This systematic review synthesizes empirical research on external risk factors for adolescent smartphone addiction.Scopus and Web of Science were searched for English peer-reviewed empirical articles from 2008 onward;...This systematic review synthesizes empirical research on external risk factors for adolescent smartphone addiction.Scopus and Web of Science were searched for English peer-reviewed empirical articles from 2008 onward;28 met inclusion criteria(excluding non-adolescents,generic internet addiction,non-empirical work,or non-English).Thematic synthesis organized findings into three external risk domains—family,school,and peers—considering cultural/contextual mechanisms.Family dynamics(parental phubbing,harsh parenting,dysfunction),school stressors,and adverse peer relationships were identified as accumulating,direct and indirect contributors to smartphone addiction.These operate within a techno-ecological framework,where digital technologies amplify vulnerabilities and create new pathways for maladaptive use.Evidence favors an ecological,multi-level perspective.Future research should use longitudinal designs,standardize measures across cultures,and examine understudied regions—especially Africa—to guide culturally sensitive interventions.展开更多
Objectives This study aimed to explore the lagged and cumulative effects of risk factors on disability in older adults using distributed lag non-linear models(DLNMs).Methods We utilized data from the China Health and ...Objectives This study aimed to explore the lagged and cumulative effects of risk factors on disability in older adults using distributed lag non-linear models(DLNMs).Methods We utilized data from the China Health and Retirement Longitudinal Study(CHARLS).After feature selection via Elastic Net Regularization,we applied DLNMs to evaluate the lagged effects of risk factors.Disability was defined as the presence of any difficulties in basic activities of daily living(BADL).The cumulative relative risk(CRR)was calculated by summing the lag-specific risk estimates,representing the cumulative disability risk over the specified lag period.Effect modifications and sensitivity analyses were also performed.Results This study included a total of 2,318 participants.Early-phase lag factors,such as the difficulty in stooping(CRR=3.58;95%CI:2.31-5.55;P<0.001)and walking(CRR=2.77;95%CI:1.39-5.55;P<0.001),exerted the strongest effects immediately upon occurrence.Mid-phase lag factors,such as arthritis(CRR=1.51;95%CI:1.10-2.06;P=0.001),showed a resurgence in disability risk within 2-3 years.Late-phase lag factors,including depressive symptoms(CRR=2.38;95%CI:1.30-4.35;P<0.001)and elevated systolic blood pressure(CRR=1.64;95%CI:1.06-2.79;P=0.02),exhibited significant long-term cumulative risks.Conversely,grip strength(CRR=0.80;95%CI:0.54-0.95;P=0.02)and social participation(CRR=0.89;95%CI:0.73-0.99;P=0.04)were significant protective factors.Conclusions The findings underscore the importance of tailored interventions that account for various lag characteristics of different factors to effectively mitigate disability risk.Future studies should explore the underlying biological and sociological mechanisms of these lagged effects,identify intervention strategies that target risk factors with different lagged patterns,and evaluate their effectiveness.展开更多
The pathophysiology of many ailments,including neurological,gastrointestinal,and metabolic disorders,is well known to be influenced by intestinal dysbiosis.Clinical research has provided evidence suggesting a strong c...The pathophysiology of many ailments,including neurological,gastrointestinal,and metabolic disorders,is well known to be influenced by intestinal dysbiosis.Clinical research has provided evidence suggesting a strong correlation between dysbiosis of the gut microbiome and colorectal cancer(CRC)development.The active reprogramming of metabolic pathways to boost glycolysis,fatty acid production,lipogenesis,and glutaminolysis constitutes a major metabolic shift in cancer development,including CRC.The complex combination of different factors leads to CRC,making it an environmental disease.These factors include food and lifestyle choices,genetics and family history,age,underlying intestinal diseases,and dysbiosis of the gut microbiota.One of the primary risk factors for carcinoma development is diet,which impacts an individual’s gut microbiome.In addition to impacting CRC formation,the gut microbiome also has immunomodulatory effects,including various immunological interactions and the underlying mechanisms governing them.Microbial interactions in CRC have been extensively studied,yet numerous unresolved queries exist on how gut bacteria can influence treatment.Microbiome-driven immunotherapies,focusing on probiotics,prebiotics,and synbiotics,represent a promising therapeutic avenue.However,large-scale treatment utilization in CRC patients is limited by several issues,including variations in the microbial makeup of each patient’s gut and a lack of established methods.The study highlights the impact of several risk factors,including dysbiosis of the gut microbiome and different approaches to halting and treating CRC progression with a focus on diet changes and modulation of the gut flora.Given the foregoing,we propose that if research gaps are addressed and immunotherapy is paired with microbial interventions,microbiota-based therapeutics could potentially impede the growth of tumors and treat CRC.展开更多
Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June ...Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June 2023.They were divided into 2 groups according to the occurrence of kinesiophobia after THA.The demographic data of the 2 groups were analyzed by single-factor analysis.The factors with statistically significant differences were analyzed by binary logistic regression as independent variables.Finally,Spearman analysis was used to analyze the relationship between risk factors and the degree of kinesiophobia.Results:Among 213 THA patients,38 patients were diagnosed with kinetophobia,and the incidence of kinetophobia was 17.84%.visual analogue scale(VAS)and pain duration before operation were higher in patients with kinetophobia than in patients without kinetophobia.The scores of education level,self-efficacy,and social support were significantly lower than those of the non-phobia group,with statistical significance(P<0.05).Logistic regression analysis showed that VAS was a risk factor for kinetophobia after THA.Education level and self-efficacy were protective factors to reduce the occurrence of kinetophobia after THA(P<0.05).Spearman correlation analysis showed that the degree of pain(r=0.697,P<0.001)was positively correlated with the degree of kinetophobia,while the degree of education(r=-0.647,P<0.001)and self-efficacy(r=-0.756,P<0.001)were negatively correlated with the degree of kinetophobia.Conclusions:The degree of pain is a risk factor of kinesiophobia after THA,and it is positively correlated with the degree.Educational level and self-efficacy were protective factors to reduce the incidence of kinesiophobia and were negatively correlated with the degree of kinesiophobia.展开更多
