BMC Emerg Med. 2026 Jan 29. doi: 10.1186/s12873-026-01479-x. Online ahead of print.
NO ABSTRACT
PMID:41612184 | DOI:10.1186/s12873-026-01479-x
Tag: statistics
Int J Dermatol. 2026 Jan 29. doi: 10.1111/ijd.70321. Online ahead of print.
ABSTRACT
BACKGROUND: Cutaneous melanoma remains a major public health issue with increasing incidence among fair-skinned populations. Beyond well-established risk factors such as ultraviolet exposure, there is evidence suggesting female sex hormone influence in melanoma biology and prognosis. Although several epidemiological studies have explored the relationship between exogenous hormones and melanoma risk, findings remain inconsistent. This study aims to investigate the association between exogenous hormonal use and Breslow thickness assessing differences across female life stages.
METHODS: A retrospective study of 464 female patients with histologically confirmed primary superficial spreading melanoma (SSM) diagnosed from 2010 to 2021 in Andreas Sygros Hospital of Cutaneous and Venereal Diseases was conducted. Multiple linear regression models were performed to examine the association of hormonal use and thickness among females of different age groups (< 45, 45-59, and ≥ 60 years).
RESULTS: Significant inverse associations between hormone use and Breslow thickness were found for women aged 45-59 years, with oral contraceptive (OC) use being associated with a 30% reduction in thickness (95% confidence interval [CI]: -47.9, -6.4) when considering all confounders. Exposure to any exogenous hormone was found to be positively associated (percent of change [PC]: 25.6, 95% CI: -7.2, 70.1) with tumor thickness among women above 60 years, indicating an effect modified by age. No significant associations were observed in females under 45 years.
CONCLUSIONS: These results indicate that the effect of exogenous hormone use on tumor thickness may be age-related, with an inverse association observed during the peri-menopausal period, and a positive relationship found among females above 60 years. Future research is needed to explore estrogen-mediated mechanisms influencing melanoma prognosis.
PMID:41612167 | DOI:10.1111/ijd.70321
Med Phys. 2026 Feb;53(2):e70258. doi: 10.1002/mp.70258.
ABSTRACT
BACKGROUND: Radiotherapy treatment planning (TP) aims to maximize radiation dose delivered to tumors while minimizing exposure to surrounding healthy tissues. Beam angle optimization (BAO) is a crucial component of TP, characterized by high dimensionality and non-convexity, and is traditionally solved via heuristic or manual iterative approaches. These conventional methods are time-consuming and often yield suboptimal solutions due to incomplete exploration of the vast solution space.
PURPOSE: This study introduces a novel framework integrating a general-purpose large language model (LLM) within a reinforcementlearning (RL)-inspired iterative strategy to automate BAO in radiotherapy planning. Taking advantage of the inherent knowledge embedded in LLMs, the method uses visual and scalar feedback to produce clinically meaningful treatment plans without requiring any domain-specific fine-tuning or additional training.
METHODS: The proposed framework employs an off-the-shelf Generative Pre-trained Transformer, GPT-4 model (denoted GPT-4o) in an inference-only setting. At each iteration, GPT-4o suggests a set of gantry angles, which are subsequently input into the MatRad software to generate a dose distribution. A scalar reward is computed from this distribution using a custom reward function designed to balance target dose conformity and sparing of organs-at-risk (OARs). This reward, along with the corresponding dose maps, serves as feedback for the LLM to iteratively refine its suggestions. The refinement process consists of distinct exploration and exploitation phases inspired by classical RL paradigms. We evaluated six configurations that varied in exploration duration and in the Computed Tomography (CT) slice inputs provided to the LLM (Single-View vs. Multi-View). Performance was benchmarked against a random-angle selection baseline across three anatomical sites: prostate, head-and-neck, and liver.
