Tag: statistics

Ann Ital Chir. 2026 Jul 14;97(7):1172-1181. doi: 10.62713/aic.4529.

ABSTRACT

AIM: The cortical bone trajectory (CBT) screw fixation technique has been widely adopted in adult spinal surgery due to its minimally invasive nature and biomechanical advantages. However, systematic research on its anatomical feasibility and morphometric parameters in the pediatric lumbar spine remains lacking. This study aimed to evaluate the anatomical feasibility of CBT screw fixation in the pediatric lumbar spine, and to characterize the variations in screw dimensions and insertion angles across different age groups and lumbar levels, providing an individualized reference for pediatric lumbar surgery.

METHODS: This retrospective study included 80 pediatric patients aged 5-16 years without lumbar pathologies. Participants were stratified into four age groups (5-7, 8-10, 11-13, and 14-16 years, denoted as Groups 1, 2, 3, and 4, respectively), with 20 patients per group and sex-matched distribution (10 males and 10 females per group). Multiplanar reconstruction based on computed tomography (CT) images with 1 mm reconstruction was performed to measure the following parameters at each lumbar level (L1-L5): maximum screw length (MSL), maximum screw diameter (MSD), lateral angle (LA), and cephalad angle (CA). Statistical analysis was conducted using a mixed linear effects model to assess the influence of age, sex, lumbar level, and their interactions on each parameter, supplemented by analysis of variance (ANOVA) and post hoc multiple comparisons with Bonferroni correction.

RESULTS: MSL increased significantly with age and showed a level-specific pattern, generally rising from L1 to L3 and declining at L5. In the mixed-effects model, age group and lumbar level had significant effects on MSL, and a significant Group 4 × female interaction was observed. MSD increased progressively from L1 to L5 and was significantly affected by age group, sex, lumbar level, and age × sex interaction, with a particularly significant Group 2 × female interaction (estimate = 0.459, p < 0.001). LA generally increased with age and caudal progression of the lumbar level and was significantly influenced by age group, sex, and lumbar level. In contrast, CA decreased progressively from L1 to L5 within each age group and was significantly influenced by age group and lumbar level, whereas the age × sex interaction was not significant. Anatomical feasibility was assessed using a screw diameter threshold of ≥ 4.5 mm. The applicability rate of CBT fixation increased with both age and caudal lumbar level, with lower feasibility mainly observed at upper lumbar levels in younger children. At L1, applicability rates were 50% in Group 1, 70% in Group 2, and 100% in Groups 3 and 4; at L5, applicability reached 100% in all groups.

CONCLUSIONS: The anatomical parameters for CBT screw placement in the pediatric lumbar spine are significantly influenced by age, lumbar level, and sex. This study provides a systematic anatomical reference for CBT screw dimensions and trajectory angles across pediatric age groups. Anatomical feasibility, defined by a ≥4.5 mm screw diameter threshold, was higher in older children, whereas the use in younger children requires careful individual evaluation due to limited space and increased risk of cortical disruption, especially at upper lumbar levels. These findings offer supportive evidence for guiding patient selection and preoperative planning, though clinical applicability requires further biomechanical and outcome validation.

PMID:42464836 | DOI:10.62713/aic.4529

Ann Ital Chir. 2026 Jul 14;97(7):1232-1238. doi: 10.62713/aic.4499.

ABSTRACT

AIM: To assess the changes in biochemical indicators of nutritional deficiencies before and after bariatric surgery.

METHODS: This retrospective cohort study included 480 adult patients who underwent bariatric surgery between June 2016 and June 2019 at a tertiary care center in Saudi Arabia. Demographic data, comorbidities, and pre- and postoperative biochemical parameters, including hemoglobin, iron profile, Vitamin D, Vitamin B12, albumin, calcium, and parathyroid hormone levels, were extracted from the medical records. These biochemical parameters were used to assess micronutrient status and identify clinically relevant nutritional deficiencies based on established laboratory thresholds. Paired t– and McNemar tests were used to compare the pre- and postoperative values. Statistical significance was set at p < 0.05.

RESULTS: We found a high prevalence of pre- and postoperative nutritional deficiencies among patients. The mean hemoglobin decreased from 13.09 to 12.34 g/dL (mean difference -0.75 g/dL; 95% CI -0.89 to -0.61; p < 0.001). We observed a significant association between ferritin and gender pre- and postoperatively, which was lower in women than in men preoperatively and decreased in both sexes postoperatively. The prevalence of 25-hydroxyvitamin D deficiency was 88.0% preoperatively and 72.7% postoperatively in patients with available laboratory data.

