistaltic anastomosis, with earlier first flatus (31.7 ± 8.7 vs. 39.3 ± 10.2 hours; p = 0.005), while time to first stool did not differ significantly (51.2 ± 12.5 vs. 55.8 ± 9.0 hours; p = 0.159). Length of hospital stay was comparable (5.2 ± 0.8 vs. 5.6 ± 1.3 days; p = 0.172). Estimated blood loss was significantly lower in the ANISO group (34.6 ± 17.0 vs. 47.6 ± 13.6 mL; p = 0.006). Conversion rate and postoperative complications were comparable between groups (p = 1.000 and p = 0.743 respectively). No differences were observed in inflammatory markers, analgesic use, or costs. GIQLI scores at 30 days were similar between groups (126.9 ± 11.0 vs. 123.0 ± 8.1; p = 0.166).

CONCLUSIONS: Anisoperistaltic anastomosis following splenic flexure resection is safe and effective and is associated with shorter operative time and faster postoperative gastrointestinal recovery without compromising short-term outcomes. The choice of anastomotic orientation may be influenced by intraoperative anatomical conditions and technical factors.

PMID:42304157 | DOI:10.62713/aic.4318

Ann Ital Chir. 2026 Jun 10;97(6):973-982. doi: 10.62713/aic.4495.

ABSTRACT

AIM: Single-photon emission computed tomography/computed tomography (SPECT/CT) technology is a promising imaging tool for the detection of postoperative residual and recurrent lesions in differentiated thyroid cancer (DTC). However, existing studies presented mixed results, and the overall diagnostic efficacy of this technology remains unclear. Therefore, this meta-analysis was conducted to systematically evaluate the diagnostic value of ¹³¹I-SPECT/CT for identifying residual or recurrent disease in patients with DTC.

METHODS: A systematic literature search was conducted across PubMed, Web of Science, EMBASE, and Cochrane Library from inception to 4 December 2025. The search strategy incorporated relevant keywords and MeSH terms, such as “differentiated thyroid cancer”, “thyroidectomy”, “SPECT”, “SPECT/CT”, “SPECT-CT”, “metastasis”, “recurrence”, and “residual”. Study selection, data extraction, and risk-of-bias assessment were performed independently by two investigators. The overall diagnostic performance was assessed by calculating the pooled sensitivity (SENS), specificity (SPEC), and summary receiver operating characteristic (SROC) curve. Sensitivity analyses were performed by excluding individual studies to assess the robustness and stability of the pooled results. Subgroup analysis was used to determine the source of heterogeneity.

RESULTS: Six studies involving 800 patients were included. Pooled analysis showed that lesion-level ¹³¹I-SPECT/CT had a pooled SENS of 0.59 (0.33-0.81) and a pooled SPEC of 0.92 (0.85-0.96). The pooled diagnostic odds ratio (DOR) was 18 (3-91), and the area under the curve (AUC) was 0.92. Based on patient-level ¹³¹I-SPECT/CT, the pooled SENS was 0.89 (0.63-0.98), the pooled SPEC was 0.95 (0.70-0.99), and the DOR was 166 (7-4126). The AUC of the SROC curve was 0.97. The overall diagnostic accuracy of ¹³¹I-SPECT/CT was confirmed, regardless of whether it was conducted at the patient or lesion level. To avoid potential patient overlap, we excluded an earlier study for a sensitivity analysis. The results after exclusion remained within reasonable limits, supporting the robustness of the main findings. Subgroup analyses indicated that patient type may be a potential source of heterogeneity in the non-threshold effect. No publication bias was statistically suggested through Deeks’ funnel plot.

CONCLUSIONS: ¹³¹I-SPECT/CT demonstrates efficacy for the targeted detection of postoperative residual and recurrent lesions in DTC, showing high diagnostic accuracy. However, existing evidence is subject to high heterogeneity, and clinical application should be carefully interpreted in combination with the specific characteristics of patients. Future higher-quality studies conducted using unified standards are needed to further verify its clinical value.

PMID:42304154 | DOI:10.62713/aic.4495

Ann Ital Chir. 2026 Jun 10;97(6):1017-1025. doi: 10.62713/aic.4624.

ABSTRACT

AIM: Postoperative recovery after heart valve surgery is an important topic in the realm of nursing care. This study aimed to evaluate the effect of individualized positioning care on cardiac function recovery and comfort in patients after heart valve surgery.

METHODS: A single-center, retrospective cohort study was conducted, continuously enrolling patients who underwent heart valve surgery at Affiliated Hospital of Xuzhou Medical University from June 2022 to June 2025. A total of 150 patients were included. The patients were divided into a control group (conventional positioning care, n = 76) and an experimental group (individualized positioning care, n = 74) according to the nursing method received. The primary outcome measures were changes in cardiac function indicators, such as left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP) before and after nursing, as well as postoperative comfort scores measured using the Visual Analog Scale for Comfort (VAS-Comfort). Secondary outcomes included postoperative pain scores (Numeric Rating Scale [NRS]), sleep quality (Richards-Campbell Sleep Questionnaire [RCSQ]), pulmonary complications, pressure ulcer incidence, intensive care unit (ICU) length of stay, and postoperative hospital days. Group comparisons were performed using t-test, Mann-Whitney U test, Chi-square test, or Fisher’s exact test. Postoperative NT-proBNP was analyzed using analysis of covariance (ANCOVA), adjusting for baseline levels.

