Category: Statistics

Plast Reconstr Surg. 2026 Jun 19. doi: 10.1097/PRS.0000000000013135. Online ahead of print.

ABSTRACT

BACKGROUND: Breast lipofilling is a commonly utilized method in plastic surgery for breast reconstruction and augmentation. However, the procedure is often limited by the unpredictable survival of fat grafts, leading to dissatisfied patients and associated risks of complications. To address these challenges, recent innovations in fat processing methods, such as the Cell Enriched Lipotransfer (CELT) technique, have been developed to improve both graft retention and overall clinical outcomes.

PURPOSE: This study aims to compare patient satisfaction and complication rates associated with different fat preparation techniques- including filtration, sedimentation, and CELT method-in breast lipofilling procedures.

METHODS: All patients who underwent breast lipofilling between 2010 and 2022, were identified. Patients were followed for an average of 20 months (range: 3 -173 months). Data including patient demographics, fat preparation methods, and outcomes were extracted from clinical records. Patient satisfaction was assessed using a modified BreastQ questionnaire, and complications were recorded from postoperative follow-ups.

RESULTS: We included 572 breast lipofillings (7 male; 374 female) with a mean age of 45.34 ± 12.2 years (range 14-79). Patient demographics did not differ statistically significantly (p = 0.85). A total of 464 lipofilling interventions (82.8%) were eligible for analysis, as 99 lipofilling interventions (87 patients) were lost to follow-up or refused to participate in the questionnaire. The surgical site complication rate of the study was as follows: CELT (8.0%), filtration (14.9%), and sedimentation (16.4%). Specific complications for CELT included oil cyst formation (4.8%), hematomas (1.6%), no infections (0%), and postoperative wound healing disorders (1.6%). The CELT method resulted in a significantly higher patient satisfaction rate (p < 0.001) with a mean score of 1.70 (where 1 indicates very satisfied) and the lowest complication rate of 8.0%. Satisfaction rates for other techniques were as follows: Filtration (2.31) and Sedimentation (mean score of 2.43). In subgroup analyses, outcomes did not differ significantly between radiated and non-radiated patients in this cohort (p ≥ 0.06).

CONCLUSION: The Cell Enriched Lipotransfer (CELT) method has emerged as a highly effective fat preparation technique for breast lipofilling, demonstrating enhanced patient satisfaction and a lower incidence of complications. However, further validation through larger-scale, prospective studies is essential to confirm these findings and establish robust evidence.

PMID:42320038 | DOI:10.1097/PRS.0000000000013135

JMIR Res Protoc. 2026 Jun 19;15:e86787. doi: 10.2196/86787.

ABSTRACT

BACKGROUND: Language barriers in mental health care can hinder diagnostic accuracy, communication quality, and therapeutic rapport. Multilingual mental health care providers (MHCPs) or qualified interpreters are not always available, prompting interest in mobile translation apps as alternative tools. The usability of such tools in mental health consultations remains underexplored.

OBJECTIVE: This pilot study aims to assess whether a mobile machine translation app can support MHCPs in conducting accurate mental health assessments with patients who speak a different language. Secondary objectives include assessing usability, communication quality, translation accuracy, and nonverbal interaction in a simulated mental health care setting. The feasibility objectives are to examine recruitment, retention, data completeness, time adherence, acceptability, scenario realism, and resource requirements to inform the design of a larger future trial.

METHODS: This is a single-arm, simulation-based, mixed methods pilot study involving 12 German-speaking MHCPs and 2 Turkish-speaking standardized service users. In this study, MHCPs include both fully trained professionals and individuals in advanced training involved in mental health care delivery. Each health care provider will participate in a simulated mental health consultation lasting up to 30 minutes, using the mobile translation app Mabel, which provides real-time translation during multilingual clinical interactions. Data will be collected via video and audio recordings, app use metrics, postsimulation questionnaires, and optional qualitative interviews. Data will be analyzed using descriptive statistics, thematic analysis, and mixed methods triangulation.

RESULTS: As of March 2026, no participants have been enrolled. The pilot study is being conducted within an ongoing Volkswagen Foundation-funded research project. Preparatory work, including scenario development, scoring rubrics, and data collection materials, is at an advanced stage. Recruitment is scheduled to begin in May 2026, with data collection completion anticipated in July 2026. Results will be reported in a future publication.

CONCLUSIONS: This pilot study will provide initial evidence on the usability and feasibility of mobile translation apps in mental health care and inform the design of a larger implementation study.

TRIAL REGISTRATION: OSF Registries osf.io/7r2hn; https://osf.io/7r2hn.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/86787.

PMID:42320032 | DOI:10.2196/86787

JMIR Cardio. 2026 Jun 19;10:e76932. doi: 10.2196/76932.

