Tag: statistics

JAMA Netw Open. 2026 Aug 3;9(8):e2628395. doi: 10.1001/jamanetworkopen.2026.28395.

ABSTRACT

IMPORTANCE: Metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity, yet patient selection and prioritization remain largely based on body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) thresholds rather than clinical conditions. The Lancet Diabetes and Endocrinology Commission recently proposed distinguishing clinical obesity (adiposity with obesity-related organ dysfunction) from preclinical obesity (excess adiposity with preserved function). The implications of this framework for MBS practice have not been evaluated.

OBJECTIVE: To assess the prevalence of clinical and preclinical obesity among MBS candidates and examine their demographic and clinical profiles, perioperative risk, and long-term prognosis.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter, cross-sectional study audited data of adults (aged ≥18 years) undergoing primary MBS (laparoscopic gastric bypass or sleeve gastrectomy) between January 1, 2014, and December 31, 2025, at 4 high-volume tertiary centers in the UK, Spain, France, and Brazil. Patients who underwent revisional procedures or multiple bariatric operations within the same year were excluded.

EXPOSURES: Classification of obesity as clinical or preclinical using a pragmatic operationalization.

MAIN OUTCOMES AND MEASURES: The primary outcome was the prevalence of clinical obesity. Secondary outcomes were patterns of organ dysfunction, BMI levels, baseline American Society of Anesthesiologists classification and Charlson Comorbidity Index, estimated 10-year cardiovascular risk (Framingham risk score), and 30-day major postoperative complications (Clavien-Dindo grade ≥3). Comparative analyses between patients with clinical obesity vs those with preclinical obesity were performed only within each individual cohort. No direct statistical comparisons were performed between centers as patient-level data were not shared across cohorts.

RESULTS: Among the 2316 patients included, 1709 (73.8%) had clinical obesity (mean [SD] age across cohorts, 45.6 [11.0] to 48.9 [11.7] years; 1149 women [67.2%]) and 607 (26.2%) had preclinical obesity (mean [SD] age across cohorts, 34.7 [10.4] to 40.0 [9.8] years; 486 women [80.1%]). Clinical obesity was the most prevalent category across all centers (from 62.7% in the Brazilian cohort to 79.3% in the UK cohort). Mean (SD) BMI ranged from 40.2 (4.9) (preclinical obesity in the Brazilian cohort) to 48.5 (9.0) (preclinical obesity in the UK cohort), and BMI levels and BMI category distributions (<40, 40-49, ≥50) were similar between clinical and preclinical obesity. Patients with clinical obesity were significantly older compared with those with preclinical obesity (UK cohort: mean [SD], 48.9 [11.7] vs 39.5 [9.7] years; French cohort: mean [SD], 45.6 [11.0] vs 34.7 [10.4] years; Spanish cohort: mean [SD], 47.1 [9.3] vs 40.0 [9.8] years; Brazilian cohort: mean [SD], 48.3 [11.7] vs 40.0 [9.4] years (all P < .001) and had a higher American Society of Anesthesiologists classification (UK cohort: median [IQR], 3 [2-3] vs 2 [2-3]; P < .001; French cohort: median [IQR], 3 [3-3] vs 2 [2-3]; P < .001; Spanish cohort: median [IQR], 2 [2-3] vs 2 [1-2]; P < .001; Brazilian cohort: median [IQR], 2 [2-2] vs 2 [2-2]; P = .02), as well as higher estimated cardiovascular Framingham risk score (Spanish cohort: median [IQR], 1.31 [0.20-4.34] vs 0.20 [0.20-1.68]; Brazilian cohort: median [IQR], 1.57 [0.20-5.28] vs 0.20 [0.20-0.20]; French cohort: median [IQR], 8.00 [3.00-13.00] vs 2.00 [1.00-4.00]) (all P < .001) and all-cause mortality risk (Charlson Comorbidity Index score) (UK cohort: median [IQR], 1 [0-2] vs 0 [0-0]; Spanish cohort: median [IQR], 1 [0-1] vs 0; Brazilian cohort: median [IQR], 1 [1-3] vs 1 [0-1]) (all P < .001). Clinical obesity was associated with increased 30-day major postoperative complications (Clavien-Dindo grade ≥3) compared with preclinical obesity in the French cohort (4.0% vs 1.1%; P = .04).

