Tag: statistics

Int Orthop. 2026 Jun 6. doi: 10.1007/s00264-026-06873-5. Online ahead of print.

ABSTRACT

PURPOSE: Accurate acetabular cup positioning is crucial in primary total hip arthroplasty (THA), as malposition is associated with instability and early failure. We hypothesized that acetabular cup orientation may differ according to the surgical approach used. The aim of this study was to assess whether acetabular anteversion and inclination vary according to surgical approach and whether these differences affect the proportion of acetabular cups positioned outside reference orientation zones.

MATERIALS AND METHODS: A retrospective single-centre comparative study was conducted including 300 primary THAs performed between 2018 and 2022. A stratified random sample of 100 hips per approach was selected: posterolateral (PLA), direct lateral (DLA), and direct anterior (DAA). Cup inclination and anteversion were measured on standardized postoperative radiographs using calibrated digital software. Positioning was analyzed according to the safe zones described by Lewinnek and Reina, as well as the zone corresponding to the lowest observed dislocation ratio reported by Esposito et al. Continuous and categorical variables were compared using appropriate statistical tests (p < 0.05).

RESULTS: Mean inclination and anteversion for the overall cohort were 41.5° and 17.6°, respectively. Significant differences were observed between approaches for both inclination (p < 0.001) and anteversion (p = 0.011), with the DLA demonstrating lower mean anteversion compared with the PLA and DAA. No significant differences were observed in the proportion of cups positioned within the Lewinnek safe zone (p = 0.276). However, significant differences were observed in the proportion of cups within the Reina target zone (p = 0.0015) and within the zone centred on 48° inclination and 24° anteversion (± 10°) derived from Esposito et al. (p = 0.0004).

CONCLUSION: Acetabular cup positioning appears to vary according to surgical approach in primary THA, particularly regarding anteversion, with the PLA demonstrating higher mean anteversion and the DLA lower values. However, these differences did not translate into clinically relevant differences in positioning within established reference orientation zones according to widely used criteria.

PMID:42250144 | DOI:10.1007/s00264-026-06873-5

Indian J Gastroenterol. 2026 Jun 6. doi: 10.1007/s12664-026-02021-4. Online ahead of print.

ABSTRACT

BACKGROUND: Supragastric belching (SGB) is a behavioral disorder involving rapid air influx into the esophagus through a transiently relaxed upper esophageal sphincter, followed by immediate expulsion. Unlike gastric belching, it is not related to lower esophageal sphincter (LES) dysfunction or gastroesophageal reflux disease (GERD). Often associated with psychological stress, SGB can significantly impair quality of life and some patients remain refractory to conventional therapies.

METHODS: In this retrospective study, clinical records of patients diagnosed with refractory supragastric belching were systematically analyzed. Extracted data included detailed clinical history and upper gastrointestinal endoscopy findings; high-resolution esophageal manometry (HREM) was performed using Herbert’s 16-channel water perfusion system, with interpretation of esophageal motility patterns based on the Chicago Classification version 3.0 and perceived stress levels assessed using the PSS-10 questionnaire. All patients underwent a standardized intervention protocol consisting of nasogastric tube insertion followed by structured diaphragmatic breathing training (Yellapu Technique), aimed at behavioral modulation of belching. Follow-up evaluations included symptom assessment and perceived stress scores over a three-month period to determine therapeutic response.

RESULTS: Total 56 patients were analyzed (40 females and 16 males, mean age of 45.6 ± 10.0 years). Upper gastrointestinal endoscopy and HREM findings were within normal limits in all patients. Endoscopy showed normal mucosal findings. HREM demonstrated normal esophageal motility and sphincter function, with a baseline esophagogastric junction (EGJ) pressure of 33.75 ± 6.45 mmHg and an integrated relaxation pressure (IRP) of 10.90 ± 2.8 mmHg, both within physiological limits. Complete resolution of supragastric belching was observed in 55 patients. The paired mean Perceived Stress Scale (PSS) score showed a statistically significant reduction, decreasing from 33 ± 3.65 at baseline to 22.92 ± 2.34 at one month (p < 0.001). No recurrence of symptoms was reported during the follow-up period.

CONCLUSION: In conclusion, the Yellapu Technique appears to offer a practical and innovative therapeutic approach for the management of refractory supragastric belching. By combining mechanical interruption with behavioral modification, it was associated with immediate symptom relief as well as sustained improvement. These findings suggest that this technique may represent a promising adjunct or alternative to existing therapies, warranting further validation through well-designed prospective controlled studies.

PMID:42250134 | DOI:10.1007/s12664-026-02021-4

Pediatr Nephrol. 2026 Jun 6. doi: 10.1007/s00467-026-07362-y. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 infection has been associated with significant morbidity and mortality across all age groups, yet data on pediatric kidney transplant outcomes associated with COVID-19 positive (COVID +) donors remain limited.