ABSTRACT

BACKGROUND: Rapid activation of the cardiac catheterization laboratory (CCL) for ST-segment elevation myocardial infarction (STEMI) is essential to minimize time to reperfusion. However, system-wide efforts to reduce treatment delays have been accompanied by increased false activations, defined as activations that do not result in emergent coronary intervention. False activations contribute to unnecessary team mobilization (UTM), staff fatigue, workflow disruption, and inefficient resource use.

OBJECTIVE: This study aimed to evaluate whether the implementation of a cloud-based care coordination platform (Stenoa) was associated with reductions in false activations and UTMs at a high-volume tertiary cardiac center.

METHODS: In September 2021, the McGill University Health Centre implemented Stenoa, a mobile, cloud-based STEMI coordination platform enabling systematic case validation using electrocardiographic and clinical data. A retrospective cohort study was conducted, including all CCL activations between September 2020 and December 2022. Activations were grouped as preimplementation (group 0: September 2020 to September 2021) and postimplementation (group 1: September 2021 to December 2022) periods. A false activation was defined as a CCL activation followed by case cancellation before any procedure was performed. The primary outcome was the rate of UTM.

RESULTS: In total, 632 activations were analyzed (group 0: n=288; group 1: n=344). UTM decreased from 8.7% (23/265) to 4.4% (14/316) following platform implementation (P=.04). False activation frequency decreased from 10.2% (27/265) to 6.9% (22/316), although this difference did not reach statistical significance (P=.16). Among false activations, the proportion resulting in UTM declined from 85% to 63% (P=.08).

CONCLUSIONS: The implementation of a cloud-based STEMI coordination platform was associated with a significant reduction in unnecessary catheterization laboratory team mobilization. Structured digital communication may improve workflow efficiency and resource use in STEMI systems of care. Further multicenter evaluation is warranted.

PMID:42320015 | DOI:10.2196/76932

Anal Chem. 2026 Jun 19. doi: 10.1021/acs.analchem.6c01147. Online ahead of print.

ABSTRACT

Histone post-translational modifications (PTMs) alter chromatin dynamics and contribute to the regulation of gene expression in health and disease, yet mass spectrometry-based histone PTM analysis remains constrained by inefficient sample preparation workflows. Here, we develop RIPUP (Rapid Identification of histone PTMs in Underivatized Peptides), a streamlined multiprotease workflow that reduces sample preparation to hours while improving PTM coverage and quantitative accuracy. Systematic evaluation of Arg-C Ultra and a recombinant (r)-Chymotrypsin protease under varied conditions, including standard derivatization with propionic anhydride and tandem mass tag (TMT) labeling, demonstrated that Arg-C Ultra with TMT labeling achieves a detection of total PTM that exceeds Trypsin-based approaches. Using the HiP-Frag computational framework for unrestrictive PTM identification, we discovered that TMT’s tertiary amine provides charge compensation that rescues the ionization of negatively charged acylations revealing 58 succinylation and 31 glutarylation sites─a “dark epigenome” largely undetected by propionylation-based methods. Complementary digestion with Arg-C Ultra and r-Chymotrypsin provides orthogonal sequence coverage, enabling the detection of PTMs in H2A variants, linker histones, and regions poorly represented by arginine-specific cleavage alone. In HEK293T cells treated with the pan-sirtuin inhibitor nicotinamide, RIPUP quantified 112 statistically significant peptidoforms (adj p < 0.05), predominantly increasing with the NAM dose (88 up, 24 down). Application of RIPUP to frozen-thawed rat hippocampal sections within a 3 h workflow identified >200 PTMs including H3 K27/K36/K37 methylation, H4 N-terminal acetylation patterns, and H2A K118/K119 ubiquitination. This rapid, high-efficiency platform enables timely discovery of epigenetic mechanisms and accelerates the path from PTM identification to therapeutic target validation.

PMID:42319981 | DOI:10.1021/acs.analchem.6c01147

J Med Internet Res. 2026 Jun 17. doi: 10.2196/92647. Online ahead of print.

ABSTRACT

BACKGROUND: Background: Depression, anxiety,, and PTSD are leading global causes of disability. Standard interventions utilize slow mechanisms of action, high attrition, and significant accessibility barriers. While intravenous (IV) and intranasal ketamine are rapid-acting alternatives, high cost and intensive logistical requirements limit adoption. Sublingual (SL) at-home ketamine addresses some gaps but is constrained by low bioavailability and variable absorption. Subcutaneous (SC) administration offers high bioavailability and precise dosing, potentially bridging the gap between in-clinic effectiveness and at-home accessibility.

OBJECTIVE: Objective: This retrospective observational study evaluated the safety, feasibility, and clinical outcomes of a telehealth, at-home SC ketamine protocol using a convenience sample of de-identified health records collected via Mindbloom’s telehealth platform across 38 states.

