Category: Statistics

Enzyme Microb Technol. 2026 May 8;199:110898. doi: 10.1016/j.enzmictec.2026.110898. Online ahead of print.

ABSTRACT

Enzyme-linked immunosorbent assays (ELISA) commonly use horseradish peroxidase (HRP) to detect chromogenic and chemiluminescent signals. The enzymatic oxidation of these probes requires hydrogen peroxide, which is inherently unstable at ambient temperature and pH, thus affecting the reproducibility and long-term storage stability of the assays. In this study, an enzyme-mediated peroxide supply using glucose oxidase (GOD)/glucose was established as an alternative source of hydrogen peroxide for chemiluminescent ELISA. The performance of the system was evaluated relative to that of conventional ELISA using hydrogen peroxide solution. The optimal reaction conditions were estimated, including GOD and glucose concentrations, as well as the reaction time for the chemiluminescent ELISA. The performance of the enzyme-mediated hydrogen peroxide supply was demonstrated using four commercial ELISA kits for the detection of alpha-fetoprotein (AFP), hepatitis B surface antigen (HBsAg), human immunodeficiency virus 1/2 antibody (HIV-1/2 Ab), and carcinoembryonic antigen (CEA). The GOD-mediated hydrogen peroxide supply-based ELISA achieved a limit of detection (LOD) comparable to that obtained with the conventional hydrogen peroxide condition, a high statistical agreement (|mean bias| ≤ 0.02, |95% limit of agreement (LoA)| ≤ 0.15, Spearman’s ρ > 0.96).

PMID:42143822 | DOI:10.1016/j.enzmictec.2026.110898

Eur J Oncol Nurs. 2026 May 16;82:103212. doi: 10.1016/j.ejon.2026.103212. Online ahead of print.

ABSTRACT

PURPOSE: Research on bereavement has mainly focused on risk factors linked to negative outcomes, while protective factors have been less evaluated. This study investigated the associations of resilience and perceived support from healthcare professionals with self-reported health-related quality of life (HRQoL) in young adults who had lost a sibling to cancer 2-10 years earlier. Additionally, the study explored gender differences in HRQoL, resilience, and perceived social support from healthcare professionals.

METHODS: Of 99 young adults who experienced the loss of a sibling to cancer between 2009 and 2014, 36 participants (response rate = 36.4%) were included in this nationwide Norwegian study. We measured HRQoL (Young Adult Version of the Pediatric Quality of Life), resilience (Resilience Scale for Adolescents), and perceived social support from healthcare professionals during the sibling’s illness, following the death, and during the past year.

RESULTS: Participants were aged 18-26 years at the time of the survey, with the loss occurring 2.5-10 years prior. We did not detect statistically significant gender differences in HRQoL, resilience, or perceived social support. Analysis showed that higher resilience and greater perceived social support during the past year were significantly associated with higher HRQoL among bereaved siblings (adjusted R² = 0.62; F(6, 35) = 14.7; p < 0.001).

CONCLUSION: Young adults with higher resilience and stronger perceived social support during the past year reported better HRQoL 2-10 years after the loss of a sibling to cancer. These results underscore the need to enhance resilience and provide ongoing psychosocial care beyond early bereavement to promote long-term HRQoL among bereaved siblings.

PMID:42143816 | DOI:10.1016/j.ejon.2026.103212

Zoology (Jena). 2026 May 7;176-177:126338. doi: 10.1016/j.zool.2026.126338. Online ahead of print.

ABSTRACT

Blindsnakes (Scolecophidia) are among the most morphologically conservative reptiles, yet the extent and nature of their phenotypic variation is poorly documented. We provide an integrative assessment of allometry and trophic ecology in two sympatric species of Amerotyphlops from the Atlantic Forest of northeastern Brazil, A. brongersmianus and A. paucisquamus. Based on 100 individuals, we combined morphometric, reproductive, dietary, and phenological data to discuss how fossoriality influences body shape and ecological strategies. A. brongersmianus exhibited greater overall robustness, with females displaying significant allometric shifts in snout and trunk width, whereas A. paucisquamus showed somatic isometry (including body mass), contrasting with strong positive allometry in reproductive organs. Regarding sexual dimorphism, neither species exhibited statistically significant differences in body proportions after correction for multiple comparisons, although A. brongersmianus presented higher SSD indices. Reproductive allometry revealed divergent strategies, contrasting the negative scaling of testis width in A. brongersmianus with the marked positive scaling of testicular dimensions in A. paucisquamus. Furthermore, while A. brongersmianus lacked significant bilateral asymmetry, A. paucisquamus exhibited directional asymmetry in testis width. The species displayed distinct phenologies associated with rainfall, yet shared an exceptionally narrow myrmecophagous niche, feeding almost exclusively on ant brood. Morphological differences in cranial width and trunk robustness align with distinct prey assemblages and soil use, although these differences fall within a narrowly conserved morphofunctional space, implying fine-scale ecological partitioning. Our results show that morphological stasis in Amerotyphlops may coexist with modest, non-pervasive adaptive adjustments along constrained functional axes, highlighting how subtle developmental and ecological modulations sustain evolutionary persistence in fossorial lineages.

