Tag: statistics

Target Oncol. 2026 Jul 29. doi: 10.1007/s11523-026-01238-9. Online ahead of print.

ABSTRACT

BACKGROUND: Numerous case series have corroborated the efficacy of the first-line approach of platinum-based chemotherapy and avelumab maintenance followed by enfortumab vedotin monotherapy (PBC-AM-EV) in real-world patients with advanced urothelial carcinoma.

OBJECTIVE: The present investigation aimed to characterize the baseline clinical and pathological characteristics and outcomes of the PBC-AM-EV treatment sequence in the advanced urothelial carcinoma population.

METHODS: ARON-2^EV is a global retrospective study investigating the real-world use of EV in patients with advanced urothelial carcinoma. Two hundred and three patients receiving PBC-AM-EV were analyzed. Primary endpoints were disease response, therapy sequence duration, and overall survival. Secondary objectives included the evaluation of clinical factors associated with outcomes. Patient characteristics were analyzed using descriptive statistics; overall survival and therapy sequence duration were estimated using the Kaplan-Meier method and assessed with log-rank tests and Cox proportional hazards models.

RESULTS: Following a median follow-up of 23.1 months, the median overall survival from PBC initiation was 31.6 months, with a 2-year overall survival rate of 68%. Survival outcomes were consistent across most clinicopathologic subgroups, but were significantly influenced by Eastern Cooperative Oncology Group performance status, prior response to PBC, and cisplatin-based regimens. Median therapy sequence duration was 26.5 months and was prolonged in patients with exclusive nodal metastases and cisplatin exposure. A 43% objective response rate was achieved by EV, including durable disease control, particularly among patients who benefited from prior PBC and avelumab maintenance.

CONCLUSIONS: The PBC-AM-EV sequence demonstrates sustained real-world efficacy, with outcomes driven by baseline characteristics, platinum responsiveness, and preserved EV activity irrespective of prior immunotherapy response.

PMID:42525332 | DOI:10.1007/s11523-026-01238-9

Phys Eng Sci Med. 2026 Jul 29. doi: 10.1007/s13246-026-01768-6. Online ahead of print.

ABSTRACT

This study evaluated the feasibility of generative adversarial network (GAN)-based postprocessing super-resolution for T2-weighted lumbar spine magnetic resonance imaging (MRI) using both objective resolution metrics and perceptual assessment. Sagittal lumbar spine MRI datasets from healthy volunteers were analyzed. An enhanced super-resolution GAN (ESRGAN) was trained on downsampled images, while zero-filling, bicubic, and bilinear interpolation, as well as enhanced deep residual networks for single image super-resolution (EDSR), were used as comparators. Image quality was assessed by comparing upscaled images from 256 × 256 acquisitions with corresponding 512 × 512 reference images, using full width at half maximum (FWHM) and normalized integrated power spectrum (NIPS), along with similarity metrics including structural similarity index, peak signal-to-noise ratio, and root mean square error. Subjective image quality was evaluated using a ranking method. An additional analysis using 320 × 320 and 640 × 640 image pairs was conducted to assess consistency across resolution settings. Statistical comparisons were performed using the Friedman test with Bonferroni correction. ESRGAN showed no significant differences from the original high-resolution images in FWHM and NIPS, whereas interpolation methods and EDSR demonstrated inferior performance (P < 0.05). Although interpolation methods achieved higher scores in pixel-wise metrics, ESRGAN obtained the highest subjective ratings and interrater agreement. These findings indicate that ESRGAN better restores high-frequency structural information not captured by conventional similarity metrics. GAN-based postprocessing super-resolution may improve image quality in lumbar spine MRI and warrants further investigation of its clinical impact.

PMID:42525326 | DOI:10.1007/s13246-026-01768-6

Gastric Cancer. 2026 Jul 29. doi: 10.1007/s10120-026-01783-2. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical complications after gastrectomy significantly impact recovery and long-term prognosis. While iron status influences outcomes, the conventional 20% transferrin saturation (TSAT) threshold ignores sex-specific physiological differences. We developed a modified TSAT (mTSAT) based on sex and anemia status and evaluated its value in predicting complications.