METHODS: Using the Scientific Registry of Transplant Recipients, we identified 143 pediatric kidney recipients (< 18 years) of COVID + donors transplanted between September 2020 and February 2025 and compared them with 1808 recipients of COVID-19 negative (COVID -) donors using propensity score weighting to account for transplant year, age at transplant, sex, race, human leukocyte antigen mismatch, prior transplant, and immunosuppression.

RESULTS: Among 1940 pediatric recipients, 7.3% received kidneys from COVID + donors, with utilization increasing from 2.5% in 2020 to 10.5% in 2025. No statistically significant differences were observed in patient survival (HR 0.83, 95% CI 0.10-6.73, p = 0.86) and overall graft failure (HR 1.35, 95% CI 0.67-2.73, p = 0.41) between COVID + and COVID – groups over a median follow-up of 1.2 years. Delayed graft function (7.7% vs. 7.2%) and median initial hospital stay (8.0 vs. 8.0 days) were also comparable.

CONCLUSIONS: The use of COVID + donors for pediatric kidney transplantation has increased over time. The posttransplant outcomes are similar between COVID + and COVID – pediatric recipients, supporting the use of COVID + donors in this population.

PMID:42250098 | DOI:10.1007/s00467-026-07362-y

Adv Ther. 2026 Jun 6. doi: 10.1007/s12325-026-03621-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Infectious keratitis can lead to significant ocular morbidity and threaten vision if not treated promptly with antimicrobial therapy. Adjuvant treatment with corneal cross-linking (CXL) can improve visual outcomes in cases of infectious keratitis. Anterior segment optical coherence tomography (AS-OCT) can provide additional qualitative and quantitative information on healing.

METHODS: This was a prospective, comparative control study of 40 eyes of 40 patients with infectious keratitis. The effectiveness of a customised epi-off CXL protocol was evaluated as adjuvant therapy. Clinical and AS-OCT parameters on days 7 and 14 of treatment, date of first report of healing and 1 month following reported healing were recorded.

RESULTS: Forty patients were randomly allocated to group A (medical treatment) and group B (medical treatment and CXL). The mean healing duration in days was 27.3 ± 9.27 in group A and 30.75 ± 7.39 in group B. The AS-OCT parameters corneal thickness (CT), infiltrate thickness (IT) and infiltrate width (IW) showed significant reduction compared to preoperative state with no clinically significant change between the groups (p > 0.05). The scar thickness (SC) was measured following reported complete healing and showed a statistically significant difference between the two groups (p < 0.03).

CONCLUSION: The addition of CXL to the treatment of infectious keratitis is associated with reduced scar thickness in the healing phase. Clinically, CXL as an adjuvant therapy to the medical treatment for infectious keratitis did not improve the healing duration or the final visual outcome.

TRIAL REGISTRATION: NCT06967376 on ClinicalTrials.gov retrospectively registered on 13 May 2025.

PMID:42250077 | DOI:10.1007/s12325-026-03621-4

EJNMMI Res. 2026 Jun 6. doi: 10.1186/s13550-026-01446-4. Online ahead of print.

ABSTRACT

BACKGROUND: To systematically review and meta-analyse the prognostic value of quantitative mid-treatment imaging biomarkers for predicting locoregional tumour control in patients undergoing definitive radiotherapy for mucosal head and neck squamous cell carcinoma.

MAIN BODY: A systematic literature search (2005-2023) was conducted in PubMed, EMBASE, Scopus, and Cochrane databases according to a pre-registered PROSPERO protocol. Studies evaluating quantitative imaging features derived from CT, MRI, or PET during radiotherapy were included. Imaging features were grouped as baseline, absolute mid-treatment, or relative mid-treatment (delta) parameters. A random-effects meta-analysis was performed on studies reporting receiver operating characteristic (ROC)-based area under the curve (AUC) values. Forty-one studies encompassing 1654 patients were included. Seventeen studies (n = 612 patients) reported sufficient data for meta-analysis. The pooled AUC for relative mid-treatment parameters was 0.796 (95% CI: 0.762-0.831), demonstrating higher predictive performance than absolute mid-treatment parameters (AUC 0.686; 95% CI: 0.628-0.745). Baseline parameters showed moderate predictive ability (AUC 0.736; 95% CI: 0.688-0.785), and while numerically lower than relative mid-treatment parameters, this difference did not reach statistical significance. Diffusion-weighted MRI (ΔADCmean) and FDG-PET (ΔMTV, ΔTLG) emerged as the most consistently predictive modalities. Relative measures offer practical advantages, including internal self-normalisation and improved reproducibility across imaging platforms.

