Category: Statistics

Front Endocrinol (Lausanne). 2026 Apr 21;17:1735979. doi: 10.3389/fendo.2026.1735979. eCollection 2026.

ABSTRACT

OBJECTIVE: Research on the association between TyG-GGT index and diabetes mellitus (DM) risk remains scarce. This study aimed to investigate the relationship between TyG-GGT and DM incidence.

METHODS: This retrospective cohort investigation enrolled 8,678 participants who underwent comprehensive health screenings at Kuichong People’s Hospital in Shenzhen from 2018 through 2023. Cox proportional hazards regression models were employed to assess the association between TyG-GGT and DM risk, and Cox proportional hazards regression model with restricted cubic spline functions was used to evaluate non-linear relationships. Subgroup analyses and sensitivity analyses further verified the stability of these findings. Finally, receiver operating characteristic (ROC) curve methodology and time-dependent ROC analysis were performed to determine the predictive capacity of TyG-GGT for incident DM within a 5-year period.

RESULTS: Following multivariable adjustments, higher TyG-GGT levels were found to be associated with elevated DM risk, demonstrating an HR of 1.116 (95% CI: 1.041-1.196) per 50-unit increase in TyG-GGT. Additionally, a non-linear association between them was observed, exhibiting a threshold value at 380. When below this inflection point, the HR per 50-unit increase in TyG-GGT was 1.723 (95% CI: 1.500-1.979), while above this value the association was not statistically significant. Additionally, in predicting DM risk, TyG-GGT had the highest AUC value (0.732), while the AUC values of TG (0.635), GGT (0.649), FPG (0.660), and TyG (0.675) were all lower than this value. Time-dependent ROC analysis revealed that the AUC values of TyG-GGT remained stable between 0.7292-0.7338 over a prediction horizon of 1.0 to 5.0 years. The stability of these results was further corroborated via sensitivity analysis.

CONCLUSION: This study found that TyG-GGT demonstrated an independent positive association and non-linear relationship with DM risk, with an inflection point at 380. TyG-GGT below 380 was associated with higher observed DM risk. Additionally, TyG-GGT exhibits discriminatory performance for DM risk assessment and may serve as a clinically useful predictor, thereby aiding clinicians in early identification of high-risk individuals and providing a novel perspective for optimizing clinical prevention and management of DM.

PMID:42095185 | PMC:PMC13138955 | DOI:10.3389/fendo.2026.1735979

Front Endocrinol (Lausanne). 2026 Apr 21;17:1801280. doi: 10.3389/fendo.2026.1801280. eCollection 2026.

ABSTRACT

BACKGROUND: Cardiometabolic multimorbidity (CMM) has become an increasingly serious public health problem. Patients with type 2 diabetes mellitus (T2DM) often present with multiple cardiometabolic disorders and carry a significantly higher risk of CMM. Insulin resistance (IR) is the core mechanism of T2DM and atherosclerotic cardiovascular disease. The triglyceride-glucose index (TyG index) can serve as a reliable alternative for evaluating IR. The pericoronary fat attenuation index (FAI) is a non-invasive biomarker of coronary inflammation based on coronary CT angiography. However, the combined associations of the TyG index and FAI with CMM among patients with T2DM remain unknown. Therefore, this study aims to evaluate the TyG index, RCA-FAI, LAD-FAI, and LCX-FAI in relation to CMM among middle-aged and elderly patients with T2DM in China.

METHOD: We conducted a cross-sectional study and enrolled 497 middle-aged and elderly patients (aged ≥45 years) with T2DM who underwent coronary CT angiography for clinical indications. We defined CMM as the concurrent presence of T2DM together with coronary heart disease or stroke. We used a multivariate logistic regression model to analyze the association between the TyG index and the FAI in each coronary segment (including RCA-FAI, LAD-FAI, and LCX-FAI) with CMM. We presented the study results as odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). We employed restricted cubic splines to analyze the nonlinear relationship and used receiver operating characteristic (ROC) curves to assess the discriminatory capacity of each index in identifying CMM.

