Category: Statistics

BMC Palliat Care. 2026 Apr 10. doi: 10.1186/s12904-026-02084-2. Online ahead of print.

NO ABSTRACT

PMID:41963933 | DOI:10.1186/s12904-026-02084-2

BMC Oral Health. 2026 Apr 10. doi: 10.1186/s12903-026-08246-1. Online ahead of print.

NO ABSTRACT

PMID:41963919 | DOI:10.1186/s12903-026-08246-1

BMC Pediatr. 2026 Apr 11. doi: 10.1186/s12887-026-06835-1. Online ahead of print.

ABSTRACT

BACKGROUND: Aimed to investigate the association between a low-carbohydrate diets (LCD) score and the prevalence of obesity in a large, nationally representative sample of children and adolescents in the United States.

METHODS: This cross-sectional study utilized data from participants aged 2-17 years from the National Health and Nutrition Examination Survey (NHANES) spanning 2003 to 2018. The exposure of interest was an LCD score, calculated based on the relative intake of carbohydrates, proteins, and fats from the mean of two 24-hour dietary recalls. The primary outcome was obesity, defined as a body mass index at or above the 95th percentile for age and sex. Multivariable logistic regression analysis with three progressive models, restricted cubic spline (RCS) analysis, and subgroup analyses were performed.

RESULTS: A total of 12,684 participants were included in the final analysis, including 7,392 with obesity and 11,679 without obesity. After comprehensive adjustment for demographic, socioeconomic, and dietary covariates (including total energy intake), a higher LCD score was positively associated with the odds of obesity. When treated as a continuous variable, each one-unit increase in the LCD score corresponded to a 2% increase in the odds of obesity (OR = 1.02, 95% CI: 1.01-1.03, P < 0.001). When categorized into quartiles, participants in the highest quartile (Q4) had 40% higher odds of obesity compared to those in the lowest quartile (Q1) (OR = 1.40, 95% CI: 1.17-1.68, P < 0.001). The RCS analysis confirmed a significant non-linear association between the LCD score and the odds of obesity (P for non-linearity = 0.001). Furthermore, subgroup analyses indicated that the association varied across strata; for instance, a significant positive association was observed in children aged 12 years and younger but not in older adolescents, and was stronger in males than in females, though formal tests for interaction were not statistically significant.

CONCLUSION: In this nationally representative sample of U.S. children and adolescents, a higher LCD score was associated with increased odds of obesity. This finding suggests that a dietary pattern characterized by a lower proportion of carbohydrates and higher proportions of fat and protein may reflect poor overall dietary quality rather than a structured, health-promoting diet, which is associated with higher obesity prevalence.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41963893 | DOI:10.1186/s12887-026-06835-1

BMC Public Health. 2026 Apr 10. doi: 10.1186/s12889-026-27147-0. Online ahead of print.

NO ABSTRACT

PMID:41963892 | DOI:10.1186/s12889-026-27147-0

BMC Med Genomics. 2026 Apr 10. doi: 10.1186/s12920-026-02364-z. Online ahead of print.

ABSTRACT

BACKGROUND: Biallelic DIAPH1 mutations are linked to hereditary microcephaly syndrome, yet the underlying pathogenic mechanism remains unelucidated. This study aimed to clarify how DIAPH1 biallelic mutations cause microcephaly and visual impairment, focusing on the gene’s regulatory role in the Wnt/β-catenin signaling pathway.

METHODS: Whole exome sequencing was performed on a patient’s peripheral blood to identify DIAPH1 mutations. A zebrafish model was established by microinjecting mutant human DIAPH1 cDNA into one-cell embryos (no zebrafish DIAPH1 homolog exists). Phenotypic analyses (morphology, neuronal axon growth, behavior) and quantitative real-time PCR for Wnt/β-catenin pathway genes were conducted. Data were mean ± SEM; statistical tests (Student’s t-test, ANOVA, χ²) used GraphPad Prism 5.0 (P < 0.05, P < 0.0001 for significance).

RESULTS: Compound heterozygous DIAPH1 mutations (c.1051 C > T, p.R351X; c.609delA, p.E203E fs*19) were found and associated with clinical symptoms. Mutant DIAPH1 zebrafish showed abnormal eye shape, shortened body length, axis defects, impaired motor axon growth, reduced locomotor activity, upregulated WNT8A, WNT9A, LRP5, LRP6, and downregulated AXIN1, AXIN2, β-CATENIN, indicating excessive Wnt/β-catenin pathway activation.

CONCLUSIONS: DIAPH1 compound heterozygous mutations may trigger microcephaly and visual impairment by abnormally activating the Wnt/β-catenin pathway. The zebrafish model provides a reliable in vivo system for studying DIAPH1-related microcephaly, advancing understanding of hereditary primary microcephaly pathogenesis and potential therapeutic target exploration.

