Category: Statistics

Environ Toxicol Chem. 2026 Jun 5:vgag125. doi: 10.1093/etojnl/vgag125. Online ahead of print.

ABSTRACT

Microplastics are complex contaminants, potentially posing both a physical and chemical risk to aquatic organisms. To better understand the physical and chemical impacts of microplastics, we conducted a large in situ pelagic mesocosm experiment in a freshwater boreal lake at the International Institute for Sustainable Development-Experimental Lakes Area. An equal mixture of polyethylene, polystyrene, and polyethylene terephthalate fragments with and without chemical additives were added to mesocosms as a single pulse and were contrasted with a control treatment with no added microplastics. Plankton communities were monitored for 62 days following microplastic additions. Total phytoplankton biomass was not affected by either microplastic treatment; however, a shift in phytoplankton community composition was detected in the microplastic treatment without additives on Day 62. Total zooplankton and cladoceran abundance marginally increased over time in both microplastic treated mesocosms, and diversity was lower in the additive treatment. There was a negative impact on Tropocyclops extensus egg production in microplastic treatments with and without additives, and the abundance of early-instar Chaoborus was temporarily higher in mesocosms containing microplastics without additives. Overall, the impacts of microplastics were relatively small, irrespective of the presence or absence of chemical additives, on natural pelagic phytoplankton or zooplankton communities over the 62-day exposure.

PMID:42247215 | DOI:10.1093/etojnl/vgag125

Ann Med. 2026 Dec;58(1):2677997. doi: 10.1080/07853890.2026.2677997. Epub 2026 Jun 5.

ABSTRACT

PURPOSE: Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening opportunistic infection. Recent studies have demonstrated a poor prognosis and higher mortality rate in non-human immunodeficiency virus (HIV) patients, with associated risk factors including cytomegalovirus (CMV) co-infection. We aimed to investigate the outcomes of concomitant PJP and CMV infection in non-HIV mechanically ventilated critically ill patients.

PATIENTS AND METHODS: We retrospectively enrolled adult patients admitted to an intensive care unit (ICU) and diagnosed with PJP infection from January 2017 to December 2022. Data were retrieved from the Chang Gung Research Database, including clinical manifestations, comorbidities and mortality.

RESULTS: A total of 132 adult patients without HIV infection received mechanical ventilation in the ICU, underwent bronchoalveolar lavage and diagnosed with PJP were enrolled, of whom 26 patients had concomitant CMV infection and 106 did not. The PJP and concomitant CMV infection group had a significantly lower PaO2/FiO2 ratio (73.5 vs. 95.6, p = 0.04) and higher procalcitonin level (2.2 ng/ml vs. 0.4 ng/ml, p = 0.004). While CMV co-infection was associated with higher ICU mortality in the univariate analysis (33.3% vs. 11.1%, p = 0.002), multivariate analysis revealed that systemic CMV co-infection was not an independent predictor of mortality. Instead, the extended model demonstrated that mortality was significantly associated with acute respiratory distress syndrome (ARDS) (HR 4.281, 95% CI:1.178-15.565, p = 0.027) and the duration of PJP treatment (HR: 0.892, 95% CI: 0.803-0.990, p = 0.006).

CONCLUSION: Concomitant CMV infection was about one-fifth in the non-HIV critically ill patients with PJP infection but does not independently increase mortality risk. Clinical management should prioritize early, sustained anti-pneumocystis therapy and lung-protective strategies for ARDS.

PMID:42247214 | DOI:10.1080/07853890.2026.2677997

Arch Osteoporos. 2026 Jun 5;21(1):87. doi: 10.1007/s11657-026-01721-w.

ABSTRACT

Osteoporotic fractures are underrepresented in administrative data. In the present study, only 1 of 94 admissions for osteoporotic fracture was coded correctly, mostly due to inadequate clinical documentation. Following education of junior doctors, 36% of osteoporotic fractures were coded correctly, with coding of femur fractures particularly amenable to improvement.

PURPOSE: Osteoporotic fractures are underrepresented in hospital administrative data. This study analysed the accuracy of clinical coding of osteoporotic fractures and prospectively evaluated the effectiveness of an educational intervention for junior medical officers (JMO) to improve documentation and coding accuracy.

METHODS: Coding accuracy was measured in 279 consecutive inpatients deemed to have suffered an osteoporotic fracture based on predetermined criteria. Subsequently, an education programme for JMO was delivered, focusing on osteoporotic fracture criteria and clinical coding requirements. A 10-week post-intervention analysis was conducted to determine improvement in coding accuracy using baseline data as a historical control.