PMID:42143808 | DOI:10.1016/j.zool.2026.126338

Heart Lung. 2026 May 17;79:102839. doi: 10.1016/j.hrtlng.2026.102839. Online ahead of print.

ABSTRACT

BACKGROUND: Community-acquired pneumonia (CAP) is a significant global health burden, particularly in severe cases. Corticosteroids have been proposed as adjunctive therapy to improve outcomes, though evidence remains mixed.

OBJECTIVE: To determine the effect of corticosteroid therapy on mortality and morbidities in patients with CAP.

METHODS: We conducted a systematic review and meta-analysis of 20 randomized controlled trials (RCTs) involving 5,866 adult patients with CAP. Studies comparing systemic corticosteroids to placebo or usual care were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel and inverse variance methods under a random-effects model. Statistical heterogeneity was assessed using the I² statistic.

RESULTS: Corticosteroids did not significantly reduce overall mortality (RR 0.84; 95% CI: 0.68-1.03; p = 0.10), but a significant reduction was observed in patients with severe CAP (n = 3,326; RR 0.73; 95% CI: 0.57-0.93; p = 0.01). No mortality benefit was seen in less severe CAP (n = 2,451; RR 1.14; 95% CI: 0.89-1.45; p = 0.31). Hospital length of stay was significantly reduced with corticosteroids (n = 4,175; MD -2.13 days; 95% CI: -3.07 to -1.19; p < 0.00001), with reductions observed in both less severe (-1.03 days) and severe CAP (-3.04 days). ICU stay was also shorter in the corticosteroid group (MD -1.70 days; p = 0.005). Corticosteroids did not significantly increase the need for mechanical ventilation (RR 0.57; p = 0.10), or increase the risk of secondary infections (RR 0.99; p = 0.92), or gastrointestinal bleeding (RR 0.80; p = 0.29).

CONCLUSION: Corticosteroids improve outcomes in severe CAP by reducing mortality and duration of hospitalization without increasing adverse events. Routine use in less severe CAP is not supported.

PMID:42143791 | DOI:10.1016/j.hrtlng.2026.102839

J Crit Care. 2026 May 17;95:155613. doi: 10.1016/j.jcrc.2026.155613. Online ahead of print.

ABSTRACT

BACKGROUND: Central venous catheters have been historically preferred over peripheral venous catheters for the administration of vasoactive medications in critically ill patients to reduce the risk of extravasation. Peripheral vasopressor administration is gaining attention as a strategy to expedite initiation while avoiding the procedural risks of central venous catheter placement. Although prior systematic reviews have focused on anatomical site and peripheral venous catheter gauge, the impact of implementing a peripheral vasopressor protocol on the safety profile of peripheral vasopressor administration has not been systematically evaluated.

OBJECTIVE: To determine whether a peripheral vasopressor protocol influences the safety profile of peripherally administered vasopressors in critically ill patients.

STUDY DESIGN AND METHODS: A comprehensive search was conducted across MEDLINE (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials (Ovid), and PubMed, encompassing studies published since January 2000. Statistical analysis was conducted using R (v. 4.4.3; https://www.r-project.org/), with two-tailed significance set at p < 0.05.

RESULTS: A total of 22 studies involving 10,983 adult patients (≥18 years) were identified. Median extravasation rates were similar between studies using a peripheral vasopressor protocol and those not (33.5 [12.3-53.0] vs. 31.2 [12.0-39.6] per 1000 patients), with no statistically significant difference (U = 68, p = 0.78).

CONCLUSION: This review demonstrated that peripheral vasopressor protocols did not yield statistically significant reductions in extravasation rates among patients receiving peripheral vasopressor therapy.

PMID:42143789 | DOI:10.1016/j.jcrc.2026.155613

J Eval Clin Pract. 2026 Jun;32(4):e70466. doi: 10.1111/jep.70466.

ABSTRACT

BACKGROUND: While controlled interrupted time series (CITS) are commonly used to evaluate public health policies, how to incorporate control(s) into their statistical modelling has received limited attention. We aimed to compare the statistical performance of different model formulations for including control groups in various segmented regression model specifications (with a particular focus on CITS and Difference-in-Difference [DiD] designs) under conditions where their assumptions are met, as well as when they are violated.