METHODS: Methods: A sample of N=3,870 patients with moderate-to-severe symptoms of depression (PHQ-9 ≥ 10), anxiety (GAD-7 ≥ 10), or PTSD (PCL-5 ≥ 33) participated in a structured program involving clinical assessment, mandatory peer monitoring, and remote physiological screening. Injection kits and blood pressure monitors were mailed home. Dosing followed a subanesthetic protocol starting at 0.5 mg/kg with clinician-guided titration. Primary outcomes were measured at baseline and after weeks 2, 4, and 6 using the PHQ-9, GAD-7, and PCL-5 via online survey. Linear mixed-effects models with cubic splines analyzed symptom trajectories and accounted for time-varying assessments. Statistical significance was defined as alpha = .05; effect sizes were reported. Sensitivity analyses utilized multiple imputation and LOCF.

RESULTS: Results: Patients (mean age 44.7 years; 52.4% female) demonstrated high adherence, with 0.5% switching from SC to SL administration. After 6 sessions (approximately 44 days), adjusted marginal means showed significant declines: PHQ-9 scores dropped from 14.64 (13.99-15.29) to 6.30 (5.90-6.70), GAD-7 from 13.06 (12.45-13.67) to 6.09 (5.72-6.47), and PCL-5 from 46.7 (43.30-50.10) to 27.5 (25.40-29.70) with large effect sizes ($d_z$) ranging from 1.35 to 1.58. Minimal Clinically Important Difference (MCID) was achieved by 81.8% of MDD, 80% of GAD, and 84.6% of PTSD patients ($p < .001$ for all). Adverse events were low (2.8%-3.2%), with no serious complications related to SC administration.

CONCLUSIONS: Conclusions: This study is the first large-scale evaluation of at-home SC ketamine. Results suggest at-home SC ketamine is a safe, feasible intervention associated with high rates of symptom reduction in depression, anxiety, and PTSD. It differs from existing literature by utilizing a high-bioavailability (93%) SC route in a remote setting, whereas patients typically receive infusions of this potency in-clinic. Patients achieved clinical outcomes comparable to or exceeding traditional and intranasal therapies, potentially closing the access gap for treatment-resistant populations and supporting the expansion of supervised telehealth models in mental health care.

PMID:42319752 | DOI:10.2196/92647

Indian J Pediatr. 2026 Jun 19. doi: 10.1007/s12098-026-06195-9. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate diagnostic utility of reticulocyte hemoglobin equivalent (Ret-He) in identifying iron deficiency anemia (IDA) in acutely ill hospitalized children in comparison to serum ferritin.

METHODS: After excluding chronic inflammatory and anemic conditions unrelated to iron deficiency (ID), patients were categorized as (1) IDA: low hemoglobin+ microcytosis+ red-cell-distribution-width (RDW) index >220, (2) Non-anemia-iron-deficiency (NAID): normal haemoglobin+ microcytosis+ RDW index >220 and (3) Normal-group: normal hemoglobin+ normocytosis. Diagnostic utility indices for IDA were calculated using low hemoglobin+ microcytosis + RDW index >220 as surrogate standard. Correlation coefficients and receiver-operating-characteristic (ROC) curve cut-offs for Ret-He and ferritin were calculated.

RESULTS: Anemic (n = 180) and non-anemic (n = 66) acutely ill children, after exclusion criteria, were classified into IDA (n = 102), NAID (n = 14) and normal (n = 21). IDA group had significantly lower Ret-He levels (p <0.001). Ferritin levels showed no significant difference (p = 0.062). For IDA detection, Ret-He cut-off of 27.7 pg yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 87.2%, 80.9%, 95.7%, 56.7% and 86.2% whereas ferritin at cut-off of 147.0 ng/ml showed values of 58.8%, 66.7%, 89.5%, 25.0% and 60.2% respectively. For NAID detection, Ret-He cut-off of 29.1 pg showed sensitivity, specificity, PPV, NPV and accuracy of 71.4%, 57.1%, 52.6%, 75.0% and 62.9%, while ferritin at cut-off of 153 ng/ml showed values of 57.1%, 61.9%, 50.0%, 68.4%, and 60.0% respectively.

CONCLUSIONS: Ret-He demonstrated superior diagnostic utility compared to serum ferritin for IDA in acutely ill hospitalized children. Optimal cut-off for serum ferritin for IDA was significantly higher than WHO reference standard.

PMID:42319743 | DOI:10.1007/s12098-026-06195-9

J Robot Surg. 2026 Jun 19;20(1):613. doi: 10.1007/s11701-026-03575-3.