CONCLUSIONS: A high prevalence of pre- and postoperative nutritional deficiencies was observed among patients undergoing bariatric surgery in Saudi Arabia. Although certain parameters improved after surgery, others remained prevalent or worsened postoperatively. These findings highlight the importance of structured nutritional assessments and regular biochemical monitoring before and after bariatric surgery.

PMID:42464830 | DOI:10.62713/aic.4499

Ann Ital Chir. 2026 Jul 14;97(7):1279-1291. doi: 10.62713/aic.4473.

ABSTRACT

AIM: To systematically compare the perioperative safety, early recovery, and mid-term clinical outcomes between on-pump and off-pump coronary artery bypass grafting (CABG) in very elderly patients (≥80 years).

METHODS: This single-center retrospective study enrolled 62 very elderly patients (≥80 years) undergoing isolated CABG from 2012 to 2022, assigned to on-pump (n = 22) or off-pump (n = 40) groups. Baseline characteristics, intraoperative data, and one-year follow-up outcomes were collected and compared. The primary endpoint was 30-day major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, stroke, and myocardial infarction. Secondary endpoints included the individual components of MACCE and key recovery metrics (duration of mechanical ventilation, intensive care unit (ICU) length of stay, and total hospital length of stay).

RESULTS: No statistically significant differences were observed between the two groups in perioperative mortality, incidence of major adverse cardiac and cerebrovascular events (including stroke and myocardial infarction), or one-year survival rates (p > 0.05). The off-pump group had significantly shorter median durations of postoperative mechanical ventilation (15 hours vs. 20.5 hours, p = 0.014) and ICU stay (3 days vs. 5 days, p = 0.007) compared to the on-pump group. However, there were no statistically significant differences in median total postoperative hospitalization (14 days vs. 15 days, p = 0.525) or in the time from ICU transfer to discharge (10 days vs. 9.5 days, p = 0.318). Analysis of postoperative complications revealed a high incidence of severe pulmonary inflammation, with no statistically significant difference between the groups. New-onset postoperative stroke was identified as a leading cause of early and mid-term mortality in this population.

CONCLUSIONS: In this exploratory retrospective analysis of selected very elderly patients, both on-pump and off-pump CABG demonstrated comparable survival and major adverse event outcomes. Although the off-pump group exhibited a statistically significant signal toward faster early physiological recovery (shorter ventilation and ICU stay), this observation warrants cautious interpretation due to baseline imbalances and should be considered hypothesis-generating rather than definitive. These preliminary findings highlight the need for future risk stratification tools and integrated care pathways, rather than prescribing a specific surgical technique based on recovery speed alone.

PMID:42464826 | DOI:10.62713/aic.4473

Euro Surveill. 2026 Jul;31(28). doi: 10.2807/1560-7917.ES.2026.31.28.2500916.

ABSTRACT

BACKGROUNDWhile bacterial sexually transmitted infections (STIs) have increased across Europe over the past decade, Poland continuously reported the lowest notification rates in the European Union/European Economic Area (EU/EEA), raising concerns about under-ascertainment and diagnostic gaps.AIMWe describe national STI trends in Poland from 2013 to 2024, temporal changes around 2020 and subsequent years, and demographic and geographic patterns relevant for STI control.METHODSWe analysed aggregated statutory surveillance data for syphilis, gonorrhoea and Chlamydia trachomatis infections, and calculated annual incidence rates overall and by sex, age group and voivodeship. Temporal trends were assessed using year-over-year per cent change and average annual per cent change (AAPC) estimated from log-linear models.RESULTSAll three infections increased modestly before 2020, declined in 2020 and increased markedly thereafter. Between 2013 and 2024, incidence increased 2.7-3.8-fold. It was highest among men, young adults aged 20-34 years and in urbanised regions. By 2023, syphilis incidence reached 7.92 per 100,000 population in Poland compared with 9.9 per 100,000 in the EU/EEA, whereas gonorrhoea and chlamydia incidence remained substantially lower. National AAPC estimates were not statistically significant, although they increased in several demographic groups and voivodeships.CONCLUSIONReported bacterial STI notifications in Poland are increasing, particularly among young adults and in urban regions. Persistently low gonorrhoea and chlamydia notification rates relative to EU/EEA levels probably reflect differences in diagnostic access and testing intensity rather than low transmission. Improving surveillance completeness, access to NAAT diagnostics, and testing coverage will be important to enhance detection and control.