Objectives:Uretero-enteric strictures are feared complications following cystectomy.Despite surgical advancements,particularly the rise of robot-assisted approaches,the risk factors associated with these strictures re...Objectives:Uretero-enteric strictures are feared complications following cystectomy.Despite surgical advancements,particularly the rise of robot-assisted approaches,the risk factors associated with these strictures remain poorly defined.This study aimed to identify the risk factors associated with uretero-enteric anastomotic strictures after cystectomy,according to the surgical approach and type of urinary diversion(extracorporeal vs.intracorporeal).Methods:We conducted a single-center retrospective study including 340 patients who underwent cystectomy between 2016 and 2024 at Tours University Hospital.Clinical,biological,perioperative,and postoperative data were analyzed.The occurrence of a uretero-ileal anastomotic stricture was defined radiologically by a uretero-hydronephrosis≥20 mm.We constructed and analyzed a learning curve for robotic surgery with intracorporeal urinary diversion.Results:Strictures occurred in 60 patients(17.6%).On multivariable analysis,reduced preoperative glomerular filtration rate(odds ratio[OR]=1.45 per 10 mL/min decrease,95%CI[1.12-1.87],p=0.004),elevated creatinine(OR=1.30 per 10μmol/L increase,95%CI[1.05-1.61],p=0.018),prior myocardial infarction(OR=2.25,95%CI[1.10-4.62],p=0.027),and postoperative urinary tract infection(OR=3.10,95%CI[1.65-5.82],p<0.001)were independent predictors.Most strictures were left-sided.Intracorporeal robotic diversion had a higher,though non-significant,stricture rate(21.5%vs.15.2%,OR=1.52,p=0.12).Stricture rates fell markedly after 20 robotic cases per surgeon(23.8%vs.12.1%).Conclusion:Uretero-enteric strictures are multifactorial,strongly influenced by baseline renal function,cardiovascular comorbidity,and postoperative infection.Robotic intracorporeal diversion shows a learning curve effect,underlining the importance of surgical expertise and infection prevention in reducing risk.展开更多
BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and dep...BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and depression(PSD)do not receive sufficient attention.AIM To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.METHODS This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024.Based on assessments using the Hamilton Rating Scale for Anxiety(HAMA)and Hamilton Rating Scale for Depression(HAMD)at 2 weeks(±3 days)post-stroke,patients were classified into the PSD group(HAMA≥7 and/or HAMD≥7)and the non-PSD group(HAMA<7 and HAMD<7).Observation indicators included psychological assessment,demographic and clinical characteristics,stroke-related clinical indicators,neuroimaging assessments,and laboratory biomarkers.Multivariate logistic regression analysis was used to identify independent risk factors for PSD,and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.RESULTS Of the 112 patients,46(41.1%)were diagnosed with PSD.Multivariate analysis identified five independent risk factors:Female gender[Odds ratio(OR)=2.32,95%confidence interval(CI):1.56-3.45],history of mental disorders prior to stroke(OR=3.17,95%CI:1.89-5.32),infarct location in the frontal lobe or limbic system(OR=2.86,95%CI:1.73-4.71),stroke severity with National Institutes of Health Stroke Scale≥8 at admission(OR=2.54,95%CI:1.62-3.99),and low social support(Social Support Rating Scale<35,OR=2.18,95%CI:1.42-3.36).Subgroup analysis showed that depression patients more commonly had left hemisphere lesions(68.4%vs 45.2%),while anxiety patients more frequently presented with right hemisphere lesions(59.5%vs 39.5%).The PSD group exhibited larger infarct volumes(8.7 cm^(3) vs 5.3 cm^(3)),more severe white matter hyperintensities,and more pronounced frontal lobe atrophy.Analysis of inflammatory markers showed significantly elevated levels of interleukin-6(7.8 pg/mL vs 4.5 pg/mL)and tumor necrosis factor-alpha(15.6 pg/mL vs 9.8 pg/mL)in the PSD group,while hypothalamicpituitary-adrenal axis function assessment revealed higher cortisol levels(386.5±92.3 nmol/L vs 328.7±75.6 nmol/L)and flattened diurnal rhythm in the PSD group.CONCLUSION PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry,neuroinflammatory responses,and dysfunction of the hypothalamic-pituitary-adrenal axis.展开更多
BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.A...BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.AIM To determine the incidence of depression and its independent risk factors in patients with esophageal cancer and bone metastasis.METHODS A total of 100 consecutive eligible patients admitted between March 2022 and March 2025 were recruited.Depression was assessed with the Beck Depression Inventory-II;scores>4 defined the depression group(n=42)and scores≤4 the non-depression group(n=58).Demographic,clinical,and laboratory variables were compared between the groups.Multivariate logistic regression was used to identify independent risk factors.RESULTS Depression prevalence was 42.0%(42/100).Univariate analysis demonstrated significant differences in monthly per-capita household income,education level,social support,sleep disorders,and serum high-sensitivity C-reactive protein(all P<0.05);no differences were observed in sex,age,tumor characteristics,or other laboratory indices(all P>0.05).Multivariable analysis revealed the following independent risk factors for depression:Low income[odds ratio(OR)=2.66,95%confidence interval(CI):1.17-6.03],low education(OR=2.46,95%CI:1.08-5.61),low social support(OR=5.10,95%CI:1.81-14.39),sleep disorders(OR=2.79,95%CI:1.23-6.35),and elevated high-sensitivity C-reactive protein(OR=1.31 per unit increase,95%CI:1.18-1.46).CONCLUSION Depression is common among patients with esophageal cancer and bone metastasis.Low socioeconomic status,limited education,insufficient social support,sleep disturbances,and systemic inflammation were independent predictors.Interventions that address these modifiable factors may reduce depression risk in this population.展开更多