RESULTS: At baseline, 1 of 94 (1.1%) admissions meeting the criteria for osteoporotic fracture received the correct ICD-10 M80 primary diagnosis code. Post-intervention, coding accuracy improved markedly, with 14 out of 39 (36%) osteoporotic fracture admissions coded correctly. However, this improvement varied by site, with 77% of femur fractures, but only 10% of radius and 13% of humerus fractures receiving the correct primary clinical code. Coding accuracy decreased with time, from 42% in the first 5 weeks post-education to 27% in the subsequent 5 weeks.

CONCLUSION: Osteoporotic fractures are severely underrepresented in hospital administrative data due to inadequate documentation leading to inaccurate coding. Whilst education programmes can improve coding accuracy, long-term efficacy is limited by multiple factors. Since clinical coding forms an important part of public health resource allocation, automated system-based solutions are required to ensure accurate statistical capture of the true burden of osteoporosis and associated fractures.

PMID:42247205 | DOI:10.1007/s11657-026-01721-w

Biotechnol Lett. 2026 Jun 5;48(4):78. doi: 10.1007/s10529-026-03748-y.

ABSTRACT

The mortality rate of Acute Lymphoblastic Leukemia (ALL) has reduced after the incorporation of L-asparaginase (L-ASNase) in therapeutic regimes, which function via selective starvation of the cancer cells, sparing the rest. However, challenges persist due to the immunogenic nature of the enzyme and the co-glutaminase activity. This study investigates the L-ASNase coded for by the ansB gene from Serratia marcescens MTCC 97. An initial study led to a titer of 1.6 U/mL of L-ASNase in a semi synthetic media. However, due to the opportunistic pathogenic nature of the strain and lower yield of the enzyme, a robust eukaryotic host, and the Pichia pastoris GlycoSwitch® SuperMan₅ (pep4^–prb1^–) strain was selected for the expression. The gene was codon optimized to further enhance the yield. The recombinant strain produced 16.6 U/mL of L-ASNase in a complex BMMY medium. Process and parameter optimization were done via statistical design using the Taguchi orthogonal array, leading to a final yield of 22.3 U/mL of L-ASNase, obtained at 37 °C, at a strictly neutral pH, when 1% inoculum was used to initiate the fermentation, with 0.5% v/v methanol induction. Batch bioreactor cultivation further enhanced the L-ASNase titer to 31.75 U/mL. However, the L-ASNase was also found to have a glutaminase activity, for which in-silico characterization of the enzyme was done for an elevated understanding of the intricate structure and active sites. Through modelling and simulation studies, possible mutations were explored with an aim to reduce the glutaminase activity, and thereby reduce the secondary function of the L-ASNase.

PMID:42247194 | DOI:10.1007/s10529-026-03748-y

Environ Sci Pollut Res Int. 2026 Jun 5. doi: 10.1007/s11356-026-37902-w. Online ahead of print.

ABSTRACT

Harmful algal blooms (HABs) pose water quality risks, including the depletion of dissolved oxygen and human health impacts. Remote sensing is a proven tool for monitoring HABs, yet knowledge is limited about its effectiveness in pond-sized waterbodies, whose size and shape may preclude multi-spectral platforms with large spatial resolutions and increase the probability of mixed pixels. This comparative limnology case study evaluates whether optical remote sensing is a viable tool to monitor HABs in pond-sized waterbodies. We use Sentinel-2 imagery with previously studied chlorophyll-a and cyanobacteria detection algorithms and performed targeted in situ sampling in four small waterbodies in Boulder, CO, USA, from June to August 2021 to validate the algorithms and better understand underlying biogeochemical processes. The chlorophyll-a algorithm indicated persistent algal growth occurred in all waterbodies, yet only Sombrero Marsh chlorophyll-a expressed a statistically significant relationship with the remote sensing output (p < 0.0005, r² = 0.80). Meanwhile, the cyanobacteria algorithm resulted in false negatives, only showing potential cyanobacteria at Sombrero Marsh despite in situ samples from all waterbodies indicating cyanobacteria were present. Samples from Sombrero Marsh had the highest chlorophyll-a (average = 132.5 µg/L) and percent cyanobacteria (average = 43.5%). These findings suggest that there is uncertainty in relying on remote sensing for monitoring HABs in small waterbodies unless a high concentration of algae is present on the water surface. However, in a resource- and time-limited system, remote sensing can be a useful tool as an initial assessment for monitoring algal blooms.

PMID:42247175 | DOI:10.1007/s11356-026-37902-w

Diabetologia. 2026 Jun 5. doi: 10.1007/s00125-026-06758-7. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: The aim of this study was to determine whether overall and time-specific patterns of hyperglycaemia, particularly soon after diagnosis, are associated with incident cancer in adults with newly diagnosed type 2 diabetes.