METHODS: We retrospectively analyzed 243 patients who underwent curative gastrectomy. Optimal TSAT cut-off values for predicting complications classified as Clavien-Dindo grade II or higher were determined using receiver operating characteristic curves stratified by sex and anemia status. Predictive performance was compared between mTSAT and the conventional 20% threshold using the corrected Akaike Information Criterion.

RESULTS: The optimal mTSAT cut-offs were 22.2% for men and 14.2% for women. The mTSAT model demonstrated an improved fit compared with the conventional threshold. The low mTSAT group (mTSAT below the sex-specific cut-off) comprised 78 patients and exhibited a significantly higher incidence of complications than the normal mTSAT group, particularly anastomotic leakage and delayed gastric emptying/ileus. Moreover, postoperative hospital stay was significantly longer in this group. In the primary multivariable analysis, low mTSAT was significantly associated with postoperative complications, whereas the conventional 20% threshold was not. After additional adjustment for clinical stage and surgical approach, the association was attenuated and no longer reached statistical significance.

CONCLUSIONS: Preoperative low mTSAT was associated with an increased risk of postoperative complications. Rather than a standalone predictor, mTSAT functions as a valuable composite clinical indicator reflecting stage-related systemic vulnerability, surgical invasiveness, and underlying malnutrition or iron deficiency.

PMID:42525320 | DOI:10.1007/s10120-026-01783-2

World J Microbiol Biotechnol. 2026 Jul 29;42(8):436. doi: 10.1007/s11274-026-05165-9.

ABSTRACT

Bacterial leaf blight (BLB), caused by Xanthomonas oryzae pv. oryzae (Xoo), threatens global rice production while growing bactericide resistance and environmental concerns necessitate sustainable disease management alternatives. We employed a microbiome-guided, habitat-specific isolation strategy targeting naturally recovered plants from BLB-endemic hotspots across ten districts of Punjab, Pakistan operating on the ecological premise that plants under pathogen pressure selectively enrich protective microbial taxa, making disease-affected hosts the most coherent source of adapted biocontrol agents. Screening of 1,036 bacterial isolates from rice rhizosphere and phyllosphere using dual-culture antagonism assays yielded six elite strains: Bacillus velezensis, B. amyloliquefaciens, B. subtilis, Pseudomonas fluorescens, and two P. aeruginosa isolates, confirmed by 16 S rRNA and rpoD gene sequencing (> 99% sequence identity). Biochemical profiling revealed multifunctional plant growth-promoting traits including siderophore production, biological nitrogen fixation, indole-3-acetic acid biosynthesis, phosphate solubilization, and hydrogen cyanide production, indicating the potential capacity of selected strains for integrated disease suppression and plant growth promotion. Greenhouse trials across six rice varieties with contrasting genetic resistance backgrounds demonstrated significant reductions in BLB incidence (25-67%) and severity (31-55%) relative to uninoculated controls. Field validation under natural pathogen pressure across two consecutive growing seasons confirmed robust performance, with incidence suppression of 33-65% and severity reduction of 46-67% compared to controls. B. velezensis fsdls3 emerged as the most effective individual agent, achieving 114.5% mean yield protection relative to diseased controls and approaching streptomycin sulfate performance with no statistically significant overall yield difference while outperforming the chemical standard on specific variety-strain combinations. Five of six PGPR agents exceeded the 100% yield protection threshold, delivering agronomic co-benefits including enhanced tillering, increased productive panicles, and elevated total biomass unavailable from chemical bactericide treatment alone. Pronounced cultivar × treatment interactions confirmed that PGPR efficacy is modulated by host genetic background, with resistant varieties carrying pyramided Xa resistance genes showing additive responses to biological treatment. These results establish habitat-adapted, host-recruited PGPR as scientifically credible and ecologically coherent alternatives to chemical bactericides for integrated BLB management in rice.