PMID:42464818 | DOI:10.2807/1560-7917.ES.2026.31.28.2500916

Endokrynol Pol. 2026 Jul 17. doi: 10.5603/ep.111545. Online ahead of print.

ABSTRACT

INTRODUCTION: The C-reactive protein-triglyceride-glucose index (CTI) is an emerging composite biomarker reflecting insulin resistanceand systemic inflammation. Research regarding the relationship between CTI and risks of all-cause and cardiovascular mortality remainslimited and inconsistent.

MATERIAL AND METHODS: Data from 9,264 USA adults aged ≥ 20 years were obtained from the National Health and Nutrition Examination Survey (1999-2010). Mortality status was determined through linkage to the National Death Index through 31 December 2019. Hazardratios (HRs) for all-cause and cardiovascular mortality were estimated using weighted Kaplan-Meier methods, restricted cubic spline(RCS) models, and multivariable Cox proportional hazards regression models. Prespecified subgroup analyses and sensitivity analyseswere conducted to assess the robustness of the findings.

RESULTS: Over a median follow-up of 12.8 years, 2,644 deaths occurred, including 2,009 attributable to all causes and 635 to cardiovascular causes. After adjustment for potential confounders, each one-unit increment in CTI was associated with a 26% higher risk of all-causemortality [HR, 1.26; 95% confidence interval (CI), 1.15-1.38; p < 0.001) and a 25% higher risk of cardiovascular mortality (HR, 1.25; 95% CI,1.03-1.51; p = 0.021). Participants in the highest CTI quartile demonstrated a 33% higher risk of all-cause mortality compared with thosein the lowest quartile (HR, 1.33; 95% CI, 1.07-1.64; p = 0.010). RCS analyses indicated a nonlinear association between CTI and all-causemortality (p for nonlinearity = 0.018), with an inflection point at a CTI value of 9.25, whereas a linear association was observed for cardiovascular mortality (p for nonlinearity = 0.072). No statistically significant interactions were identified across prespecified subgroups. The results remained consistent after exclusion of early deaths (≤ 2 years) and after exclusion of participants with neoplasms.

CONCLUSIONS: Higher CTI levels were independently associated with increased risks of all-cause and cardiovascular mortality among USA adults. These findings suggest that CTI may serve as a clinically relevant biomarker for early identification of individuals at elevated mortality risk, with potential implications for risk stratification, targeted prevention strategies, and healthcare resource allocation.

PMID:42464808 | DOI:10.5603/ep.111545

J Phys Chem Lett. 2026 Jul 17. doi: 10.1021/acs.jpclett.6c01412. Online ahead of print.

ABSTRACT

The quantitative prediction of biomolecular recognition is crucial to molecular science. The challenge is not merely structural determination but the prediction of (thermo)dynamic and kinetic observables arising from high-dimensional molecular ensembles, such as free energies, conformational distributions, and rate processes across different conditions. As the field shifts from structure-centric to ensemble-based descriptions, two complementary modeling strategies have matured: explicit energy-based approaches grounded in statistical mechanics and data-driven models that learn statistical representations of molecular configurations from large data sets. Physics-based methods, including molecular dynamics and free energy perturbation, estimate observables by sampling (Boltzmann-distributed) configurations under approximate molecular Hamiltonians, thereby providing mechanistic interpretability and thermodynamic consistency, albeit at non-negligible computational cost and with inherent force field limitations. In contrast, modern machine learning approaches rapidly generate structures and propose conformational ensembles without explicit thermodynamic weighting, by learning statistical patterns in structural and bioactivity data. While these methods often achieve high predictive performance, they do not inherently enforce thermodynamic consistency due to the lack of an explicit connection to a partition function and thus may produce configurations that are not physically realizable. We argue that, since physics-based simulations and machine learning provide complementary approximations to the underlying probability distribution associated with biomolecular recognition events, and they excel respectively in consistency with free-energy landscapes and state populations and in predictive accuracy, the central challenge for the coming decade will be integrating them into hybrid frameworks that are scalable and transferable.

PMID:42464806 | DOI:10.1021/acs.jpclett.6c01412

JMIR Mhealth Uhealth. 2026 Jul 16;14:e88887. doi: 10.2196/88887.

ABSTRACT

BACKGROUND: Use of effective contraceptive methods (ECMs) reduces maternal mortality. Person-centered counseling increases uptake, but barriers to high-quality counseling persist. Telehealth may improve access to comprehensive contraceptive care, but its effectiveness remains unclear.