AIM:To assess risk factors for epiretinal membranes(ERM)and examine their interactions in a nationally representative U.S.dataset.METHODS:Data from the 2005–2008 National Health and Nutrition Examination Survey(NHANE...AIM:To assess risk factors for epiretinal membranes(ERM)and examine their interactions in a nationally representative U.S.dataset.METHODS:Data from the 2005–2008 National Health and Nutrition Examination Survey(NHANES)were analyzed,a nationally representative U.S.dataset.ERM was identified via retinal imaging based on the presence of cellophane changes.Key predictors included age group,eye surgery history,and refractive error,with additional demographic and health-related covariates.Weighted univariate and multiple logistic regression models were used to assess associations and interaction effects between eye surgery and refractive error.RESULTS:Totally 3925 participants were analyzed.Older age,eye surgery,and refractive errors were significantly associated with ERM.Compared to those under 65y,the odds ratio(OR)for ERM was 3.08 for ages 65–75y(P=0.0014)and 4.76 for ages 75+years(P=0.0069).Eye surgery increased ERM risk(OR=3.48,P=0.0018).Moderate to high hyperopia and myopia were also associated with ERM(OR=2.65 and 1.80,respectively).A significant interaction between refractive error and eye surgery was observed(P<0.0001).Moderate to high myopia was associated with ERM only in those without eye surgery(OR=1.92,P=0.0443).Eye surgery was most strongly associated with ERM in the emmetropic group(OR=3.60,P=0.0027),followed by the moderate to high myopia group(OR=3.01,P=0.0031).CONCLUSION:ERM is significantly associated with aging,eye surgery,and refractive errors.The interaction between eye surgery and refractive error modifies ERM risk and highlights the importance of considering combined effects in clinical risk assessments.These findings may help guide individualized ERM risk assessment that may inform personalized approaches to ERM prevention and management.展开更多
BACKGROUND:Sepsis may increase the risk of long-term cardiovascular outcomes.This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.METHODS:We c...BACKGROUND:Sepsis may increase the risk of long-term cardiovascular outcomes.This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.METHODS:We conducted a comprehensive systematic search of MEDLINE,EMBASE,the Cochrane Library,Wanfang,and CNKI from database inception through May 2025,without language restrictions.The primary outcome was a composite of myocardial infarction,stroke,congestive heart failure,or cardiovascular death.To evaluate the association between sepsis survivors and cardiovascular outcomes,we calculated cumulative incidence rates and hazard ratios(HRs)with corresponding 95%confi dence intervals(95%CIs).RESULTS:Twenty-fi ve observational studies comprising 7,525,271 participants were included.The pooled cumulative incidence of major cardiovascular events was 9.0%(95%CI:6.1%-11.9%),myocardial infarction 2.4%(95%CI:1.6%-3.1%),stroke 4.9%(95%CI:3.8%-6.1%),and congestive heart failure 8.6%(95%CI:4.6%-12.6%).Compared with non-sepsis controls,sepsis survivors had a signifi cantly higher risk of major cardiovascular events(HR:1.54;95%CI:1.32-1.79),myocardial infarction(HR:1.41;95%CI:1.29-1.54),stroke(HR:1.45;95%CI:1.32-1.60),and congestive heart failure(HR:1.51;95%CI:1.46-1.56).Risk factors associated with increased cardiovascular events in sepsis survivors included age≤45 years,male,hyperlipidemia,and multiple comorbidities.CONCLUSION:Adult sepsis survivors may face significantly increased risks of long-term cardiovascular outcomes.Both common cardiovascular risk factors and sepsis-related pathophysiological changes contribute to this association.展开更多
Engineered water systems such as wastewater treatment plants(WWTPs)are potential reservoirs of various biological risk factors(BRFs),including pathogens,antibiotic resistance genes(ARGs),and virulence factors(VFs).Cur...Engineered water systems such as wastewater treatment plants(WWTPs)are potential reservoirs of various biological risk factors(BRFs),including pathogens,antibiotic resistance genes(ARGs),and virulence factors(VFs).Currently,a BRF database relevant to engineered water systems on a global geographic scale is lacking.Here,we present the Global Wastewater Pathogen Database(GWPD),an online database that provides information on the diversity,abundance,and distribution of BRFs from 1302 metagenome samples obtained from 186 cities,68 countries,and six continents.We sorted these samples into six types:sewer networks,influent,anoxic activated sludge,oxic activated sludge,effluent,and receiving/natural waters.In total,476 pathogens,442 ARGs,and 246 VFs were identified.As a multifunctional database,GWPD provides an interactive visualization of these BRFs in a world map,an information retrieval interface,and an online one-click service for BRF annotation from metagenome sequencing data.GWPD is built on a web service framework,which can be readily extended to future versions of GWPD by adding more functional modules and connecting to other data sources,such as epidemic databases,to support risk assessment and control in the context of“One Health.”展开更多
BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world ...BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development,treatment failure,and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies,reduce treatment burden,and improve outcomes in patients with CPF.AIM To describe the epidemiology,treatments,outcomes,and associated risk/protective factors for complex CPF.METHODS Electronic databases(MEDLINE,EMBASE,EBM Reviews,EconLit)were searched.Two reviewers independently used populations,interventions,comparators,outcomes,study designs,and time criteria to identify relevant studies.Observational studies published in English from January 1,2015 to February 17,2022 with>50 patients were included,even if complex CPF was not defined.Items of interest included complex CPF definitions,epidemiology,treatment patterns,morbidity,mortality,and risk factors associated with complex CPF development,treatment failure,and undergoing multiple surgeries.Data were reported using descriptive statistics.RESULTS Overall,140 studies were included.Complex CPF definitions were heterogeneous and rarely reported(24 studies).Hence,data mostly related to CPF in general.CPF prevalence was variable(range:1.5%-81.0%).Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn’s disease diagnosis(range:3.5%-50.1%).Overall healing and failure rates after treatment were in the range of 10.5%-80.2%and 3.6%-83.0%,respectively.Abscesses were the most frequently reported morbidity(n=18).No CPF-related deaths were reported.No consistent risk or protective factors were identified.CONCLUSION Epidemiology,treatment patterns,and risk factors for CPF vary,likely due to inconsistent CPF and clinical outcome definitions.Standardization would facilitate comparability,which may inform optimal complex CPF treatment strategies.展开更多
