AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional...AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W.Kenya,amongst a seminomadic tribe(Maasai).Students in Grades 1-8 were included.Visual acuity was measured using the Snellen“tumbling E”chart at 6 m.Children with symptoms of refractive error underwent non-cycloplegic refraction.RESULTS:A total of 2036 children(1084 males)between the ages of 4-20y were examined.Conjunctival actinic changes were present in 22%(442/2036).Nine cases were seen with a potential squamous carcinoma.No overt classical ocular signs of vitamin A deficiency were noted,although 181(8.9%)children complained of nyctalopia.Three hundred thirty-six(16.5%)children had a visual acuity worse than 6/12 in either eye,were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error.Refractive data led to an estimate of hyperopia of+1.00 D or more in 3.9%and of myopia of-0.50 D or more in either eye in 3.0%of the study population.CONCLUSION:Solar exposure-and dust-related conjunctival pathology is common.As this may develop into potentially sight-or even life-threatening conditions,it warrants further study,and preventive strategies may be needed.Complaints of nyctalopia were common and could suggest vitamin A deficiency.The prevalence of refractive errors is low in this rural African population.展开更多
Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respir...Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respiratory viral infections,remains a substantial public health concern owing to its considerable disease burden,particularly in highrisk groups.Mounting epidemiological evidence has linked influenza to extreme heat and cold weather^([2–4]).展开更多
BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecti...BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecting oncological outcomes and postoperative complications.AIM To investigate the relationship between radiologically assessed pelvic anatomy and surgical outcomes as well as the impact on local recurrence following rectal cancer surgery.METHODS We retrospectively analyzed 107 patients with rectal adenocarcinoma treated with elective rectal surgery between January 1,2017,and September 1,2022.Pelvimetric measurements were performed using computed tomography(CT)-based two-dimensional methods(n=77)by assessing the pelvic inlet area in mm^(2),and magnetic resonance imaging(MRI)-based three-dimensional techniques(n=52)using the pelvic cavity index(PCI).Patient demographic,clinical,radiological,surgical,and pathological characteristics were collected and analyzed in relation to their pelvimetric data.RESULTS When patients were categorized based on CT measurements into narrow and normal/wide pelvis groups,a significant association was observed with male sex,and a lower BMI was more common in the narrow pelvis group(P=0.002 for both).A significant association was found between a narrow pelvic structure,indicated by low PCI,and increased surgical morbidity(P=0.049).Advanced age(P=0.003)and male sex(P=0.020)were significantly correlated with higher surgical morbidity.Logistic regression analysis identified four parameters that were significantly correlated with local recurrence:older age,early perioperative readmission,longer operation time,and a lower number of dissected lymph nodes(P<0.05).However,there were no significant differences between the narrow and normal/wide pelvis groups in terms of the operation time,estimated blood loss,or overall local recurrence rate(P>0.05).CONCLUSION MRI-based pelvimetry may be valuable in predicting surgical difficulty and morbidity in rectal cancer surgery,as indicated by the PCI.The observed correlation between low PCI and increased surgical morbidity suggests the potential importance of a preoperative MRI-based pelvimetric evaluation.In contrast,CT-based pelvimetry did not show significant differences in predicting surgical outcomes or cancer recurrence,indicating that the utility of pelvimetry alone may be limited in these respects.展开更多
目的系统综述降水量、极端降水事件对人群呼吸系统疾病的影响研究。方法以降水、暴雨、呼吸系统疾病等关键词,本研究系统检索了PubMed、Web of Science和中国知网等数据库,收集降水对呼吸系统疾病影响的已发表文献,检索时段为2015年1月...目的系统综述降水量、极端降水事件对人群呼吸系统疾病的影响研究。方法以降水、暴雨、呼吸系统疾病等关键词,本研究系统检索了PubMed、Web of Science和中国知网等数据库,收集降水对呼吸系统疾病影响的已发表文献,检索时段为2015年1月—2025年3月,语种限定为中文和英文。结果经筛选共纳入15篇文献,均为原始研究性文章,其中9篇研究探讨降水量与呼吸系统疾病风险的关联,6篇研究极端降水事件与呼吸系统疾病风险的关联;综述结果表明,已有研究多采用时间序列等生态学研究设计,伴随降水量的增加,呼吸系统疾病的发病和死亡风险均可能增加。短期暴露于极端降水事件与哮喘急性发作、呼吸系统症状加重(如喘息、呼吸困难)以及急诊就诊或住院风险增加潜在相关。长期暴露于极端降水事件(如季节性高降水量,尤其是冬季降水)可能增加慢性呼吸系统疾病的恶化风险,并与呼吸系统感染及死亡率上升相关。结论降水暴露与呼吸系统疾病风险增加存在潜在关联,但证据存在不一致,部分研究显示降水与哮喘呈负相关,未来研究应基于多中心数据进一步明确不同类型降水暴露与呼吸系统疾病及其亚型疾病风险的关联,识别敏感疾病,为公共卫生干预提供科学依据。展开更多