RESULTS: Baseline characteristics were balanced and comparable between the two groups (all p > 0.05). Compared to the control group receiving conventional care, the experimental group receiving individualized positioning care showed more significant improvement in cardiac function: the change in LVEF (ΔLVEF) was significantly higher in the experimental group (0.85 ± 3.98% vs. -3.15 ± 4.20%, p < 0.001); NT-proBNP levels on postoperative day 7 were significantly lower in the experimental group (median: 685.00 pg/mL vs. 1003.50 pg/mL, p < 0.001), and the difference remained statistically significant after adjusting for preoperative values (F = 12.13, p < 0.001). The VAS-Comfort score at 72 h postoperatively was significantly higher in the experimental group (p < 0.001). For secondary outcomes, the experimental group had significantly lower NRS pain scores at 72 h postoperatively (p < 0.001), significantly higher RCSQ sleep scores (69.26 ± 9.87 vs. 59.86 ± 12.02, p < 0.001), a lower incidence of pulmonary complications (9.46% vs. 23.68%, p = 0.019), and significantly shorter ICU stay and postoperative hospital days (both p < 0.001). There were no statistically significant differences between the two groups in the incidence of pressure ulcers or adverse events (p > 0.05).

CONCLUSIONS: Individualized positioning care can significantly promote cardiac function recovery, enhance comfort, and improve clinical outcomes in patients after heart valve surgery without increasing safety risks.

PMID:42304150 | DOI:10.62713/aic.4624

Hypertens Res. 2026 Jun 16. doi: 10.1038/s41440-026-02710-9. Online ahead of print.

ABSTRACT

Management of chronic hypertension in pregnancy remains uncertain, and current guidelines do not address whether the prognostic significance of blood pressure (BP) varies across gestation. To evaluate gestational age-specific associations between maternal BP in the first half of pregnancy and adverse maternal and neonatal outcomes. We conducted a multicenter registry-based cohort study from April 2022 to March 2023 at 65 tertiary referral centers in Japan. A total of 273 women with chronic hypertension and singleton pregnancies were enrolled before 14 weeks’ gestation (median age, 37 years; IQR, 34-40). Systolic and diastolic BP were assessed at three gestational windows (8-9, 10-13, and 14-18 weeks). Aspirin exposure was treated as time-dependent. The primary outcome was a composite of adverse maternal and neonatal events. Cox proportional hazards models and restricted cubic spline analyses were used. Adverse outcomes occurred in 32.6% (89/273). BP-risk associations differed by timing. No association was observed at 8-9 weeks. At 10-13 weeks, risk increased progressively with higher systolic BP, including excess risk in the moderate range (120-134 mmHg) and the highest risk at ≥135 mmHg (HR, 4.11; 95% CI, 1.14-14.82). At 14-18 weeks, a threshold pattern emerged, with increased risk above 140 mmHg (HR, 2.19; 95% CI, 1.40-3.43). Associations were weaker among women who initiated aspirin before 10 weeks, although interaction was not statistically significant. In chronic hypertension, maternal BP during 10-13 weeks of gestation carries heightened prognostic relevance. These findings support gestational age-specific risk assessment and motivate evaluation of early preventive strategies.

PMID:42304127 | DOI:10.1038/s41440-026-02710-9

Pediatr Res. 2026 Jun 16. doi: 10.1038/s41390-026-05184-0. Online ahead of print.

ABSTRACT

BACKGROUND: Infants undergoing therapeutic hypothermia (TH) due to neonatal encephalopathy often require sedation and pain medication. Dexmedetomidine may be a good alternative to morphine as it provides both sedation and analgesia. However, the safety and pharmacokinetics (PK) of dexmedetomidine in this population are not well established.

METHODS: In this Phase II, multicenter, open-label, randomized, safety and PK trial, 48 infants undergoing TH for encephalopathy were randomized to receive dexmedetomidine (25) or morphine (23) using standardized doses. PK parameters of dexmedetomidine in this population were calculated using a nonlinear mixed effects modeling using NONMEM^® 7.5 software.

RESULTS: There were no statistically significant differences between groups in baseline characteristics, hospitalization outcomes and adverse events. A total of 315 dexmedetomidine PK samples using a 1-compartment model with first-order elimination analysis were analyzed. Median clearance and volume of distribution were 0.51 L/kg/h and 0.25 L/kg. Weight, post-menstrual age, maximum liver enzymes, and encephalopathy severity influenced dexmedetomidine PK.

CONCLUSION: The incidence of adverse events and hospitalization outcomes in infants randomized to dexmedetomidine or morphine during hypothermia were similar. Using population PK to model dexmedetomidine, lower clearance and volume of distribution parameters were found in infants undergoing hypothermia compared to previously published parameters in non-cooled infants.

IMPACT: Infants undergoing therapeutic hypothermia for encephalopathy often require drugs to treat pain and for sedation in the intensive care unit. Dexmedetomidine may be a better alternative to opiates since it provides sedation, analgesia, and prevents shivering but does not suppress ventilation. In this randomized, unmasked, safety and PK trial we found no significant differences in short term hospital outcomes and incidence of adverse events in infants receiving dexmedetomidine when compared to infants receiving morphine. The pharmacokinetics of dexmedetomidine in this at-risk population was further established.

PMID:42304121 | DOI:10.1038/s41390-026-05184-0