CONCLUSIONS AND RELEVANCE: This international, multicenter cross-sectional study found that the majority of MBS candidates met criteria for clinical obesity, while a substantial minority were classified as having preclinical obesity. Despite similar BMI distributions, patients with clinical obesity may have a greater disease burden, higher operative risk, and higher estimated cardiovascular risk, supporting its potential value as a clinically meaningful framework for surgical practice.

PMID:42579277 | DOI:10.1001/jamanetworkopen.2026.28395

J Robot Surg. 2026 Aug 11;20(1):814. doi: 10.1007/s11701-026-03811-w.

ABSTRACT

To compare short-term outcomes and resource use between ambulatory and conventional inpatient robot-assisted partial nephrectomy (RAPN). This single-center retrospective cohort included 143 consecutive adults with localized renal tumors who underwent RAPN from June 2021 to December 2024. The ambulatory group (n = 75) followed a standardized pathway with planned discharge within 48 h and structured post-discharge nursing follow-up; the conventional inpatient group comprised 68 patients. Perioperative recovery, hospital resource use, renal function, and 30-day safety outcomes were compared. Baseline, tumor, operative, and renal-function measures did not differ significantly between groups. The ambulatory group had shorter drainage-tube duration, earlier ambulation, oral intake, catheter removal, and return to normal activity, shorter hospital stay [29.0 (27.5-30.5) vs. 87.5 (80.8-99.0) h], and lower hospitalization cost [45,860 (44,876 – 46,806) vs. 62,096 (60,452 – 63,862) CNY] (all P < 0.001). Planned discharge was completed by 67 of 75 ambulatory patients (89.3%); 8 (10.7%) had delayed discharge. No statistically significant between-group differences were detected in transfusion, positive margins, readmission, reoperation, 30-day complications, wound infection, or eGFR through 3 months. The ambulatory group had more follow-up calls and messages within 7 days (both P < 0.001). In selected patients at an experienced center, ambulatory RAPN was associated with shorter hospitalization, lower in-hospital cost, and earlier recovery without a statistically detectable increase in short-term adverse outcomes. The retrospective single-center design and low event counts preclude causal or equivalence conclusions.

PMID:42579266 | DOI:10.1007/s11701-026-03811-w

Probiotics Antimicrob Proteins. 2026 Aug 11. doi: 10.1007/s12602-026-11156-x. Online ahead of print.

ABSTRACT

Vaginal infections are a major public health concern in sub-Saharan Africa, where antimicrobial resistance increasingly compromises clinical management. This study aimed to determine the prevalence of vaginal infections, describe their antimicrobial resistance profiles, and evaluate the probiotic potential of lactic acid bacteria (LAB) isolated from cervicovaginal samples of women consulting in Garoua, North Cameroon. A mixed retrospective-prospective and analytical study was conducted at three hospital facilities in Garoua (January 2023-December 2024). Microbial identification used the VITEK 2 system and API 50 CHL galleries. Antibacterial and antifungal susceptibility were interpreted per EUCAST guidelines (versions 13.1-14.0) and CLSI M60 breakpoints, respectively. LAB isolates were characterized for safety, physiological tolerance, aggregation capacity, and antimicrobial activity. Statistical analyses included chi-square tests, odds ratio, Shannon diversity index, MARI, and PCA. Among 877 records analyzed, overall prevalence was 60.55% (95% CI: 57.27%-63.73%), declining significantly from 69.60% in 2023 to 53.78% in 2024 (OR = 1.97; p < 0.0001). Women aged 15-35 years were most affected (62.55%), with a seasonal peak in August (69.31%). Gardnerella vaginalis predominated (52.02%), followed by Candida albicans (18.60%). Clotrimazole (85.50%) showed critical antifungal resistance, while econazole retained the greatest activity (82.11% sensitivity). All five bacterial species fulfilled multidrug resistance criteria, with resistance confirmed in ≥ 82% of antibiotic families tested per species. Six LAB isolates identified as Lacticaseibacillus paracasei, Lactobacillus acidophilus, Lactiplantibacillus plantarum, Lactiplantibacillus pentosus, and Lactococcus raffinolactis displayed satisfactory probiotic profiles, including absence of virulence factors, acid and bile stress tolerance, strong aggregation capacity, and antimicrobial activity against Staphylococcus aureus, Neisseria gonorrhoeae, and Escherichia coli. This study reveals a high burden of vaginal infections with alarming multidrug resistance in Garoua. The identified LAB isolates represent promising locally sourced candidates for vaginal probiotic development. Institutionalized antimicrobial surveillance, revised antifungal prescribing practices, and targeted prevention campaigns are urgently needed.