PMID:42525313 | DOI:10.1007/s11274-026-05165-9

J Neurovirol. 2026 Jul 29;32(4):32. doi: 10.1007/s13365-026-01329-3.

ABSTRACT

To evaluate whether varying degrees of lymphocyte count decline in HIV-positive adults are associated with increased short-term incidence of epilepsy or convulsions. A retrospective cohort study was conducted using the TriNetX global research network. HIV-positive patients with a lymphocyte count ≥ 1.2 × 10³/µL were categorized based on subsequent decline within 3 months: mild (1.01-1.19), moderate (0.81-1.0), or significant (0.61-0.8). Risk analysis and Kaplan-Meier survival analysis were performed and patients with prior diagnosis of epilepsy (G40) or convulsions (R56.9) were excluded. The risk of developing epilepsy or convulsions increased with greater lymphocyte decline. Compared to patients with stable counts, the odds ratios were 1.073 for the mild group, 2.222 for the moderate group, and 3.189 for the significant drop group. Hazard ratios followed a similar trend, reaching 3.24 in the 0.61-0.8 group. Only the mild drop group did not show a statistically significant difference in risk or survival curves. Kaplan-Meier analysis at 1 year showed significant separation between survival curves for all groups except the mild group (p = 0.6973). Among HIV-positive adults, greater short-term lymphocyte count decline is associated with a higher short-term risk of epilepsy or convulsions. These findings suggest that lymphocyte trends may serve as an early signal for neurologic vulnerability. Further investigation is warranted to clarify the underlying mechanisms and clinical implications.

PMID:42525309 | DOI:10.1007/s13365-026-01329-3

Support Care Cancer. 2026 Jul 29;34(8):812. doi: 10.1007/s00520-026-10998-z.

ABSTRACT

BACKGROUND: Patient navigation programs (PNPs) have been increasingly applied in breast cancer (BC) care of underserved clients, as they can significantly assist them with coordinating services across the care continuum. However, existing evidence has produced inconclusive findings regarding the empirical adequacy of BC-related caring interventions developed from PNPs. Hence, the aim of the present systematic review and meta-analysis was to clarify the benefits of PNPs across all phases of the BC care continuum. Primary outcomes comprised care-continuum indicators extracted predominantly from medical records, while secondary outcomes included client-reported healthcare measures.

METHODS: Five electronic data sources were searched for randomized controlled trials (RCTs) that investigated the effectiveness of PNPs across the BC care continuum from 1995 to January 10, 2025, with no restrictions on clients’ sociodemographic characteristics. A random-effects model, using both the DerSimonian-Laird (DL) method and the Hartung-Knapp (HK) adjustment, was applied to estimate standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, with 95% confidence intervals (CIs).

RESULTS: Thirty-seven RCTs met the inclusion criteria, including four cluster RCTs and 33 individual RCTs. Quantitative synthesis was not feasible for time-to-resolution, adherence to adjuvant or post-treatment follow-up care, timely treatment initiation, treatment completion, satisfaction with care, or psychological distress; therefore, the effectiveness of PNPs for these outcomes remains uncertain. Meta-analyses of individual RCTs, all conducted using a DL random-effects model, indicated that PNPs significantly improved diagnostic follow-up compliance (OR, 2.42; 95% CI, 1.64, 3.59; P < 0.001); screening mammogram adherence (OR, 2.18; 95% CI, 1.71, 2.77; P < 0.001); and timely diagnostic resolution (OR, 2.51; 95% CI, 1.21, 5.24; P = 0.014). Using the same DL model, PNPs also improved quality of life (SMD, 0.44; 95% CI, 0.09, 0.79; P = 0.014) and reduced anxiety (SMD, -0.94; 95% CI, -1.66, -0.22; P = 0.010). However, no statistically significant effects were observed under the DL model for depression (SMD, -0.34; 95% CI, -0.71, 0.04; P = 0.076) or BC knowledge (SMD, 0.27; 95% CI, -0.19, 0.73; P = 0.247). Substantial heterogeneity was observed across most pooled outcomes (I² = 63.9%-93.0%), accompanied by wide prediction intervals that included the null value. After applying the HK adjustment, the previously observed beneficial effects of PNPs on timely diagnostic resolution, quality of life, and anxiety were no longer statistically significant.