METHODS: Based on a real-world dataset, we simulated and compared the statistical performance of four model formulations grounded on segmented regressions for including control groups in a pre- and post-evaluation. The compared model formulations were: (1) CITS segmented regression, (2) DiD segmented regression, (3) single ITS of the difference between control and intervention series, and (4) incorporating the control as a covariate in a single ITS. Models were tested across scenarios challenging assumptions around the control group (e.g., non-parallel trends -challenging DiD assumptions-, or inconsistent trend difference over time between groups -challenging CITS assumption-) or regression errors (e.g., heteroscedasticity or autocorrelation). We also included models, including restricted cubic splines of time, which may mitigate distortions from assumption violations. Additionally, we tested for detecting non-parallel trends.

RESULTS: Standard DiD, CITS, and the ITS of the difference between series yielded the lowest bias whenever their design assumptions were satisfied. Overall, including time splines as covariates into ITS of the difference between series achieved the lowest bias and highest coverage also when design assumptions were violated. This makes it a valuable tool for causal inference in settings with parallel, non-parallel or inconsistent trend patterns between groups. Since violations of the trends assumption are often undetectable, methods robust to such violations are extremely valuable.

CONCLUSIONS: Modelling CITS as an ITS of the difference between series is among the most robust methods to embed control series into model specifications. Incorporating time splines as model covariates within an ITS of the difference has the potential of reducing bias from assumption violations (including parallel trends) without negative impacts when assumptions hold.

PMID:42143773 | DOI:10.1111/jep.70466

J Urol. 2026 May 17:101097JU0000000000005091. doi: 10.1097/JU.0000000000005091. Online ahead of print.

ABSTRACT

PURPOSE: Medication cessation is an important motivator for patients undergoing benign prostatic hyperplasia (BPH) surgery; however, evidence on this topic remains limited. We evaluated rates and probabilities of BPH and overactive bladder (OAB) medication cessation in a statewide cohort.

MATERIALS AND METHODS: Using Michigan statewide claims data (2017-2022) from the Michigan Value Collaborative, patients who underwent BPH surgery with pre-existing BPH or OAB medications were identified. Procedures were categorized as (1) transurethral surgery, including transurethral resection of the prostate (TURP), laser photovaporization (PVP), robotic waterjet therapy (RWJT), and laser enucleation of the prostate (LEP); (2) minimally invasive surgical therapies (MISTs), including water vapor thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic artery embolization (PAE), and transurethral microwave thermotherapy (TUMT); and (3) simple prostatectomy (SP). Medication cessation was defined as no refills between 181 and 365 days postoperatively. Multivariable logistic regression estimated procedure-specific probabilities of cessation.

RESULTS: Among 12,633 patients with continuous pharmacy enrollment, 8628 (68%) were prescribed BPH medications and 933 (7%) were prescribed OAB medications preoperatively. Medication cessation occurred in 61% and 62% of the BPH and OAB cohort, respectively. Predicted probabilities of BPH medication cessation were highest for LEP and SP (≥ 84%) and lowest for MISTs (< 60%). No statistically significant differences in OAB medication cessation were found across procedures.

CONCLUSIONS: In this real-world, statewide cohort, BPH medication cessation varied by procedure type. Transurethral surgeries and SP were associated with higher BPH medication cessation rates, while minimally invasive surgical therapies had lower rates. These findings provide practical estimates to inform shared decision-making and counseling when considering BPH interventions.

PMID:42143772 | DOI:10.1097/JU.0000000000005091

Clin Exp Dent Res. 2026 Jun;12(3):e70379. doi: 10.1002/cre2.70379.

ABSTRACT

BACKGROUND AND OBJECTIVES: Periodontitis is a chronic inflammatory disease affecting tooth-supporting structures, while depression is a common mental disorder with emotional and behavioral disturbances. Previous studies suggest a potential association between the two conditions. This study aimed to evaluate salivary concentrations of Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL) and Osteoprotegerin (OPG)-key regulators of osteoclast activity and periodontal bone resorption-in patients with periodontitis and depression.

MATERIALS AND METHODS: In this cross-sectional study, 80 patients from Shahid Beheshti University Dental School were categorized into four groups based on the presence or absence of periodontitis and depression. Periodontitis was defined as having ≥ 2 teeth in ≥ 2 quadrants with bleeding on probing, pocket depth > 3 mm, and interdental clinical attachment loss ≥ 1 mm. Depression was assessed using the Persian PHQ-9, and individuals meeting criteria for major depressive disorder(MDD) were classified as depressed. Unstimulated saliva samples (1 mL) were collected, stored at -20°C, and analyzed for OPG and RANKL using ELISA kits. Statistical analyses included two-way ANOVA (SPSS v27; p < 0.05 significant).