PMID:42579253 | DOI:10.1007/s12602-026-11156-x

Am J Clin Dermatol. 2026 Aug 11. doi: 10.1007/s40257-026-01065-8. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis progresses to psoriatic arthritis in up to 30% of patients, causing irreversible joint damage and substantial healthcare burden. Whether biologic therapy reduces psoriatic arthritis risk remains unclear.

OBJECTIVE: The aim of this paper was to evaluate the association between biologic therapy and psoriatic arthritis risk in psoriasis patients.

METHODS: We conducted a systematic review and meta-analysis of cohort studies (PROSPERO: CRD420251240466), searching PubMed, EMBASE, and Cochrane Library from inception to December 2025. We included cohort studies of adults with psoriasis without prior psoriatic arthritis that reported adjusted risk estimates for incident psoriatic arthritis and used an ‘on-drug’ analytical framework to account for changes in treatment status over time. Pooled hazard ratio (HRs) with 95% confidence interval (CI) were calculated using fixed- or random-effects models.

RESULTS: In total, 15 cohort studies including 124,138 psoriasis patients with over 778,690 person-years of follow-up were included. Biologic use was associated with a 46% lower psoriatic arthritis risk versus non-biologic therapy (pooled HR 0.54, 95% CI 0.43-0.68), consistent versus non-systemic therapies (HR 0.57, 95% CI 0.33-0.97) and methotrexate (HR 0.48, 95% CI 0.45-0.51). Interleukin (IL)-17 inhibitors (HR 0.65, 95% CI 0.49-0.87; 3 studies) and IL-12/23 or IL-23 inhibitors (HR 0.46, 95% CI 0.36-0.60; 4 studies) were associated with lower psoriatic arthritis risk than tumor necrosis factor inhibitors. IL-23 inhibitors showed greater protection than IL-17 inhibitors (HR 0.67, 95% CI 0.58-0.77), while IL-23 inhibitors and IL-12/23 inhibitors did not differ (HR 0.88, 95% CI 0.69-1.13).

CONCLUSIONS: Biologic therapy for psoriasis, particularly IL-23/IL-17-targeted agents, is associated with reduced incident psoriatic arthritis risk. These findings suggest early pathway suppression may delay clinical psoriatic arthritis diagnosis, though causal inference is limited by the observational data.

PMID:42579249 | DOI:10.1007/s40257-026-01065-8

J Robot Surg. 2026 Aug 11;20(1):823. doi: 10.1007/s11701-026-03789-5.

ABSTRACT

Robot-assisted Roux-en-Y gastric bypass (RYGB) may facilitate suturing and ergonomics, but its value versus laparoscopy remains debated. We compared laparoscopic RYGB with a standardized Real Robotic 3-arm, 3-port technique. This prospective, single-center, non-randomized study included consecutive primary RYGB procedures performed from December 2024 to December 2025. The primary per-protocol analysis excluded non-isolated procedures, one conversion, and one robotic protocol deviation; an as-intended sensitivity analysis retained both intended robotic cases. Outcomes included operating-room times, direct material costs, length of stay, 30-day complications and readmissions, and surgeon satisfaction. The primary analysis included 109 patients (61 LGB, 48 RGB). Groups were broadly comparable, although hypertension was more frequent in RGB. Preparation time was slightly longer with RGB (median 34 vs. 29 min; shift 5.0 min, 95% CI approximately 0.0-9.0; p = 0.049), as were skin-to-skin time (144.5 vs. 113.0 min; shift 32.0 min, 95% CI 20.0-44.0; p < 0.001) and total operating-room occupancy (180 vs. 140 min; shift 38.0 min, 95% CI 22.0-50.0; p < 0.001). Direct material costs were modestly higher with RGB (median €2,044.3 vs. €1,931.3; shift €113.06; p < 0.001). Length of stay was one day in both groups. No leaks occurred, and no statistically significant differences were detected in 30-day complications or readmissions. Surgeon satisfaction was numerically higher with RGB but not statistically significant (p = 0.050). After the initial learning curve, the standardized robotic technique appeared feasible within an experienced single-center team. It was associated with longer operative times and modestly higher direct material costs, without statistically significant differences in short-term clinical outcomes.