PMID:41963888 | DOI:10.1186/s12920-026-02364-z

BMC Pregnancy Childbirth. 2026 Apr 10. doi: 10.1186/s12884-026-09047-8. Online ahead of print.

NO ABSTRACT

PMID:41963856 | DOI:10.1186/s12884-026-09047-8

J Epidemiol Popul Health. 2026 Apr 9;74(4):203387. doi: 10.1016/j.jeph.2026.203387. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, with chronic hepatitis B virus (HBV) infection being a major risk factor. To date, existing predictive scores of HCC are mainly based on traditional Cox proportional hazard (CPH) models. This study aimed to compare the variable selection process and performance of CPH models with those of machine learning (ML) and deep learning (DL) algorithms in predicting HCC among patients with chronic HBV infection.

METHODS: We used data from 4,370 individuals with chronic HBV infection enrolled in the French prospective multicentre ANRS CO22 HEPATHER cohort, of which 56 (1.3%) developed an HCC. Two published CPH-based scores (ADAPTT and SADAPTT) were compared to Random Survival Forest (RSF), Survival Support Vector Machine (SVM), Survival XGBoost, and DeepSurv algorithms. Models were evaluated using Harrell’s C-index, Inverse-Probability-of-Censoring Weighting win ratio statistic, and time-dependent area under the ROC curve at 3, 5, and 8 years. The same set of covariables was used to build all the models.

RESULTS: CPH models demonstrated similar or higher performances (C-index [95% confidence interval]: 0.84 [0.82-0.85]) for HCC prediction compared to ML and DL models, with less overfitting. Survival SVM and RSF performed similarly (0.81 [0.79-0.83] and 0.81 [0.79-0.82], respectively) without outperforming CPH models. Variable selection was consistent across top-performing models, though CPH models more effectively captured the predictive value of certain behavioural factors, such as soft drink intake.

CONCLUSIONS: In this dataset with a limited sample size and strongly imbalanced outcome, traditional CPH models provided robust, interpretable, and computationally efficient predictions for HCC risk. ML and DL methods did not outperform traditional models, reinforcing the validity of traditional statistical approaches in small to medium datasets.

PMID:41962179 | DOI:10.1016/j.jeph.2026.203387

J Neurosurg Pediatr. 2026 Apr 10:1-12. doi: 10.3171/2025.11.PEDS25377. Online ahead of print.

ABSTRACT

OBJECTIVE: Surgical management of hypothalamic hamartomas (HHs) presents substantial challenges due to their deep-seated location and proximity to critical neurovascular structures. Less invasive techniques, such as endoscopic disconnection and laser interstitial thermal therapy (LITT), have become preferred over traditional microsurgery to enhance seizure control while minimizing complications. Notably, LITT has steadily gained popularity in recent years. The aim of this study was to assess seizure, neurocognitive, and endocrine outcomes following endoscopic disconnection in patients with HH-related epilepsy, and to determine whether endoscopy remains a viable treatment option in the management of HH.

METHODS: This retrospective analysis included patients with HH-related epilepsy who underwent robotic-assisted endoscopic disconnection between 2011 and 2023 at a single institution. All patients received comprehensive presurgical evaluation, and formal assessments of global cognitive and neuropsychological function were conducted preoperatively and postoperatively in eligible patients.

RESULTS: Twenty-nine patients who underwent 37 procedures were included in this analysis. All patients experienced gelastic seizures, and most patients (51.7%) had type II HH according to the Delalande classification system. Twenty-two patients (75.9%) underwent a single intervention. The procedure was repeated 2 times in 6 patients and 3 times in 1 patient. Endoscopy proved effective in providing direct visualization, real-time monitoring, and histopathological sampling during procedures. Permanent postoperative complications occurred after 4 procedures (10.8%); these included mild CN VI deficit (n = 1), hypothalamic obesity (n = 1), and hypothyroidism (n = 2) after second procedure. Over a mean follow-up of 6.9 years, Engel class I seizure freedom was achieved in 65.5% of patients, with the best outcomes seen for those with type II HH. Among the 22 patients who underwent a single procedure, the long-term endocrinological status remained unchanged compared with the preoperative condition in 17 (77.3%), improved in 4 (18.2%), and worsened in 1 (4.5%). Among the 20 patients with available comparative data, cognitive outcomes remained stable or improved for most patients, although some exhibited decline. Statistical analysis revealed a moderate correlation between the HH type and postoperative Engel class outcome. Comparison between patients who underwent single versus multiple procedures revealed a significantly poorer seizure outcome in the repeat surgery group, while the complication rates were comparable. The outcome was significantly associated with the number of procedures.

CONCLUSIONS: Endoscopic disconnection remains a viable and minimally invasive surgical option for the treatment of HH-related epilepsy, particularly for newly diagnosed or residual HHs with intraventricular involvement.

