Tag: statistics

Curr Environ Health Rep. 2026 May 1;13(1):19. doi: 10.1007/s40572-026-00536-8.

ABSTRACT

PURPOSE OF REVIEW: Exposure to endocrine disrupting chemicals (EDC) is linked to numerous adverse health outcomes. However, limiting exposure to EDCs remains a significant challenge due to their widespread uses and persistence in the environment. Adequate micronutrient status supports optimal health and may offer actionable strategies for mitigating the adverse health effects of EDCs. This scoping review aimed to summarize the epidemiologic evidence on micronutrients as potential mitigators of EDC-related health outcomes, with the goal of guiding future research and methodologies.

RECENT FINDINGS: We identified 71 epidemiologic studies assessing micronutrients as mitigators of EDC-outcome relations, focused primarily on exposures during pregnancy (n = 34). Most studies examined phthalates and/or environmental phenols (n = 25), per- and polyfluoroalkyl substances (n = 15), polycyclic aromatic hydrocarbons (n = 10), and self-reported pesticide exposure (n = 6). Most studies suggested higher levels of some micronutrients attenuated adverse associations of EDCs with some health outcomes, particularly iodine (thyroid hormones); folic acid (fertility, birth outcomes, neurodevelopment); vitamin D (lung function, neurodevelopment); and antioxidants (birth outcomes, aging, metabolic health). However, included studies assessed a wide range of micronutrients, EDCs, and outcomes, with limited overlap across studies. This scoping review identified few topics with substantial evidence to warrant focused systematic reviews, suggesting that additional prospective research is needed, especially in at-risk populations and sensitive periods outside of pregnancy. Future epidemiologic research should consider the co-occurrence of EDCs and micronutrients in foods and include multiple methods for assessing micronutrients. Finally, to strengthen causal inference, future research should thoughtfully model potential confounding, mediation, effect measure modification, and/or statistical interaction.

PMID:42062659 | DOI:10.1007/s40572-026-00536-8

CNS Drugs. 2026 Apr 30. doi: 10.1007/s40263-026-01293-w. Online ahead of print.

ABSTRACT

BACKGROUND: Augmentation of collateral circulation is an alternative method to improve cerebral hypoperfusion when revascularization is not suitable. DL-3-n-butylphthalide (NBP) has been shown to enhance cerebral collateral circulation and improve cerebral blood flow (CBF) in previous studies. The objective of this study was to explore the effect of NBP on cerebral hemodynamic impairment due to atherosclerotic stenosis in internal carotid system.

METHODS: This was a double-blind, placebo-controlled, randomized clinical trial conducted in 38 Chinese hospitals between 14 January 2022, and 11 April 2024. Eligible participants were aged 35-85 years with ≥ 70% stenosis in unilateral internal carotid artery or middle cerebral artery, accompanied by cerebral hypoperfusion and no recent cerebral ischemic events. The patients were randomly assigned in a 1:1 ratio to a treatment group receiving 600 mg NBP daily or a placebo group receiving an ineffective dose of NBP daily for 4 weeks. The cerebral perfusion was assessed by computed tomography perfusion. The grades of cerebral perfusion change from baseline to 12 weeks were classified into amelioration, stabilization, and deterioration. The primary efficacy outcome was the percentage of patients achieving CBF amelioration.

RESULTS: Of 485 enrolled patients (median age 63 years, 66.6% men), 244 were assigned to the NBP group and 241 to the placebo group. At the end of follow-up, 204 in the NBP group and 212 in the placebo group completed second cerebral perfusion. NBP group had 113 (55.4%) patients with CBF amelioration in stenotic territory and placebo group had 93 (43.9%) comparable patients at 12 weeks (risk ratio 1.32; 95% confidence interval 1.08-1.61; p = 0.006).

CONCLUSIONS: For cerebral hypoperfusion from atherosclerotic stenosis in internal carotid system, NBP treatment resulted in a higher proportion of patients achieving CBF amelioration than placebo.

TRIAL REGISTRATION: chictr.org.cn: ChiCTR2100053112.

PMID:42062656 | DOI:10.1007/s40263-026-01293-w

Cardiovasc Intervent Radiol. 2026 Apr 30. doi: 10.1007/s00270-026-04452-0. Online ahead of print.

ABSTRACT

BACKGROUND: Endovascular options for infrapopliteal artery disease include plain balloon angioplasty (PTA), drug‑coated balloons (DCB), drug‑eluting and bare‑metal stents (DES), and atherectomy. Retrievable scaffold therapy (RST) has recently emerged as a temporary scaffolding strategy used with DCB, but its comparative effectiveness remains uncertain.