RESULTS: Across the liver and head-and-neck cases, all LLM-based configurations significantly outperformed the random baseline ( ). In the prostate scenario, most strategies demonstrated statistically significant improvements, except for the Multi-View configurations with extended exploration phases (10 and 15 iterations). Rewards consistently increased during the exploitation phase, and the resulting dose-volume histograms and dose distributions exhibited improved conformity to target volumes with enhanced sparing of OARs. Notably, plans of clinically plausible quality were obtained within 20 iterative refinement steps in this proof-of-concept setting.
CONCLUSIONS: This study demonstrates that general-purpose LLMs, operating without specialized model training or fine-tuning, can effectively serve as intelligent agents for automated radiotherapy TP, specifically addressing the BAO problem. This flexible and scalable framework has the potential to enhance clinical decision-making workflows in radiotherapy. Future research directions include exploring more comprehensive and clinically nuanced reward functions and extending the methodology to other components of radiotherapy TP.
PMID:41612144 | DOI:10.1002/mp.70258
Anesth Analg. 2026 Jan 29. doi: 10.1213/ANE.0000000000007875. Online ahead of print.
ABSTRACT
INTRODUCTION: The 76th World Health Assembly highlighted the urgent need for action to enhance surgical care. Given the postoperative complication rate of around 20% and the rapidly increasing surgical burden related to noncommunicable diseases, implementing the Enhanced Recovery After Surgery (ERAS) protocol is recommended, particularly in low- and middle-income countries (LMICs). This evidence synthesis aimed to assess the effectiveness of the ERAS protocol in improving short-term and intermediate surgical outcomes among patients in LMICs.
METHOD: This systematic review and meta-analysis were registered in the PROSPERO database (CRD42024524807). A systematic search for observational studies and clinical trials was conducted in PubMed, Scopus, Cochrane, and Web of Science, along with online trial registries, Google Scholar, and reference search. The search strategy included keywords related to “Enhanced Recovery After Surgery,” “ERAS,” “Fast-Track Surgery,” “LMICs,” and the names of LMICs. Risk of bias was assessed using the Cochrane risk of bias and the Newcastle-Ottawa scale. RevMan 5.4.1 software was used for data collection and reporting, Mendeley was used for reference management, and RStudio for meta-analysis. relative risk (RR) and standardized mean differences (SMDs) were used to report pooled results.
RESULTS: A total of 1332 studies were initially identified, and after removing duplicates, 1243 studies remained, with 56 papers eligible for full-text review. Eight studies were identified from the reference search and were added to the evidence synthesis. Thirty-five studies, 23 clinical trials, and 12 observational studies were included for review, and 33 studies were included for meta-analysis. Eighty-four percent of the publications were from South and Southeast Asia. Comparable numbers of participants were distributed in the intervention (n = 3163) and control (n = 3243) groups. The studies comprised mostly abdominal surgeries (n = 17). Each study compared ERAS protocols with routine perioperative care. Meta-analysis indicated a significant reduction of postoperative morbidity after the implementation of the ERAS protocol (RR = 0.63; 95% confidence interval [CI], 0.66-0.55 with I2 of 1.1%). Also, a significant reduction in postoperative length of hospital stay was observed when the ERAS protocol was implemented (SMD= -0.68 [95% CI, -0.47 to -0.90] with I2 = 86.7). There was no significant difference in 30-day postoperative mortality and readmission rate.
CONCLUSIONS: ERAS protocols represent a practical approach to improving surgical outcomes in LMICs, with evidence showing reduced postoperative morbidity and hospital stay, without an increase in readmission or mortality. Although there could be an ERAS implementation cost, its role in expediting recovery could reduce hospitalization costs. Tailored implementation and improved adherence reporting are essential to guide future adoption and policy.
PMID:41612136 | DOI:10.1213/ANE.0000000000007875
J Sci Food Agric. 2026 Jan 29. doi: 10.1002/jsfa.70436. Online ahead of print.