PMID:42579245 | DOI:10.1007/s11701-026-03789-5

Forensic Sci Med Pathol. 2026 Aug 11. doi: 10.1007/s12024-026-01320-8. Online ahead of print.

ABSTRACT

Hymenal examination plays an important role in the forensic examination of suspected child sexual abuse. However, interpretation of hymenal findings remains challenging because of anatomical variation and subtle genital injuries, creating the potential for misinterpretation in medico-legal assessments. This study aimed to characterize hymenal morphology, hymenal injuries, and related forensic findings among female child sexual abuse victims in Vietnam and to examine patterns associated with repeated abuse. A retrospective analysis was conducted using forensic examination records of female children under 16 years of age referred for suspected sexual abuse at a specialized medico-legal center. Sociodemographic characteristics, assault-related information, hymenal morphology, and genital and extra-genital injuries were extracted from standardized forensic reports. Cases with diagnostic uncertainty or complex forensic findings were reviewed through expert consultation, and final conclusions were established by consensus within the forensic assessment team. A total of 443 children were included, with a mean age of 13.3 ± 2.6 years. The median interval between the alleged assault and forensic examination was 19 days (IQR: 4-89 days). Repeated sexual abuse accounted for 68.4% of cases. In multivariable analysis, older age (aOR = 1.25, 95% CI: 1.14-1.37), parental divorce (aOR = 1.95, 95% CI: 1.15-3.30), and abuse occurring in private or semi-private settings were independently associated with repeated sexual abuse. The annular hymen was the most frequently observed morphology (60.3%). Overall, 69.3% of cases showed combined hymenal dilatation and tear, followed by tear only (19.6%) and dilatation only (6.3%), while 4.7% had no hymenal injury. Most tears were old (81.7%) and located in the anterior region (65.2%). Additional genital and extra-genital injuries were uncommon. Repeated sexual abuse was common among examined victims. The annular hymen was the most frequently observed morphology, and combined hymenal dilatation and tear was the predominant injury pattern, while other genital and extra-genital injuries were uncommon. While these findings provide additional forensic reference data, no single hymenal morphology or injury pattern should be interpreted as diagnostic of sexual abuse in isolation and findings should be considered within the broader clinical and investigative context.

PMID:42579240 | DOI:10.1007/s12024-026-01320-8

J Mol Neurosci. 2026 Aug 11;76(3):128. doi: 10.1007/s12031-026-02586-x.