Stem cells are pluripotent cells that can divide and differentiate,forming many different types of cells.Stem cells can be obtained from various sources,with embryonic stem cells being the most advantageous as they po...Stem cells are pluripotent cells that can divide and differentiate,forming many different types of cells.Stem cells can be obtained from various sources,with embryonic stem cells being the most advantageous as they possess a broad dividing potential.When the standard treatment proves ineffective,stem cells are typically utilized as a final option.Infections and childhood malignancies are among the significant causes of mortality in the pediatric population.Stem cell therapy has shown a decrease in morbidity and mortality when used in patients with favorable conditions like young age and lack of comorbidities.This review discusses how stem cells are prepared and used in treating pediatric diseases like X-linked agammaglobulinemia,diabetes mellitus,aplastic anemia,infections,and leukemia.Technological advancement has played a significant role in producing more specific stem cells using genetic modification methods like clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9,which produce stem cells that target a particular cell type,e.g.,myocytes and hematopoietic cells,further increasing the effectiveness of the therapy.We address the obstacles faced when conducting research related to stem cells,including ethical and legal issues,which hinder the use of this therapy in some fields.We also indicate recommendations for increasing the efficacy of stem cell therapy in the pediatric population.展开更多
The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 ...The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 affected globally,older adults also experience significant psychological impact including depression,anxiety,and cognitive impairment.The implications of vision-related challenges extend far beyond mere sight.Depression and anxiety,exacerbated by social isolation and reduced physical activity,underscore the need for comprehensive interventions that address both medical and psychosocial dimensions.By recognizing the profound impact of ocular morbidities like strabismus,myopia,glaucoma,and age-related macular degeneration on mental health and investing in effective treatments and inclusive practices,society can pave the way for a healthier,more equitable future for affected individuals.There is evidence that myopic children experience a higher prevalence of depressive symptoms compared to their normal peers,and interventions like the correction of strabismus can enhance psychological outcome-demonstrating the value of an integrated management approach.展开更多
Extreme heat events contribute to high mortality[1,2]and overwhelm emergency medical services through increased ambulance calls and overcrowded emergency departments.[3]Because morbidity and mortality are directly rel...Extreme heat events contribute to high mortality[1,2]and overwhelm emergency medical services through increased ambulance calls and overcrowded emergency departments.[3]Because morbidity and mortality are directly related to both the degree and duration of hyperthermia,timely recognition and management of heat exhaustion and heat stroke are critical for preventing death and reducing healthcare burdens.展开更多
Background:The World Health Organization Disability Assessment Schedule 2.0(WHODAS 2.0)is a popular tool for eval-uating functioning and disability in a range of population demographics and medical situations.However,...Background:The World Health Organization Disability Assessment Schedule 2.0(WHODAS 2.0)is a popular tool for eval-uating functioning and disability in a range of population demographics and medical situations.However,very little is known about the WHODAS 2.0's validity and reliability,particularly when dealing with potentially life-threatening maternal condi-tions(PLTCs).The aim of this study was to evaluate the validity of the WHODAS 2.0 Tigrigna version.Methods:This cross-sectional study was conducted in Tigray,northern Ethiopia,from December 15 to 20,2023.Following translation and back translation,women who had experienced PLTCs during a recent pregnancy,childbirth,or postpartum period were administered the 36-item WHODAS 2.0 in Tigrigna version 6 months after the childbirth.In total,121 women with a history of PLTCs participated.Cronbach′sαwas used to evaluate internal consistency in all six WHODAS 2.0 domains,while Spearman′s correlation coefficient was used to evaluate convergent validity.With confirmatory factor analysis,construct validity was also examined.Results:All domain scores of the Tigrigna version of the WHODAS 2.0 indicated excellent internal consistency(α=0.917-0.978 for 36 items andα=0.874-0.940 for 12 items),while the Cronbach′sαcoefficients for the summary score were 0.981 and 0.952 for 36 and 12 items,respectively.The convergent validity between the 36-item and 12-item WHODAS 2.0 showed a strong correlation between similar constructs(r=0.909-0.981).Conclusion:Despite the small sample limitation,the WHODAS 2.0 tool adapted to the Tigrigna version indicated an acceptable reliability and validity and therefore could be applied to women with a history of PLTCs at 6 months postpartum.展开更多
BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma(HCCA)is common;however,whether it has an impact on oncological prognosis is unknown.AIM To evaluate the influence of postoperati...BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma(HCCA)is common;however,whether it has an impact on oncological prognosis is unknown.AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled.The independent risk factors for morbidity in the 30 d after surgery were investigated,and links between postoperative morbidity and patient characteristics and outcomes were assessed.Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification,and major morbidities were defined as Clavien-Dindo≥3.Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival(RFS)and overall survival(OS).RESULTS Postoperative morbidity occurred in 146 out of 239 patients(61.1%).Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus,and obesity were independent risk factors. Postoperative morbidity was associated with decreasedOS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003;RFS: 16.0 mo vs 26.0 mo, respectively,P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity wasindependently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval(CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, majormorbidity was independently associated with decreased OS (HR: 2.175;95%CI: 1.470-3.216, P <0.001) and RFS (HR: 2.054;95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA.CONCLUSIONPostoperative morbidity (especially major morbidity) may be an independent risk factor forunfavorable prognosis in HCCA patients following curative resection.展开更多
Background:Gastric cancer is the 2 nd most common cause of cancer-related deaths,and the morbidity rate after surgery is reported to be as high as 46%.The estimation of possible complications,morbidity,and mortality a...Background:Gastric cancer is the 2 nd most common cause of cancer-related deaths,and the morbidity rate after surgery is reported to be as high as 46%.The estimation of possible complications,morbidity,and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit.This study aimed to determine the prognostic value of the preoperative platelet-tolymphocyte ratio(PLR)and neutrophil-to-lymphocyte ratio(NLR)and their relations with clinical outcomes and complications after gastrectomy for gastric cancer.Methods:This single-center,retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara,Turkey.A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications.The area under the curve was computed to compare the predictive power of the NLR and PLR.Then,the cutoff points were selected as the stratifying values for the PLR and NLR.Results:The area under the curve values of the PLR(0.60,95%CI 0.542–0.657)and NLR(0.556,95%CI 0.497–0.614)were larger than those of the other preoperative laboratory values.For the PLR,the diagnostic sensitivity and specificity were 50.00%and 72.22%,respectively,whereas for the NLR,the diagnostic sensitivity and specificity were 37.50%and 80.16%,respectively.The PLR was related to morbidity,whereas the relation of the NLR with mortality was more prominent.This study demonstrated that the PLR and NLR may predict mortality and morbidity via the ClavienDindo classification in gastric cancer patients.The variable was grade≥3 in the Clavien-Dindo classification,including complications requiring surgical or endoscopic interventions,life-threatening complications,and death.Both the PLR and NLR differed significantly according to Clavien-Dindo grade≥3.In this analysis,the PLR was related to morbidity,while the NLR relation with mortality was more intense.Conclusion:Based on the results of the study,the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.展开更多