ABSTRACT
BACKGROUND: Several commercial berries have been examined for anthocyanin composition, bioaccessibility, and bioactive effects, while Brazilian berries remain underexplored. This study aimed to access the effect of in vitro gastrointestinal digestion on anthocyanin bioaccessibility, stability, and antioxidant potential in black pitanga (Eugenia uniflora var. rubra Mattos), grumixama (Eugenia brasiliensis), nhamburi (Rubus urticaefolius), and barapiroca (Eugenia involucrata) – also called Rio Grande cherry – and explore its link with the food matrix composition.
METHODS: The INFOGEST in vitro digestion model was applied to these berries, and anthocyanin were quantified using ultra-high-performance liquid chromatography-electrospray ionization-triple-quadrupole-tandem mass spectrometry. Antioxidant potential, polyphenols, flavonoids, anthocyanins, and proximate composition were analyzed by conventional protocols. The results were used in performing analysis of variance, Pearson’s R correlations, and multivariate principal component analysis to explore the food matrix key roles.
RESULTS: Brazilian native berries, particularly black pitanga, nhamburi, and grumixama, were found to be rich sources of anthocyanins. Stability during in vitro digestion oscillated between berries and anthocyanin type, besides remaining over 40%. Bioaccessibility highlights are the cyanindin-3-glucoside and malvidin-3,5-diglucoside, which had the highest bioaccessibilities (between 45% and 68%). Black pitanga and nhamburi were able to provide the highest amounts of bioaccessible anthocyanins (477 and 1172 mg g-1, respectively). Black pitanga presented the highest ferric reducing antioxidant power and oxygen radical absorbance capacity in bioaccessible fractions. Multivariate statistics showed a clear correlation between centesimal composition and anthocyanin stability.
CONCLUSION: The findings reveal complex interactions between food matrices, anthocyanin stability and bioaccessibility, and effective antioxidant potential for human health. This research emphasizes the use of Brazilian berries as good anthocyanin sources, highlighting black pitanga and nhamburi, while fostering consumer health and conservation of natural resources. © 2026 The Author(s). Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
PMID:41612125 | DOI:10.1002/jsfa.70436
J Environ Qual. 2026 Jan-Feb;55(1):e70147. doi: 10.1002/jeq2.70147.
ABSTRACT
In Germany during several decades, emissions and thus the chemical climate affecting forests have changed significantly. The effects of these changes on the element balance of forests can be documented only by long-term observations, as has been done at the Höglwald site (Southern Bavaria) since 1985. Since then, structural changes in agriculture have led to a reduction in emissions of reduced nitrogen (NH3). There was also a slight decrease in emissions of oxidized nitrogen (NOx). Air pollution control measures, especially in the 1980s, led to a particularly drastic reduction of sulfur emissions (SO2). Consequently, inputs to the ecosystem decreased by almost 95% between 1985 and 2020. Dry deposition nowadays plays practically no role for this element. High nitrogen inputs, dominated by reduced nitrogen, have led to a high proton production through N transformations. This has gradually reduced the buffering capacity of the topsoil. Comparing measured fluxes shows that with decreasing sulfur inputs, the sulfur stored in the topsoil from times of high deposition was remobilized. At the Höglwald, this process occurred rather clearly over a period of about 28 years and has resulted in only about 11% of the initial amount of sulfur being still present in the topsoil (humus layer + mineral soil down to 40 cm) in 2020. Forestry should take the changed chemical conditions into account in its nutrient management.
PMID:41612122 | DOI:10.1002/jeq2.70147
J Gen Intern Med. 2026 Jan 29. doi: 10.1007/s11606-026-10210-2. Online ahead of print.
ABSTRACT
BACKGROUND: Entrustable professional activities (EPAs) have been proposed as a holistic approach to competency-based assessment. The 13 Core EPAs for Entering Residency (CEPAER) are essential tasks that a medical student should be trusted to perform with indirect supervision upon entering residency, based on demonstrated competence.