RESULT: After fully adjusting for confounding factors, the TyG index (OR = 2.07, 95% CI: 1.44-2.99), RCA-FAI (for each increase of 1 unit: OR = 1.19, 95% CI: 1.14-1.23), LAD-FAI (OR = 1.16, 95% CI: 1.12-1.21), and LCX-FAI (OR = 1.11, 95% CI: 1.07-1.15) were all significantly and positively associated with CMM (all P < 0.001).Dosage-response analysis revealed nonlinear associations of the TyG index and LAD-FAI with CMM (P for nonlinearity < 0.05), whereas RCA-FAI and LCX-FAI showed linear relationships. Receiver operating characteristic (ROC) curve analysis was further performed to evaluate the discriminatory performance of each indicator for CMM. Among these indices, adding the RCA-FAI showed the most pronounced improvement, with a C-statistic of 0.900 (95% CI: 0.873-0.926, P < 0.001), a net reclassification improvement (NRI) of 0.749 (95% CI: 0.585-0.913, P < 0.001), and an integrated discrimination improvement (IDI) of 0.141 (95% CI: 0.110-0.171, P < 0.001). In contrast, adding the TyG index did not meaningfully improve the predictive value of the baseline clinical model.

CONCLUSION: This study confirms that among middle-aged and elderly Chinese patients with T2DM, both the TyG index and FAI, including RCA-FAI, LAD-FAI, and LCX-FAI, are independently and positively associated with CMM. However, only coronary FAI indices significantly improve the discriminatory capacity for CMM, with RCA-FAI showing the strongest association and incremental predictive value. These findings suggest that FAI could serve as a useful imaging biomarker for identifying CMM status in patients with T2DM.

PMID:42095180 | PMC:PMC13138975 | DOI:10.3389/fendo.2026.1801280

J Liq Biopsy. 2026 Apr 26;12:100470. doi: 10.1016/j.jlb.2026.100470. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Radiomics and liquid biopsy represent minimally invasive approaches to assess disease characteristics in solid tumors. We integrated computed tomography (CT) radiomics and circulating tumor DNA (ctDNA) analysis to enhance prognostic stratification and longitudinal monitoring in patients with advanced non-small cell lung cancer (NSCLC).

METHODS: This study prospectively enrolled 91 patients with advanced NSCLC. Baseline molecular profiling was performed on both tumor tissue and plasma ctDNA using targeted next-generation sequencing. Radiomic features were extracted from baseline CT lung lesions using PyRadiomics, and radiomic scores (RS) were developed using LASSO-regularized Cox models. A subgroup of 21 patients with actionable molecular alterations underwent longitudinal CT scans and liquid biopsies during targeted therapy. Clinical, radiomic, and molecular associations with overall survival (OS) and disease-free survival (DFS) were evaluated using log-rank tests and included in multivariable models.

RESULTS: Overall concordance between tissue and ctDNA (n = 67 patients) was 85%. In the combined clinical-radiomic-genetic model (C-index: 0.73), the RS (p < 0.001) and the presence of actionable alterations (p = 0.041) were independent OS predictors. For DFS, the integrated model achieved a cross-validated C-index of 0.77, outperforming the clinical-only model (0.59). In patients with EGFR-mutant NSCLC, detectable baseline ctDNA was significantly associated with a higher risk of disease progression (p = 0.018). In this subgroup, the combined clinical-radiogenomic model achieved a cross-validated C-index of 0.80 for DFS. Longitudinal analysis showed that 17 of 21 patients achieved molecular clearance of ctDNA at the first follow-up, correlating with treatment response.

CONCLUSIONS: Integrating radiomics with liquid biopsy provides a more robust prognostic assessment of advanced NSCLC than clinical or molecular data alone. This multi-modal approach may offer a minimally invasive strategy for personalized risk stratification and monitoring of treatment response in patients with NSCLC.Clinicaltrials.gov identifier: NCT06331975.

PMID:42095156 | PMC:PMC13141799 | DOI:10.1016/j.jlb.2026.100470

Front Cardiovasc Med. 2026 Apr 21;13:1673478. doi: 10.3389/fcvm.2026.1673478. eCollection 2026.

ABSTRACT

BACKGROUND: The aim of this study was to establish sex- and age-specific reference values for ramp cycle-ergometer and treadmill cardiopulmonary exercise testing (CPET) in patients with Tetralogy of Fallot (ToF). Despite successful surgical repair, residual pulmonary regurgitation remains common in repaired ToF (rToF), often leading to right or left ventricular dysfunction and reduced exercise capacity. CPET is a reliable tool for evaluating cardiopulmonary function. Although both treadmill and cycle ergometer protocols are used interchangeably, reference value ranges for each method in this population remain unclear.

METHOD: CPET data were collected from asymptomatic rToF patients who had undergone cardiac magnetic resonance imaging (CMR) and performed CPET on a treadmill or cycle ergometer between 2020 and 2024. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ).