METHODS: We retrospectively analysed a territory-wide cohort of 52,926 Hong Kong Chinese people with newly diagnosed type 2 diabetes. We examined cancer risk across groups of individuals classified according to their time-weighted mean HbA_1c over the entire follow-up period (n=49,978) or during specific early exposure periods (n=39,185). A weighted cumulative exposure model was used to determine the role of historical HbA_1c exposures in cancer development (n=49,966).

RESULTS: Among 49,978 individuals with newly diagnosed type 2 diabetes, 1758 cancer events occurred. Each 11 mmol/mol (1%) increase in time-weighted mean HbA_1c was associated with a 27% relative higher risk of cancer at any site (HR 1.27; 95% CI 1.20, 1.33). Within the first 2 years after diagnosis, a time-weighted mean HbA_1c ≥53 mmol/mol (≥7.0%) vs <53 mmol/mol (<7.0%) was associated with a 30-75% relative higher risk of cancer at any site, depending on the specific HbA_1c category, even after adjusting for subsequent HbA_1c. Longer durations of early exposure were associated with higher risk, reaching 51-213% in the first 5 years of exposure. Earlier high HbA_1c exposures contributed more strongly to cancer risk than later exposures. A 11 mmol/mol (1%) HbA_1c reduction at 1-2 years was associated with a 6% relative lower cancer risk over a hypothetical 10 year window (HR 0.94; 95% CI 0.91, 0.98), whereas reductions after 5 years showed no significant risk differences.

CONCLUSIONS/INTERPRETATION: Overall, hyperglycaemic exposure was associated with an elevated long-term cancer risk in type 2 diabetes. Notably, individuals who showed better glycaemic management soon after diagnosis exhibited a lower cancer risk than those whose glycaemic management improved later, despite comparable overall glycaemic burdens.

PMID:42247170 | DOI:10.1007/s00125-026-06758-7

Graefes Arch Clin Exp Ophthalmol. 2026 Jun 5. doi: 10.1007/s00417-026-07293-2. Online ahead of print.

ABSTRACT

BACKGROUND: To conduct a comparative analysis of the efficacy and safety profiles of Tofacitinib (Tofa) and Adalimumab (ADA) in individuals diagnosed with refractory Behçet’s uveitis.

METHODS: A retrospective analysis was conducted on the medical records of 64 patients who received Tofa (n = 30) or ADA (n = 34) in routine clinical practice. Treatment allocation was not randomized. The analysis focused on drug response rate, central macular thickness, ocular inflammation parameters, and best-corrected visual acuity at 3, 6, 12, and 24 months after treatment initiation.

RESULTS: A total of 23 patients in the Tofa group (76.6%) and 24 patients in the ADA group (70.5%) achieved remission. Both groups exhibited improvements in mean best-corrected visual acuity (BCVA, Snellen chart, from baseline 0.33 ± 0.31 to 0.54 ± 0.27 in the ADA group, and from baseline 0.31 ± 0.27 to 0.57 ± 0.31 in the Tofa group), central macular thickness (CMT, from baseline 354.53 ± 101 μm to 199.71 ± 57 μm in the ADA group and from baseline 366.77 ± 120 μm to 203.67 ± 71 μm in the Tofa group), anterior chamber cell counts, and vitreous haze. No statistically significant differences were observed between the two groups in these overall outcomes. In an exploratory subgroup analysis, Tofa showed a lower response rate in patients with central occlusive retinal vasculitis, with 1/7 patients responding, whereas 6/8 patients responded in the ADA group (P = 0.041).

CONCLUSIONS: Both ADA and Tofa demonstrated favorable efficacy in treating refractory Behçet’s uveitis in this retrospective real-world study. The observed differences according to vasculitis phenotype should be interpreted cautiously and require confirmation in larger prospective studies.

PMID:42247158 | DOI:10.1007/s00417-026-07293-2

ASAIO J. 2026 Jun 4. doi: 10.1097/MAT.0000000000002759. Online ahead of print.

ABSTRACT

Axillary percutaneous ventricular assist devices (pVADs) are increasingly utilized for refractory cardiogenic shock, yet standardized mobilization protocols are lacking. This study describes a structured mobilization protocol and evaluates its implementation in 196 patients supported with an axillary pVAD from December 2020 to June 2025. Of this cohort, 131 (67%) were mobilized per a progressive multidisciplinary exercise protocol. Mobilized patients achieved significantly higher functional status by intensive care unit (ICU) discharge via Johns-Hopkins Highest Level of Mobility (JH-HLM) scoring (p < 0.001) and hospital discharge (p = 0.002). Longitudinal analysis demonstrated significant stepwise improvement in JH-HLM scores across sessions (p < 0.001) with statistical gains appearing as early as the third session (p < 0.001). Stratified analysis confirmed feasibility across all clinical outcomes, including recovery (p = 0.002), durable left ventricular assist device (LVAD) (p < 0.001), and heart transplant (p = 0.023). Regarding clinical outcomes, the mobilized cohort had a lower mortality rate (12% vs. 58%), higher rates of myocardial recovery (46% vs. 25%), durable LVAD implantation (21% vs. 9%), and heart transplantation (20% vs. 8%) (p < 0.001). This technical report details a safe, reproducible framework for patients with axillary pVAD support, showing that a structured mobilization protocol is feasible and associated with progressive improvement in functional status.