ABSTRACT

Major depressive disorder (MDD) constitutes a substantial global health burden; however, the causal genes and cell-type-specific mechanisms underlying its pathogenesis remain incompletely understood. We conducted an integrative transcriptomic and proteomic Mendelian randomization (MR) study incorporating expression quantitative trait loci (eQTL) and protein quantitative trait loci (pQTL) datasets to prioritize genes associated with MDD. Candidate genes were further evaluated using neuron-specific single-cell eQTL analyses across multiple brain cell types, and brain imaging-derived phenotypes were assessed as exploratory structural mediators through two-step MR mediation analysis. Integrative eQTL-MR and pQTL-MR analyses identified 20 genes associated with MDD at both transcriptomic and proteomic levels. Notably, CKAP2 showed directionally discordant associations across molecular layers: genetically predicted CNS-related CKAP2 expression was inversely associated with MDD risk, whereas genetically predicted plasma CKAP2 protein levels showed an association in the opposite direction. Rather than establishing a unified causal mechanism across transcriptomic and proteomic layers, this discordance suggests that CKAP2-related genetic signals may differ across tissues, molecular layers, or instrument constructions. Single-cell eQTL analyses provided supportive evidence for a protective-direction association of CKAP2 expression in excitatory neurons (OR = 0.986, p = 0.007), inhibitory neurons (OR = 0.990, p = 0.007), and oligodendrocyte precursor cells (OR = 0.987, p = 0.009). Mediation analysis suggested that right thalamic ventral anterior nucleus volume may represent an exploratory imaging phenotype related to the CKAP2-MDD association, accounting for 17.0% of the total effect, although this finding requires independent replication. Sensitivity analyses provided no evidence of heterogeneity or horizontal pleiotropy, and reverse MR analyses showed no evidence of reverse causation, although these analyses were limited in statistical power. Collectively, these findings prioritize CKAP2 as a candidate gene with convergent but non-confirmatory genetic evidence for involvement in MDD, warranting further validation in independent causal and experimental frameworks.

PMID:42579238 | DOI:10.1007/s12031-026-02586-x

J Robot Surg. 2026 Aug 11;20(1):813. doi: 10.1007/s11701-026-03790-y.

ABSTRACT

To compare perioperative, oncologic, and learning curve outcomes between open radical prostatectomy (ORP) and Versius^®-assisted robot-assisted radical prostatectomy (RARP) in Jordan. This prospective observational case series included 133 patients (58 ORP, 75 RARP) treated at King Hussein Cancer Center (open cohort, June 2015-February 2024; robotic cohort, February 2022-December 2025). Baseline characteristics, perioperative parameters, pathologic outcomes, and complications were compared using Wilcoxon rank-sum, Chi-square, and Fisher’s exact tests. Multivariable regression adjusted for confounders. The learning-curve analysis used total operative time as the primary endpoint (console time co-primary), with data-driven breakpoint identification and CUSUM analysis. The primary surgeon had prior experience with open and da Vinci-assisted radical prostatectomies before Versius® implementation. RARP was associated with significantly longer operative time (median 360 vs. 255 min; p < 0.001) but lower estimated blood loss (200 vs. 700 mL; p < 0.001). Median hospital stay was 3 days in both groups, but open patients were more likely to stay ≥ 4 days (40.4% vs. 14.0%; p = 0.003). Positive surgical margin rates were similar (53.3% vs. 51.1%; p = 0.813). Lymph node yield was lower in the robotic cohort (median 9 vs. 19; p < 0.001). Operative and console time improved systematically with case number (ρ = -0.65 and – 0.70; both p < 0.001), with a data-driven efficiency transition around case 30 corroborated by CUSUM analysis; the blood-loss advantage was present from the earliest cases whereas the lymph-node-yield deficit persisted beyond the learning curve. Pathologic Gleason score, not surgical approach, independently predicted biochemical recurrence (OR 2.41; p = 0.008). Versius®-assisted RARP achieves lower blood loss and comparable short-term oncologic outcomes to ORP, with operative efficiency improving beyond case 30. Lymph node yield during early adoption requires prospective monitoring. These findings provide an evidence-based framework for centers adopting this emerging platform.

PMID:42579233 | DOI:10.1007/s11701-026-03790-y

Metab Brain Dis. 2026 Aug 11;41(1):181. doi: 10.1007/s11011-026-01949-y.

