Tag: statistics

J Trauma Acute Care Surg. 2026 Jan 29. doi: 10.1097/TA.0000000000004930. Online ahead of print.

ABSTRACT

BACKGROUND: Teaching hospitals serve as referral centers for pediatric trauma care. However, the impact of interhospital transfer on outcomes in pediatric traumatic brain injury (TBI) within urban teaching hospitals remains unclear. Hence, we examined whether transferred pediatric TBI patients to urban teaching hospitals experienced different outcomes from directly admitted patients, hypothesizing that results would be comparable.

METHODS: We conducted a cross-sectional study of pediatric TBI hospitalizations from 2016 to 2021 using the National Inpatient Sample database. Patients were categorized as direct admissions or transfers. Propensity score matching (1:2 with replacement) was performed using demographic, clinical, and hospital-level variables. Outcomes included in-hospital mortality, medical complications, length of stay (LOS), and postdischarge rehabilitation referral.

RESULTS: Out of 28,548 total patients, 15,324 were successfully matched with 7,239 (47.2%) interhospital transfers. Baseline demographics, clinical, and hospital characteristics were well balanced between the two groups (all standardized mean differences <10%). Unadjusted in-hospital mortality was similar between transferred and directly admitted patients (3.6% vs. 3.4%, p = 0.49). However, transferred patients experienced longer LOS (median, 2 days; interquartile range, 1-6; p < 0.001), fewer discharges to rehabilitation (5.7% vs. 6.7%, p < 0.001), and higher complications (deep vein thrombosis, 1.2 vs. 0.9; p = 0.04; urinary tract infection, 1.6 vs. 1.1; p = 0.005). After multivariable adjustment, transfer status was not associated with mortality (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.89-1.28) and rehabilitation discharge (OR, 0.92; 95% CI, 0.80-1.06). However, transfer remained independently associated with longer LOS (OR, 1.31; 95% CI, 1.24-1.39) and higher complications (OR, 1.25; 95% CI, 1.09-1.44).

CONCLUSION: Interhospital transfer was not associated with mortality or rehabilitation discharge among pediatric TBI patients treated at urban teaching hospitals. However, longer LOS and higher complications among transferred patients raise equity and system efficiency concerns. While statistically significant, these differences were modest and may not be clinically meaningful, warranting further research with more granular data.

LEVEL OF EVIDENCE: Original article, cross-sectional study; Level III.

PMID:41609509 | DOI:10.1097/TA.0000000000004930

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002018. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cohort study.

OBJECTIVE: To identify factors associated with minimally invasive surgery (MIS) utilization and compare inpatient outcomes between MIS and open fusion for traumatic thoracic vertebral fractures using a multicenter trauma registry.

SUMMARY OF BACKGROUND DATA: MIS is increasingly utilized in spine surgery due to its potential to reduce perioperative morbidity. However, its role in managing traumatic thoracic vertebral fractures remains unclear, and large-scale comparisons of MIS versus open fusion in this setting are limited.

METHODS: Adult patients (≥18 y) who underwent thoracic fusion for traumatic thoracic fractures between 2019 and 2021 were identified from the American College of Surgeons Trauma Quality Program database using ICD-10 codes. Patients were stratified by surgical approach (MIS vs. open), and demographic, injury, and clinical characteristics-as well as inpatient outcomes-were compared using chi-squared and t-tests. Multivariable logistic regression was performed to identify patient and injury factors associated with MIS utilization. A P-value < 0.05 was considered statistically significant.

RESULTS: Of 8999 patients undergoing thoracic fusion, 370 (4.1%) received MIS. MIS utilization was associated with older age, lower Injury Severity Scores, and less severe neurological impairment. The number of vertebral levels fused did not differ by approach. MIS patients had significantly shorter length of stay, higher home discharge rates, and lower rates of complications, intensive care unit admission, and mechanical ventilation.

CONCLUSION: This multicenter cohort study identifies key patient and injury characteristics associated with MIS utilization in thoracic trauma. While MIS was associated with some favorable inpatient outcomes, this may be due to selection bias rather than procedural effect. Further prospective studies are needed to clarify appropriate indications and long-term outcomes.

PMID:41609462 | DOI:10.1097/BSD.0000000000002018

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002028. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: The purpose of our study is to identify CT characteristics of unilateral cervical spine facet fractures that are predictive of instability on MRI.