BACKGROUND Acute kidney injury(AKI)is a common and serious complication following heart transplantation,significantly impacting patient outcomes and survival rates.AKI after transplantation can lead to prolonged hospi...BACKGROUND Acute kidney injury(AKI)is a common and serious complication following heart transplantation,significantly impacting patient outcomes and survival rates.AKI after transplantation can lead to prolonged hospital stays,increased morbidity,and even mortality.AIM To identify and quantify significant risk factors associated with AKI following heart transplantation through a systematic review and meta-analysis.This study aims to distinguish predictive variables that may inform perioperative risk stratification and clinical decision-making.METHODS Electronic searches on MEDLINE,Google Scholar,ScienceDirect,Clinical-Trials.gov,and Cochrane databases were conducted from inception up till September 1.Included studies were randomized controlled trials,clinical trials,retrospective cohort,and observational studies.Exclusion criteria encompassed studies with pediatric populations,non-English publications,case reports,and studies lacking sufficient data on AKI outcomes.Statistical analysis was performed using RevMan 5.4,reporting dichotomous outcomes as odds ratios(OR)and continuous outcomes as mean differences(MD)with 95%confidence intervals(CI).Quality assessment of the included studies was performed using the New Castle Ottawa Scale.RESULTS Out of 1345 articles,13 studies with 3330 patients were included.Significant risk factors included age[overall MD=2.27 years(95%CI:0.13 to 4.41)],body mass index(BMI)[MD=1.42(95%CI:0.60 to 2.24)],diabetes[overall OR=1.47(95%CI:1.16 to 1.85)],chronic kidney disease(CKD)[OR=2.67(95%CI:1.73 to 4.14)],chronic obstructive pulmonary disorder(COPD)[OR=0.49(95%CI:0.27 to 0.89)],previous thoracic surgery[(OR)=1.27,95%CI:(1.05 to 1.54)],cardio-pulmonary bypass time[(MD)=17.10,95%CI:(6.12 to 28.08)],mechanical ventilation duration[(MD)=30.87 hours,95%CI:(10.69 to 51.05)]and extracorporeal membrane oxygenation[(OR)=2.31,95%CI:(1.25 to 4.26)].Factors not associated with AKI after heart transplantation included Recipients’male sex(P=0.55),donor sex(P=0.11),hypertension(P=0.13),smoking(P=0.20),coronary artery disease(P=0.90),pulmonary artery disease(P=0.81),dilated cardiomyopathy(P=0.79),ventilation duration(P=0.24),ischemic time(P=0.06),use of intra-aortic balloon pump(P=0.14),LVAD transplantation(P=0.83),and Inotropes use(P=0.78).CONCLUSION Age,BMI,diabetes,CKD,COPD,previous thoracic surgery,prolonged CPB time,extended mechanical ventilation,and ECMO use are significant predictors of AKI following heart transplantation,necessitating vigilant monitoring and individualized risk assessment.Conversely,factors such as LVAD implantation and inotrope use showed no significant association,highlighting the need for further investigation into their roles.Future prospective studies are essential to validate these findings,elucidate underlying mechanisms,and develop targeted interventions to mitigate AKI risk and improve patient outcomes.展开更多
A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mel...A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.展开更多
Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to...Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States.Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piecewise linear regression and sensitivity analyses were also performed.Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95%CI:1.09-1.23)and CVD mortality(HR=1.17,95%CI:1.05-1.30)but not cancer mortality(HR=1.17,95%CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms.Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was Jshaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.展开更多
BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatm...BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.展开更多
BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nu...BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.展开更多
Objectives:This review aimed to explore the independent risk factors of postpartum urinary retention(PUR)after a vaginal delivery.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)w...Objectives:This review aimed to explore the independent risk factors of postpartum urinary retention(PUR)after a vaginal delivery.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)was followed and relevant studies were retrieved from eleven databases.The quality of the included articles was assessed using Critical Appraisal Skills Programme tools or the Appraisal tool for Cross-Sectional Studies.The data analysis was performed using Review Manager version 5.3.Results:A total of nine articles were included and five risk factors were identified,namely,episiotomy(OR=2.99,95%CI=1.31e6.79,P=0.009),epidural analgesia(OR=2.48,95%CI=1.09e5.68,P=0.03),primiparity(OR=2.17,95%CI=1.06e4.46,P=0.03),instrumental delivery(OR=4.01,95%CI=1.97 e8.18,P<0.001),and the duration of the second stage of labor(MD=15.24,95%CI=11.20e19.28,P<0.001).However,fetal birth weights of more than 3800 g were not identified as an independent risk factor(MD=64.41,95%CI=-12.59 to 141.41,P=0.10).Conclusion:This systematic review indicated that the independent risk factors for PUR were found to include episiotomy,epidural analgesia,instrumental delivery,primiparity,and a longer second stage of labor.In clinical practice,healthcare providers could pay more attention to women with these factors and prevent postpartum urinary retention.展开更多
Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2...Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2 days. However,untreated AMS can progress to life-threatening conditions such as high-altitude cerebral and pulmonary edema(HACE and HAPE, respectively)^([1]).展开更多
BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of an...BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of anxiety and depression among geriatric patients who underwent total hip arthroplasty(THA),explored their association with postoperative pain,and identified contributing risk factors.METHODS A total of 111 geriatric patients who underwent THA between January 2021 and January 2024 were included.Standardized psychological assessment tools-including the Zung Self-Rating Anxiety Scale(SAS)and the Zung Self-Rating Depression Scale(SDS)-and the Numeric Rating Scale(NRS)for pain quantification were systematically administered.Pearson correlation analysis was utilized to explore the relationships among SAS,SDS,and NRS scores.Univariate and multivariate binary logistic regression analyses were conducted to identify risk factors for anxiety and depression in these patients.RESULTS The cohort exhibited moderate anxiety(SAS:44.23±9.03),mild depression(SDS:46.98±9.15),and moderate postoperative pain(NRS:4.93±2.37).Patients with anxiety or depression reported significantly higher NRS scores than those without these conditions.Significant positive correlations were observed between SAS and SDS scores,as well as between each of these and NRS scores.Univariate analysis revealed that gender,age,disease duration,alcohol use,diabetes history,and NRS scores were significantly associated with anxiety and depression.Multivariate analysis further identified female gender,disease duration≥2 years,alcohol use,and NRS scores≥5 as independent predictors of postoperative psychological distress.CONCLUSION Anxiety and depression are closely linked with postoperative pain in geriatric patients post-THA recovery.Early psychological screening and multimodal pain management strategies are recommended-particularly for individuals with a disease duration of≥2 years,a history of alcohol consumption,or an NRS score of≥5,as well as female patients-to effectively mitigate their negative emotional states and improve postoperative recovery.展开更多
基金supported by the 2025 Fujian Provincial Social Science Foundation Project(FJ2025C074).