METHODS: A comprehensive literature search identified 21 randomized and 4 single‑arm trials (n = 3184). Eligible studies reported at least one prespecified outcome: 30‑day major adverse events (MAE), 12‑month all‑cause mortality, 6‑month clinically driven target lesion revascularization (CD‑TLR), or 6‑month major amputation. Random‑effects models generated odds ratios (ORs) with 95% credible intervals (CrIs). SUCRA values summarized treatment rankings.

RESULTS: Atherectomy ranked best for 30‑day MAE (SUCRA 77.2%), though no treatment yielded a statistically significant reduction in the Odds Ratio. It was also associated with a significantly reduced 12‑month mortality versus PTA (OR 0.39, 95% CrI 0.15-0.90; SUCRA 97.8%). For 6‑month CD‑TLR, atherectomy (OR 0.26, 95% CrI 0.00-0.62), DCB (OR 0.42, 95% CrI 0.30-0.58), and DES (OR 0.43, 95% CrI 0.19-0.88) showed significant benefit. No treatment significantly reduced major amputation. RST showed favorable but nonsignificant reductions, indicating a smaller number of available studies, consistently ranking mid‑tier across all outcomes. Meta‑regression identified CKD and longer lesion length as predictors of higher CD‑TLR risk.

CONCLUSIONS: Atherectomy showed the most consistent benefits across mortality and reintervention outcomes, while RST demonstrated promising but inconclusive performance. Larger randomized trials are needed to clarify RST’s role in infrapopliteal revascularization.

PMID:42062609 | DOI:10.1007/s00270-026-04452-0

Diabetologia. 2026 Apr 30. doi: 10.1007/s00125-026-06727-0. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Women with a history of gestational diabetes mellitus (GDM) have an elevated risk of type 2 diabetes in their later life, yet the underlying mechanisms of this remain unclear. We aimed to investigate the long-term impact of GDM on gut microbiota and related metabolites and to explore whether such alterations may contribute to type 2 diabetes risk.

METHODS: Among parous women from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we identified microbial species associated with a history of GDM (visit 2, 2014-2017, n=1525), and serum metabolites associated with both a history of GDM (visit 1, 2008-2011, n=2968) and GDM-related microbiota (visit 2, n=391). We further examined prospective associations of the GDM-related microbiome (visit 2, n=925) with incident type 2 diabetes over 6 years of follow-up, and of microbial-related metabolites (visit 1, n=2341) with incident type 2 diabetes over 12 years.

RESULTS: Among 1525 US Hispanic/Latino parous women (median age: 58 years), seven species differed between women with and without a history of GDM, including higher abundances of four species (e.g. Parabacteroides merdae CAG:48, a proinflammatory taxon) and lower abundances of three species (e.g. Dialister sp. CAG:588, a short-chain fatty acid producer). Fifteen metabolites were associated with both a history of GDM and the GDM-related microbiome in a consistent direction, nine of which (e.g. saturated sphingomyelins and unsaturated fatty acids) were associated with glycaemic traits and incident type 2 diabetes. Using these microbial-related metabolites as proxy measures, proxy analysis suggested a positive relationship between the GDM-related microbiome and type 2 diabetes (r=0.55, p=0.036). A metabolite score derived from the nine microbial-related metabolites mediated an estimated 20% (95% CI 9%, 42%) of the association between a history of GDM and type 2 diabetes.

CONCLUSIONS/INTERPRETATION: A history of GDM is associated with an unfavourable gut microbiota and related metabolites in US Hispanic/Latino women, suggesting a potential role of the gut microbiota in GDM-related type 2 diabetes.

PMID:42062589 | DOI:10.1007/s00125-026-06727-0

J Mater Sci Mater Med. 2026 Apr 30. doi: 10.1007/s10856-026-07051-0. Online ahead of print.

ABSTRACT

This study aimed to evaluate the osteogenic potential of a novel magnesium (Mg)-containing calcium silicate (CS)-based glass-ceramic scaffold. For this purpose, twenty-four male Wistar rats were randomly assigned to two experimental groups: Glass-ceramic scaffold developed and sintered at 900 °C/1 h (GCS9) and 1250 °C/8 h (GCS1). The scaffolds were implanted in 8 mm critical bone defects and evaluated at biological points of 15 and 45 days. Histomorphological analysis revealed that the scaffolds completely filled the bone defect, demonstrated biocompatibility, and promoted bone neoformation beyond the defect margins in direct contact with the biomaterial surface. Bone formation was observed throughout the entire defect and within the fragmented scaffolds in its central regions. Both groups exhibited mild chronic granulomatous inflammation in the interstitial tissue formed between the biomaterial fragments. Histomorphometric analysis revealed a greater bone neoformation area in the GCS1 group (44%) at 45 days, with a statistically significant difference between the biological points in this group (ANOVA p = 0.048). Therefore, this study demonstrated that Mg-containing CS-based glass-ceramic scaffolds, particularly GCS1, were notably bioactive and osteoconductive, exhibiting significant osteogenic potential for critical bone defect repair and showing promise for future clinical applications.