SUMMARY OF BACKGROUND DATA: Management of isolated subaxial cervical spine facet fractures is typically based on the neurological status of the patient and perceived stability of the injury. It has been shown that the degree of ligamentous instability can help predict instability and need for surgery, and MRIs are increasingly being used to evaluate these injuries, but not always. While there are studies that evaluate radiographic characteristics of facet fractures on CT, there are few that specify which CT findings predict instability on MRI.

METHODS: A retrospective review of 49 patients with unilateral cervical facet fractures during a 7-year period from a level I trauma center was performed. All patients had a CT and an MRI performed. Measurements of fracture fragments were obtained from CT scans. MRIs were examined by an independent radiologist and assigned an instability score. CT measurements were compared with MRI instability scores to determine which parameters were predictive of the need for operative stabilization.

RESULTS: Forty-nine patients were identified with unilateral cervical spine facet fractures. Thirty patients initially were treated nonoperatively, and 19 patients underwent surgical stabilization. One patient failed nonoperative management, having neurological deficits and pain at follow-up, and underwent a C6-C7 ACDF later. The average instability score in the operative group was 3.34, versus 1.06 in the conservative treatment group (P<0.001). Fracture displacement (P=0.013), multifragmentary fractures (P<0.001) and MRI instability score (P<0.001) were correlated with a statistically significant increased likelihood of operative necessity.

CONCLUSIONS: Fracture size did not directly correlate with ligamentous injury. Displacement and multifragmentary fractures on CT scan were had the highest correlation with instability scores on MRI. This suggests that patients with subaxial cervical facet fractures that are comminuted or have significant displacement may require operative stabilization.

LEVEL OF EVIDENCE: Level III.

PMID:41609460 | DOI:10.1097/BSD.0000000000002028

Clin Spine Surg. 2026 Jan 15. doi: 10.1097/BSD.0000000000002030. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To compare the advantages and disadvantages of two different foraminoplasty methods.

SUMMARY OF BACKGROUND DATA: Foraminoplasty is one of the most important steps in FELD surgery. In recent years, different surgical instruments for foraminoplasty have been invented, mainly, including reamer/trephine and bone drill. Different foraminoplasty methods have different effects and limitations on the surgical outcome.The aim of this study was to compare surgical outcomes, anesthesia satisfaction, and learning curves between two different foraminoplasty procedures.

PATIENTS AND METHODS: A total of 109 patients with lumbar disc herniation (LDH) treated with full endoscopic lumbar discectomy (FELD) by the same group of physicians from October 2020 to February 2022. Patients underwent foraminoplasty with bone drill were divided into group A, while foraminoplasty with trephine as group B. Back and leg visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated at different time follow-up for evaluating surgical outcomes. Different types of anesthesia were recorded, and patients’ intraoperative pain assessment was evaluated. Learning curve was presented with operation time in chronological order.

RESULTS: There were statistically differences between VAS-back postoperative (P=0.0077) on 6 months. There was also a statistical difference in back pain symptom scores under the interaction between groups and time (P=0.147). The intraoperative VAS score of group A was significantly higher group B (P=0.008). Migration herniated discs and foraminoplasty method were the main factors affecting intraoperative pain. The operation time of group A was shorter than that of group B, while there was no statistical difference (P=0.782).

CONCLUSIONS: Both surgical techniques can achieve good curative effect (excellent rate: 87.7% vs. 89.1%). Patients in group A recovered faster on postoperative function. Patients in group B had better intraoperative experience.

PMID:41609454 | DOI:10.1097/BSD.0000000000002030

Mikrobiyol Bul. 2026 Jan;60(1):53-71. doi: 10.5578/mb.2026018.