CONCLUSIONS: Relative mid-treatment imaging biomarkers demonstrate superior predictive performance compared to baseline and absolute measures, supporting their potential role in adaptive radiotherapy strategies. Further prospective multi-centre studies with standardised imaging protocols and external validation are essential for clinical translation.

PMID:42250069 | DOI:10.1186/s13550-026-01446-4

MAGMA. 2026 Jun 6. doi: 10.1007/s10334-026-01374-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for preoperative diagnosis of perineural invasion (PNI) in rectal cancer (RC).

MATERIALS AND METHODS: A total of 148 patients with pathology-confirmed RC (PNI+, n = 72; PNI-, n = 76) were enrolled. Parameters from mono-exponential (ADC), bi-exponential (D, D*, f), and stretched-exponential (DDC, α) IVIM models were analyzed. Univariate and multivariate logistic regression analyses were used to construct diagnostic models. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. The DeLong test was used to compare the AUC of the models. Internal validation was employed to assess model performance. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI), along with calibration metrics and decision curve analysis, were used to further evaluate model performance. P-value < 0.05 was considered statistically significant.

RESULTS: ADC, D, f, and DDC differed significantly between groups. Multivariate analysis identified ADC and D as independent PNI predictors. The D value yielded the highest AUC (0.84), while ADC showed the highest sensitivity (81.94%). A combined model (ADC + D) achieved an AUC of 0.85, sensitivity of 86.10%, specificity of 73.70%, and accuracy of 77.00%. The fivefold internal validation mean AUC was 0.84 ± 0.04. No significant AUC differences were found among parameters or models (DeLong test, P > 0.05). Further analyses revealed that the combined model provided significant improvements over the ADC model in individual risk reclassification (continuous NRI = 0.65, 95% CI 0.33-0.95), overall predictive accuracy (IDI = 0.07, 95% CI excluding 0), and calibration (Brier score: 0.16 vs. 0.17; MAE: 0.01 vs. 0.04; MSE: 2.3×10⁻⁴ vs. 1.91×10⁻³). Decision curve analysis demonstrated consistently higher net benefit for the combined model across threshold probabilities of 0-0.50.

CONCLUSION: IVIM-DWI demonstrates potential value for the preoperative assessment of PNI status in rectal cancer and may facilitate individualized treatment planning.

PMID:42250045 | DOI:10.1007/s10334-026-01374-3

Ir J Med Sci. 2026 Jun 6. doi: 10.1007/s11845-026-04420-0. Online ahead of print.

ABSTRACT

BACKGROUND: The association between alcohol use and poor mental health is well known. Although psychiatric services and supports are typically delivered in community settings, some individuals require specialist inpatient care for alcohol-related disorders. For many, multiple admissions may be required, referred to as the ‘Revolving Door’ (RD) phenomenon.

AIMS: This study examines alcohol-related admissions to inpatient psychiatric units during a 10-year period (2015 – 2024) using data from the Irish National Psychiatric Inpatient Reporting System (NPIRS). The study aims to compare characteristics of first admissions and re-admissions to examine factors associated with RD admissions.

METHODS: This study used retrospective, anonymised NPIRS data. Descriptive statistics were conducted, and statistical significance was assessed using Pearson X² tests.

RESULTS: During the study period, 5.9% of all inpatient admissions into psychiatric units were alcohol related and almost two-thirds were readmissions (63.8%). Both first and readmissions were predominantly single, male, employed and aged between 45 – 64 years with a diagnosis of alcohol dependency. Readmissions were significantly more likely to have a longer length of stay. Key sex differences in alcohol-related admissions were noted. Male admissions were significantly more likely to be single and younger. Females were more likely to be older, private patients and have longer inpatient stays. Rural areas accounted for a larger share of alcohol-related admissions.

CONCLUSIONS: Despite accounting for less than 6% of all psychiatric admissions, alcohol-related psychiatric hospitalisations represent substantial healthcare costs. The findings from this study highlight the need for more targeted, sex-sensitive interventions to reduce the high level of readmissions.

PMID:42250038 | DOI:10.1007/s11845-026-04420-0

Environ Monit Assess. 2026 Jun 6;198(7):694. doi: 10.1007/s10661-026-15545-1.

