Category: Statistics

Nat Prod Res. 2026 Aug 23:1-10. doi: 10.1080/14786419.2026.2710820. Online ahead of print.

ABSTRACT

Gerbera piloselloides (L.) Cass. is a medicinal and edible plant with diverse pharmacological activities attributed to its abundant metabolites. However, systematic research on the organ-specific metabolite distribution and accumulation patterns in roots, stems, and leaves remains limited. In this study, we performed a comparative metabolomic analysis of roots, stems, and leaves collected from the same population, season, and developmental stage using untargeted metabolomics combined with multivariate statistical methods, with five biological replicates per organ. UHPLC-MS/MS identified 1,221 metabolites, dominated by organooxygen compounds, fatty acyls, carboxylic acid derivatives, prenol lipids, and flavonoids. PCA revealed distinct metabolic profiles among the three organs. Analysis of differential metabolites revealed 562, 588, and 526 significant metabolites between roots and stems, roots and leaves, and stems and leaves, respectively. KEGG enrichment identified flavonoid biosynthesis, phenylpropanoid and linoleic acid metabolism as core pathways. These results reveal its organ-specific metabolism and guide rational medicinal and edible use.

PMID:42633703 | DOI:10.1080/14786419.2026.2710820

Prostate. 2026 Aug 23. doi: 10.1002/pros.70233. Online ahead of print.

ABSTRACT

BACKGROUND: Stereotactic ablative radiotherapy (SABR) is emerging as an alternative treatment for patients with locally recurrent prostate cancer after previous radiation. This approach allows for precise target coverage while limiting toxicity to surrounding organs. However, reported outcomes following re-irradiation of the prostate with SABR remain variable. This systematic review and meta-analysis therefore evaluated the efficacy and toxicity of prostate re-irradiation with SABR.

METHODS: A systematic review and meta-analysis compliant with PRISMA guidelines was conducted to evaluate studies of SABR for local re-irradiation of prostate cancer. Random-effects models were employed to pool biochemical recurrence-free survival (BRFS), local relapse-free survival (LRFS), metastasis-free survival (MFS), and gastrointestinal (GI) and genitourinary (GU) toxicities after SABR re-irradiation. Outcomes were pooled as proportions using the Freeman-Tukey double arcsine transformation, and heterogeneity was assessed using I². Statistical analyses were performed using Stata version 19.5.

RESULTS: A total of 30 treatment cohorts from 29 studies, including 1099 patients, were analysed. The pooled rates for 2-year BRFS, LRFS, and MFS were 62.5% (95% CI, 54.1-70.6%; I² = 81.9%), 89.9% (95% CI, 80.6-96.5%; I² = 85.5%), and 84.6% (95% CI, 77.3-90.7%; I² = 77.8%), respectively. Acute severe side effects were rare, with pooled rates of grade 3-4 GI toxicities of 0.7% (95% CI, 0.3-1.4%; I² = 0%) and grade 3-4 GU toxicities of 1.1% (95% CI, 0.6%-1.9%; I² = 0%). Late grade 3-4 toxicity also remained low, with pooled GI and GU rates of 1.0% (95% CI, 0.5-1.7%; I² = 0%) and 3.3% (95% CI, 2.0-5.0%; I² = 46.1%), respectively.

CONCLUSION: Prostate re-irradiation with SABR is associated with favourable short- and intermediate-term oncologic outcomes, including high local control and metastasis-free survival, with acceptable toxicity. The heterogeneity observed across studies and the very low certainty of evidence encourage the inclusion of these patients in prospective trials or registries to improve patient selection, dose-fractionation strategies, and long-term outcomes.

PMID:42633701 | DOI:10.1002/pros.70233

J Eval Clin Pract. 2026 Aug;32(5):e70577. doi: 10.1111/jep.70577.

ABSTRACT

Large samples have well-known merits in empirical research where multiple factors are at work, some beyond control. Large samples also provide a precise estimate of the effect size, although they produce results for groups and not for individuals. Nonetheless, there are situations where intensive, in-depth, study of a few may be rewarding, particularly in medical research that focuses on basic mechanism rather than treatment effect. With extreme care, logical structure, advanced tools, and rigorous reasoning, many sources of variability can be minimized or eliminated. Thus, small samples tend to foster brilliance by focusing on improved decision making. Reduced cost, faster completion, and clinically relevant effect sizes are among other advantages. Many successful studies have been done on small samples. These merits of small sample studies in certain types of medical research deserve serious consideration.