CONCLUSION: Although initial analyses suggested that PNPs may improve several BC-related outcomes, these observed benefits were reduced in magnitude and, in some cases, no longer statistically significant after applying more conservative adjustment methods. Moreover, substantial heterogeneity across studies and the overall low methodological quality limit the certainty of the evidence. Therefore, the current findings should be interpreted cautiously, and further high-quality RCTs are needed to draw more definitive conclusions about the effectiveness of PNPs across the BC care continuum.

PROSPERO REGISTRATION: CRD42023487495.

PMID:42525303 | DOI:10.1007/s00520-026-10998-z

Hernia. 2026 Jul 29;30(1):304. doi: 10.1007/s10029-026-03798-1.

ABSTRACT

PURPOSE: Mesh suture is a suture device designed to distribute pressure at the suture-tissue interface to decrease suture pull-through. The primary aim of this study was to evaluate the feasibility and short-term clinical outcomes in isolated umbilical hernia repairs.

METHODS: A retrospective cohort of patients undergoing umbilical hernia repair using mesh suture was analyzed between January 2023-2025. Patients were identified through institutional implant logs. Outcomes evaluated included surgical site infection (SSI), surgical site events (SSE), hernia recurrence, readmissions, and reoperations.

RESULTS: Fifty-eight isolated umbilical hernia repairs with mesh suture were performed by twenty-four surgeons. The mean hernia width was 1.7 cm (± 0.7). The 90-day SSI rate was 5.2% (n = 3), consisting of two superficial infections and one organ space infection. The 90-day SSE rate was 5.2% (n = 1 fascial dehiscence, n = 2 hematomas). There were seven readmissions (12.1%) within 90 days, of which only one was related to the abdominal wall closure. There were three reoperations within 90 days (5.2%): two hematoma washouts and one fascial dehiscence repair. The mean length of follow up was 594 days (± 284). There were no cases of hernia recurrence.

CONCLUSIONS: Mesh suture provides the simplicity of suture repair with increased force distribution properties of mesh. In this initial multicenter experience, mesh suture demonstrated feasibility and acceptable short-term clinical outcomes for isolated umbilical hernia repair. Future randomized controlled trials comparing mesh suture versus planar mesh and standard suture are needed to compare techniques most effectively.

PMID:42525301 | DOI:10.1007/s10029-026-03798-1

Wien Klin Wochenschr. 2026 Jul 29. doi: 10.1007/s00508-026-02799-5. Online ahead of print.

ABSTRACT

BACKGROUND: Treatment goal limitations, such as “do not resuscitate”, “do not escalate” and “comfort terminal care” are frequent in acute hospital care for patients with advanced illness, multimorbidity or impending death. Their ethical defensibility depends on transparent documentation of medical indications, proportionality and, where relevant, patient will.

OBJECTIVE: To examine whether documentation made medical rationale, patient will, advance directives, relatives’ involvement or ethics consultation visible.

METHODS: We retrospectively analyzed documentation in an Austrian internal medicine department with intensive care over 12 months. Documents were identified in the hospital information system and descriptively analyzed. Deceased patients with documented limitations underwent manual review. Data were anonymized and analyzed using Microsoft Excel for Microsoft 365 (Microsoft Corporation, Redmond, WA, USA) and IBM SPSS Statistics, version 29 (IBM Corp., Armonk, NY, USA).

RESULTS: Across 3998 inpatient stays involving 1829 patients, 277 patients had a documented treatment goal limitation (15.1%). Among 174 deceased patients, 111 had a documented limitation at death (63.8%). The most frequent order was combined do not resuscitate/do not escalate (75/111; 67.6%), followed by isolated do not resuscitate (23/111; 20.7%). Complete records were available for 101 cases; in 10 the rationale was not clearly traceable. Among the 101 manually reviewed cases, an explicit or presumed patient will was documented in 7 cases (6.9%), involvement of relatives in 13 cases (12.9%) and ethics consultation in 1 case (1.0%); medical rationale or physician decision was documented in 90 of 91 cases with traceable rationale (98.9%).