OBJECTIVE: This study assesses the effectiveness and acceptability of tailored, interactive telehealth contraceptive counseling (TECC) compared with in-person counseling.

METHODS: We conducted a systematic review and meta-analysis of English-language randomized controlled trials (RCTs) comparing TECC with in-person counseling for women and girls of any age and setting. We searched MEDLINE, Embase, Web of Science, and the Cochrane Library from inception through October 15, 2025. Outcomes were use of ECM less than 6 months from intervention (primary outcome); use of ECM at 6-12 months; use of long-acting reversible contraception (LARC); choice of ECM; choice of LARC; satisfaction with counseling; and method switching. Two researchers assessed risk of bias (RoB) using Cochrane RoB 2, certainty of evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation), and performed meta-analysis using a random-effects model. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) a priori (CRD42023404402). No specific funding was received.

RESULTS: Eight RCTs (RoB: low, n=4; moderate, n=2; and high, n=2) and 1 cluster RCT (moderate-to-high RoB) were included in the review, with 5353 participants across all included studies. Eight studies evaluated TECC as an adjunct to in-person care (hybrid model) and 1 as a standalone model, of which 7 and 1, respectively, contributed outcome data for the meta-analyses. Certainty of evidence was low to very low. The pooled effect of 4 studies of TECC on ECM use less than 6 months showed no clear evidence of an effect (relative risk [RR] 1.10; 95% CI 0.95-1.29). The pooled effect of 4 studies of TECC on choice of ECM (RR 1.07; 95% CI 0.96-1.18) likewise showed no clear effect. The pooled effect of 4 studies of TECC on ECM use at 6-12 months showed a small but statistically significant (P=.04) effect in favor of TECC, narrowly excluding the null (RR 1.07; 95% CI 1.002-1.130). Because of high statistical and clinical heterogeneity (I2=87%-96%), results for LARC choice (2 studies) and LARC use at 0-6 months (2 studies) and 6-12 months (2 studies) were narratively described. The evidence for these outcomes was very uncertain. Narrative analysis of satisfaction across 2 studies showed no difference in effect. There were no data on method switching to support the analysis.

CONCLUSIONS: Current evidence suggests, with low certainty, that adjunct TECC, when delivered alongside in-person care, shows little to no effect on contraceptive use compared with in-person care. For use at 12 months, method choice, LARC use, and satisfaction compared with in-person care, the evidence is very uncertain. Future research should prioritize adequately powered evaluations of standalone models and assess how tailoring, timing, and delivery influence effectiveness, including long-term use and method switching.

PMID:42464800 | DOI:10.2196/88887

J Clin Psychopharmacol. 2026 Jul 17. doi: 10.1097/JCP.0000000000002229. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effects of Withania somnifera extract (WSE), or Ashwagandha, on symptoms of schizophrenia and to investigate decreases in proinflammatory markers as a possible mechanism of action.

METHODS: Schizophrenia subjects with a history of a recent exacerbation were randomly assigned to receive double-blind adjunctive treatment either with WSE or placebo for 12 weeks. Outcomes were assessed using the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI), and the Perceived Stress Scale (PSS). Inflammatory markers were measured at baseline and 12 weeks.

RESULTS: Among 47 randomized subjects, 24 received WSE and 23 received placebo. WSE treatment was not associated with a greater reduction in symptoms on the PANSS, the CGI, or the PSS. We did not find a significant effect of WSE on inflammatory markers and we did not find an association between changes in inflammatory measures and changes in symptoms.

CONCLUSION: This clinical trial failed to find that WSE resulted in a statistically significant improvement of clinical measures or inflammatory markers. Disruptions from the COVID pandemic, the small sample size, heterogeneity, and baseline differences in psychopathology between the groups were important limitations of the study. However, the pattern that we observed did not indicate that the findings would have been different with a larger sample size or that the findings were influenced by the baseline differences.

PMID:42464773 | DOI:10.1097/JCP.0000000000002229

J Endovasc Ther. 2026 Jul 17:15266028261453269. doi: 10.1177/15266028261453269. Online ahead of print.

ABSTRACT

BACKGROUND: Dual-layer micromesh (DLMM) carotid stents were developed to enhance plaque scaffolding and reduce peri-procedural embolization during carotid artery stenting (CAS). Although Roadsaver is widely used in contemporary European practice, comparative evidence against first-generation stents (FGSs) and other DLMM devices remains limited. This study systematically reviews the European experience with Roadsaver and performs an exploratory meta-analysis of 30-day clinical outcomes and in-stent restenosis (ISR).