RESULTS: Among 290 patients, median age at CPET was 21.6 years (15.9-29.3), and median BMI was 22.5 kg/m² (20.0-24.9). Nearly all participants (99%) were in NYHA class I. Physical activity was classified as sedentary in 29%, moderate in 61%, and high in 9%. Median VO₂ peak was 26.4 mL/min/kg (23.0-31.5), corresponding to 72.9% predicted (62.4-83.2). Median oxygen pulse at peak was 9.9 mL/beat (8.2-12.0), with 76.9% predicted (68.0-87.5). Median VE/VCO₂ slope at the respiratory compensation point was 29.0 (26.0-32.6), and median oxygen uptake efficiency slope (OUES) was 1,792.5 mL/min/log(L/min) (1,535.0-2,181.5). VO₂ peak and percent-predicted VO₂ were significantly higher with treadmill testing in both sexes (p < 0.05); oxygen pulse was higher only in females. VE/VCO₂ slope and OUES were unaffected by modality. When stratified by age (<18 vs. ≥18 years), treadmill-related differences in VO₂ peak and percent-predicted VO₂ remained significant in both sexes ≥18 years, and in females <18 years. Oxygen pulse was significantly higher with treadmill only in females ≥18 years. VE/VCO₂ slope and OUES remained unchanged across modalities and age groups.

CONCLUSION: This study provides CPET values stratified by modality and sex in a large cohort of asymptomatic rToF patients, offering valuable reference data for clinical assessment. Future studies should validate pediatric normative CPET values through prospective, inclusive, statistically powered cohorts using standardized protocols and cross-center comparability.

PMID:42095152 | PMC:PMC13139358 | DOI:10.3389/fcvm.2026.1673478

Front Cardiovasc Med. 2026 Apr 21;13:1803696. doi: 10.3389/fcvm.2026.1803696. eCollection 2026.

ABSTRACT

BACKGROUND: The relationship between gastric cancer and cardiovascular traits, including hypertension and coronary artery disease (CAD), remains incompletely understood. Observational studies are prone to confounding and reverse causation, and genetic evidence may help clarify the nature of these associations.

METHODS: We conducted a bidirectional two-sample Mendelian randomization (MR) analysis using publicly available genome-wide association study (GWAS) summary statistics to investigate the relationships between gastric cancer, hypertension, and CAD. Multiple MR methods and sensitivity analyses were applied to assess robustness. To provide supplementary clinical context, we additionally conducted a small retrospective clinical analysis of 45 individuals, including gastric cancer cases and non-cancer controls, using logistic regression adjusted for age and sex.

RESULTS: MR analyses showed no evidence that genetic liability to gastric cancer was associated with the risk of hypertension or CAD. In contrast, genetic predisposition to hypertension was inversely associated with gastric cancer risk. These findings were consistent across sensitivity analyses. In the retrospective cohort, hypertension was not significantly associated with gastric cancer risk.

CONCLUSIONS: This study provides genetic evidence supporting an inverse association between hypertension liability and gastric cancer risk. However, the supplementary retrospective clinical analysis was limited by its small sample size and did not provide independent validation of the MR findings. Larger observational studies are needed. Further studies are warranted to clarify the underlying biological mechanisms.

PMID:42095144 | PMC:PMC13138934 | DOI:10.3389/fcvm.2026.1803696

Access Microbiol. 2026 May 5;8(5):000945.v5. doi: 10.1099/acmi.0.000945.v5. eCollection 2026.