文摘This systematic review synthesizes empirical research on external risk factors for adolescent smartphone addiction.Scopus and Web of Science were searched for English peer-reviewed empirical articles from 2008 onward;28 met inclusion criteria(excluding non-adolescents,generic internet addiction,non-empirical work,or non-English).Thematic synthesis organized findings into three external risk domains—family,school,and peers—considering cultural/contextual mechanisms.Family dynamics(parental phubbing,harsh parenting,dysfunction),school stressors,and adverse peer relationships were identified as accumulating,direct and indirect contributors to smartphone addiction.These operate within a techno-ecological framework,where digital technologies amplify vulnerabilities and create new pathways for maladaptive use.Evidence favors an ecological,multi-level perspective.Future research should use longitudinal designs,standardize measures across cultures,and examine understudied regions—especially Africa—to guide culturally sensitive interventions.
基金supported by ScientificResearch Fund of National Health Commission of the People’s Republic of China-Major Science and Technology Program for Medicine and Health in Zhejiang Province(WKJ-ZJ-2406).
文摘Objectives This study aimed to explore the lagged and cumulative effects of risk factors on disability in older adults using distributed lag non-linear models(DLNMs).Methods We utilized data from the China Health and Retirement Longitudinal Study(CHARLS).After feature selection via Elastic Net Regularization,we applied DLNMs to evaluate the lagged effects of risk factors.Disability was defined as the presence of any difficulties in basic activities of daily living(BADL).The cumulative relative risk(CRR)was calculated by summing the lag-specific risk estimates,representing the cumulative disability risk over the specified lag period.Effect modifications and sensitivity analyses were also performed.Results This study included a total of 2,318 participants.Early-phase lag factors,such as the difficulty in stooping(CRR=3.58;95%CI:2.31-5.55;P<0.001)and walking(CRR=2.77;95%CI:1.39-5.55;P<0.001),exerted the strongest effects immediately upon occurrence.Mid-phase lag factors,such as arthritis(CRR=1.51;95%CI:1.10-2.06;P=0.001),showed a resurgence in disability risk within 2-3 years.Late-phase lag factors,including depressive symptoms(CRR=2.38;95%CI:1.30-4.35;P<0.001)and elevated systolic blood pressure(CRR=1.64;95%CI:1.06-2.79;P=0.02),exhibited significant long-term cumulative risks.Conversely,grip strength(CRR=0.80;95%CI:0.54-0.95;P=0.02)and social participation(CRR=0.89;95%CI:0.73-0.99;P=0.04)were significant protective factors.Conclusions The findings underscore the importance of tailored interventions that account for various lag characteristics of different factors to effectively mitigate disability risk.Future studies should explore the underlying biological and sociological mechanisms of these lagged effects,identify intervention strategies that target risk factors with different lagged patterns,and evaluate their effectiveness.
文摘The pathophysiology of many ailments,including neurological,gastrointestinal,and metabolic disorders,is well known to be influenced by intestinal dysbiosis.Clinical research has provided evidence suggesting a strong correlation between dysbiosis of the gut microbiome and colorectal cancer(CRC)development.The active reprogramming of metabolic pathways to boost glycolysis,fatty acid production,lipogenesis,and glutaminolysis constitutes a major metabolic shift in cancer development,including CRC.The complex combination of different factors leads to CRC,making it an environmental disease.These factors include food and lifestyle choices,genetics and family history,age,underlying intestinal diseases,and dysbiosis of the gut microbiota.One of the primary risk factors for carcinoma development is diet,which impacts an individual’s gut microbiome.In addition to impacting CRC formation,the gut microbiome also has immunomodulatory effects,including various immunological interactions and the underlying mechanisms governing them.Microbial interactions in CRC have been extensively studied,yet numerous unresolved queries exist on how gut bacteria can influence treatment.Microbiome-driven immunotherapies,focusing on probiotics,prebiotics,and synbiotics,represent a promising therapeutic avenue.However,large-scale treatment utilization in CRC patients is limited by several issues,including variations in the microbial makeup of each patient’s gut and a lack of established methods.The study highlights the impact of several risk factors,including dysbiosis of the gut microbiome and different approaches to halting and treating CRC progression with a focus on diet changes and modulation of the gut flora.Given the foregoing,we propose that if research gaps are addressed and immunotherapy is paired with microbial interventions,microbiota-based therapeutics could potentially impede the growth of tumors and treat CRC.
基金supported by the Henan Provincial Medical Science and Technology Research Program,grant funded by the Henan Provincial Health Commission(No.LHGJ 20200888)。
文摘Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June 2023.They were divided into 2 groups according to the occurrence of kinesiophobia after THA.The demographic data of the 2 groups were analyzed by single-factor analysis.The factors with statistically significant differences were analyzed by binary logistic regression as independent variables.Finally,Spearman analysis was used to analyze the relationship between risk factors and the degree of kinesiophobia.Results:Among 213 THA patients,38 patients were diagnosed with kinetophobia,and the incidence of kinetophobia was 17.84%.visual analogue scale(VAS)and pain duration before operation were higher in patients with kinetophobia than in patients without kinetophobia.The scores of education level,self-efficacy,and social support were significantly lower than those of the non-phobia group,with statistical significance(P<0.05).Logistic regression analysis showed that VAS was a risk factor for kinetophobia after THA.Education level and self-efficacy were protective factors to reduce the occurrence of kinetophobia after THA(P<0.05).Spearman correlation analysis showed that the degree of pain(r=0.697,P<0.001)was positively correlated with the degree of kinetophobia,while the degree of education(r=-0.647,P<0.001)and self-efficacy(r=-0.756,P<0.001)were negatively correlated with the degree of kinetophobia.Conclusions:The degree of pain is a risk factor of kinesiophobia after THA,and it is positively correlated with the degree.Educational level and self-efficacy were protective factors to reduce the incidence of kinesiophobia and were negatively correlated with the degree of kinesiophobia.