PMID:42633697 | DOI:10.1111/jep.70577

J Eval Clin Pract. 2026 Aug;32(5):e70573. doi: 10.1111/jep.70573.

ABSTRACT

AIM: Care transitions involve high risks for adverse drug events among residents of long-term care institutions. This pilot study aimed to investigate the association of a discharge Medication Safety Checklist-grounded in the 8 P risk-assessment framework-with readmission outcomes, specifically unplanned 90-day hospital readmission rates.

METHODS: A two-arm, two-ward, nonrandomized cluster-allocated pilot quasi-experimental study enrolled 200 residents in a regional teaching hospital in central Taiwan (March-November 2024), with 100 in the intervention group receiving the checklist and 100 in the control group receiving standard care. Following the TREND reporting guidelines (see Supporting Information S1), data were analyzed using Cox proportional hazards regression as an exploratory individual-level analysis, with prespecified covariates to address individual-level confounders, acknowledging that ward-level confounding could not be formally adjusted due to the two-ward design.

RESULTS: The intervention group had a 51.1% lower risk of 90-day readmission than the control group (HR = 0.489, 95% CI = 0.324-0.731).

CONCLUSIONS: Implementation of a risk assessment-based medication safety checklist was associated with a lower risk of 90-day readmissions among residents of long-term care institutions. These preliminary findings suggest the feasibility of integrating high-risk medication identification with optimized transitional communication to enhance medication safety. However, as a pilot study, these results should be viewed as hypothesis-generating, and the observed associations require confirmation in future adequately powered, cluster-appropriate randomized studies.

PMID:42633689 | DOI:10.1111/jep.70573

Prostate. 2026 Aug 23. doi: 10.1002/pros.70237. Online ahead of print.

ABSTRACT

BACKGROUND: PI-RADS 3 lesions represent a clinical gray zone in prostate cancer diagnostics, often leading to unnecessary biopsies. Additional biomarkers are needed to improve risk stratification and safely exclude clinically significant prostate cancer (csPCa). This study aimed to compare the performance of whole-gland prostate-specific antigen density (PSAD) and transition zone PSA density (TZ-PSAD) in predicting csPCa and to evaluate their clinical utility in biopsy decision-making.

METHODS: We conducted a single-center retrospective cohort study between 2022 and 2024, including 395 biopsy-naïve patients with PI-RADS 3 lesions on mpMRI. All patients underwent systematic and cognitive targeted prostate biopsy. PSAD and TZ-PSAD were calculated using MRI-derived prostate and transition zone volumes. Clinically significant prostate cancer (csPCa) was defined as ISUP Grade Group ≥ 2. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, and area under the curve (AUC) values were compared using the DeLong test. Optimal cut-off values were determined using the Youden index. Multivariable logistic regression was performed to evaluate predictors, and clinical utility was assessed using 10-fold cross-validated decision curve analysis.

RESULTS: Among 395 patients, clinically significant prostate cancer (csPCa) was detected in 22 cases (5.6%). In ROC analysis, AUC values were 0.737 for PSA, 0.902 for PSAD, and 0.927 for TZ-PSAD. Both PSAD and TZ-PSAD demonstrated significantly higher discriminative performance than PSA (p < 0.001), while no statistically significant difference was observed between PSAD and TZ-PSAD (p = 0.163). In multivariable analysis, only TZ-PSAD remained statistically significant (OR = 1.06; 95% CI: 1.02-1.10; p = 0.009). Using a TZ-PSAD threshold of ≥ 0.331 ng/mL², 74.9% of biopsies could be avoided, while the csPCa detection rate among biopsied patients increased to 35.7%. In comparison, a PSAD threshold of ≥ 0.15 ng/mL² resulted in a 65.8% reduction in biopsies with a csPCa detection rate of 19.3%. The number of missed csPCa cases was identical in both strategies (n = 2). Decision curve analysis indicated a potential net clinical benefit of TZ-PSAD over PSAD within low-to-intermediate probability thresholds despite comparable ROC performance.

CONCLUSION: TZ-PSAD demonstrated discriminative performance comparable to PSAD, remained an independent predictor in multivariable analysis, and reduced unnecessary biopsies without compromising the detection of clinically significant prostate cancer in patients with PI-RADS 3 lesions. The zone-specific normalization of PSA may account for PSA elevation related to benign prostatic hyperplasia (BPH) and may facilitate more individualized biopsy decision-making in patients with PI-RADS 3 lesions. These findings suggest that TZ-PSAD may serve as a clinically useful parameter for reducing unnecessary biopsies in patients with PI-RADS 3 lesions; however, further prospective and multicenter studies are warranted to validate its role in clinical practice.

