Determining the predictors of screen media use will assist nurses and clinicians to identify the children that are in most need for intervention. There is limited literature regarding the predictors of screen media us...Determining the predictors of screen media use will assist nurses and clinicians to identify the children that are in most need for intervention. There is limited literature regarding the predictors of screen media use among children. This study aimed to examine the association between selected predictors and screen media use among children aged 3 - 13. The findings of this study are based on 192 children aged 3 - 13 and their caregivers recruited from Facebook and WhatsApp groups. A descriptive cross-sectional design was employed. The participants filled a demographic questionnaire and the Problematic Media Use Measure Short Form to obtain data about parents’ and children characteristics, screen time and problematic use of media. The screen time for 83% of the children was more than two hours. Mobile ownership (beta (β) = 0.22) and conflict about mobile use (beta (β) = 0.16) have significantly predicted the child total screen time. Child age (beta (β) = 0.17) and conflict about mobile use (beta (β) = −0.33) have significantly predicted the problematic use of media. Most children in the current study exceeded the recommended screen time. There is an urgent need to implement interventions that mitigate children’s excessive use of media.展开更多
Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan ...Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan Hospital of Wuhan University (January 2022 to January 2024) analysed thyroid tumor characteristics using B-mode ultrasound, colour Doppler imaging, and CEUS post-RFA. Thyroid hormone levels were also assessed before RFA and at 1, 3, and 6 months after the procedure. Results: The study involved 72 patients with benign thyroid nodules, comprising 13 males and 59 females, with a mean age of 45.8 ± 12.1 years. Complete inactivation was achieved in 70.8% of nodules, while 29.2% showed partial inactivation. Nodules with complete inactivation exhibited more calcification (p = 0.040), whereas those with partial inactivation demonstrated higher vascularity (p Conclusion: In conclusion, this study found that therapeutic RFA effectively achieves high rates of complete inactivation in benign thyroid nodules, with the degree of inactivation mainly influenced by nodule vascularity and calcifications.展开更多
Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predi...Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predict recurrence after the first febrile seizure,and identify modifiable risk factors to mitigate recurrence risks.Methods:This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures,seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital.Data were collected via parent interviews,physical exams,and laboratory tests.The questionnaire covered demographics,antenatal,natal,and postnatal events,seizure history,family history,immunization,daycare attendance,and fever management.Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge.Laboratory tests assessed anemia,dyselectrolytemia,and hypoglycemia.Data were analyzed in SPSS Version 25 using descriptive statistics,t-tests,Chi-square tests,and odds ratios with 95%confidence intervals(CI),with significance set at P<0.05.Results:451 children were included in this study.Low birth weight(OR=2.60,95%CI=1.12-6.33,P=0.026),age at first episode>12 months(OR=0.28,95%CI=0.16-0.48,P0.001),family history of febrile seizure(OR=5.21,95%CI=2.92-9.28,P<0.001),no intermittent prophylaxis(OR=15.25,95%CI=7.05-32.90,P<0.001),treatment for fever(OR=0.26,95%CI=0.13-0.51)and low socioeconomic status(OR=5.87,95%CI=3.32-10.38)were significantly associated with recurrent febrile seizures.Conclusions:Low birth weight,age at first episode≤12 months,family history of febrile seizure,no intermittent prophylaxis,inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.展开更多
Objective The geriatric nutritional risk index(GNRI)is widely used for nutritional assessment.Poor nutritional status is associated with complications and poor survival in cirrhotic patients.We aimed to investigate th...Objective The geriatric nutritional risk index(GNRI)is widely used for nutritional assessment.Poor nutritional status is associated with complications and poor survival in cirrhotic patients.We aimed to investigate the value of the GNRI in predicting outcomes in cirrhotic patients.Methods This retrospective study included 420 cirrhotic patients from three centers between 2013 and 2017.Patients were divided into the high GNRI group(≥92)and low GNRI group(<92).Overall survival(OS)in the two groups was evaluated via the Kaplan‒Meier method.Cox proportional hazards model was used to estimate the value of the GNRI in predicting outcomes.Restricted cubic spline model was used to intuitively display the dose‒response associations between the GNRI and OS.A nomogram was constructed to predict OS.Results During the 2-year follow-up period,58(13.81%)patients died,and 262(62.38%)patients experienced episodes of complications.Compared with patients in the low GNRI group,those in the high GNRI group had lower mortality