Nosocomial infection （NI） is one of the most significant complications arising after open heart surgery, and leads to increased mortality, hospitalization time and health resource allocation. This study investigated...Nosocomial infection （NI） is one of the most significant complications arising after open heart surgery, and leads to increased mortality, hospitalization time and health resource allocation. This study investigated the morbidity, mortality, and independent risk factors associated with NI following open heart surgery. We retrospectively surveyed the records of 1606 consecutive cardiovascular surgical patients to identify those that developed NI. The NI selection criteria were based on the Centers for Disease Control and Prevention （CDC） guidelines. The term NI encompasses surgical site infection （SSI）, central venous catheter-related infection （CVCRI）, urinary tract infection （UTI）, respiratory tract infection and pneumonia （RTIP）, as well as other types of infections. Of 1606 cardiovascular surgery patients, 125 developed NI （7.8%, 125/1606）. The rates of NI following surgery for congenital malformation, valve replacement, and coronary artery bypass graft were 2.6% （15/587）, 5.5% （26/473） and 13.6% （32/236）, respectively. The NI rate following surgical repair of aortic aneurysm or dissection was 16.8% （52/310）. Increased risk of NI was detected for patients with a prior preoperative stay 〉3 days （OR=2.11, 95% CI=1.39-3.20）, diabetes （OR=2.00, 95%=CI 1.26-3.20）, length of surgery 〉6 h （OR=2.26, 95% CI=1.47-3.47）, or postoperative cerebrovascular accident （OR=4.08, 95% CI=1.79-9.29）. Greater attention should be paid toward compliance with ventilator and catheter regulations in order to decrease NI morbidity and mortality following cardiovascular procedures.展开更多
AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality ...AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.展开更多
Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complica...Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III morbidity, pancreatic stula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching signi cance were further analyzed in order to calculate a predictive score. Results: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 (P=0.04). Patients with PF presented higher CRP on POD2 (P=0.001), higher lactate on POD1 (P=0.007) and POD2 (P=0.008), and lower lymphocytes on POD1 (P=0.007) and POD2 (P=0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (P =0.048, P =0.038), lower lymphocytes on POD1 (P =0.001) and POD2 (P =0.003), and higher CRP on POD2 (P =0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was de ned according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥ 250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.展开更多
To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score. METHODSWe enr...To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score. METHODSWe enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old (Group A), and 333 patients were aged < 79 years old (Group B). We compared the surgical outcomes and survival of the two groups after IPTW. RESULTSPostoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B (P < 0.05). Overall survival (OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage I disease, OS was significantly lower in Group A (P < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection were independent prognostic values for OS. CONCLUSIONWhen the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.展开更多
AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy wer...AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.展开更多
基金Supported by Vision International Eye Missions-USA,“One Drop for All”,Italy,and Private Donors in the Netherlands.
文摘AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W.Kenya,amongst a seminomadic tribe(Maasai).Students in Grades 1-8 were included.Visual acuity was measured using the Snellen“tumbling E”chart at 6 m.Children with symptoms of refractive error underwent non-cycloplegic refraction.RESULTS:A total of 2036 children(1084 males)between the ages of 4-20y were examined.Conjunctival actinic changes were present in 22%(442/2036).Nine cases were seen with a potential squamous carcinoma.No overt classical ocular signs of vitamin A deficiency were noted,although 181(8.9%)children complained of nyctalopia.Three hundred thirty-six(16.5%)children had a visual acuity worse than 6/12 in either eye,were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error.Refractive data led to an estimate of hyperopia of+1.00 D or more in 3.9%and of myopia of-0.50 D or more in either eye in 3.0%of the study population.CONCLUSION:Solar exposure-and dust-related conjunctival pathology is common.As this may develop into potentially sight-or even life-threatening conditions,it warrants further study,and preventive strategies may be needed.Complaints of nyctalopia were common and could suggest vitamin A deficiency.The prevalence of refractive errors is low in this rural African population.
基金supported by a Grant-inAid for Scientific Research(KAKENHI)from the Japan Society for the Promotion of Science(grant no.22J23183)。
文摘Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respiratory viral infections,remains a substantial public health concern owing to its considerable disease burden,particularly in highrisk groups.Mounting epidemiological evidence has linked influenza to extreme heat and cold weather^([2–4]).