PMID:42633675 | DOI:10.1002/pros.70237

Orv Hetil. 2026 Aug 23;167(34):1353-1358. doi: 10.1556/650.2026.33635. Print 2026 Aug 23.

ABSTRACT

INTRODUCTION: Penile prosthesis implantation is one of the most effective treatment options for erectile dysfunction, providing high patient satisfaction. To date, there has been a paucity of publications on this topic in Hungarian literature.

OBJECTIVE: The aim of our study was to assess complications and patient satisfaction following penile prosthesis implantation performed at a tertiary referral center.

METHOD: We conducted a retrospective study of patients who underwent penile prosthesis implantation between 2022 and 2025. Demographic data, the etiology of erectile dysfunction, perioperative parameters, postoperative complications, and patient satisfaction assessed by questionnaire were analyzed.

RESULTS: During the study period, 12 penile prostheses were inserted. The median age of the patients was 57 (54-66) years. Erectile dysfunction was vasculogenic, neurogenic, and hormonal in six, five, and one cases, respectively. Malleable, two-piece inflatable, and three-piece inflatable prosthesis were implanted in five, two, and five patients, respectively. The procedures were performed via a penoscrotal approach, with a median surgical time of 135 (100-150) minutes and a median nursing time of 2 (1-2) days. The overall complication rate was 33% (4/12). In the early postoperative period, two mild (Clavien-Dindo grade I) and one severe (Clavien-Dindo grade IIIb) complications were observed. During a median follow-up period of 36 (10-47) months, one late complication was observed, penile prosthesis revision was performed due to glans hypermobility. No prosthesis infection, mechanical failure, erosion, or glans necrosis occurred. Based on the questionnaire survey, all respondents were able to participate in sexual intercourse, and 89% were satisfied with the surgery.

DISCUSSION: Penile prosthesis implantation is a safe procedure associated with high patient satisfaction. Our findings are consistent with international data on complications and patient satisfaction.

CONCLUSION: Continuous monitoring of surgical outcomes is essential to ensure quality assurance, prevent complications, and optimize patient satisfaction. Orv Hetil. 2026; 167(34): 1353-1358.

PMID:42633635 | DOI:10.1556/650.2026.33635

Stat Med. 2026 Sep;45(20-22):e70713. doi: 10.1002/sim.70713.

ABSTRACT

Spatial regression effects may depend on covariates in disease-mapping models. For example, the association between infectious disease incidence and risk factors may vary according to climatic factors, such as time, season, and temperature. In this study, we aim to develop a spatial model that accounts simultaneously for the spatial and varying effects of covariates believed to modulate the spatial association. We employ a local linear estimation method to estimate covariate-dependent coefficients in a model for excess zero counts. The local linear estimator effectively smooths covariate-dependent coefficient estimation. Comprehensive simulation studies were conducted to evaluate the performance of the local linear estimators, and reported dengue cases in villages in Kaohsiung City from January 2014 to December 2015 are used to inform our proposed method for practical use in real-world applications.

PMID:42633632 | DOI:10.1002/sim.70713

Physiother Res Int. 2026 Oct;31(4):e70325. doi: 10.1002/pri.70325.

ABSTRACT

BACKGROUND AND PURPOSE: This study investigated the effects of combining incentive spirometry with cardiac rehabilitation compared with cardiac rehabilitation alone on postoperative pulmonary complications, clinical-functional recovery, and hospital length of stay in patients undergoing cardiac surgery.

METHODS: Randomized controlled trial was conducted from May 2019 to October 2023 in two hospitals, including 46 inpatients undergoing cardiac surgery. Participants were assigned to incentive spirometry plus cardiac rehabilitation or cardiac rehabilitation alone. Both interventions were performed twice daily; spirometry used a volume-oriented device, and rehabilitation followed a seven-step protocol (2-4 METs). Outcomes included postoperative pulmonary complications, functional capacity (6-min walk test), handgrip strength, respiratory muscle function, and length of hospital stay.

RESULTS: The incentive spirometry associated with cardiac rehabilitation group had a longer extracorporeal circulation time (98 ± 26 min) than the cardiac rehabilitation group (76 ± 1; p = 0.008). Both groups showed a postoperative decline in respiratory muscle strength, and walking distance (MD: -64.37 m; 95% CI: [-24.1; -104.6]; d = 0.71), with no difference in postoperative pulmonary complications and handgrip strength. The incentive spirometry associated with cardiac rehabilitation group did not significantly differ on postoperative hospital stay compared with the cardiac rehabilitation group (MD: -1 day; 95% CI: [-4.71; 2.71]; d = -0.19).