PMID:42247139 | DOI:10.1097/MAT.0000000000002759

Surg Endosc. 2026 Jun 5. doi: 10.1007/s00464-026-12904-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Gastroesophageal Reflux Disease (GERD) is treated primarily with proton pump inhibitors (PPIs), with surgery reserved for patients refractory to PPIs or with symptomatic hiatal hernias. PPI efficacy depends on metabolism by cytochrome P450 2C19 (CYP2C19) in the liver, which varies with genetic polymorphisms. Rapid (RM) and ultra-rapid (UM) metabolizers may require higher PPI doses for efficacy, while poor (PM) and intermediate (IM) metabolizers respond to lower doses but have higher risk of side effects. This study assesses CYP2C19 phenotype prevalence in medically versus surgically managed GERD. We hypothesized a higher RM/UM rate among surgical patients, suggesting PPI resistance.

METHODS: This was a multi-site retrospective cohort study of adult patients with GERD and CYP2C19 genotyping from 2012 to 2023. Medical patients included those with Barrett’s esophagus, LA grade C/D esophagitis, or abnormal pH testing. Surgical patients included those who underwent anti-reflux surgery. CYP2C19 phenotypes were grouped as PM/IM, normal metabolizer (NM), and RM/UM based on the anticipated need for PPI dose adjustment. Descriptive statistics were used for analysis.

RESULTS: A total of 261 patients were included in this study: 187 medical (female: 59%, mean age: 57 (SD 15), 77% White) and 74 surgical (female: 69%, mean age: 58 (SD 13), 89% White). Medical patients included the following esophageal pathologies: 52% Barrett’s esophagus, 31% abnormal pH testing, and 17% LA grade C/D esophagitis. Surgical patients had a significantly higher proportion of RM/UM phenotypes compared to medical patients (p = 0.018). There was also a significant difference in hiatal hernia size between medical and surgical patients (p < 0.001).

CONCLUSION: Surgical patients have a higher prevalence of hypermetabolizing (RM/UM) CYP2C19 phenotypes compared to medical patients. Dose escalation of PPI should be considered in medical patients with these phenotypes, and if ineffective, a timely referral for anti-reflux surgery should be made.

PMID:42247133 | DOI:10.1007/s00464-026-12904-4

J Orthop Traumatol. 2026 Jun 5. doi: 10.1186/s10195-026-00937-3. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic-assisted total knee arthroplasty (RA-TKA) is increasingly being adopted for its ability to enhance bone-resection accuracy and component alignment. However, whether these technical gains influence the risk of periprosthetic joint infection (PJI) remains uncertain, especially in the context of prolonged operative duration. This study aimed to compare the 1-year rate of PJI following conventional total knee arthroplasty (cTKA) and RA-TKA in a propensity-score-matched cohort.

METHODS: We retrospectively reviewed 1284 consecutive patients who underwent primary TKAs at a single centre between 2021 and 2023. The patients were stratified according to surgical technique (cTKA versus RA-TKA) and subsequently matched 1:1 using propensity score analysis (age, sex, body mass index [BMI], American Society of Anesthesiologists [ASA] score, Charlson Comorbidity Index [CCI] score, CCI components and smoking), resulting in 522 pairs (1044 patients) for the final comparative analysis. Operative time and 1-year PJI were assessed using multivariable logistic regression. Infections were stratified according to timing: ≤ 90 days and from 90 days to 1 year after surgery.

RESULTS: The 1-year rate of PJI was 0.77% (4/522) after RA-TKA and 0.96% (5/522) after cTKA (P = 1.000). All PJIs in patients who underwent RA-TKA occurred within 90 days, whereas PJIs in patients who underwent cTKA occurred in both time windows. Multivariable logistic regression analysis did not identify surgical modality as an independent predictor of PJI (adjusted odds ratio [OR] 0.75, 95% confidence interval [CI] 0.22-2.90; P = 0.57). The median operative time was longer in the RA-TKA group than in the cTKA group (115 (range, 90-145) versus 85 (range, 60-105) min; P < 0.001).

CONCLUSIONS: RA-TKA was associated with a longer operative time, while no statistically significant difference in 1-year PJI rates was detected compared with cTKA. Nevertheless, these findings should be interpreted cautiously given the limited number of infection events.

LEVEL OF EVIDENCE: Level 3, non-randomised observational study.

PMID:42247101 | DOI:10.1186/s10195-026-00937-3