文摘Objectives:Uretero-enteric strictures are feared complications following cystectomy.Despite surgical advancements,particularly the rise of robot-assisted approaches,the risk factors associated with these strictures remain poorly defined.This study aimed to identify the risk factors associated with uretero-enteric anastomotic strictures after cystectomy,according to the surgical approach and type of urinary diversion(extracorporeal vs.intracorporeal).Methods:We conducted a single-center retrospective study including 340 patients who underwent cystectomy between 2016 and 2024 at Tours University Hospital.Clinical,biological,perioperative,and postoperative data were analyzed.The occurrence of a uretero-ileal anastomotic stricture was defined radiologically by a uretero-hydronephrosis≥20 mm.We constructed and analyzed a learning curve for robotic surgery with intracorporeal urinary diversion.Results:Strictures occurred in 60 patients(17.6%).On multivariable analysis,reduced preoperative glomerular filtration rate(odds ratio[OR]=1.45 per 10 mL/min decrease,95%CI[1.12-1.87],p=0.004),elevated creatinine(OR=1.30 per 10μmol/L increase,95%CI[1.05-1.61],p=0.018),prior myocardial infarction(OR=2.25,95%CI[1.10-4.62],p=0.027),and postoperative urinary tract infection(OR=3.10,95%CI[1.65-5.82],p<0.001)were independent predictors.Most strictures were left-sided.Intracorporeal robotic diversion had a higher,though non-significant,stricture rate(21.5%vs.15.2%,OR=1.52,p=0.12).Stricture rates fell markedly after 20 robotic cases per surgeon(23.8%vs.12.1%).Conclusion:Uretero-enteric strictures are multifactorial,strongly influenced by baseline renal function,cardiovascular comorbidity,and postoperative infection.Robotic intracorporeal diversion shows a learning curve effect,underlining the importance of surgical expertise and infection prevention in reducing risk.
文摘BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and depression(PSD)do not receive sufficient attention.AIM To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.METHODS This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024.Based on assessments using the Hamilton Rating Scale for Anxiety(HAMA)and Hamilton Rating Scale for Depression(HAMD)at 2 weeks(±3 days)post-stroke,patients were classified into the PSD group(HAMA≥7 and/or HAMD≥7)and the non-PSD group(HAMA<7 and HAMD<7).Observation indicators included psychological assessment,demographic and clinical characteristics,stroke-related clinical indicators,neuroimaging assessments,and laboratory biomarkers.Multivariate logistic regression analysis was used to identify independent risk factors for PSD,and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.RESULTS Of the 112 patients,46(41.1%)were diagnosed with PSD.Multivariate analysis identified five independent risk factors:Female gender[Odds ratio(OR)=2.32,95%confidence interval(CI):1.56-3.45],history of mental disorders prior to stroke(OR=3.17,95%CI:1.89-5.32),infarct location in the frontal lobe or limbic system(OR=2.86,95%CI:1.73-4.71),stroke severity with National Institutes of Health Stroke Scale≥8 at admission(OR=2.54,95%CI:1.62-3.99),and low social support(Social Support Rating Scale<35,OR=2.18,95%CI:1.42-3.36).Subgroup analysis showed that depression patients more commonly had left hemisphere lesions(68.4%vs 45.2%),while anxiety patients more frequently presented with right hemisphere lesions(59.5%vs 39.5%).The PSD group exhibited larger infarct volumes(8.7 cm^(3) vs 5.3 cm^(3)),more severe white matter hyperintensities,and more pronounced frontal lobe atrophy.Analysis of inflammatory markers showed significantly elevated levels of interleukin-6(7.8 pg/mL vs 4.5 pg/mL)and tumor necrosis factor-alpha(15.6 pg/mL vs 9.8 pg/mL)in the PSD group,while hypothalamicpituitary-adrenal axis function assessment revealed higher cortisol levels(386.5±92.3 nmol/L vs 328.7±75.6 nmol/L)and flattened diurnal rhythm in the PSD group.CONCLUSION PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry,neuroinflammatory responses,and dysfunction of the hypothalamic-pituitary-adrenal axis.
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
文摘BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.AIM To determine the incidence of depression and its independent risk factors in patients with esophageal cancer and bone metastasis.METHODS A total of 100 consecutive eligible patients admitted between March 2022 and March 2025 were recruited.Depression was assessed with the Beck Depression Inventory-II;scores>4 defined the depression group(n=42)and scores≤4 the non-depression group(n=58).Demographic,clinical,and laboratory variables were compared between the groups.Multivariate logistic regression was used to identify independent risk factors.RESULTS Depression prevalence was 42.0%(42/100).Univariate analysis demonstrated significant differences in monthly per-capita household income,education level,social support,sleep disorders,and serum high-sensitivity C-reactive protein(all P<0.05);no differences were observed in sex,age,tumor characteristics,or other laboratory indices(all P>0.05).Multivariable analysis revealed the following independent risk factors for depression:Low income[odds ratio(OR)=2.66,95%confidence interval(CI):1.17-6.03],low education(OR=2.46,95%CI:1.08-5.61),low social support(OR=5.10,95%CI:1.81-14.39),sleep disorders(OR=2.79,95%CI:1.23-6.35),and elevated high-sensitivity C-reactive protein(OR=1.31 per unit increase,95%CI:1.18-1.46).CONCLUSION Depression is common among patients with esophageal cancer and bone metastasis.Low socioeconomic status,limited education,insufficient social support,sleep disturbances,and systemic inflammation were independent predictors.Interventions that address these modifiable factors may reduce depression risk in this population.
基金Supported by Chengdu Municipal Science and Technology Bureau Key R&D Support Program(No.2023-YF09-00041-SN)。
文摘AIM:To assess risk factors for epiretinal membranes(ERM)and examine their interactions in a nationally representative U.S.dataset.METHODS:Data from the 2005–2008 National Health and Nutrition Examination Survey(NHANES)were analyzed,a nationally representative U.S.dataset.ERM was identified via retinal imaging based on the presence of cellophane changes.Key predictors included age group,eye surgery history,and refractive error,with additional demographic and health-related covariates.Weighted univariate and multiple logistic regression models were used to assess associations and interaction effects between eye surgery and refractive error.RESULTS:Totally 3925 participants were analyzed.Older age,eye surgery,and refractive errors were significantly associated with ERM.Compared to those under 65y,the odds ratio(OR)for ERM was 3.08 for ages 65–75y(P=0.0014)and 4.76 for ages 75+years(P=0.0069).Eye surgery increased ERM risk(OR=3.48,P=0.0018).Moderate to high hyperopia and myopia were also associated with ERM(OR=2.65 and 1.80,respectively).A significant interaction between refractive error and eye surgery was observed(P<0.0001).Moderate to high myopia was associated with ERM only in those without eye surgery(OR=1.92,P=0.0443).Eye surgery was most strongly associated with ERM in the emmetropic group(OR=3.60,P=0.0027),followed by the moderate to high myopia group(OR=3.01,P=0.0031).CONCLUSION:ERM is significantly associated with aging,eye surgery,and refractive errors.The interaction between eye surgery and refractive error modifies ERM risk and highlights the importance of considering combined effects in clinical risk assessments.These findings may help guide individualized ERM risk assessment that may inform personalized approaches to ERM prevention and management.