ABSTRACT

Dysregulated lipid metabolism and neuroinflammation are increasingly recognized as interacting contributors to Alzheimer’s disease (AD), but the cell-type-specific genetic links between fatty acid metabolism and AD remain incompletely defined. This study aimed to identify fatty acid metabolism-related genes associated with AD risk and to characterize their relevance to perivascular macrophage (PVM) states. Single-cell RNA-sequencing data from GSE160936 and bulk transcriptomic data from GSE270454 were integrated to evaluate cell-type-specific fatty acid metabolism activity in AD and control samples.The primary data sources, fatty acid metabolism gene set, AUCell scoring strategy, CellChat workflow, GSEA resources, and MR software settings were specified to improve reproducibility. PVMs were further analyzed for differential expression, ligand-receptor communication, pathway enrichment, transcription factor regulation, and pseudotime-associated transcriptional changes. Cis-eQTL-based two-sample Mendelian randomization was performed using eQTLGen exposure data and AD GWAS summary statistics, followed by sensitivity analyses, reverse MR, and Bayesian colocalization.The analyses were interpreted across three distinct evidence levels: cell-type-resolved transcriptional association, systemic genetic expression prioritization, and tissue-level protein expression. Nominal MR findings were interpreted alongside multiple-testing considerations and colocalization support.Candidate protein expression was examined in hippocampal tissue from APP/PS1 and wild-type mice by Western blotting. Single-cell analysis identified eight major cell populations and showed increased fatty acid metabolism activity in PVMs from AD samples. Mendelian randomization prioritized ten fatty acid metabolism-related genes associated with AD risk, among which ACSL1, EPM2AIP1, MALT1, and RASGRP3 showed strong colocalization support (PP.H4 > 0.9). Pathway analyses linked these genes to lipid metabolic regulation, inflammatory signaling, phagocytosis, and mitochondrial/peroxisomal fatty acid metabolism. Co-expression analysis suggested associations between MALT1 and fatty acid oxidation-related genes, including ACADM and ACOX1. Western blotting in whole hippocampal lysates from APP/PS1 mice provided exploratory tissue-level protein evidence, showing increased ACSL1 and MALT1 and decreased RASGRP3 expression; these findings should not be interpreted as confirmatory PVM-specific validation. This integrative analysis prioritizes ACSL1, EPM2AIP1, MALT1, and RASGRP3 as candidate genes connecting fatty acid metabolic dysregulation with AD-associated neuroinflammatory processes. Because the genetic instruments were blood-derived and the protein assays used whole hippocampal lysates, the findings should be interpreted as candidate-gene prioritization and hypothesis generation rather than proof of direct PVM-specific causality.Accordingly, the study supports a prioritized candidate framework for future functional testing, not validated therapeutic targets or direct causal proof.

PMID:42579211 | DOI:10.1007/s11011-026-01949-y

Cancer Causes Control. 2026 Aug 11;37(9):145. doi: 10.1007/s10552-026-02228-y.

ABSTRACT

BACKGROUND: The impact of cancer extends beyond clinical outcomes, often disrupting interpersonal relationships and living situations. Although these social factors are important for survivorship, little is known about how marital status, residential urbanicity, and income change over time for cancer patients.

METHODS: Using SEER 17, we obtained data from 457,058 adults diagnosed with multiple primary cancers from 2000 to 2021 and evaluated changes in marital status, urbanicity, and household income between the first and last recorded diagnoses. Analyses were stratified by follow-up interval (short: 2-5, long: > 5 years). Marital status change was evaluated among patients who were married at the first cancer diagnosis (n = 255,939), and changes in urbanicity and household income were evaluated as secondary analyses among patients who remained married from first to last diagnosis (n = 214,956). Logistic regressions adjusted for demographic and clinical factors were used to estimate odds ratios and 95% confidence intervals.

RESULTS: Among patients married at the first diagnosis, 5% became not married (divorced/separated/single) and 11% were widowed; rates were higher in women (6% not married; 16% widowed) than men (4; 7%). Among patients who remained married from the first to the last diagnosis, 5% changed urbanicity (1.5% more rural; 3.4% more urban) and 26% changed income (15% increase; 10% decrease). NHB patients had > twofold higher odds of being unmarried (not married or widowed) and income decrease compared to non-Hispanic Whites. Hispanic patients also had elevated odds of unmarried, while Non-Hispanic Asian/Pacific Islander patients had lower odds of income decrease.

CONCLUSIONS: Cancer diagnoses are associated with notable social and economic disruptions, disproportionately affecting women and vulnerable racial/ethnic populations. This study provides the first large-scale analysis of how marital status, residence, and income evolve, highlighting the need to address social determinants of health in survivorship care.

PMID:42579198 | DOI:10.1007/s10552-026-02228-y