OBJECTIVE: To study the validity and reliability of workplace-based assessments of the 13 core EPAs as measurements of medical student performance and growth over the Internal Medicine (IM) clerkship.
DESIGN: Correlational-based population study.
PARTICIPANTS: A total of 398 third-year medical students at the University of Minnesota Medical School participated. Students were enrolled in a required 8-week IM clerkship during the 2023-2024 and 2024-2025 academic years. A total of 825 assessors provided EPA ratings with a mean number of 12 per assessor; SD = 15.08.
MAIN MEASURES: There were 10,034 EPA-based assessments collected (mean per student = 25; SD = 6.1). The most frequently assessed EPAs were EPA 6 (Provide an oral presentation of a clinical encounter; n = 1866; mean per student = 4.69), EPA 5 (Document a clinical encounter in the patient record; n = 1662; mean per student = 4.18), and EPA 2 (Recommend and interpret common diagnostic and screening tests; n = 1421; mean per student = 3.57).
KEY RESULTS: Regression analyses indicated statistically significant growth in entrustment scores for EPAs 1, 2, 3, 5, 6, 8, 10, and 12. Generalizability analysis showed that to achieve adequate reliability (Ep2 ≥ 0.80), at least 5 assessments were required to be conducted by 5 raters.
CONCLUSION: EPAs represent a valid and reliable measure for medical student growth during the IM clerkship, particularly for EPAs 1, 2, 3, 5, 6, 8, and 10.
PMID:41612117 | DOI:10.1007/s11606-026-10210-2
Environ Geochem Health. 2026 Jan 29;48(3):122. doi: 10.1007/s10653-026-02989-0.
ABSTRACT
This study investigated the hydrogeochemical characteristics of surface waters in the Congonhas Mineral District (CMD), located in the southern portion of Quadrilátero Ferrífero, Brazil. A total of 38 sites were monitored between 2021 and 2024 to understand seasonal and spatial variability across distinct lithologies and land uses. Hydrogeochemical patterns revealed dominant mixed bicarbonate facies associated with metavolcano-sedimentary terrains, while domains of granitoids exhibited alkali enrichment. Waters under the influence of larger Urban settlements were enriched in Na, Cl, sulfate, and nutrients. By integrating geospatial classification, seasonal sampling, and robust statistical techniques, we investigated the behavior of Fe and Mn, key elements influenced by both natural geological sources and mining activities. Reference values for geochemical background and baseline thresholds, based on samples from preserved and mixed land use areas, respectively, were estimated using three distinct statistical approaches. Among these, the upper tolerance limit (UTL) method was considered the most consistent and suitable. Spatial and seasonal patterns revealed elevated Fe and Mn levels during the rainy season, particularly in areas influenced by mining and urbanization. The proposed reference values provide a realistic basis for identifying contamination, and can give support for more realistic regulatory frameworks, and definition of strategies for water quality management. The obtained results highlight the relevance of tailored guidelines in mining contexts, where reference values adopted by regulatory agencies may not reflect local geochemical conditions.
PMID:41612109 | DOI:10.1007/s10653-026-02989-0
Neurosurg Rev. 2026 Jan 30;49(1):173. doi: 10.1007/s10143-025-04128-2.
ABSTRACT
BACKGROUND: Stent-assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for intracranial bifurcation aneurysms. However, studies comparing FDs and SAC were scarce. Thus, we performed a two-center, propensity score matched (PSM) cohort study to compare the FDs and SAC devices for intracranial bifurcation aneurysms.
METHODS: Consecutive patients with intracranial bifurcation aneurysms were treated with FDs or SAC at two advanced stroke centers were enrolled in the study. Propensity score matching (PSM) was employed to adjust for demographic and aneurysm characteristics. The perioperative and midterm follow-up outcomes were compared between the two devices.