ABSTRACT

Hyperemesis gravidarum (HEG) is a pregnancy complication characterized by severe nausea, vomiting more than four times a day and dehydration, especially occurring in the first trimester of pregnancy. In recent years it has been shown that the intestinal bacterial microbiome profile may be associated with a wide range of diseases. The aim of this study was to determine whether the intestinal bacterial microbiome profiles differ between pregnant women diagnosed with hyperemesis gravidarum (HEG) and those with healthy pregnancies. Fresh stool samples were collected from 15 pregnant women diagnosed with HEG and 14 healthy pregnant women who did not have any complaints in the first trimester. After DNA isolation from the samples, 16S rRNA gene-based microbial profiling was performed with next-generation sequencing. The 16S rRNA V3-V4 region was sequenced with paired-end reads (2×250 base pair) on the Illumina MiSeq platform. The average sequence number for each sample was similar (HEG= ~2.54 million, control= ~1.48 million; p> 0.05). After quality filtering, reads obtained from all samples were analyzed by rarefaction at equal depth. Alpha diversity measures were found to be significantly higher in the HEG group compared to the control group (Shannon, ACE, and Chao1 indices; p< 0.05 for all). In the beta diversity analysis, it was observed that the gut microbiome compositions of the two groups were separated; In the Principal Coordinates Analysis plot, the groups were clearly clustered and the group difference was found to be statistically significant by PERMANOVA test (p< 0.01). Significant differences were also found in the comparisons at the taxonomic level. At the class level, the relative abundance of Clostridia was significantly higher in the HEG group (p< 0.05), while the class Bacilli was dominant in the control group (p< 0.05). At the family level, the abundances of Lachnospiraceae and Prevotellaceae were found to be significantly higher in the HEG group than in the control group (p< 0.05). In contrast, at the family level, the rates of Enterobacteriaceae and at the genus level, the rates of Escherichia-Shigella were found to be significantly higher in the control group (p< 0.05). Some bacterial taxa detected only in the HEG group samples were also noteworthy: Collinsella, Blautia, and Dialister genera, which are only found in the intestines of patients with HEG, were not detected in the control group. In conclusion, these findings reveal that there are significant differences between the intestinal microbiome profiles of pregnant women with HEG and healthy pregnant women. The high microbial diversity observed in the HEG group and changes in certain bacterial groups suggest that processes related to lipid and carbohydrate metabolism may play a role in the pathogenesis of HEG. In the future, the clinical significance and possible therapeutic targets of these differences can be evaluated with more comprehensive studies aiming at clarifying causality.

PMID:41609448 | DOI:10.5578/mb.2026018

Mikrobiyol Bul. 2026 Jan;60(1):28-40. doi: 10.5578/mb.202601112.

ABSTRACT

Acute gastroenteritis (AGE) is an important public health problem that is very common all over the world. Knowing the causative agents is important for understanding the clinical course of the disease, effective treatment and necessary precautions to be taken. In this study, we aimed to determine the pathogen distribution in AGE cases admitted to our center using multiplex real-time polymerase chain reaction (mRt-PCR) and to demonstrate the clinical and laboratory differences between luminal (type I) and mucosal/invasive (type II) infections. We also aimed to define biomarker thresholds to facilitate decision-making in situations where access to advanced diagnostic tests is limited. Eighty-five patients aged ≥ 18 years were retrospectively analyzed between June and September 2023. Clinical complaints, stool macroscopy and laboratory results recorded at admission including; leukocyte count, neutrophil/ lymphocyte ratio (NLR), hemoglobin, platelet count, C-reactive protein (CRP), renal and hepatic function tests and lactate dehydrogenase (LDH) values were recorded. Stool samples were evaluated by microscopic examination, culture/antigen tests and Bio-Speedy Gastroenteritis mRt-PCR (MX-24L). According to PCR results, the cases were categorized as a pathogen-negative group, a mucosal-type infection group and a luminal-type infection group. Appropriate statistical tests were used, ROC analysis was performed for CRP, NLR and platelet count to predict mucosal type. The median age was 54 years (interquartile range= 38-67) and 56.5% were male. At least one pathogen was detected by PCR in 76% (65/85) of the cases; the most common were Campylobacter spp. (17.3%), enteroinvasive Escherichia coli (12.9%) and norovirus (12.9%). 41.2% of the cases were mucosal type, 35.3% were luminal-type and 23.5% were in the group in which no causative agent was detected. Age was higher in the mucosal type group (p= 0.009). Red color/blood in stool and fever were significantly more common in mucosal type group (both p< 0.001); vomiting was more common in mucosal type group (p= 0.016). CRP and NLR values were significantly higher in mucosal type group (both p≤ 0.001), while platelet count was lower (p= 0.021). ROC analysis revealed CRP as the strongest predictor for mucosal type group. mRt-PCR enables high-rate detection of acute gastroenteritis pathogens, supporting accurate and early treatment and contributing to a reduction in unnecessary antibiotic use. By using this test, the most frequently identified acute gastroenteritis pathogens in our region were detected as Campylobacter, norovirus and EIEC. In settings where these tests are not available, CRP levels ≥ 42.5 mg/L and/or NLR ≥ 3 may serve as indicators in favor of mucosal-type pathogens and thrombocytopenia may further support this clinical profile. The use of simple and easily accessible biomarkers in combination with clinical findings may contribute to more effective field management of AGE cases.