文摘BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecting oncological outcomes and postoperative complications.AIM To investigate the relationship between radiologically assessed pelvic anatomy and surgical outcomes as well as the impact on local recurrence following rectal cancer surgery.METHODS We retrospectively analyzed 107 patients with rectal adenocarcinoma treated with elective rectal surgery between January 1,2017,and September 1,2022.Pelvimetric measurements were performed using computed tomography(CT)-based two-dimensional methods(n=77)by assessing the pelvic inlet area in mm^(2),and magnetic resonance imaging(MRI)-based three-dimensional techniques(n=52)using the pelvic cavity index(PCI).Patient demographic,clinical,radiological,surgical,and pathological characteristics were collected and analyzed in relation to their pelvimetric data.RESULTS When patients were categorized based on CT measurements into narrow and normal/wide pelvis groups,a significant association was observed with male sex,and a lower BMI was more common in the narrow pelvis group(P=0.002 for both).A significant association was found between a narrow pelvic structure,indicated by low PCI,and increased surgical morbidity(P=0.049).Advanced age(P=0.003)and male sex(P=0.020)were significantly correlated with higher surgical morbidity.Logistic regression analysis identified four parameters that were significantly correlated with local recurrence:older age,early perioperative readmission,longer operation time,and a lower number of dissected lymph nodes(P<0.05).However,there were no significant differences between the narrow and normal/wide pelvis groups in terms of the operation time,estimated blood loss,or overall local recurrence rate(P>0.05).CONCLUSION MRI-based pelvimetry may be valuable in predicting surgical difficulty and morbidity in rectal cancer surgery,as indicated by the PCI.The observed correlation between low PCI and increased surgical morbidity suggests the potential importance of a preoperative MRI-based pelvimetric evaluation.In contrast,CT-based pelvimetry did not show significant differences in predicting surgical outcomes or cancer recurrence,indicating that the utility of pelvimetry alone may be limited in these respects.
文摘目的系统综述降水量、极端降水事件对人群呼吸系统疾病的影响研究。方法以降水、暴雨、呼吸系统疾病等关键词,本研究系统检索了PubMed、Web of Science和中国知网等数据库,收集降水对呼吸系统疾病影响的已发表文献,检索时段为2015年1月—2025年3月,语种限定为中文和英文。结果经筛选共纳入15篇文献,均为原始研究性文章,其中9篇研究探讨降水量与呼吸系统疾病风险的关联,6篇研究极端降水事件与呼吸系统疾病风险的关联;综述结果表明,已有研究多采用时间序列等生态学研究设计,伴随降水量的增加,呼吸系统疾病的发病和死亡风险均可能增加。短期暴露于极端降水事件与哮喘急性发作、呼吸系统症状加重(如喘息、呼吸困难)以及急诊就诊或住院风险增加潜在相关。长期暴露于极端降水事件(如季节性高降水量,尤其是冬季降水)可能增加慢性呼吸系统疾病的恶化风险,并与呼吸系统感染及死亡率上升相关。结论降水暴露与呼吸系统疾病风险增加存在潜在关联,但证据存在不一致,部分研究显示降水与哮喘呈负相关,未来研究应基于多中心数据进一步明确不同类型降水暴露与呼吸系统疾病及其亚型疾病风险的关联,识别敏感疾病,为公共卫生干预提供科学依据。
文摘Stem cells are pluripotent cells that can divide and differentiate,forming many different types of cells.Stem cells can be obtained from various sources,with embryonic stem cells being the most advantageous as they possess a broad dividing potential.When the standard treatment proves ineffective,stem cells are typically utilized as a final option.Infections and childhood malignancies are among the significant causes of mortality in the pediatric population.Stem cell therapy has shown a decrease in morbidity and mortality when used in patients with favorable conditions like young age and lack of comorbidities.This review discusses how stem cells are prepared and used in treating pediatric diseases like X-linked agammaglobulinemia,diabetes mellitus,aplastic anemia,infections,and leukemia.Technological advancement has played a significant role in producing more specific stem cells using genetic modification methods like clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9,which produce stem cells that target a particular cell type,e.g.,myocytes and hematopoietic cells,further increasing the effectiveness of the therapy.We address the obstacles faced when conducting research related to stem cells,including ethical and legal issues,which hinder the use of this therapy in some fields.We also indicate recommendations for increasing the efficacy of stem cell therapy in the pediatric population.
