Tag: statistics

J Thromb Thrombolysis. 2026 Jul 25. doi: 10.1007/s11239-026-03366-5. Online ahead of print.

ABSTRACT

Hypercoagulability and platelet activation are central components of COVID-19 pathophysiology. However, despite growing evidence that sex-related biological differences may influence thromboinflammatory responses, studies focusing on sex-based genetic variations in coagulation and platelet indices remain limited. This study includes 324 COVID-19 patients, investigated the sex-specific effects of FGB – 455 G > A (rs1800790) and ITGB3 T1565C (rs5918) polymorphisms. Genotypes were determined using TaqMan-based real-time PCR, and patients were stratified by sex; demographic, hematological, and biochemical data were retrieved and analyzed statistically. The GA genotype of FGB rs1800790 was more frequent in females than males, whereas the TC genotype of ITGB3 (rs5918) was less frequent in females (OR = 1.71, 95% CI: 1.06-2.76, p = 0.028; OR = 0.53, 95% CI: 0.31-0.90, p = 0.020, respectively). In the GG genotype of FGB (rs1800790), females were younger and had lower urea, creatinine, and WBC, with no differences in other parameters (p = 0.026, d = 0.367; p = 0.006, d = 0.485; p = 0.012, d = 0.440; and p = 0.010, d = 0.431 respectively). No sex differences were observed in the GA genotype, whereas aPTT was lower in AA-genotype females (p = 0.045, d = 0.830). For ITGB3 (rs5918), males with the TC genotype were older and had higher PT, ferritin, urea, creatinine, and WBC, but lower eosinophils (p = 0.030, d = 0.584; p = 0.042, d = 0.667; p = 0.001, d = 1.081; p = 0.005, d = 0.803; p = 0.020, d = 0.655; p = 0.020, d = 0.609; and p = 0.012, d = 0.733 respectively); the CC genotype was observed only in three males. These results emphasize the combined influence of sex and coagulation-related genetic variants on thrombo-inflammatory patterns in COVID-19. These findings highlight the potential clinical importance of considering sex-genotype interactions when evaluating thrombo-inflammatory responses and may contribute to more personalized risk assessment and management strategies in patients with COVID-19.

PMID:42502144 | DOI:10.1007/s11239-026-03366-5

Int Urol Nephrol. 2026 Jul 26. doi: 10.1007/s11255-026-05306-x. Online ahead of print.

ABSTRACT

BACKGROUND: Physical inactivity is a significant yet modifiable risk factor for all-cause mortality and falls among peritoneal dialysis (PD) patients; however, their inadequate exercise adherence remains poorly understood. This study aimed to characterize current patterns of exercise adherence in PD patients and identify key determinants influencing adherence behaviors.

METHODS: A multicenter cross-sectional survey was conducted from July 2024 to July 2025 across four tertiary hospitals in Shenzhen, enrolling 207 eligible PD patients. Data were collected using demographic questionnaires, the Exercise Adherence Rating Scale, the Tampa Scale for Kinesiophobia, the Self-Efficacy for Managing Chronic Disease Scale, and the Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Statistical analyses included multiple linear regression and mediation analysis.

RESULTS: The mean exercise adherence score was 32.06 ±8.28, indicating moderate adherence. Multiple linear regression identified receipt of structured exercise guidance (β= 4.124, p < 0.001), higher self-efficacy (β= 1.392, p < 0.001), and lower kinesiophobia (β= -0.282, p = 0.033) as significant predictors of exercise adherence. Mediation analysis showed indirect associations via self-efficacy [β= 0.136, 95% CI (0.064, 0.220)] and kinesiophobia [β= 0.120, 95% CI (0.046, 0.202)], accounting for 76.2% of the total association.

CONCLUSION: Exercise adherence in PD patients is influenced by multiple factors, with exercise guidance, self-efficacy, and kinesiophobia emerging as critical determinants. Fatigue was indirectly associated with adherence through self-efficacy and kinesiophobia in exploratory analyses. Clinicians may consider prioritizing early identification of at-risk patients and develop and implement theory-driven, multifaceted interventions to enhance adherence.