RESULTS: A total of 131 patients with 131 intracranial bifurcation aneurysms were included. After PSM, 66 aneurysms treated with the FDs and SAC were matched (n = 33 in each group). At a median follow-up of 6-7 months, significant differences were observed in procedure time (105.00 min vs. 155.00 min, p < 0.001), rate of complete aneurysm occlusion (60.6% vs. 93.9%, p = 0.001) between the FDs and SAC group. There were no statistical differences in total perioperative complications (3.0% vs. 9.1%, p = 0.302), in-stent stenosis (9.1% vs. 9.1%, p = 1.000), device-related challenges (3.0% vs. 6.1%, p = 0.555) and follow-up mRS score of 3-5 (3.0% vs. 3.0%, p = 1.000) between the FDs and SAC group.
CONCLUSION: Compared with SAC, FDs provide a comparable rate of perioperative and clinical outcomes in unruptured intracranial bifurcation aneurysms. Nevertheless, a better occlusion status in the SAC group needs to be further verified over a longer follow-up period.
PMID:41612108 | DOI:10.1007/s10143-025-04128-2
Clin Rheumatol. 2026 Jan 29. doi: 10.1007/s10067-026-07936-z. Online ahead of print.
ABSTRACT
OBJECTIVE: To explore the value of combining chest muscle measurements, spleen density, and immunological serum indicators for predicting the occurrence of interstitial lung disease (ILD) in Sjögren’s syndrome (SS).
METHODS: A retrospective study was performed by SS patients admitted to the First Affiliated Hospital of Henan Medical University from January 2018 to June 2025 and 196 cases were included. Propensity score matching (PSM) was used to balance baseline characteristics, resulting in the Sjögren’s syndrome without interstitial lung disease (SS-NILD, n = 59) and Sjögren’s syndrome-associated interstitial lung disease (SS-ILD, n = 32) groups. Spearman correlation analysis was performed to assess variable relationships, and variance inflation factor (VIF) and tolerance (TOL) to quantify multicollinearity severity. Binary logistic regression was used to build models. The area under the receiver operating characteristic curve (AUC) was used to determine discriminatory ability and DeLong’s test to compare different models. Finally, model performance was assessed through calibration curves, decision curve analysis (DCA), and Bootstrap internal validation, and the contribution of imaging indicators was analyzed.
RESULTS: The occurrence of SS-ILD was associated with reduced spleen density (SD), decreased total pectoral muscle area (T-PMA), decreased right pectoral muscle area (R-PMA), lower CD4⁺T lymphocyte percentage (CD4+T%), lower CD4⁺/CD8⁺ ratio, and decreased complement C4 levels. There was significant collinearity between T-PMA and R-PMA, and potential collinearity between CD4⁺T% and CD4⁺/CD8⁺ ratio. Four models were constructed. Validation via calibration and decision curves confirmed that model 1 (T-PMA, SD, CD4⁺T%, and C4) had high predictive accuracy and clinical net benefit (AUC = 0.872, sensitivity = 0.813, specificity = 0.797, 95% CI: 0.800-0.945). Bootstrap internal validation indicated high stability for model 1 and analysis of model 1’s components showed enhanced predictive performance with imaging indicators.
CONCLUSION: Model 1 (T-PMA, SD, CD4⁺T%, and C4) demonstrates potential for the early prediction of SS-ILD and carries substantial clinical translational value. Key Points • Developed a SS-ILD predictive model using pectoral muscle area, spleen density, CD4⁺T cell percentage, and complement C4. • Built via correlation heatmap, collinearity diagnosis, and propensity score matching for bias control, the model includes more indicators than prior studies and has reliable internal validation. • Identified the association of pectoralis muscle cross-sectional area with SS-ILD, and potential links of systemic immune dysregulation, muscle atrophy, splenic involvement to SS-ILD pathogenesis. • Selected indicators are easily accessible, facilitating clinical application and validation.
PMID:41612106 | DOI:10.1007/s10067-026-07936-z