文摘The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 affected globally,older adults also experience significant psychological impact including depression,anxiety,and cognitive impairment.The implications of vision-related challenges extend far beyond mere sight.Depression and anxiety,exacerbated by social isolation and reduced physical activity,underscore the need for comprehensive interventions that address both medical and psychosocial dimensions.By recognizing the profound impact of ocular morbidities like strabismus,myopia,glaucoma,and age-related macular degeneration on mental health and investing in effective treatments and inclusive practices,society can pave the way for a healthier,more equitable future for affected individuals.There is evidence that myopic children experience a higher prevalence of depressive symptoms compared to their normal peers,and interventions like the correction of strabismus can enhance psychological outcome-demonstrating the value of an integrated management approach.
文摘Extreme heat events contribute to high mortality[1,2]and overwhelm emergency medical services through increased ambulance calls and overcrowded emergency departments.[3]Because morbidity and mortality are directly related to both the degree and duration of hyperthermia,timely recognition and management of heat exhaustion and heat stroke are critical for preventing death and reducing healthcare burdens.
文摘Background:The World Health Organization Disability Assessment Schedule 2.0(WHODAS 2.0)is a popular tool for eval-uating functioning and disability in a range of population demographics and medical situations.However,very little is known about the WHODAS 2.0's validity and reliability,particularly when dealing with potentially life-threatening maternal condi-tions(PLTCs).The aim of this study was to evaluate the validity of the WHODAS 2.0 Tigrigna version.Methods:This cross-sectional study was conducted in Tigray,northern Ethiopia,from December 15 to 20,2023.Following translation and back translation,women who had experienced PLTCs during a recent pregnancy,childbirth,or postpartum period were administered the 36-item WHODAS 2.0 in Tigrigna version 6 months after the childbirth.In total,121 women with a history of PLTCs participated.Cronbach′sαwas used to evaluate internal consistency in all six WHODAS 2.0 domains,while Spearman′s correlation coefficient was used to evaluate convergent validity.With confirmatory factor analysis,construct validity was also examined.Results:All domain scores of the Tigrigna version of the WHODAS 2.0 indicated excellent internal consistency(α=0.917-0.978 for 36 items andα=0.874-0.940 for 12 items),while the Cronbach′sαcoefficients for the summary score were 0.981 and 0.952 for 36 and 12 items,respectively.The convergent validity between the 36-item and 12-item WHODAS 2.0 showed a strong correlation between similar constructs(r=0.909-0.981).Conclusion:Despite the small sample limitation,the WHODAS 2.0 tool adapted to the Tigrigna version indicated an acceptable reliability and validity and therefore could be applied to women with a history of PLTCs at 6 months postpartum.
基金Supported by National Natural Science Foundation of China, No.81874211Personalized Training of Key Support Objects for The Talent People of The Army Medical University, No.XZ-2019-505-014
文摘BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma(HCCA)is common;however,whether it has an impact on oncological prognosis is unknown.AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled.The independent risk factors for morbidity in the 30 d after surgery were investigated,and links between postoperative morbidity and patient characteristics and outcomes were assessed.Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification,and major morbidities were defined as Clavien-Dindo≥3.Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival(RFS)and overall survival(OS).RESULTS Postoperative morbidity occurred in 146 out of 239 patients(61.1%).Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus,and obesity were independent risk factors. Postoperative morbidity was associated with decreasedOS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003;RFS: 16.0 mo vs 26.0 mo, respectively,P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity wasindependently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval(CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, majormorbidity was independently associated with decreased OS (HR: 2.175;95%CI: 1.470-3.216, P <0.001) and RFS (HR: 2.054;95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA.CONCLUSIONPostoperative morbidity (especially major morbidity) may be an independent risk factor forunfavorable prognosis in HCCA patients following curative resection.
