Tag: statistics

Front Nutr. 2026 Apr 21;13:1786580. doi: 10.3389/fnut.2026.1786580. eCollection 2026.

ABSTRACT

BACKGROUND: Both intermittent enteral nutrition (IEN) and continuous enteral nutrition (CEN) are used to provide nutritional support to critically ill patients. However, their comparative effects on gastrointestinal tolerance and clinical outcomes remain uncertain.

OBJECTIVES: We conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of IEN versus CEN in critically ill patients.

METHODS: We performed a comprehensive literature search of PubMed, Embase, Scopus, and the Cochrane Library from inception through December 10, 2025, to identify RCTs comparing IEN and CEN in critically ill adults. The primary outcome was all-cause mortality in the intensive care unit (ICU). Secondary outcomes included gastrointestinal complications, length of ICU stay, and achievement of nutritional goals. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models as appropriate. Subgroup analyses were performed according to mechanical ventilation status.

RESULTS: Twenty-two RCTs comprising 1,662 critically ill patients (IEN, n = 816; CEN, n = 846) were included. Compared with CEN, IEN was associated with a significantly higher incidence of diarrhea (RR 1.56, 95% CI 1.23 to 1.98, I ² = 19%) and abdominal distension (RR 1.68, 95% CI 1.10 to 2.57, I ² = 18%), as well as prolonged ICU length of stay (MD 0.91, 95% CI 0.41 to 1.41, I ² = 0%). Conversely, IEN was associated with a lower incidence of constipation (RR 0.74, 95% CI 0.57 to 0.97, I ² = 0%). These effects were more pronounced in mechanically ventilated patients, whereas no statistically significant differences were observed in non-ventilated patients. No significant differences were identified between the two strategies regarding ICU mortality, vomiting, gastric retention, aspiration pneumonia, or achievement of nutritional goals.

CONCLUSION: This updated meta-analysis demonstrates that IEN is associated with increased rates of diarrhea and abdominal distension and prolonged ICU length of stay compared with CEN, particularly among mechanically ventilated patients. Although IEN reduces the incidence of constipation, CEN may be the preferable feeding strategy for most critically ill patients. Individualized approaches considering patient-specific factors and clinical context are warranted. Further high-quality trials are needed to identify patient subgroups who might benefit from IEN.

SYSTEMATIC REVIEW REGISTRATION: https://osf.io/krs8v.

PMID:42095216 | PMC:PMC13139002 | DOI:10.3389/fnut.2026.1786580

Front Sports Act Living. 2026 Apr 21;8:1793910. doi: 10.3389/fspor.2026.1793910. eCollection 2026.

ABSTRACT

INTRODUCTION: The Modified Maddocks Questions Tool (MMQT) is part of the Concussion Recognition Protocol used for sideline assessment of suspected concussion. Although widely used in English-speaking populations, it has not been validated in Spanish-speaking children. This study aimed to evaluate comprehension and response accuracy of a Spanish-adapted MMQT in soccer players aged 4-8 years.

METHODS: We conducted a cross-sectional observational study in Montevideo, Uruguay, between July and October 2024. Eighty-eight male soccer players aged 4-8 years were assessed at halftime using a Spanish-adapted version of the MMQT. Comprehension was evaluated by asking participants to reformulate each question. Associations between age, comprehension, and response accuracy were analyzed using chi-square or Fisher’s exact tests and logistic regression models.

RESULTS: No statistically significant association was found between age and either comprehension or accuracy. Overall comprehension exceeded 96%. However, Question 4 (“Which team won the last match?”) consistently showed a lower correct response rate across all ages. Our findings reinforce previous observations showing that questions assessing recall of past events can be challenging for younger children and suggest caution when evaluating MMQT responses in this age group.