ABSTRACT

To compare the efficacy and safety of TiRobot-assisted versus conventional surgery for spinal deformity through meta-analysis, with age-stratified subgroup analyses in pediatric and adult patients. Comparative studies assessing TiRobot-assisted and conventional surgery for spinal deformity were systematically retrieved. Pooled analyses were conducted for operative outcomes, perioperative parameters, radiographic correction, pedicle screw accuracy, complications, and postoperative functional outcomes. Pediatric and adult subgroup analyses were subsequently performed. TiRobot-assisted surgery was associated with longer operative time overall, with statistical significance observed in pediatric patients. Screw insertion time was significantly shorter only in the pediatric subgroup. Intraoperative blood loss was significantly reduced in both pediatric and adult patients receiving TiRobot assistance. Adult patients in the TiRobot-assisted group had shorter hospital stays, whereas pediatric patients underwent fewer fluoroscopic exposures. Although overall radiographic correction was largely comparable between groups, TiRobot assistance significantly improved pedicle screw accuracy. The proportion of Gertzbein-Robbins grade A + B screws was higher, particularly in pediatric patients, while the proportion of grade 0 + 1 screws was higher in adults. In addition, TiRobot-assisted surgery significantly reduced overall and neurologic complication rates, with the reduction in neurologic complications being particularly evident in adult patients. TiRobot-assisted surgery for spinal deformity improves pedicle screw placement accuracy and perioperative safety while providing selective advantages in perioperative recovery. The pattern of benefit differs between pediatric and adult populations, but the overall balance of evidence favors TiRobot assistance over conventional techniques.

PMID:42319690 | DOI:10.1007/s11701-026-03575-3

Ir J Med Sci. 2026 Jun 19. doi: 10.1007/s11845-026-04506-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Learning about conflicts of interest should be one of the core aspects aspect of clinical ethics in undergraduate and postgraduate training. However, the focus may direct more to external factors such as ties with, or inducements from, pharmaceutical interests rather than inherent fallibilities and motives of practitioners. At first sight it would appear that there is very limited concentration on the impact of income or private versus public practice on clinical practice in ethics textbooks.

METHOD: A list of clinical/medical ethics textbooks available on open shelves was established in the libraries of Trinity College Dublin, a deposit library alongside Oxford and Cambridge, each of which has rights to a copy of all publications originating in the British Isles. Two researchers independently established the presence and proportion of text relating to income or private practice in each textbook. In cases of disagreement, the senior author adjudicated. Descriptive statistics were used.

RESULTS: Of 123 ethics textbooks examined, 304 out of 38,410 pages (mean 2.5 (0.89%), standard deviation 1.73, median 0) were dedicated to the issue of income and private practice.

CONCLUSIONS: Leaders in clinical ethics should devote more emphasis to scrutiny and debate on the impact of income in addition to private and dual practice in education and research. There is significant opportunity to enhance such teaching by incorporating an informed approach to the wit and wisdom of the reflections on doctors and their income by Plautus, Molière and GB Shaw.

PMID:42319686 | DOI:10.1007/s11845-026-04506-9

Ir J Med Sci. 2026 Jun 19. doi: 10.1007/s11845-026-04485-x. Online ahead of print.

ABSTRACT

BACKGROUND: Sport-related concussion injuries are common in community Rugby Union. Despite research advancements in SRC management in recent years, little is known about the translation of research to practice within community Rugby Union cohorts.

AIMS: To develop and evaluate a novel system to track comprehensive SRC history, symptoms, and treatment data within community Rugby Union players.

METHODS: The Three-Phase Rugby Concussion System (TPRCS) collected comprehensive SRC data from players throughout the 2024-25 community Rugby Union season at baseline, 0-5 days post-SRC, and 0-5 days post-unrestricted return to play. Semi-structured interviews were conducted for stakeholders (players and club medics, n = 10) involved post-season, to evaluate participation experience, alongside perceived research facilitators, barriers, and usefulness.

RESULTS: Survey compliance ranged from 51% at baseline (n = 135), to 74% for post-SRC (n = 23), and post-clearance surveys (n = 23). The evaluation surveys received positive feedback for TPRCS’s ease of use and communication pathways, with player enthusiasm levels for study participation being the lowest-scoring survey response. The main facilitators for TPRCS included club culture, incentives, and personal contact, whilst the main barriers were absence of injury reporting and lack of prioritisation from players. Stakeholders identified education, injury treatment, and policy change as potential areas of usefulness.

CONCLUSIONS: Medics and players in community Rugby Union are enthusiastic to progress practice and behaviours in line with research. Overall, this stakeholder-evaluated comprehensive SRC data collection system can serve as a novel SRC research framework across Rugby Unions.

PMID:42319685 | DOI:10.1007/s11845-026-04485-x