ABSTRACT

Anthropogenic activities and fast industrial growth influence the level of PTEs in the soil and the food chain. The contents of PTEs were examined in two wild Cosmos species (C. bipinnatus and D. cosmos) from Jiangsu City, using chemical and AAS methods to determine the risk to human health. The highest mean concentrations of PTEs in plants showed statistically significant (p < 0.05) differences between diverse plant parts and followed the decreasing order Mn (85.0 mg kg^-1 in flower) > Zn (62.0 mg kg^-1 in flower) > Cu (12.0 mg kg^-1 in flower) > Cr (4.3 mg kg^-1 in root) > Ni (0.97 mg kg^-1 in root) > Cd (0.38 mg kg^-1 in root) > Pb (0.03 mg kg^-1 in shoot) > As (0.025 mg kg^-1 in root). The highest values of Cr, Mn, Zn, and Cd in plant samples exceeded the permitted limit. While the quantity of Cr in the soil sample was high, the transfer coefficients (K) were high for Zn and Mn. The high percentage of Mn in roots was 68% and 61%, respectively, for C. bipinnatus and D. cosmos. The THQ values for Mn and HI exceeded 1 in all plant parts, except for the D. cosmos shoot (S2) and flower (F2). The assessment revealed that they are indicating a potential non-carcinogenic risk in human health. The TCR values for Cd and Ni showed a potential carcinogenic risk in adult and child health. This study reveals, for the first time, that wild Cosmos plants in an urban environment accumulate PTEs at levels posing a potential human health risk. The key risk metrics (HI > 1, TCR for Cd/Ni > 10^-4) are highlighting significant health concerns. It is recommended to limit the use of urban-grown wild Cosmos plants for food purposes until further safety assessments are conducted.

PMID:42250037 | DOI:10.1007/s10661-026-15545-1

Qual Life Res. 2026 Jun 6;35(7):186. doi: 10.1007/s11136-026-04200-4.

ABSTRACT

PURPOSE: The Pediatric Quality of Life Inventory™ (PedsQL™ 4.0) is widely used to assess quality of life (QoL) in children, yet evidence on the reliability and validity of young children’s self-reports is inconsistent. We evaluated whether self-reported QoL in young children varies by parental presence during administration and whether parent-child agreement differed between mothers and fathers.

METHODS: Secondary analyses were conducted using data from primary schools (n = 303, children aged 5-7 years) including at least one participating parent. Children completed the PedsQL self-report either at school with a trained research assistant (parent-absent) or at home with a parent who read items aloud and recorded answers (parent-present). Mothers and fathers completed parallel proxy-reports. Multilevel modeling was used to estimate mean differences and correlations between reporters and conditions, with age and sex as covariates.

RESULTS: Internal consistency of child self-reports was limited across the four subdomains, with somewhat lower values in the parent-absent condition. Parent ratings showed no systematic differences between conditions, whereas children scored higher when a parent was present, yielding smaller parent-child gaps and higher correlations. These patterns were similar for mothers and fathers.

CONCLUSIONS: In this school-based community sample, improved agreement with a parent present was driven by higher child scores, consistent with brief, non-leading parental assistance (clarification/recall). Self-reports of young children obtained without a parent present warrant caution. Clear, age-appropriate guidance on administration and structured parental support is needed.

PMID:42250032 | DOI:10.1007/s11136-026-04200-4

Qual Life Res. 2026 Jun 6;35(7):182. doi: 10.1007/s11136-026-04301-0.

ABSTRACT

BACKGROUND: Indigenous Australians in rural and remote areas experience substantial health-related quality of life (HRQoL) impacts alongside persistent healthcare access barriers. Community-led virtual primary care services offer an innovative approach to improving access to health care services for Indigenous Australians in rural and remote areas.

OBJECTIVE: To examine age-stratified HRQoL patterns and estimate the lifetime quality-adjusted life year (QALY) loss among Indigenous Australians with chronic conditions enrolled in a rural virtual primary care service.

METHODS: We conducted a cross-sectional analysis of 75 Indigenous adults residing in rural Queensland. HRQoL was measured using the EQ-5D-5L instrument. Lifetime QALY loss was calculated using Queensland Indigenous life tables and population norms, with sensitivity analyses using Australian norms and varying discount rates.

RESULTS: Overall mean utility was 0.775 (SD = 0.246). Age-stratified analysis revealed significant heterogeneity, with three age groups (18-54, 55-64, 65-74 years) demonstrating lower HRQoL than Queensland norms. The 55-64 age group experienced poorest HRQoL (utility = 0.701, SD = 0.287) and highest projected lifetime QALY loss (4.44 QALYs undiscounted; 2.63 with 5% discount). In contrast, participants aged 75 years and above exceeded population norms (utility = 0.872 vs. 0.863). Chronic disease burden was associated with HRQoL decline in adults aged 18-64 years, while physical activity was associated with higher HRQoL in those aged 65 years and over.

CONCLUSIONS: Indigenous Australians aged 55-64 years represent a critical priority for virtual primary care interventions. Targeted support strategies for this ‘at-risk’ age group are essential to address substantial lifetime health burdens and improve long-term outcomes within remote delivery models.

PMID:42250030 | DOI:10.1007/s11136-026-04301-0