CONCLUSIONS: In this study, no additional benefit was observed with the addition of incentive spirometry to cardiac rehabilitation compared with cardiac rehabilitation alone. No significant differences were detected between groups in postoperative pulmonary complications, hospital length of stay, or clinical-functional recovery among individuals undergoing cardiac surgery.

TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC) under the number RBR-8tsjf97.

PMID:42633619 | DOI:10.1002/pri.70325

Vet Med Sci. 2026 Sep;12(5):e71198. doi: 10.1002/vms3.71198.

ABSTRACT

BACKGROUND: Appropriate reproductive management is essential for improving pregnancy outcomes and neonatal survival in dogs. However, information on the practices adopted by Italian dog breeders remains limited.

OBJECTIVES: This study aimed to describe reproductive and neonatal management practices among certified Italian dog breeders, compare them across Northern, Central and Southern Italy, and assess their consistency with current veterinary recommendations.

METHODS: An anonymous online questionnaire comprising 41 questions was distributed to Italian dog breeders between October 2023 and March 2024. It collected information on oestrus monitoring, mating and artificial insemination, semen type, pregnancy diagnosis and puppy management until weaning. Of all questionnaires received, 251 met the inclusion criteria.

RESULTS: The study included 154 breeders from Northern, 49 from Central and 48 from Southern Italy. Management practices were generally homogeneous across areas. Progesterone measurement was used by 96.4% of breeders, although approximately 70% were unaware of the analytical method employed. Natural mating and fresh semen were the preferred reproductive options. Ultrasonography was widely used for pregnancy diagnosis, performed at 26.55 ± 4.84 days after expected ovulation, whereas 87% of breeders requested radiographic foetal counting. Regional differences concerned oestrus detection, diagnostic testing, mating intervals, radiographic timing and puppy weighing frequency. Northern breeders weighed puppies more frequently than Central and Southern breeders (p < 0.001).

CONCLUSION: Italian breeders generally follow established reproductive and neonatal practices. Nevertheless, targeted education on progesterone assay interpretation, vaginal cytology and advanced reproductive technologies could improve and standardize breeding management.

PMID:42633613 | DOI:10.1002/vms3.71198

J Natl Cancer Inst. 2026 Aug 22:djag285. doi: 10.1093/jnci/djag285. Online ahead of print.

ABSTRACT

BACKGROUND: Anal cancer screening is recommended for people with HIV in the United States (US). Because HIV prevalence varies geographically, the distribution of anal cancer diagnoses occurring among people with HIV may also differ by geography. Characterizing geographic variation can help identify areas needing enhanced screening infrastructure and outreach.

METHODS: Using data from the HIV/AIDS Cancer Match Study, US cancer registries, and CDC’s National HIV Surveillance System, we estimated the proportion of incident anal squamous cell carcinomas (SCC) among people with HIV across the 50 states, the District of Columbia (DC), and major metropolitan statistical areas (MSAs).

RESULTS: During 2010-2019, an average of 2,160 anal SCC diagnoses occurred annually among males, 414 (20.1%; Uncertainty Interval [UI]=19.4%-20.6%) among males with HIV. Among females, 58 of an average 4,099 annual anal SCC diagnoses (1.4%; UI = 1.3%-1.5%) occurred among females with HIV. Geographic variation among males was substantial. California had the highest annual number of anal SCC diagnoses among males with HIV (70/239; 29.2% [UI = 26.7%-31.8%]), followed by New York (48/161; 29.8% [UI = 26.3%-33.4%]), Florida (42/182; 23.1% [UI = 20.3%-26.1%]), Texas (36/132; 27.0% [UI = 23.7%-30.4%]), and Georgia (20/80; 25.2% [UI = 20.9%-29.8%]). New York had the highest annual number of diagnoses among females with HIV (10/263; 3.7% [UI = 3.0%-4.5%]). Across MSAs, the highest burden was in New York-Jersey City-White Plains (57 diagnoses [UI = 43-73]), with several MSAs in California, Texas, and Florida also showing a high burden.

DISCUSSION: Geographic differences underscore the need for targeted anal cancer screening outreach and implementation.

PMID:42633606 | DOI:10.1093/jnci/djag285