PMID:42502141 | DOI:10.1007/s11255-026-05306-x

Diabetologia. 2026 Jul 25. doi: 10.1007/s00125-026-06814-2. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Environmental exposures have been adversely associated with the risk of diabetes but their role in the remission and progression of prediabetes (impaired glucose tolerance [IGT] and/or impaired fasting glucose [IFG]), especially different phenotypes, is poorly understood. This study aimed to investigate the relationship between environmental exposures and remission or progression of prediabetes phenotypes.

METHODS: Data were derived from the KORA (Cooperative Health Research in the Region of Augsburg) cohort in Southern Germany (2006-2022). Glucose tolerance status was defined according to the 1999/2006 WHO criteria. We included annual values of particulate matter (PM), light at night (LAN), normalised difference vegetation index (NDVI), imperviousness (IMP) and air temperature variation (T_sd). We fitted complementary log-log regression models for associations between IQR changes in exposures and the incidence of prediabetes phenotypes (isolated impaired fasting glucose [iIFG], isolated impaired glucose tolerance [iIGT], or their combination [IFG+IGT]), remission to normal glucose tolerance (NGT) or progression to type 2 diabetes. We also applied Quantile g-computation regression models for joint association analysis.

RESULTS: During the follow-up, 370/1618 participants developed prediabetes (124 iIFG, 199 iIGT and 47 IFG+IGT). Among participants with prediabetes, 136/367 (without medication) regressed to NGT and 133/420 progressed to type 2 diabetes. We observed consistent associations of air pollutants and the built environment with iIGT or IFG+IGT. For example, an IQR increase in PM_2.5 (aerodynamic diameter ≤2.5 μm) showed an HR of 1.89 (95% CI 1.07, 3.31) for the risk of IFG+IGT and 1.59 (95% CI 1.03, 2.46) with a decrease in NDVI. Co-exposure to environmental mixtures (higher air pollution, T_sd, IMP and LAN, and lower NDVI) was associated with increased risks of iIFG, iIGT and IFG+IGT. Additionally, lower NDVI (HR 0.52 [95% CI 0.28, 0.96]), higher LAN (HR 0.22 [95% CI 0.08, 0.62]) and higher IMP were associated with reduced remission of iIFG but we found no statistically significant associations with the progression to type 2 diabetes.

CONCLUSIONS/INTERPRETATION: The findings indicate potential heterogeneity in environmental exposures and prediabetes phenotypes. Specifically, they are associated with increased incidence of IGT and decreased remission of iIFG.

PMID:42502136 | DOI:10.1007/s00125-026-06814-2

Sports Med. 2026 Jul 26. doi: 10.1007/s40279-026-02483-8. Online ahead of print.

ABSTRACT

BACKGROUND: Musculoskeletal stretching, a low-skill and accessible exercise, may help lower cardiovascular disease (CVD) risk by reducing arterial stiffness (AS). The most well-established measure of AS is pulse wave velocity (PWV).

OBJECTIVES: To determine (1) the effects of acute and longitudinal musculoskeletal stretching interventions on PWV in adults; and (2) whether the pooled effect is moderated by stretching prescription (i.e., frequency, intensity, time, and type [FITT]), study design (e.g., supervision), study quality and risk of bias, and study outcome (e.g., specific PWV segment).

DATA SOURCES: Electronic databases (PubMed, Scopus, Embase, and Web of Science) were searched from 1974 to 2025, using the search terms: stretching AND (arterial stiffness OR pulse wave velocity OR PWV OR vascular stiffness). The reference lists of relevant studies and previous reviews were also screened.

STUDY SELECTION: The eligibility criteria included (1) adults aged 18 years or older; (2) randomized controlled, nonrandomized controlled, or crossover; (3) PWV outcome(s) measured; (4) published in English; (5) published since 1974; and (6) published in peer-reviewed journals.