METHODS: A systematic search of PubMed, Embase, and Medline identified European studies published between January 1, 2014 and December 31, 2024 reporting transfemoral CAS using the Roadsaver stent. Adult patients with extracranial, de novo carotid stenosis-symptomatic or asymptomatic-were included. Comparative analyses were limited to studies reporting paired outcomes for Roadsaver versus FGSs or C-Guard. Primary endpoints were 30-day stroke and death; the secondary endpoint was ≥50% ISR at approximately 12 months, as defined by each study. Pooled effects were calculated using Peto odds ratios with random-effects DerSimonian-Laird models.

RESULTS: Twenty-two studies comprising 3539 Roadsaver procedures were included in the qualitative review; 5 studies met criteria for quantitative pooling. Across all studies, 30-day stroke and death occurred in 1.6% and 0.5% of patients, respectively. Meta-analysis showed no statistically significant differences in 30-day stroke or death between Roadsaver and FGSs, with low heterogeneity. In-stent restenosis comparisons similarly demonstrated no significant differences between Roadsaver and FGSs or between Roadsaver and C-Guard; however, ISR analyses were limited by marked heterogeneity in definitions, imaging modalities, and follow-up timing.

CONCLUSIONS: Roadsaver DLMM stenting in European practice is associated with low 30-day stroke and death rates. Exploratory pooled analyses did not identify significant differences between Roadsaver and FGSs or between DLMM devices; however, the small number of comparative studies, variability in ISR assessment, and predominantly observational evidence base substantially limit the certainty of these findings. Larger, rigorously designed comparative studies, and randomized trials are needed to determine whether clinically meaningful differences exist between carotid stent platforms.Clinical impactIn this paper, transfemoral CAS with the Roadsaver dual-layer micromesh stent was associated with low 30-day stroke and death rates in European practice. Comparative analyses did not demonstrate significant differences versus first-generation stents or between DLMM devices; however, the observed safety profile, combined with mechanistic data on enhanced plaque scaffolding and embolic protection, supports the use of Roadsaver in routine CAS, including complex anatomies. These findings reinforce DLMM technology as a contemporary standard option rather than an experimental alternative, while underscoring the need for standardized ISR assessment and adequately powered randomized trials to guide device selection in carotid revascularization.

PMID:42464753 | DOI:10.1177/15266028261453269

Eur J Psychotraumatol. 2026 Dec;17(1):2692768. doi: 10.1080/20008066.2026.2692768. Epub 2026 Jul 17.

ABSTRACT

Background: Childhood maltreatment (CM) is associated with sleep disturbance, but observational findings may be affected by confounding, shared familial liability, and reverse-direction explanations. We conducted bidirectional two-sample Mendelian randomization (MR) to examine genetic evidence linking composite CM liability with six sleep-related phenotypes.Methods: Genetic instruments for CM were obtained from a large European-ancestry multi-cohort GWAS meta-analysis. CM was defined as a composite phenotype encompassing multiple abuse and neglect subtypes and ascertainment modes. Summary statistics for chronotype, daytime sleepiness (DS), insomnia symptoms, sleep apnea (SA), daytime napping (DN), and sleep duration (SD) were derived from large European-ancestry GWASs. Inverse-variance weighted MR was the primary method, with weighted median and MR-Egger sensitivity analyses. Benjamini-Hochberg correction was applied and reported as P(BH).Results: In forward MR, genetically proxied CM was associated with higher DS (OR = 1.04, 95% CI 1.01-1.07; P(BH) = 0.030), insomnia symptoms (OR = 1.08, 95% CI 1.01-1.15; P(BH) = 0.030), and DN (β = 0.07, 95% CI 0.03-0.09; P(BH) = 0.002). Little evidence was observed for chronotype, SA, or SD. In exploratory reverse-direction MR, genetic liability to DN (β = 0.16, 95% CI 0.05-0.27; P(BH) = 0.012) and insomnia symptoms (β = 0.21, 95% CI 0.07-0.35; P(BH) = 0.012) was associated with CM liability.Conclusions: This study provides suggestive genetic evidence linking composite CM liability with selected sleep-related phenotypes, particularly self-reported DS, insomnia symptoms, and DN. Reverse-direction findings may reflect shared genetic liability, gene-environment correlation, reporting-related mechanisms, or broader familial pathways rather than temporal effects of adult sleep traits on CM. Given modest effects and uneven sensitivity support, findings should be interpreted cautiously.

PMID:42464740 | DOI:10.1080/20008066.2026.2692768