PMID:41609446 | DOI:10.5578/mb.202601112

Mikrobiyol Bul. 2026 Jan;60(1):14-27. doi: 10.5578/mb.202601103.

ABSTRACT

Carbapenem-resistant Enterobacterales (CRE) are pathogens that cause difficult-to-treat infections and are identified as a priority threat by global health authorities. Increasing resistance rates limit the efficacy of existing antibiotics and increase the risk of mortality. Cefiderocol, an innovative siderophore cephalosporin, shows broad-spectrum in vitro activity against both serine and metallo-β-lactamases and remains largely stable against classical resistance mechanisms. This study aimed to evaluate the in vitro activity of cefiderocol, the concordance of susceptibility tests performed using three methods [broth microdilution (BMD) based commercial ComASP® panel , gradient strip and disk diffusion] and its association with major carbapenemase genes and the ceftazidime/avibactam (CZA) susceptibility. The study included 100 carbapenem-resistant Enterobacterales isolates from a single center during 2023- 2024. Species identification was performed using the VITEK 2 system. Cefiderocol susceptibility was tested using the reference method (BMD) based commercial ComASP® panel, the gradient strip test and disk diffusion. Five major carbapenemase genes (blaOXA-48, blaKPC, blaNDM, blaVIM, blaIMP) were screened by real-time polymerase chain reaction for the molecular diagnosis. Quantitative and categorical agreement between susceptibility tests were assessed using Passing-Bablok and Deming regression analyses. Cohen’s kappa, McNemar’s test and error types (major and very major) were analyzed. Comparative analyses with CZA susceptibility and genetic findings were also performed. According to BMD, 99% of the isolates were susceptible to cefiderocol and 1% were resistant; the results of the gradient strip test were categorically identical to those of BMD. In the disk diffusion test, 92% of isolates were classified as susceptible and 8% as resistant. Compared with BMD, disk diffusion showed a major error rate of 7%, a very major error rate of 0%, 93% categorical agreement, poor concordance by the kappa test and statistically significant categorical discordance by McNemar’s test (p= 0.016). A moderate correlation was found between the gradient strip test and BMD, and gradient MICs were systematically lower than those obtained by BMD. For CZA, 47% of isolates were susceptible and 53% were resistant; of the 53 CZA-resistant isolates, 98% were still susceptible to cefiderocol (McNemar’s test, p< 0.001). In the molecular analysis, OXA-48 was positive in 64% of isolates, KPC in 25%, NDM in 48%, VIM in 7%, and IMP in 18%. No association was observed between cefiderocol resistance and the presence of specific genes. However, in multivariate models, the presence of OXA-48 was significantly associated with CZA resistance (p= 0.001). Cefiderocol demonstrated very high in vitro activity against CRE isolates and retained its activity against the majority of CZA-resistant strains. However, due to the risk of major errors-especially near breakpoint zones-disk diffusion results should be interpreted with caution, and confirmation with BMD is recommended in critical cases.

PMID:41609445 | DOI:10.5578/mb.202601103

J Sports Med Phys Fitness. 2026 Jan 29. doi: 10.23736/S0022-4707.25.17557-9. Online ahead of print.

ABSTRACT

BACKGROUND: Fireball Extreme Challenge^TM is a coeducational high-intensity intermittent-explosive sport that lacks normative performance data; this study aimed to create multidimensional athlete profiles and establish reference benchmarks to support talent identification and training prescription.

METHODS: Twenty-one national-level athletes (13 males and 8 females; mean age 26.2±5.8 years) completed countermovement jump, one-repetition maximum strength assessment, bilateral handgrip testing, and the 30-15 intermittent fitness test under standardized indoor (21 °C, 50% relative humidity) and outdoor (37 °C, 68% relative humidity) field conditions representative of the athletes’ typical training environment in coastal southern Mexico, recorded for ecological validity rather than thermal control. We calculated descriptive statistics and percentile distributions (25^th, 50^th, 75^th), performed sex-stratified analyses adjusted for age, and conducted exploratory principal component and cluster analyses to examine interdomain associations and emergent performance groupings.