基金supported by Zhejiang Province Medical and Health Science and Technology Plan Project(2022KY241)Hangzhou Health Science and Technology Plan Project(ZD20230017).
文摘BACKGROUND:Sepsis may increase the risk of long-term cardiovascular outcomes.This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.METHODS:We conducted a comprehensive systematic search of MEDLINE,EMBASE,the Cochrane Library,Wanfang,and CNKI from database inception through May 2025,without language restrictions.The primary outcome was a composite of myocardial infarction,stroke,congestive heart failure,or cardiovascular death.To evaluate the association between sepsis survivors and cardiovascular outcomes,we calculated cumulative incidence rates and hazard ratios(HRs)with corresponding 95%confi dence intervals(95%CIs).RESULTS:Twenty-fi ve observational studies comprising 7,525,271 participants were included.The pooled cumulative incidence of major cardiovascular events was 9.0%(95%CI:6.1%-11.9%),myocardial infarction 2.4%(95%CI:1.6%-3.1%),stroke 4.9%(95%CI:3.8%-6.1%),and congestive heart failure 8.6%(95%CI:4.6%-12.6%).Compared with non-sepsis controls,sepsis survivors had a signifi cantly higher risk of major cardiovascular events(HR:1.54;95%CI:1.32-1.79),myocardial infarction(HR:1.41;95%CI:1.29-1.54),stroke(HR:1.45;95%CI:1.32-1.60),and congestive heart failure(HR:1.51;95%CI:1.46-1.56).Risk factors associated with increased cardiovascular events in sepsis survivors included age≤45 years,male,hyperlipidemia,and multiple comorbidities.CONCLUSION:Adult sepsis survivors may face significantly increased risks of long-term cardiovascular outcomes.Both common cardiovascular risk factors and sepsis-related pathophysiological changes contribute to this association.
基金supported by the National Natural Science Foundation of China(52321005,52293441,52293443,52230004)the Shenzhen Stability Support Key Program in Colleges and Universities of China(GXWD20231127195344001)+3 种基金the Natural Science Foundation of Guangdong Basic and Applied Basic Research Foundation(2024A1515010085)the Shenzhen Overseas High-level Talents Research Startup Program(20200518750C)the Shenzhen Science and Technology Program(KQTD20190929172630447)the Open Project of the Key Laboratory of Environmental Biotechnology,CAS(KF2021006).
文摘Engineered water systems such as wastewater treatment plants(WWTPs)are potential reservoirs of various biological risk factors(BRFs),including pathogens,antibiotic resistance genes(ARGs),and virulence factors(VFs).Currently,a BRF database relevant to engineered water systems on a global geographic scale is lacking.Here,we present the Global Wastewater Pathogen Database(GWPD),an online database that provides information on the diversity,abundance,and distribution of BRFs from 1302 metagenome samples obtained from 186 cities,68 countries,and six continents.We sorted these samples into six types:sewer networks,influent,anoxic activated sludge,oxic activated sludge,effluent,and receiving/natural waters.In total,476 pathogens,442 ARGs,and 246 VFs were identified.As a multifunctional database,GWPD provides an interactive visualization of these BRFs in a world map,an information retrieval interface,and an online one-click service for BRF annotation from metagenome sequencing data.GWPD is built on a web service framework,which can be readily extended to future versions of GWPD by adding more functional modules and connecting to other data sources,such as epidemic databases,to support risk assessment and control in the context of“One Health.”
基金Supported by Takeda Pharmaceuticals USA,Inc.Medical writing support was provided by Luke Humphreys,PhD,of Oxford PharmaGenesis,Oxford,UK and was funded by Takeda Development Center Americas,Inc.
文摘BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development,treatment failure,and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies,reduce treatment burden,and improve outcomes in patients with CPF.AIM To describe the epidemiology,treatments,outcomes,and associated risk/protective factors for complex CPF.METHODS Electronic databases(MEDLINE,EMBASE,EBM Reviews,EconLit)were searched.Two reviewers independently used populations,interventions,comparators,outcomes,study designs,and time criteria to identify relevant studies.Observational studies published in English from January 1,2015 to February 17,2022 with>50 patients were included,even if complex CPF was not defined.Items of interest included complex CPF definitions,epidemiology,treatment patterns,morbidity,mortality,and risk factors associated with complex CPF development,treatment failure,and undergoing multiple surgeries.Data were reported using descriptive statistics.RESULTS Overall,140 studies were included.Complex CPF definitions were heterogeneous and rarely reported(24 studies).Hence,data mostly related to CPF in general.CPF prevalence was variable(range:1.5%-81.0%).Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn’s disease diagnosis(range:3.5%-50.1%).Overall healing and failure rates after treatment were in the range of 10.5%-80.2%and 3.6%-83.0%,respectively.Abscesses were the most frequently reported morbidity(n=18).No CPF-related deaths were reported.No consistent risk or protective factors were identified.CONCLUSION Epidemiology,treatment patterns,and risk factors for CPF vary,likely due to inconsistent CPF and clinical outcome definitions.Standardization would facilitate comparability,which may inform optimal complex CPF treatment strategies.
