Category: Statistics

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

Neuromuscul Disord. 2026 May 22;64:106463. doi: 10.1016/j.nmd.2026.106463. Online ahead of print.

ABSTRACT

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder primarily affecting motor neurons; however, non-motor symptoms, including sensory and autonomic disturbances, are increasingly recognized. This retrospective cross-sectional study evaluated the frequency of sensory and entrapment neuropathies in 114 patients with ALS using electrodiagnostic (EDX) studies. Demographic characteristics, comorbidities, and sensory and autonomic symptoms were documented. Electrophysiological evidence of sensory neuropathy was identified in 20 patients overall (20/114, 17.5%), including 10 patients without diabetes mellitus (DM), whereas entrapment neuropathy was detected in 28 patients overall (28/114, 24.6%), including 16 of those without DM or hypothyroidism. Sensory neuropathy was significantly associated with both DM and a history of chronic disease. In contrast, these comorbid conditions were not significantly associated with entrapment neuropathy. Furthermore, patient-reported symptoms showed no correlation with electrophysiological evidence of sensory involvement on EDX. Sensory neuropathy was more frequent in patients with spinal-onset than bulbar-onset disease, although the difference was not statistically significant. This study confirms that sensory involvement is not uncommon in ALS. Although clinical symptoms are poor predictors, electrophysiological abnormalities consistent with sensory and entrapment neuropathies are common. A significant proportion of these abnormalities are idiopathic and may directly reflect the disease process itself, particularly in spinal-onset cases.

PMID:42263370 | DOI:10.1016/j.nmd.2026.106463

Int J Pediatr Otorhinolaryngol. 2026 May 30;207:112876. doi: 10.1016/j.ijporl.2026.112876. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital laryngeal webs are rare laryngeal anomalies resulting from incomplete re-canalization of the primitive larynx. They present a significant therapeutic challenge, requiring a delicate balance between establishing a patent airway and preserving vocal function. This study details a ten-year, single-surgeon experience at a tertiary care centre to evaluate the efficacy of a graded management protocol and long-term outcomes.

METHODS: A retrospective chart review was conducted for 23 pediatric patients managed for congenital laryngeal webs between 2015 and 2025. Data regarding demographics, Cohen’s classification, presenting symptoms, surgical management, and postoperative outcomes were analyzed. Treatment choice was dictated by web severity: endoscopic release for thin webs, open web release with keel placement for thick webs without subglottic extension and open reconstruction for thick webs with subglottic extension.

RESULTS: The cohort included 23 patients (10 males, 13 females) with a mean age of 4.5 years. The study population presented with severe pathology; Type III webs were the most prevalent (65.2%). Consequently, respiratory symptoms (82.6%) were more common than isolated voice abnormalities (78.2%). Management strategies included endoscopic web release (17.4%), endoscopic web release and keel placement (21.7%), open web release with keel placement (8.7%) and open laryngotracheal reconstruction (LTR) (34.8%). Post-operative airway patency was achieved in all tracheostomized patients, yielding a 100% decannulation rate (8/8). Revision surgery was required in 2 patients (1 in Type III and 1in Type IV), (8.7%). Perceptual voice analysis yielded a mean GRBAS score of G2R1B1A1S1.

CONCLUSIONS: Congenital laryngeal webs are rare but clinically significant airway anomalies that may present with a wide spectrum of respiratory and phonatory symptoms. A tailored algorithm-reserving endoscopic techniques for thin webs and open LTR for thick webs-results in excellent decannulation rates. Overall, a multidisciplinary approach with careful surgical technique and long-term follow-up is essential to optimize both airway stability and voice outcomes in children with congenital laryngeal webs.

PMID:42263361 | DOI:10.1016/j.ijporl.2026.112876

Horm Behav. 2026 Jun 9;183:105954. doi: 10.1016/j.yhbeh.2026.105954. Online ahead of print.

ABSTRACT

Poor sleep hygiene is reported to impair subjective sleep and disrupt circadian system, yet the association between sleep hygiene and objective alterations in sleep continuity is scarcely studied. Moreover, the role of gender differences is largely neglected. In this pilot study, sixty-five adults (66% females) completed a psychometric assessment including the Sleep Hygiene Index (SHI) and wore an actigraph for one week for the assessment of sleep. No statistically significant gender differences on sleep hygiene practices were found. Bedtime and waketime were later in males than females. Males showed longer sleep onset latency (SOL), and wake after sleep onset (WASO), and lower sleep efficiency compared to females. General linear analyses showed that poorer sleep hygiene was associated with shorter SOL and longer WASO in males but not in females. Age, habitual insomnia and psychological distress did not influence the results. Current findings suggest a differential impact of sleep hygiene behaviors on objective alternations in males. While future research is needed to investigate the role of specific sleep promoting and sleep inhibiting behaviors on objective sleep, current results highlight the importance of considering gender differences in sleep hygiene research. Gender differences in homeostatic, circadian, and neuroendocrine factors related to sleep hygiene should be further investigated in mechanistic studies also considering non-binary participants.

PMID:42263358 | DOI:10.1016/j.yhbeh.2026.105954

Arch Med Res. 2026 Jun 9;57(6):103446. doi: 10.1016/j.arcmed.2026.103446. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: This study aimed to evaluate whether preoperative nutritional risk, as measured by the NRS-2002 score, predicts hepatic regeneration after ALPPS in patients with HBV-related HCC.

METHODS: Among the 54 patients who completed both ALPPS stages, intervals to adequate regeneration were dichotomized (≤14 vs. >14 d). Logistic regression identified predictors of prolonged intervals, and a nomogram was developed.

RESULTS: Univariable and multivariable logistic analyses revealed that the NRS-2002 score (≥3), resected-side portal vein thrombosis (PVT), and decreased prealbumin (pre-ALB) levels were independently identified as preoperative risk factors for prolonged intervals. The nomogram showed exploratory accuracy in estimating the prolonged interval, with an AUC of 0.905 (95% CI:0.828-0.981). It should be noted that the wide confidence intervals for the predictor odds ratios (e.g., NRS-2002 ≥3: OR = 11.406, 95% CI: 1.481-87.841) reflect the uncertainty inherent to the sample size, and the model may be susceptible to overfitting. However, the relatively wide confidence intervals for key predictors and the modest sample size warrant caution against overfitting, and external validation is required before clinical application. Correlation analysis revealed a statistically significant positive association was observed between standard future liver remnant (sFLR)/standard liver volume (SLV) before stage 1 and sFLR/SLV before stage 2. Patients with lower NRS-2002 scores had better survival outcomes than those with higher scores.

CONCLUSIONS: Preoperative NRS-2002 score, prealbumin, and portal vein thrombosis may help identify patients with HBV-related HCC at risk for delayed regeneration after ALPPS. However, these findings require validation in intention-to-treat cohorts.

PMID:42263344 | DOI:10.1016/j.arcmed.2026.103446