RESULTS: Across all participants, the observed performance spectrum spanned a broad range of neuromuscular and metabolic capacities, with individual variability captured through percentile reference values (25^th, 50^th, 75^th). The highest jump heights (up to 48 cm) and peak power outputs (≈2100 W) coexisted with moderate endurance and balanced heart rate responses, defining the multidimensional nature of Fireball Extreme Challenge™ performance. Sex-stratified distributions are presented descriptively but were not the primary analytical outcome. Principal component analysis identified two dominant performance domains-neuromuscular power and metabolic strain-explaining 59% of total variance. Hierarchical clustering revealed three mixed profiles that integrated both male and female athletes, illustrating overlapping phenotypes rather than categorical differences.

CONCLUSIONS: This study provides the first multidimensional performance profile of Fireball Extreme Challenge™ athletes, establishing normative reference percentiles and identifying key physical domains-neuromuscular power and metabolic capacity-that characterize success in this coeducational, high-intensity team sport. The derived phenotypic clusters highlight overlapping attributes between male and female athletes, reflecting the integrated dynamics of mixed-team performance. These findings offer a foundational framework for evidence-based training design, athlete monitoring, and future validation in larger international cohorts.

PMID:41609441 | DOI:10.23736/S0022-4707.25.17557-9

J Sports Med Phys Fitness. 2026 Jan 29. doi: 10.23736/S0022-4707.25.17463-X. Online ahead of print.

ABSTRACT

BACKGROUND: Artistic gymnastics (AG) is a sport that requires high percentages of muscle strength and power for successful execution of the exercises in various apparatus. However, studies investigating their relationship with rate of force development (RFD) as well as AG performance are limited. The purpose of the present research was to investigate the relationship between muscle strength, muscle power and RFD of lower extremities in isometric and dynamic measurement condition with performance on balance beam. A partial objective was to examine the relationship of lean mass with RFD and AG performance.

METHODS: Thirteen competitive level female gymnasts, with an average age of 11.6 years participated in the research and were evaluated in terms of body composition, isometric leg press strength and RFD and countermovement jump (CMJ). In addition, balance beam routines were evaluated by four international judges. Pearson’s r coefficient was used to investigate the correlation of the variables under consideration.

RESULTS: There was no statistically significant correlation between force-time characteristics during isometric and dynamic assessment with balance beam performance (P>0.05). However, a strong correlation was found between total lean body mass (TLM) and power (r=0.985), relative power (RP) (r=0.933), max strength (MS) (r=0.727), and RFD 100 ms (r=643) and RFD 150 ms (r=0.896) during the CMJ. Furthermore, there was a strong correlation of bone density (BD) with power (r=0.903), MS (r=0.74), RFD 100 ms (r=0.735) and RFD 150 ms (r=0.883) time intervals in CMJ.

CONCLUSIONS: Balance beam performance is influenced by other physical factors and technical execution of exercises rather than lower limb strength characteristics.

PMID:41609440 | DOI:10.23736/S0022-4707.25.17463-X

Int J Cancer. 2026 Jan 29. doi: 10.1002/ijc.70349. Online ahead of print.

ABSTRACT

This study provides an update on global patterns and trends in kidney cancer incidence and mortality. We used the most recent GLOBOCAN estimates, based on the best available data sources, including population-based cancer registries (PBCRs), to compare incidence and mortality in 185 countries or territories in 2022 and to assess time trends based on recorded PBCR and vital statistics data in 71 countries. Incidence age-standardised rates (ASRs) varied 10-fold across UN regions and 20-fold at the country level in 2022. Kidney cancer ASRs were consistently higher in males than females and ranged from 1.6 per 100,000 in low Human Development Index (HDI) countries to 12.6 in very high HDI countries among men and from 1.1 to 5.9 among women. The highest ASRs in males were in Belarus (22.9), Uruguay (20.5), and Latvia (19.2), and in females in Latvia (9.5), Uruguay (8.7), USA (8.7). While the patterns were similar for mortality, variations were less pronounced. The mortality-to-incidence ratio was lowest in Oceania (0.2) and highest in Africa (0.7). Over the past 15 years, incidence ASRs have tended to increase or stabilise in most European countries, Northern America and Oceania, but increased in Asia and Latin America. Mortality ASRs decreased in most countries, but increased in Portugal, Romania, Moldova, the Philippines, Malaysia and in 9 of 14 countries in Latin America. Regional variations in incidence call for a greater focus on risk factors amenable to prevention, coupled with an assessment of the role of diagnostics. The varied mortality patterns indicate present treatment inequalities.

PMID:41609424 | DOI:10.1002/ijc.70349