APPRAISAL AND SYNTHESIS METHODS: Initially, 242 studies were identified. After screening, six studies on acute stretching and six studies on longitudinal stretching were included. Effect sizes were calculated as standardized mean differences (SMD). Data were pooled using a 3-level model with restricted maximum likelihood estimation, and the magnitude of the effect was adjudicated as trivial (< 0.2), small (0.2), moderate (0.5), or large (0.8).

RESULTS: Acute stretching led to a small, nonsignificant reduction (beneficial) in PWV (SMD = – 0.22, p = 0.258), whereas longitudinal stretching resulted in a large and statistically significant reduction in PWV (SMD = – 1.02, p = 0.012). The pooled effect size was significantly greater (more beneficial) when each stretch was repeated three or more times (versus less than three times, SMD contrast = – 1.46, p < 0.001). Larger (beneficial) pooled effect sizes were also observed when stretching was prescribed for 5-7 days/week (versus 3-4 days/week, SMD contrast = – 1.05, p = 0.149), when stretching sessions lasted at least 30 min (versus less than 30 min, SMD contrast = – 0.79, p = 0.169), and when sessions were supervised (versus unsupervised, SMD contrast = – 1.11, p = 0.130); however, these differences did not reach statistical significance.

CONCLUSIONS: A single bout of stretching resulted in a small acute decrease in PWV (SMD = – 0.22, 95% CI – 0.62 to 0.17). There was a large decrease in PWV (SMD = – 1.02, 95% CI – 1.79 to – 0.25) following a 4- to 12-week intervention. We recommend stretching each major muscle-tendon group three or more times. These findings may be used to help design a future intervention to test the efficacy and biological plausibility of stretching exercises to reduce arterial stiffness and possibly CVD risk.

PMID:42502132 | DOI:10.1007/s40279-026-02483-8

J Community Health. 2026 Jul 25. doi: 10.1007/s10900-026-01603-9. Online ahead of print.

ABSTRACT

Earthquakes have caused devastating impacts throughout history, highlighting the growing importance of pre-disaster risk management. With the increasing use of digital technologies, social media platforms such as YouTube have become widely used sources of information on earthquake preparedness. However, the quality and reliability of such content remain questionable. This study aimed to evaluate the quality, reliability, and content of YouTube videos related to earthquake preparedness. In this cross-sectional study, the top 100 most-viewed videos for the keywords “earthquake preparedness” and “earthquake safety information” were analyzed on January 19, 2026. After applying eligibility criteria, 72 videos were included. Video quality and reliability were assessed using the Global Quality Scale (GQS) and modified DISCERN (mDISCERN), while popularity was measured through view rate and the Video Power Index (VPI). Content analysis and non-parametric statistical tests were performed. The findings showed that the overall quality and reliability of videos were low to moderate. Longer videos tended to have higher quality and reliability scores, whereas engagement metrics did not reflect content quality. These results indicate a need to improve the availability of accurate, evidence-based, and practical earthquake preparedness information on digital platforms.

PMID:42502127 | DOI:10.1007/s10900-026-01603-9

Mol Psychiatry. 2026 Jul 25. doi: 10.1038/s41380-026-03772-4. Online ahead of print.

ABSTRACT

Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental disorder with complex molecular etiology. Since genetic causes account for less than 50% of ASD cases, novel approaches are required to overcome the challenges of characterizing genes and molecular pathways linking risk alleles to phenotype. Here we use RNA-sequencing, 3-dimensional protein-centric chromatin conformation (Hi-ChIP), and whole genome DNA methylation sequencing approaches to investigate hippocampal tissue from an ASD mouse model (Cntnap2 knockout [Cntnap2 KO]) to determine if multi-omic data integration improves the resolution of key molecular pathways contributing to the complex ASD phenotype. Each -omic dataset individually identified disruptions in numerous genes and pathways, providing broad ASD-related insights, such as 1) 699 downregulated genes with an enrichment of neuronal ontological terms; 2) unique chromatin interactions in Cntnap2 KO mice; and 3) that most differentially methylated genes (1220/1659) have a neuronal function. The multi-omic data integration reduced the heterogeneity and refined the data to 43 genes with links to ASD (e.g., Zbtb18, Cttnbp2, Gabbr2). A pathways analysis of these 43 genes identified one gene ontological term: regulation of neuronal synaptic plasticity. These findings are consistent with large scale gene expression studies of human ASD postmortem brain tissue, suggesting that multi-omic data integration can be used to achieve a greater resolution of the heterogeneous ASD molecular etiology.