ABSTRACT

Background. Antibiotic misuse, influenced by urbanization and limited healthcare access, has accelerated antibiotic resistance, impacting global health. Surveillance in Sri Lanka’s National Strategic Plan for Combating Antimicrobial Resistance (2017-2022) shows significant multidrug resistance in hospitals, with 12.7% of the health budget (3.3 billion) spent on antimicrobials. This resistance complicates treatment and increases patient management costs, particularly in the Western Province, a focal area for analysing antibiotic misuse. Objectives. To assess public awareness of antibiotic misuse and antimicrobial resistance in the Western Province of Sri Lanka. Methodology. A cross-sectional study was conducted on 200 adults in the Western Province from 23 December 2023 to 16 January 2024, using in-person interviews and a Google form questionnaire. Descriptive statistics were applied to analyse the data, and a binary logistic regression analysis was conducted to identify predictors of antimicrobial resistance (AMR) knowledge among participants. The model included sociodemographic, behavioural and awareness-related variables, with statistical significance set at P<0.05. Results. Of the respondents, 83% knew antibiotics combat bacterial infections, while 71.5% adhered to completing antibiotic courses. However, 28.5% opposed doing so, with 65.5% stopping antibiotics once they felt better. Regarding antimicrobial resistance, 60.5% recognized the term, and 61% acknowledged that unnecessary antibiotic use could increase bacterial resistance. Participants from the Kalutara District had nearly nine times more good AMR knowledge (AOR=9.10, P=0.005), while those earning LKR 20,000-75,000 had almost 11 times more good knowledge (AOR=11.10, P=0.033) and those who followed the advice of a health professional had even more knowledge (AOR=851.08, P=0.016). Poor knowledge was observed from the rural population (AOR=0.15, P=0.006) and those who had ever been infected (AOR=0.21, P=0.023). Good knowledge was also present among those who had been divorced or widowed (AOR=12.21, P=0.029), had used antibiotics privately and without prescriptions (AOR=4.67, P=0.027) or who had heard of AMR but could not remember the source (AOR=51.60, P<0.001). Conclusion. Most participants understood antibiotics’ role, though gaps in correct use and awareness of misuse consequences persisted. While there was a positive attitude towards antimicrobial resistance, further educational efforts are essential to address knowledge gaps, as recent studies show high resistance levels and limited progress in awareness.

PMID:42095137 | PMC:PMC13143338 | DOI:10.1099/acmi.0.000945.v5

J Build Phys. 2025 Oct 17;49(6):829-851. doi: 10.1177/17442591251367436. eCollection 2026 May.

ABSTRACT

Low-cost indoor air quality (IAQ) sensors offer new opportunities for real-time monitoring in the built environment by occupants and researchers. However, their performance can vary substantially depending on the environmental conditions. This study presents a comprehensive evaluation of carbon dioxide (CO₂) and fine particulate matter (PM_2.5) measurements from two consumer-grade low-cost sensors (the Airthings View Plus for CO₂ only and Air Gradient Pro for CO₂ and PM_2.5) through co-location tests with two reference instruments, Graywolf DSII-8 for CO₂ and Lighthouse Handheld 3016 for PM_2.5. Using time-series analysis, linear regression, Pearson correlation, Root-Mean Squared Error (RMSE), Bland-Altman test, and paired t-tests, we assess the precision and accuracy of these sensors. At a 5-minute sampling interval, the Air Gradient sensor had a higher coefficient of determination (R ²), stronger Pearson correlation, and narrower range of limits of agreement (LoAs), but higher bias (i.e. the mean difference) and RMSE, suggesting higher precision but lower accuracy when compared to Airthings. As a result, it can perform well for tracking the relative changes in CO₂, though less ideal for absolute concentrations without calibration. For PM_2.5, the Air Gradient also had relatively high R ² (0.79), moderately strong Pearson correlation (ρ = 0.69, p < 0.05), and a narrow range of LOAs (30.1 μg/m³) and low RMSE (5.8 μg/m³). Averaging the 5-minute measurements over 30-minute intervals generally improved the accuracy and precision of both sensors. However, statistically significant differences from the reference instruments remained for both sensors. Overall, this study offers a multi-metric assessment of consumer-grade sensors and highlights the need for in-situ calibration prior to long-term deployment.

PMID:42095132 | PMC:PMC13143174 | DOI:10.1177/17442591251367436

JB JS Open Access. 2026 May 6;11(2):e25.00315. doi: 10.2106/JBJS.OA.25.00315. eCollection 2026 Apr-Jun.

ABSTRACT

BACKGROUND: Surgical skill assessment in orthopaedic trauma surgery still relies on subjective expert ratings, which limits consistency and scalability. While digitalization offers a path toward objective and scalable assessment, the highly manual and haptic nature of surgery makes tool use difficult to capture digitally, keeping such approaches underdeveloped. This study introduces a digital assessment framework for orthopaedic trauma training that derives digital behavioral metrics (DBM) from tracked surgical tool motion. Specifically, it investigates (1) which DBM indicate technical proficiency and (2) to what extent these DBM are capable of predicting expert-rated surgical performance.

METHODS: Twenty-eight participants performed 3 standardized fracture fixations on synthetic bone models of the radius, ulna, and fibula. Tool motion was captured and transformed into a digital twin from which metrics such as path length, smoothness, and task duration were derived. These metrics were statistically compared with the average Global Rating Scale (GRS) obtained from 4 experts who rated each surgical performance. (1) Correlation analysis identified skill-relevant metrics and (2) a predictive model was trained to estimate performance from DBM evaluating its accuracy against the individual expert ratings.