文摘BACKGROUND Acute kidney injury(AKI)is a common and serious complication following heart transplantation,significantly impacting patient outcomes and survival rates.AKI after transplantation can lead to prolonged hospital stays,increased morbidity,and even mortality.AIM To identify and quantify significant risk factors associated with AKI following heart transplantation through a systematic review and meta-analysis.This study aims to distinguish predictive variables that may inform perioperative risk stratification and clinical decision-making.METHODS Electronic searches on MEDLINE,Google Scholar,ScienceDirect,Clinical-Trials.gov,and Cochrane databases were conducted from inception up till September 1.Included studies were randomized controlled trials,clinical trials,retrospective cohort,and observational studies.Exclusion criteria encompassed studies with pediatric populations,non-English publications,case reports,and studies lacking sufficient data on AKI outcomes.Statistical analysis was performed using RevMan 5.4,reporting dichotomous outcomes as odds ratios(OR)and continuous outcomes as mean differences(MD)with 95%confidence intervals(CI).Quality assessment of the included studies was performed using the New Castle Ottawa Scale.RESULTS Out of 1345 articles,13 studies with 3330 patients were included.Significant risk factors included age[overall MD=2.27 years(95%CI:0.13 to 4.41)],body mass index(BMI)[MD=1.42(95%CI:0.60 to 2.24)],diabetes[overall OR=1.47(95%CI:1.16 to 1.85)],chronic kidney disease(CKD)[OR=2.67(95%CI:1.73 to 4.14)],chronic obstructive pulmonary disorder(COPD)[OR=0.49(95%CI:0.27 to 0.89)],previous thoracic surgery[(OR)=1.27,95%CI:(1.05 to 1.54)],cardio-pulmonary bypass time[(MD)=17.10,95%CI:(6.12 to 28.08)],mechanical ventilation duration[(MD)=30.87 hours,95%CI:(10.69 to 51.05)]and extracorporeal membrane oxygenation[(OR)=2.31,95%CI:(1.25 to 4.26)].Factors not associated with AKI after heart transplantation included Recipients’male sex(P=0.55),donor sex(P=0.11),hypertension(P=0.13),smoking(P=0.20),coronary artery disease(P=0.90),pulmonary artery disease(P=0.81),dilated cardiomyopathy(P=0.79),ventilation duration(P=0.24),ischemic time(P=0.06),use of intra-aortic balloon pump(P=0.14),LVAD transplantation(P=0.83),and Inotropes use(P=0.78).CONCLUSION Age,BMI,diabetes,CKD,COPD,previous thoracic surgery,prolonged CPB time,extended mechanical ventilation,and ECMO use are significant predictors of AKI following heart transplantation,necessitating vigilant monitoring and individualized risk assessment.Conversely,factors such as LVAD implantation and inotrope use showed no significant association,highlighting the need for further investigation into their roles.Future prospective studies are essential to validate these findings,elucidate underlying mechanisms,and develop targeted interventions to mitigate AKI risk and improve patient outcomes.
基金Jiangsu College of Nursing 2023 Special Fund for Research and Development of Medical-Educational Integration。
文摘A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.
基金National Key Research and Development Program of China(2022YFC2503500 and 2022YFC2503504)。
文摘Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States.Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piecewise linear regression and sensitivity analyses were also performed.Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95%CI:1.09-1.23)and CVD mortality(HR=1.17,95%CI:1.05-1.30)but not cancer mortality(HR=1.17,95%CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms.Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was Jshaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.
文摘BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.
文摘BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.
基金We would like to appreciate Alice May and tutors in the personal development department and library from Birmingham City University for their guidance and assistance.We are grateful to Affiliated Shenzhen Maternity&Child Healthcare Hospital,Southern Medical University.
文摘Objectives:This review aimed to explore the independent risk factors of postpartum urinary retention(PUR)after a vaginal delivery.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)was followed and relevant studies were retrieved from eleven databases.The quality of the included articles was assessed using Critical Appraisal Skills Programme tools or the Appraisal tool for Cross-Sectional Studies.The data analysis was performed using Review Manager version 5.3.Results:A total of nine articles were included and five risk factors were identified,namely,episiotomy(OR=2.99,95%CI=1.31e6.79,P=0.009),epidural analgesia(OR=2.48,95%CI=1.09e5.68,P=0.03),primiparity(OR=2.17,95%CI=1.06e4.46,P=0.03),instrumental delivery(OR=4.01,95%CI=1.97 e8.18,P<0.001),and the duration of the second stage of labor(MD=15.24,95%CI=11.20e19.28,P<0.001).However,fetal birth weights of more than 3800 g were not identified as an independent risk factor(MD=64.41,95%CI=-12.59 to 141.41,P=0.10).Conclusion:This systematic review indicated that the independent risk factors for PUR were found to include episiotomy,epidural analgesia,instrumental delivery,primiparity,and a longer second stage of labor.In clinical practice,healthcare providers could pay more attention to women with these factors and prevent postpartum urinary retention.
文摘Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2 days. However,untreated AMS can progress to life-threatening conditions such as high-altitude cerebral and pulmonary edema(HACE and HAPE, respectively)^([1]).
文摘BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of anxiety and depression among geriatric patients who underwent total hip arthroplasty(THA),explored their association with postoperative pain,and identified contributing risk factors.METHODS A total of 111 geriatric patients who underwent THA between January 2021 and January 2024 were included.Standardized psychological assessment tools-including the Zung Self-Rating Anxiety Scale(SAS)and the Zung Self-Rating Depression Scale(SDS)-and the Numeric Rating Scale(NRS)for pain quantification were systematically administered.Pearson correlation analysis was utilized to explore the relationships among SAS,SDS,and NRS scores.Univariate and multivariate binary logistic regression analyses were conducted to identify risk factors for anxiety and depression in these patients.RESULTS The cohort exhibited moderate anxiety(SAS:44.23±9.03),mild depression(SDS:46.98±9.15),and moderate postoperative pain(NRS:4.93±2.37).Patients with anxiety or depression reported significantly higher NRS scores than those without these conditions.Significant positive correlations were observed between SAS and SDS scores,as well as between each of these and NRS scores.Univariate analysis revealed that gender,age,disease duration,alcohol use,diabetes history,and NRS scores were significantly associated with anxiety and depression.Multivariate analysis further identified female gender,disease duration≥2 years,alcohol use,and NRS scores≥5 as independent predictors of postoperative psychological distress.CONCLUSION Anxiety and depression are closely linked with postoperative pain in geriatric patients post-THA recovery.Early psychological screening and multimodal pain management strategies are recommended-particularly for individuals with a disease duration of≥2 years,a history of alcohol consumption,or an NRS score of≥5,as well as female patients-to effectively mitigate their negative emotional states and improve postoperative recovery.