PMID:42502111 | DOI:10.1038/s41380-026-03772-4

World J Urol. 2026 Jul 25;44(1):518. doi: 10.1007/s00345-026-06644-2.

ABSTRACT

BACKGROUND: Aquablation is a semi-automated, ejaculation-sparing surgical option for treatment of benign prostatic hyperplasia (BPH). While previous studies have demonstrated that approximately 50 cases are required to achieve surgical competence in prostate laser enucleation, objective evaluations of Aquablation learning curve remain limited. The aim of this study was to assess Aquablation learning curve using cumulative sum (CUSUM) method, based on operative parameters and postoperative outcomes.

METHODS: We retrospectively analyzed data from 80 patients who underwent Aquablation by a single surgeon with prior experience in prostate resection and enucleation (01/2024 – 07/2025). Patient demographics, including prostate volume (PV) and comorbidities, were recorded. Operative parameters were collected. Patient evaluations were conducted at baseline, 3, 6 months postoperatively, including uroflowmetry and assessment using the International Prostate Symptom Score (IPSS). Ejaculation preservation was assessed. Trifecta was defined as preserved ejaculation, IPSS < 8, and maximum urinary flow rate (Qmax) > 15 mL/s at 6 months. Descriptive statistics, linear regression analyses, and CUSUM method were applied.

RESULTS: Median (interquartile range [IQR]) prostate volume and baseline IPSS-total score were 60 (45-78) mL and 21 (14-27). Median total operative time was 39 (31-47) minutes. Postoperative complications occurred in 18 patients (22.5%). Median IPSS-total score and Qmax improved significantly at 3- and 6-month follow-up visits (p < 0.01). Antegrade ejaculation was preserved in 81.2% of patients at 6-month follow-up. Trifecta at 6 months was achieved in 49 patients (61.2%). CUSUM analysis demonstrated that learning curve for setup and ablation tissue time reached plateau after 14 cases, while coagulation time stabilized after 21 procedures. CUSUM charts for trifecta achievement revealed an initial learning phase requiring 18 cases to achieve stable performance, subsequently maintained.

CONCLUSION: Aquablation is a reproducible, ejaculation-sparing surgical option for BPH, with procedural efficiency and stable functional outcomes achieved after approximately 12-21 cases. Aquablation offers a faster acquisition of technical proficiency due to its high degree of automation and standardized planning, leading to a rapid integration into clinical practice.

PMID:42502110 | DOI:10.1007/s00345-026-06644-2

Environ Monit Assess. 2026 Jul 25;198(8):881. doi: 10.1007/s10661-026-15726-y.

ABSTRACT

Urban public transport is a critical source of environmental acoustic pollution, yet the specific drivers of its disruptive and highly transient pollution intensity at bus stops remain poorly quantified. This study investigated the determinants of short-term acoustic pollution fluctuation, defined as the difference between the L₁₀ (peak) and L₅₀ (median) sound levels (ΔNoise), at 100 bus stations in Isfahan. Using a stratified sampling design, we collected continuous acoustic measurements alongside contextual data on traffic and passenger activity. A generalized additive model (R² = 0.837) was employed to analyze the non-linear effects of predictors on ΔNoise as an indicator of fluctuating pollution intensity. The results revealed a highly impulsive acoustic pollution environment, with a mean ΔNoise of 6.30 dB. Motorcycle count was the dominant predictor, exhibiting a strong, linear positive relationship (edf ≈ 1.00, F = 200.87, p < 0.001). Vehicle speed showed a significant non-linear effect (edf = 3.31, p < 0.001), with ΔNoise peaking at intermediate speeds (~ 35 km/h). Scenario analysis demonstrated that a 60% reduction in motorcycle flow yielded the largest pollution mitigation, reducing ΔNoise by a mean of 4.31 dB. In contrast, reducing passenger density alone had a minimal effect (0.605-dB reduction). These findings show that acoustic pollution fluctuation at bus stops is primarily governed by motorcycle traffic and vehicular speed patterns. They provide a critical evidence base for targeted traffic-source control strategies rather than generalized pollution management measures.