PMID:42062557 | DOI:10.1007/s10856-026-07051-0

Leukemia. 2026 Apr 30. doi: 10.1038/s41375-026-02939-w. Online ahead of print.

ABSTRACT

Myelodysplastic neoplasms (MDS) with TP53 multihit alterations are associated with dismal outcomes. MDS with isolated del(5q) present favorable prognosis but is defined by the absence of TP53 multihit alterations. However, whether TP53 multihit alterations exert the same adverse impact in this genetic context remains uncertain. We retrospectively analyzed the characteristics and outcome of 43 patients with MDS with isolated del(5q) harboring TP53 multihit alterations (MDS-del(5q) TP53 multihit) and compared with 68 patients with low-blast MDS with TP53 multihit and without isolated del(5q) (MDS-LB TP53 multihit). Patients with MDS-del(5q) TP53 multihit showed significantly higher platelet counts, more frequent SF3B1 mutations, were less often classified as high-risk by IPSS-R or IPSS-M, and had significantly better outcomes than patients with MDS-LB TP53 multihit: overall survival of 70.2 vs 13.9 months, and time to acute myeloid leukemia progression (AML) of 31.9 vs 7.2 months, respectively. Moreover, the superior outcomes of MDS-del(5q) TP53 multihit patients persisted significant even when compared with MDS-LB TP53 multihit cases without complex karyotype (survival of 70.2 vs 39.9 months; time to AML progression of 31.9 vs 11.4 months). These findings indicate that, in MDS-del(5q) the adverse impact of TP53 multihit alterations may be less important than in other MDS subtypes.

PMID:42062555 | DOI:10.1038/s41375-026-02939-w

Support Care Cancer. 2026 May 1;34(5):482. doi: 10.1007/s00520-026-10694-y.

ABSTRACT

PURPOSE: To investigate and compare the prevalence and experience of dental caries in childhood cancer survivors (CCS) with that in healthy controls.

METHODS: A total of 113 CCS (0-18 years) who completed cancer treatment between 2017 and 2021 at Haukeland University Hospital were invited. Two healthy controls per CCS were randomly selected from the Norwegian National Population Register and matched by age and sex. Decayed, missing, and filled teeth (DMFT/dmft) and surfaces (DMFS/dmfs) were used as indices of dental caries experience. The difference in the number of affected teeth/surfaces per patient between CCS and controls was assessed via Poisson regression, with a significance level of 0.05.

RESULTS: A total of 97 CCS (85.8%) provided consent and completed the clinical examinations. The mean age among CCS was 10.4 years. Among both the CCS (34/97) and healthy controls (68/194), 35.1% had d_3-5mft and/or D_3-5MFT > 0. The mean d_3-5mft and/or D_3-5MFT was 1.15 in CCS and 0.96 in controls. A significantly greater degree of caries experience (d_3-5mfs and/or D_3-5MFS, p < 0.001; d_3-5mft and/or D_3-5MFT, p = 0.002) was observed in the CCS group than in the healthy control group for mixed dentition. No significant associations were found for the other dentitions or for d_1-5mfs and/or D_1-5MFS or d_1-5mft and/or D_1-5MFT.

CONCLUSIONS: This study compared caries experience in CCS and matched healthy controls and found no overall differences at the tooth level, indicating that awareness and follow-up of oral health in paediatric cancer patients may play a role in limiting caries development and disease burden.

PMID:42062554 | DOI:10.1007/s00520-026-10694-y

J Hum Hypertens. 2026 Apr 30. doi: 10.1038/s41371-026-01151-8. Online ahead of print.