CONCLUSION: Treatment goal limitations were common and usually medically justified in the records. The findings do not imply inappropriate decisions or lack of communication but show limited reconstruction of patient-centered reasoning. Documentation should make clearer how benefit, care, respect for autonomy and justice informed treatment limitation.

PMID:42525299 | DOI:10.1007/s00508-026-02799-5

Int Ophthalmol. 2026 Jul 29;46(1):316. doi: 10.1007/s10792-026-04193-6.

ABSTRACT

PURPOSE: To evaluate whether umbilical cord blood platelet lysate (UCB-PL) can preserve the morphology and characteristics of human corneal endothelial cells during organ culture and serve as a xeno-free alternative to fetal bovine serum (FBS).

METHODS: Paired human donor corneas were cultured for 28 days in α-MEM-based medium supplemented with either 2% FBS or 2% UCB-PL. Endothelial morphology, cell density, viability, and mosaic regularity were assessed at predefined time points. Metabolic activity was evaluated by measuring pH, glucose, and lactate concentrations in the culture media. Endothelial integrity, apoptosis, and proliferation were analyzed by whole-mount immunofluorescence staining for ZO-1, Na⁺/K⁺-ATPase, caspase-3, and Ki-67.

RESULTS: Corneas stored in UCB-PL-supplemented medium demonstrated endothelial morphology, cell density decline, and viability comparable to those observed in FBS-supplemented medium throughout the culture period. No significant differences were detected between groups at any time point. Metabolic analysis showed sustained glucose availability and expected lactate accumulation in both media, without evidence of nutrient depletion. Immunofluorescence confirmed preserved endothelial junctional organization and pump protein expression, with no signs of endothelial apoptosis or proliferation.

CONCLUSION: In this pilot feasibility study, UCB-PL supported preservation of human corneal endothelial morphology and endothelial-associated protein expression during organ culture and demonstrated similar trends to FBS. These findings support further investigation of UCB-PL as a potential xeno-free alternative for corneal storage media.

PMID:42525298 | DOI:10.1007/s10792-026-04193-6

Naunyn Schmiedebergs Arch Pharmacol. 2026 Jul 29. doi: 10.1007/s00210-026-05765-0. Online ahead of print.

ABSTRACT

Hypertonic saline solution (HSS) combined with furosemide has been proposed as a strategy to enhance decongestion in acute decompensated heart failure (ADHF). We aimed to compare two HSS regimens with conventional furosemide therapy with respect to neurohormonal and echocardiographic markers of decongestion at 72 h. In this prospective, open-label, randomized, three-arm comparative study, 78 patients with ADHF (NYHA class III) were randomized to the following: group 1 (n = 28): HSS 50 mL BID + furosemide 3 × 2 amp IV bolus; group 2 (n = 25): HSS 100 mL OD + furosemide bolus-to-infusion; and group 3 (n = 25): conventional furosemide bolus-to-infusion. Primary endpoints were NT-proBNP reduction and IVC diameter change at 72 h. HSS groups achieved significantly greater reductions in NT-proBNP (- 2317 vs. – 416 pg/mL; p = 0.010) and IVC diameter (- 0.32 vs. – 0.20 cm; p = 0.036) compared with conventional therapy. Urine output and body weight reduction were numerically higher in the HSS groups but did not reach statistical significance (p = 0.089 and p = 0.114, respectively). HSS was associated with superior preservation of plasma sodium and potassium (both p = 0.001). No neurological or cardiopulmonary adverse events were observed. The addition of HSS to furosemide in patients with ADHF was associated with greater improvement in neurohormonal and echocardiographic indices of decongestion while maintaining electrolyte homeostasis compared with conventional furosemide therapy. These findings support further evaluation of this therapeutic approach in larger prospective randomized studies.

PMID:42525296 | DOI:10.1007/s00210-026-05765-0