文摘Background:Gastric cancer is the 2 nd most common cause of cancer-related deaths,and the morbidity rate after surgery is reported to be as high as 46%.The estimation of possible complications,morbidity,and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit.This study aimed to determine the prognostic value of the preoperative platelet-tolymphocyte ratio(PLR)and neutrophil-to-lymphocyte ratio(NLR)and their relations with clinical outcomes and complications after gastrectomy for gastric cancer.Methods:This single-center,retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara,Turkey.A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications.The area under the curve was computed to compare the predictive power of the NLR and PLR.Then,the cutoff points were selected as the stratifying values for the PLR and NLR.Results:The area under the curve values of the PLR(0.60,95%CI 0.542–0.657)and NLR(0.556,95%CI 0.497–0.614)were larger than those of the other preoperative laboratory values.For the PLR,the diagnostic sensitivity and specificity were 50.00%and 72.22%,respectively,whereas for the NLR,the diagnostic sensitivity and specificity were 37.50%and 80.16%,respectively.The PLR was related to morbidity,whereas the relation of the NLR with mortality was more prominent.This study demonstrated that the PLR and NLR may predict mortality and morbidity via the ClavienDindo classification in gastric cancer patients.The variable was grade≥3 in the Clavien-Dindo classification,including complications requiring surgical or endoscopic interventions,life-threatening complications,and death.Both the PLR and NLR differed significantly according to Clavien-Dindo grade≥3.In this analysis,the PLR was related to morbidity,while the NLR relation with mortality was more intense.Conclusion:Based on the results of the study,the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.
文摘Nosocomial infection （NI） is one of the most significant complications arising after open heart surgery, and leads to increased mortality, hospitalization time and health resource allocation. This study investigated the morbidity, mortality, and independent risk factors associated with NI following open heart surgery. We retrospectively surveyed the records of 1606 consecutive cardiovascular surgical patients to identify those that developed NI. The NI selection criteria were based on the Centers for Disease Control and Prevention （CDC） guidelines. The term NI encompasses surgical site infection （SSI）, central venous catheter-related infection （CVCRI）, urinary tract infection （UTI）, respiratory tract infection and pneumonia （RTIP）, as well as other types of infections. Of 1606 cardiovascular surgery patients, 125 developed NI （7.8%, 125/1606）. The rates of NI following surgery for congenital malformation, valve replacement, and coronary artery bypass graft were 2.6% （15/587）, 5.5% （26/473） and 13.6% （32/236）, respectively. The NI rate following surgical repair of aortic aneurysm or dissection was 16.8% （52/310）. Increased risk of NI was detected for patients with a prior preoperative stay 〉3 days （OR=2.11, 95% CI=1.39-3.20）, diabetes （OR=2.00, 95%=CI 1.26-3.20）, length of surgery 〉6 h （OR=2.26, 95% CI=1.47-3.47）, or postoperative cerebrovascular accident （OR=4.08, 95% CI=1.79-9.29）. Greater attention should be paid toward compliance with ventilator and catheter regulations in order to decrease NI morbidity and mortality following cardiovascular procedures.
文摘AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.
文摘Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III morbidity, pancreatic stula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching signi cance were further analyzed in order to calculate a predictive score. Results: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 (P=0.04). Patients with PF presented higher CRP on POD2 (P=0.001), higher lactate on POD1 (P=0.007) and POD2 (P=0.008), and lower lymphocytes on POD1 (P=0.007) and POD2 (P=0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (P =0.048, P =0.038), lower lymphocytes on POD1 (P =0.001) and POD2 (P =0.003), and higher CRP on POD2 (P =0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was de ned according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥ 250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.
文摘To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score. METHODSWe enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old (Group A), and 333 patients were aged < 79 years old (Group B). We compared the surgical outcomes and survival of the two groups after IPTW. RESULTSPostoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B (P < 0.05). Overall survival (OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage I disease, OS was significantly lower in Group A (P < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection were independent prognostic values for OS. CONCLUSIONWhen the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.
文摘AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.