RESULTS: (1) Several DBM were found to be indicative of surgical performance. Measures based on tool path length and time per activity showed strong correlations with expert ratings, reaching coefficients of up to 0.6. Correlation strength varied across tools and procedures. (2) The predictive model achieved a mean absolute difference of 3.8 points from the average GRS score (scale range: 28-70), outperforming the mean interexpert difference of 4.6 points.

CONCLUSION: DBM were identified as valid indicators of surgical skill. The study further demonstrated their predictive value, showing closer alignment with experts’ average GRS score than individual expert ratings. These findings highlight the feasibility of objective, expert-independent performance assessment in orthopaedic trauma surgery training.

PMID:42095124 | PMC:PMC13138458 | DOI:10.2106/JBJS.OA.25.00315

JB JS Open Access. 2026 May 6;11(2):e25.00303. doi: 10.2106/JBJS.OA.25.00303. eCollection 2026 Apr-Jun.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis in many patients. In younger patients with predominantly medial compartment disease, high tibial osteotomy (HTO) is performed as a joint-preserving treatment. However, concerns remain regarding potentially compromised outcomes of TKA after previous HTO given the axial deviation, osteotomy site, secondary surgery, previous hardware, and instrumentation. Therefore, this study compared long-term implant survival, revision, and infection rates, and patient-reported outcomes between patients undergoing TKA after HTO and matched TKA-only controls.

METHODS: Postoperative complications and revision surgeries were prospectively recorded in patients who underwent TKA from 2000 to 2023 at a single academic center. Patients with previous ipsilateral HTO formed the study group and were propensity matched 1:2 to TKA-only patients without a previous osteotomy based on age, sex, and body mass index. Knee Society Scores (KSS) were collected prospectively. Implant survivorship was analyzed using Kaplan-Meier survival curves and Cox proportional hazards models.

RESULTS: The study included 134 HTO-TKA and 268 matched TKA-only patients, with a mean follow-up of 10.5 ± 6.4 years (range: 0-24 years) after TKA. Both groups showed significant postoperative improvements in KSS (p < 0.02) with comparable clinical outcomes (HTO-TKA: 79.0 (6.0), TKA-only: 79.0 (11.8)). Revision arthroplasty rates were 5.2% for HTO-TKA and 4.5% for TKA-only (p = 0.69); the mean time to revision was 8.1 ± 8.7 years vs. 4.4 ± 3.5 years, respectively (p = 0.30). Infection rates were 2.2% and 1.1%, respectively (p = 0.74).

CONCLUSIONS: Revision and infection rates were comparable between HTO-TKA and matched TKA-only patients, with no statistically significant differences. Our findings demonstrate comparable patient-reported outcomes in both groups. These findings indicate that a previous HTO does not adversely affect TKA implant longevity or clinical outcomes when compared with matched primary TKA patients within the US population.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:42095123 | PMC:PMC13138463 | DOI:10.2106/JBJS.OA.25.00303

RSC Adv. 2026 May 5;16(25):23177-23189. doi: 10.1039/d6ra03291e. eCollection 2026 Apr 29.

ABSTRACT

Severe, gap-type peripheral nerve injuries often require surgical intervention in the form of a nerve autograft or synthetic nerve guidance scaffold to promote axonal regeneration and functional recovery. In this study, nerve guidance conduits (NGCs) were fabricated from aligned polycaprolactone (PCL) nanofibres with or without encapsulated glial cell line-derived neurotrophic factor (GDNF), and a fibrin sealant-based hydrogel. These constructs were evaluated in a murine sciatic nerve transection model using Thy1-YFP-H mice, allowing regenerating axons to be visualised in transverse sections throughout the constructs. Both PCL + GDNF and PCL-only conduits facilitated Schwann cell migration and successful axonal regeneration across the site of injury. Nerve autografts, the positive control, demonstrated the highest regenerating axon count in the distal stump, although statistical significance was not observed between groups. These results demonstrate that NGCs fabricated using aligned PCL nanofibres reliably facilitate nerve regeneration across nerve gaps to a degree, but require further investigation for application in peripheral nerve repair. Future studies that optimise growth factor delivery and conduit design would be beneficial to improve regenerative outcomes.

PMID:42095107 | PMC:PMC13141687 | DOI:10.1039/d6ra03291e