RESULTS: Among 80 participants (43 females, 37 males; mean age 45.3 years), RANKL, OPG, and the RANKL/OPG ratio were higher in depressed individuals, but differences were not statistically significant (p > 0.05). RANKL levels and the RANKL/OPG ratio were significantly higher in patients with periodontitis and increased with disease severity (p ≤ 0.05), while OPG showed no significant change.

CONCLUSION: Periodontitis and its severity significantly influence salivary RANKL and the RANKL/OPG ratio, while depression does not. Within the limits of this cross-sectional design, no evidence was found that RANKL and OPG act as intermediary biomarkers linking depression and periodontitis.

PMID:42143768 | DOI:10.1002/cre2.70379

Clin Exp Dent Res. 2026 Jun;12(3):e70371. doi: 10.1002/cre2.70371.

ABSTRACT

OBJECTIVES: The relationship between tooth loss and glycemic control status in diabetes is inconclusive.

MATERIAL AND METHODS: Using data from the 2014-2018 Korean National Health and Nutrition Examination Survey (KNHANES), 2146 adults with diabetes aged ≥ 40 years were categorized by number of remaining teeth (0-19, 20-27, and ≥ 28). Uncontrolled diabetes and poorer glycemic control were defined as HbA1c ≥ 6.5% and ≥ 7.0%, respectively. Multivariable logistic regression models calculated the odds ratio (OR) for uncontrolled diabetes and poorer glycemic control according to the number of remaining teeth.

RESULTS: No significant association was observed in men. In women, fewer remaining teeth were associated with higher odds of uncontrolled diabetes (per 1-tooth increase OR 0.961, 95% CI 0.937-0.986; p = 0.002), and compared with ≥ 28 teeth, OR were higher in the 0-19 teeth (OR 2.500, 95% CI 1.535-4.074) and the 20-27 teeth (OR 1.679, 95% CI 1.073-2.629) (all p = 0.002). Furthermore, among women, the associations persisted in both 40-59 years (per 1-tooth increase OR 0.878, 95% CI 0.780-0.988; p = 0.030) and ≥ 60 years (per 1-tooth increase OR 0.965, 95% CI 0.939-0.992; p = 0.011). Among women aged ≥ 60 years, those with 0-19 teeth had higher odds of uncontrolled diabetes (OR 1.994, 95% CI 1.041-3.818; p = 0.029) and poorer glycemic control (OR 2.498, 95% CI 1.321-4.723; p = 0.008) compared with those with ≥ 28 teeth.

CONCLUSIONS: Fewer remaining teeth were associated with poorer glycemic control among women with diabetes, independent of periodontitis. This association was most pronounced in women aged ≥ 60 years. Large cohort studies are warranted to clarify causality and to evaluate the roles of periodontitis and dental caries in this relationship.

PMID:42143765 | DOI:10.1002/cre2.70371

G Ital Nefrol. 2026 Apr 30;43(2):2026-vol2. doi: 10.69097/43-02-2026-05.

ABSTRACT

Introduction. The utility of salivary bicarbonate as a non-invasive marker of systemic acid-base status in pediatric patients remains unclear. This study investigated the possible correlation between salivary and blood gas analysis at risk for acid-base disturbances, including those with chronic kidney disease (CKD) or receiving acetazolamide. Methods. In a single-center cross-sectional study (July 2024-March 2025), 94 pediatric patients (6-18 years) underwent simultaneous blood and saliva sampling for gas analysis. Patients were stratified into metabolic acidosis (<22 mmol/L), normal (22-26 mmol/L), or metabolic alkalosis (>26 mmol/L) groups based on serum bicarbonate. Results. No relationship was observed between salivary and serum bicarbonate (r = 0.112, p = 0.281), pH, or base excess. However, strong correlations emerged within salivary parameters: bicarbonate was positively associated with salivary pH (r = 0.682, p < 0.001) and base excess (r = 0.865, p < 0.001). Patients with eGFR <30 ml/min/1.73m² had significantly higher salivary bicarbonate (13.6 mmol/L vs 6.8 mmol/L, p = 0.004), independently of bicarbonate supplementation. This was also negatively associated with calcium (β = -8.67, p = 0.004) and lactate (β = -0.82, p = 0.008). Dialysis status and underlying diagnosis were additional independent predictors. While patients with metabolic acidosis showed higher median salivary bicarbonate than those with normal or alkalotic profiles, this difference was not statistically significant (p = 0.545). Conclusions. Salivary bicarbonate does not reflect systemic acid-base balance but is elevated in advanced CKD, suggesting a local regulatory phenomenon worthy of further exploration.

PMID:42143748 | DOI:10.69097/43-02-2026-05