PMID:41962169 | DOI:10.3171/2025.11.PEDS25377

J Neurosurg Spine. 2026 Apr 10:1-10. doi: 10.3171/2025.11.SPINE251323. Online ahead of print.

ABSTRACT

OBJECTIVE: Surgery on extramedullary tumors has a place among the most gratifying operations in neurosurgery. However, little data exist on permanent morbidity and long-term results. This paper provides these data and analyzes which factors influence them and how they can be managed.

METHODS: Among 2081 patients with tumors of the spinal canal presenting between 1991 and 2024, 605 patients were identified with intradural extramedullary tumors, of whom 500 patients underwent 570 operations. Multiple regression was used to identify factors influencing resection and morbidity rates. Short-term results were analyzed according to a neurological scoring system for individual symptoms, while long-term results were determined calculating recurrence-free outcome rates with Kaplan-Meier statistics.

RESULTS: The mean age for operated patients was 49.8 ± 18 years, presenting after a mean history of 21.2 ± 42 months. They were followed up by outpatient visits and questionnaires for up to 34 years (mean 43.3 ± 64 months). Overall, 87.4% of tumors were resected completely, while 11.2% underwent partial resection and 1.4% biopsy. Transient postoperative deteriorations were observed in 15.1% of surgeries. Permanent surgical morbidity occurred in 7.1%, that is, 4.8% for first surgeries and 18.4% for recurrent tumors (p < 0.0001). With complete resection, recurrence-free outcome rates of 80.5% and 77% after 5 and 10 years, respectively, were obtained, while partial resection reduced these rates to 40.0% and 36.4% after 5 and 10 years, respectively (p < 0.0001). Surgeons with > 100 operations achieved significantly higher recurrence-free outcome rates compared to surgeons with less experience at each postoperative time point. Schwannomas, meningiomas, ependymomas of the filum terminale, and hamartomas represented 89.8% of all pathologies and were analyzed separately. The best results for resection rates, permanent morbidity, and recurrence-free outcomes were observed for schwannomas. The highest morbidity rates were determined for ependymomas and hamartomas. Complete resection resulted in recurrence-free outcome rates of around 90% after 10 years for each histological group with the exception of meningiomas (73.3%).

CONCLUSIONS: Whenever an extramedullary tumor is completely resected, rates for surgical morbidity and 10-year recurrence-free outcomes are favorable. In contrast, with arachnoid adhesions, as in recurrent tumors and some hamartomas, complete resection rates decline, morbidity rates rise, and long-term results become less satisfactory. This emphasizes the importance of achieving complete resection, particularly in the first operation. Surgeons dedicated to spinal cord pathologies can expect to achieve superior long-term results.

PMID:41962167 | DOI:10.3171/2025.11.SPINE251323

J Neurosurg Pediatr. 2026 Apr 10:1-8. doi: 10.3171/2025.12.PEDS25501. Online ahead of print.

ABSTRACT

OBJECTIVE: Vagus nerve stimulator (VNS) insertion has become a common treatment for drug-resistant epilepsy in children. The growing number of children undergoing VNS insertion provides a strong incentive for studies aimed at optimizing postoperative care protocols. The objective of this retrospective study was to characterize the readmission and reoperation rates associated with VNS insertion in children.

METHODS: The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was queried from 2012 to 2022 to find patients who underwent VNS insertion (CPT code 64568). The primary outcome measured was unplanned readmission within 7 days of VNS insertion. Propensity score matching on the criteria of baseline demographics was applied. Multivariable logistic regression analysis was conducted to determine if age, race, or anesthesia time affected same-day discharge as well as unplanned readmission and reoperation rates.

RESULTS: A total of 4267 patients who underwent VNS insertion were identified in the NSQIP-P database from 2012 to 2022. After excluding patients with missing data and readmissions > 7 postoperative days, 3070 patients were included in the final analysis. Of those patients, 63 (2.1%) experienced an unplanned readmission within 7 days of their procedure. Propensity score matching differentiating between those with a total hospital length of stay of 0 days (same-day discharge) and > 0 days (inpatient admission) on the criteria of age (p = 0.63), sex (p = 0.77), race (p = 0.99), Hispanic ethnicity (p = 0.84), and American Society of Anesthesiologists classification (p = 0.18) showed no statistically significant difference in baseline characteristics between the two cohorts. No significant difference in unplanned readmissions was found between patients with same-day discharge versus those with inpatient admission (OR 1.19, 95% CI 0.72-1.99; p = 0.5).

CONCLUSIONS: Same-day discharge of pediatric patients undergoing VNS insertion was not associated with higher readmission rates compared to patients who stayed in the hospital for more than 1 day.

PMID:41962155 | DOI:10.3171/2025.12.PEDS25501