PMID:42502109 | DOI:10.1007/s10661-026-15726-y

Oncogene. 2026 Jul 25. doi: 10.1038/s41388-026-03895-6. Online ahead of print.

ABSTRACT

Progression of cutaneous primary melanoma that arises from melanocytes leads to lethal metastatic disease. Molecular mechanisms that control the growth of primary melanoma in the skin and promote progression are not fully understood. Previously we showed that RAP guanine exchange factors EPAC1/2 (Exchange Proteins Activated by cyclic AMP) promote the growth of primary melanoma and loss of dependency on EPACs is associated with metastatic progression. In this study, we show that EPACs are activated during malignant transformation of melanocytes, and chemical inhibition or genetic deletion of EPAC inhibits melanomagenesis in Braf/Pten mice. Low expression of EPAC mRNA and its effector RAP1-GTP protein in primary melanoma correlate with better recurrence-free survival. RNAseq analysis of matched primary and metastatic melanoma cells treated with an EPAC inhibitor showed that TXNIP, an important regulator of redox homeostasis, is a downstream effector of EPAC signaling. We also show that EPACs promote melanoma growth by regulating redox homeostasis and mitochondrial ROS through activation of mechanistic target of rapamycin complex 1 (mTORC1) that stabilizes hypoxia-inducible factor 1-alpha (HIF-1α), a transcriptional activator of redox regulator TXNIP and glycolytic enzymes. Our data suggest that targeting mechanisms that melanoma cells employ to bypass EPAC dependency is a potential therapeutic approach.

PMID:42502103 | DOI:10.1038/s41388-026-03895-6

Ann Surg Oncol. 2026 Jul 25. doi: 10.1245/s10434-026-20288-x. Online ahead of print.

ABSTRACT

BACKGROUND: Early recurrence after curative resection for cT3 esophageal squamous cell carcinoma (ESCC) is strongly associated with poor long-term survival. Identifying patients at high risk of early recurrence may improve postoperative risk stratification and inform tailored surveillance or adjuvant therapy.

PATIENTS AND METHODS: We retrospectively analyzed patients who underwent en bloc esophagectomy with three-field lymphadenectomy. The log odds of positive lymph nodes (LODDS) were calculated as log([number of positive nodes + 0.5]/[number of negative nodes + 0.5]). Early recurrence was defined using maximally selected rank statistics. Independent risk factors for early recurrence were identified using multivariable Firth logistic regression, followed by decision tree analysis to establish hierarchical risk stratification.

RESULTS: Among 121 patients, 109 (90.1%) achieved R0 resection. The median numbers of dissected and metastatic lymph nodes were 67.0 and 2.0, respectively, with a median LODDS of – 3.46. Early recurrence was defined as recurrence within 16.6 months after surgery. Multivariable analysis identified higher LODDS, upper thoracic location, and resectability status (resectable or borderline resectable) as independent predictors of early recurrence. In the complementary tree-based analysis, early recurrence risk was primarily stratified by LODDS using a cut-off of – 2.69. Patients with LODDS > – 2.69 had significantly worse 5-year overall survival than those with LODDS ≤ -2.69 (30.0% versus 66.1%, p < 0.001). Among patients with LODDS ≤ – 2.69, tumor location further refined risk stratification.

CONCLUSIONS: LODDS provides a robust and clinically applicable metric for postoperative risk stratification of early recurrence in patients undergoing radical esophagectomy for cT3 ESCC.

PMID:42502093 | DOI:10.1245/s10434-026-20288-x