ABSTRACT

Primary healthcare (PHC) physicians play a pivotal role in the diagnosis and management of hypertension. While guidelines suggest that blood pressure (BP) should be measured in every patient visit at PHC units, the few studies conducted among PHC physicians report a low ratio of BP measurements in PHC settings. Data on PHC physicians’ practices concerning BP measurement in Greece are lacking. This study aimed to investigate the practices of PHC physicians regarding BP measurement in Greece. A cross-sectional web-based survey was conducted among PHC physicians across Greece. A total of 284 PHC physicians completed the questionnaire and 282 responses were included in the analysis, 42.9% male, 92.9% General Practitioners, 89.4% working in the public sector, with a median of 25 (17 – 30) daily patient visits. PHC physicians reported measuring BP in 33.3% (20-50%) of their patients and recommending home BP measurements in 31.1% (SD: 24.3%) of them. Among those who measured BP, 22.3% measured it once, 44.7% measured it twice, and only 21.3% measured it three times, while 54.6% used an electronic upper arm BP monitor. The main barriers reported were high daily patient volume (60.5%), together with limited time available with patients (69.5%), while only 1.3% declared insufficient training. This is the first study in Greece investigating the practices of PHC physicians regarding BP measurements. Our findings underscore the need for targeted interventions to improve BP monitoring practices. Education and motivation of physicians and other primary care team members would be fundamental in addressing the challenge of implementing BP measurement recommendations in clinical practice.

PMID:42062548 | DOI:10.1038/s41371-026-01151-8

Eur J Clin Pharmacol. 2026 May 1;82(5):138. doi: 10.1007/s00228-026-04052-4.

ABSTRACT

PURPOSE: Drug supply shortages are a recurring issue in developed countries, with consequences for patients even before the COVID-19 pandemic. Questions arise regarding the effectiveness and tolerability of alternative treatments chosen by physicians due to these shortages.

METHODS: To answer these questions, a survey for practicing physicians was distributed to medical associations in Germany and Austria and conducted from November 2022 to January 2024. 895 physicians responded to the survey. The survey targeted 20 drugs with known supply shortages, namely amoxicillin, amoxicillin/clavulanic acid, penicillin V (phenoxymethylpenicillin), cefuroxime, cefaclor, erythromycin, cotrimoxazole, ibuprofen, paracetamol, urapidil, metoprolol, amlodipine, candesartan, tamoxifen, methotrexate, fluoxetine, lorazepam, human insulin, salbutamol and prednisolone.

RESULTS: Physicians most frequently chose a different antibacterial drug (> 60% of the physicians), while for analgesics, they more often used a different dosage form of the same drug (> 33%). For antihypertensive drugs, physicians more often chose a different dosage of the same drug. In many cases, alternative antibiotics were chosen that carried a greater risk of antimicrobial resistance than the antibiotic originally intended. The treatment success for replacing antibacterials and analgesics with a different drug was rated with 4-5 on a predefined scale of 1 (very poor) to 6 (very good) in comparison to the original drug. Using the same drug in a different dosage/dosage form was also around 4-5/6 effective.

CONCLUSIONS: Supply shortages can foster antimicrobial resistance through the use of antibacterials with a higher potential for resistance. The success of alternative treatments was not always considered to be very good in comparison to the original medication.

PMID:42062544 | DOI:10.1007/s00228-026-04052-4

Eur J Clin Nutr. 2026 Apr 30. doi: 10.1038/s41430-026-01758-7. Online ahead of print.

ABSTRACT

BACKGROUND: Over time, amyotrophic lateral sclerosis (ALS) has been considered an accelerated model of sarcopenia. However, muscle mass is rarely assessed in ALS patients. The aim of this study was to explore the agreement between bioelectrical impedance analysis (BIA)-measured and calf circumference (CC)-derived appendicular skeletal muscle mass index (ASMMI) in ALS patients.

METHODS: Body composition was assessed using anthropometric measures and BIA. Pearson analyses were used to assess correlations and Kappa (κ) statistics were used to evaluate agreement between BIA-measured and CC-derived ASMMI. CC predictive ability was assessed through the area under the receiver operating characteristic curve.

RESULTS: A total of 61 ALS patients were included. The CC-ASMM was highly correlated with the BIA-ASMM (r = 0.830, p < 0.001) and CC-ASMMI was moderately correlated with BIA-ASMMI (r = 0.62, p < 0.001). Low CC-derived and BIA-derived ASMMI presented a moderate degree of agreement in the overall sample (k = 0.546, 95% CI 0.325-0.767) and in men (k = 0.432, 95% CI 0.056-0.809), while a substantial agreement was observed in women (k = 0.613, 95% CI 0.344-0.883). The optimal cut-off values for CC in identifying low ASMMI from the ROC analysis, were 34 cm for both sexes with an area under the curve (AUC) of 0.818 for men (sensitivity 80%, specificity 78.3%) and of 0.841 (sensitivity 83.3%, specificity 72.7%) for women.

CONCLUSION: Our preliminary study showed a good predictive ability of the CC, an anthropometric parameter significantly associated with sarcopenia, in reflecting the ASMM. The best performance was found for a CC cut-off point of ≤34 cm in both sexes.

PMID:42062527 | DOI:10.1038/s41430-026-01758-7