CONCLUSIONS: The Spanish-adapted MMQT demonstrates high comprehension and may be suitable for sideline concussion screening in children aged 5-8 years. However, Question 4 appears less reliable and should be reconsidered in future versions. A conservative approach is recommended, whereby any incorrect response warrants removal from play for further evaluation.

PMID:42095200 | PMC:PMC13139062 | DOI:10.3389/fspor.2026.1793910

Public Health Chall. 2026 May 5;5:e70269. doi: 10.1002/puh2.70269. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: In low- and middle-income countries, meat consumption is often associated with health risks due to limited awareness of zoonotic disease transmission. Burkina Faso is not exempt from these public health threats. This study aimed to assess knowledge and practices related to meat-borne zoonotic risks among meat consumers in Burkina Faso.

METHODS: A cross-sectional descriptive and analytical survey was conducted from August to November 2022, including 849 participants. Data were collected using a structured questionnaire administered through face-to-face interviews. Scores were attributed to assess levels of knowledge and practices regarding zoonotic risks associated with meat handling and consumption. Statistical analysis was performed using descriptive statistics and chi-square and Fisher’s exact tests.

RESULTS: According to findings, although 90.22% acknowledged that meat could transmit zoonotic diseases to humans, only 31.22% could name at least one zoonotic disease. Poor hygiene in meat sale outlets was reported by 50.77% of respondents. Good practices, such as proper meat storage, were inconsistently reported, as 66.90% reportedly stored meat exposed to open air, and 46.29% used the same utensils for meat preparation and meal service in households. Overall, level of education, professional occupation, religion and position held in the household were significantly associated with both knowledge and practices (p < 0.05), and participants having better knowledge were more likely to adopt safer practices (p < 0.05).

CONCLUSION: Despite a general awareness of meat-related health risks, including zoonotic diseases, knowledge gaps and unsafe practices remain prevalent among consumers. Reducing meat-borne zoonotic diseases requires shifting from general awareness to actionable, behaviour-oriented interventions. By combining community education, improved market hygiene and multi-sectoral collaboration, public health authorities can substantially reduce preventable exposure to zoonotic pathogens while preserving the nutritional benefits of meat consumption.

PMID:42095195 | PMC:PMC13142224 | DOI:10.1002/puh2.70269

Health Sci Rep. 2026 May 4;9(5):e72021. doi: 10.1002/hsr2.72021. eCollection 2026 May.

ABSTRACT

BACKGROUND AND AIMS: Shoulder impingement syndrome (SIS) is a common cause of shoulder pain and dysfunction. This study explored the association between coracoacromial ligament (CAL) thickness and SIS using magnetic resonance imaging (MRI).

METHODS: This cross-sectional MRI-based observational study involved 47 patients aged 18-70 years with shoulder pain. T2 fat-saturated sagittal MRI views were used to measure CAL thickness at proximal and distal portions by two radiologists. Statistical analyses included t-tests, χ ² tests, and Pearson’s correlation, with significance set at p < 0.05.

RESULTS: Mean proximal CAL thickness was 1.24 mm (SD = 0.44 mm), and distal thickness was 1.50 mm (SD = 0.72 mm). Patients with SIS had significantly greater thickness at proximal (1.36 mm vs. 1.05 mm, p = 0.002, d = 0.82) and distal (1.78 mm vs. 1.12 mm, p = 0.001, d = 0.92, 95% CI: 0.39-0.93). Males showed greater distal thickness (1.62 mm) than females (1.34 mm, p = 0.04, d = 0.45). Age did not correlate with thickness (p > 0.71). Subacromial bursitis (70.21%, p < 0.001) and acromioclavicular (AC) joint osteophytes (68.09%, p = 0.003) were prevalent and associated with SIS.

CONCLUSION: CAL thickness, particularly at the distal portion, was strongly associated with SIS, independent of age but varying by gender. Measuring CAL thickness may aid SIS diagnosis.

PMID:42095187 | PMC:PMC13139633 | DOI:10.1002/hsr2.72021

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