rates(18.73%vs.5.23%,P<0.001).The GNRI was an independent predictor of OS(hazard ratio[HR]=0.958,95%confidence interval[CI]0.929–0.988,P=0.007).The GNRI was associated with the cumulative incidence of ascites(HR=0.954,95%CI 0.940–0.969,P<0.001),spontaneous bacterial peritonitis(HR=0.928,95%CI 0.891–0.966,P<0.001),hepatic encephalopathy(HE;HR=0.944,95%CI 0.920–0.968,P<0.001),and hepatorenal syndrome(HRS)(HR=0.916,95%CI 0.861–0.974,P=0.005).Furthermore,6 independent factors were included to construct the nomogram for OS prediction,including GNRI,age,total bilirubin,serum sodium,history of HE and HRS.The C statistics of our model were 0.83(95%CI 0.75–0.90)and 0.80(95%CI 0.73–0.86)at 1 and 2 years,respectively.Patients whose GNRI score decreased within 3 and 6 months had poorer outcomes(P<0.001).Conclusions The lower GNRI score was associated with the higher cumulative incidence of complications and poorer OS of cirrhotic patients.The GNRI could be a helpful tool for assessing nutritional status and prognosis of these patients.展开更多
A brain-computer interface(BCI)based on motor imagery(MI)provides additional control pathways by decoding the intentions of the brain.MI ability has great intra-individual variability,and the majority of MI-BCI system...A brain-computer interface(BCI)based on motor imagery(MI)provides additional control pathways by decoding the intentions of the brain.MI ability has great intra-individual variability,and the majority of MI-BCI systems are unable to adapt to this variability,leading to poor training effects.Therefore,prediction of MI ability is needed.In this study,we propose an MI ability predictor based on multi-frequency EEG features.To validate the performance of the predictor,a video-guided paradigm and a traditional MI paradigm are designed,and the predictor is applied to both paradigms.The results demonstrate that all subjects achieved>85%prediction precision in both applications,with a maximum of 96%.This study indicates that the predictor can accurately predict the individuals’MI ability in different states,provide the scientific basis for personalized training,and enhance the effect of MI-BCI training.展开更多
BACKGROUND Dissection of the right paraesophageal lymph node(RPELN)in managing papillary thyroid carcinoma remains a contentious issue.This meta-analysis assesses previously established and novel risk factors associat...BACKGROUND Dissection of the right paraesophageal lymph node(RPELN)in managing papillary thyroid carcinoma remains a contentious issue.This meta-analysis assesses previously established and novel risk factors associated with RPELN metastasis.AIM To evaluate previously established and novel risk factors associated with RPELN metastasis in patients with papillary thyroid carcinoma papillary thyroid carcinoma through a comprehensive meta-analysis.METHODS We searched MEDLINE(via PubMed),ScienceDirect,Scopus and EMBASE up to December 2024.Studies were assessed using the Newcastle-Ottawa Scale.Statistical analysis was conducted with RevMan version 5.4,using the Q-test and I2-test for heterogeneity.Sensitivity was evaluated with the leave-one-out method,and publication bias with the Egger regression test and funnel plot.RESULTS Of 2444 articles retrieved,26 were included in our meta-analysis with 16427 patients.The RPELN metastasis rate was 12.98%[95%confidence interval(CI):12.46%-13.50%].The pooled results suggested that age<55 years[odds ratio(OR)=1.71,95%CI:1.35-2.16,P<0.00001],sex(OR=0.60,95%CI:0.54-0.67,P<0.00001),tumor size 1 cm(OR=3.37,95%CI:2.69-4.21,P<0.00001),multifocality(OR=1.81,95%CI:1.49-2.20,P<0.00001),capsular invasion(OR=2.94,95%CI:2.05-4.20,P<0.00001),vascular invasion(OR=2.16,95%CI:1.56-2.99,P<0.00001),extra-thyroid extension(OR=3.30,95%CI:1.82-5.98,P<0.0001),central lymph node metastasis(OR=7.77,95%CI:4.73-12.76,P<0.00001),lateral lymph node metastasis(OR=6.94,95%CI:6.11-7.89,P<0.00001),Hashimoto thyroiditis(OR=0.79,95%CI:0.69-0.92,P=0.002),micro-calcifications(OR=2.29,95%CI:1.20-4.37,P=0.01),and echogenicity(OR=0.62,95%CI:0.40-0.98,P=0.04)should be considered with RPELN metastasis.CONCLUSION The male<55,tumor size>1 cm,multifocality,capsular and vascular invasion,extrathyroidal extension,lymph node metastasis,and Hashimoto thyroiditis were significantly associated with RPELN metastasis and should be carefully assessed during dissection.展开更多
BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has ass...BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has assessed the relationship between TN and adenomatous colonic polyps.AIM To assess the association between adenomatous colonic polyps,thyroid-stimulating hormone,and TN.METHODS We searched PubMed,MEDLINE,Cochrane Library,EBSCO,and the first 100 articles in Google for articles published in English from inception until April 2025.We included prospective cohorts,retrospective studies,case-control studies,and cross-sectional studies.The keywords thyroid nodules,adenomatous colon polyps,thyroid volume,metabolic syndrome,insulin resistance,and thyroid malignancy were used.RESULTS Out of 237 articles,25 full texts were reviewed,and 5 full texts were included in the final meta-analysis.No relationship was found between TN,colonic polyps,and thyroid-stimulating hormone levels[odd ratio(OR):1.78,95%confidence interval(CI):0.55-5.74,P=0.33].Colonic polyps were more common among patients with TN when addressing heterogeneity(OR:0.42,95%CI:0.30-0.52,P<0.001 and OR:0.08,95%CI:0.70-0.86,P=0.85).CONCLUSION TN were similar among patients with and without adenomatous colonic polyps.However,TN was more common among colon polyps when addressing the heterogeneity.Thyroid-stimulating hormone was not different between those with and without TN.Age,sex,adiposity,and smoking effects might explain the higher rate observed by the included studies.Further studies controlling for the same are needed.展开更多
Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of ve...Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF.Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very elderly,680 patients)and those under 85 years.Results Compared to patients<85 years,very elderly patients were more frequently women,had more hypertension and disease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardial infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41%vs.25%,P<0.001).The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estimated survival of less than 6 months assessed by the physician in charge of the patient care.Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.展开更多
AIM:To identify optical coherence tomography(OCT)features present at the diagnosis of neovascular age-related macular degeneration(nAMD)that could predict retinal atrophy(RA)and visual performance in patients treated ...AIM:To identify optical coherence tomography(OCT)features present at the diagnosis of neovascular age-related macular degeneration(nAMD)that could predict retinal atrophy(RA)and visual performance in patients treated with intravitreal aflibercept.METHODS:OCT data collected at the time of nAMD diagnosis(T0),after the first(T1)and third(T2)intravitreal aflibercept injection,and 5y post-diagnosis(T3)were analyzed.The study included 46 eyes from patients undergoing treatment.The association of OCT features with RA and visual acuity(VA)development over time were evaluated.RESULTS:Patients with RA at T3 exhibited worse VA(35.19±5.7 vs 8.90±2.3,P<0.001)and a lower rate of improvement or stability at T2(90.48%vs 56.00%,P=0.019)and T3(85.71%vs 8.00%,P<0.001).The development of RA at T3 was linked with type 2 macular neovascularization(MNV;4.76%vs 36.00%,P=0.013),thinner outer nuclear layer(ONL,88.89±7.82μm vs 71.38±14.14μm,P=0.033),presence of intraretinal fluid(IRF,42.86%vs 80.00%,P=0.014),presence of IRF without subretinal fluid at T0(SRF,4.76%vs 32.00%,P=0.027),and reduced central foveal thickness at T3(CFT,190.14±22.79μm vs 124.32±14.35μm,P<0.001).The presence of SRF with or without IRF at the diagnosis was comparable between the two groups(90.48%vs 68.00%;P=0.084).CONCLUSION:Type 2 MNV,reduces ONL and CFT,and IRF presence at baseline may signal a higher risk of RA in treatment-naive nAMD patients,underscoring the importance of these OCT features in early risk assessment and management strategies.展开更多
This editorial delves into the potential of systemic immune indicators(SIIs)as early predictors of renal damage in children with newly diagnosed type 1 diabetes mellitus.By exploring the recent study published by Cao ...This editorial delves into the potential of systemic immune indicators(SIIs)as early predictors of renal damage in children with newly diagnosed type 1 diabetes mellitus.By exploring the recent study published by Cao et al,this article aims to highlight the importance of early detection and intervention.This study compre-hensively analyzes various SIIs,examining their correlation with renal compli-cations in newly diagnosed type 1 diabetic children.The findings reveal a sig-nificant association between immune system dysregulation and the onset of renal damage,suggesting that certain immune indicators can be early markers for predicting renal complications.This editorial emphasizes the clinical implications and applications of utilizing SIIs for early detection in pediatric diabetes care.It underscores the importance of innovative diagnostic approaches and illustrates real-world applications and outcomes.Additionally,it addresses the challenges and considerations in adopting these indicators and outlines future research directions to enhance diabetes management in children.展开更多
Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,m...Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.展开更多
Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of&q...Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of"the Bogor Cohort Study on Non-Communicable Disease Risk Factors".Data were collected by interview method with structured questionnaires,physical measurements three times a year,and laboratory examination every two years during a 10-year follow-up(2011-2021,without examination in 2020).The incidence of stroke is based on anamnesis results and examination by a neurologist.Other stroke predictor variables include characteristics,biological conditions,and risk behavior.We analysed 4445 stroke-free samples with Cox proportional hazard regression test.Results:During the 10-year observation,stroke incidence was 440 person-years per 100000 population(95%CI 370-530).During the follow-up of ten years,the main predictor of stroke was mental-emotional disorders with HR 4.2(95%CI 2.8-6.3)after adjustment by age,hypertension,obesity,abdominal obesity,and high LDL-cholesterol levels.Conclusions:Mental-emotional disorders are the strongest predictor of stroke incidence.Hence,psychological factors must be controlled in a stroke prevention program.展开更多
BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amin...BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amino acids(AAAs:Tyrosine,tryptophan,phenylalanine)show high sensitivity and specificity in predicting diabetes in animals and predict T2DM 10-19 years before T2DM onset in clinical studies.However,improvement is needed to support its clinical utility.AIM To evaluate the effects of body mass index(BMI)and sex on BCAAs/AAAs in new-onset T2DM individuals with varying body weight.METHODS Ninety-seven new-onset T2DM patients(<12 mo)differing in BMI[normal weight(NW),n=33,BMI=22.23±1.60;overweight,n=42,BMI=25.9±1.07;obesity(OB),n=22,BMI=31.23±2.31]from the First People’s Hospital of Yunnan Province,Kunming,China,were studied.One-way and 2-way ANOVAs were conducted to determine the effects of BMI and sex on BCAAs/AAAs.RESULTS Fasting serum AAAs,BCAAs,glutamate,and alanine were greater and high-density lipoprotein(HDL)was lower(P<0.05,each)in OB-T2DM patients than in NW-T2DM patients,especially in male OB-T2DM patients.Arginine,histidine,leucine,methionine,and lysine were greater in male patients than in female patients.Moreover,histidine,alanine,glutamate,lysine,valine,methionine,leucine,isoleucine,tyrosine,phenylalanine,and tryptophan were significantly correlated with abdominal adiposity,body weight and BMI,whereas isoleucine,leucine and phenylalanine were negatively correlated with HDL.CONCLUSION Heterogeneously elevated amino acids,especially BCAAs/AAAs,across new-onset T2DM patients in differing BMI categories revealed a potentially skewed prediction of T2DM development.The higher BCAA/AAA levels in obese T2DM patients would support T2DM prediction in obese individuals,whereas the lower levels of BCAAs/AAAs in NW-T2DM individuals may underestimate T2DM risk in NW individuals.This potentially skewed T2DM prediction should be considered when BCAAs/AAAs are to be used as the T2DM predictor.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophage...BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophageal strictures,particularly local injection of triamcinolone acetonide(TA),is a relatively effective method to prevent esophageal strictures.However,even with steroid prophylaxis,stenosis still occurs in up to 45%of patients.Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.AIM To identify the predictors of esophageal strictures after steroids application.METHODS Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion-and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study.The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.RESULTS A total of 120 patients were included in the analysis.In the oral prednisone and oral prednisone combined with local tretinoin injection groups,the stenosis rates were 44/53(83.0%)and 56/67(83.6%),respectively.Among them,univariate analysis showed that the lesion circumference(P=0.01)and submucosal injection solution(P=0.04)showed significant correlation with the risk of stenosis formation.Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports,such as additional chemoradiotherapy and tumor location.We identified a lesion circumference<5/6(OR=0.19;P=0.02)and submucosal injection of sodium hyaluronate(OR=0.15;P=0.03)as independent predictors of on esophageal stricture formation.CONCLUSION Steroid prophylaxis effectively prevents stenosis.Moreover,the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures.Additional interventions should be considered in high-risk patients.展开更多
BACKGROUND Infective endocarditis(IE)is a life-threatening infection with an annual mortality of 40%.Embolic events reported in up to 80%of patients.Vegetations of>10 mm size are associated with increased embolic e...BACKGROUND Infective endocarditis(IE)is a life-threatening infection with an annual mortality of 40%.Embolic events reported in up to 80%of patients.Vegetations of>10 mm size are associated with increased embolic events and poor prognosis.There is a paucity of literature on the association of multiple vegetations with outcome.AIM To study the echocardiographic(ECHO)features and outcomes associated with the presence of multiple vegetations.METHODS In this retrospective,single-center,cohort study patients diagnosed with IE were recruited from June 2017 to June 2019.A total of 84 patients were diagnosed to have IE,of whom 67 with vegetation were identified.Baseline demographic,clinical,laboratory,and ECHO parameters were reviewed.Outcomes that were studied included recurrent admission,embolic phenomenon,and mortality.RESULTS Twenty-three(34%)patients were noted to have multiple vegetations,13(56.5%)were male and 10(43.5%)were female.The mean age of these patients was 50.Eight(35%)had a prior episode of IE.ECHO features of moderate to severe valvular regurgitation[odds ratio(OR)=4],presence of pacemaker lead(OR=4.8),impaired left ventricle(LV)relaxation(OR=4),and elevated pulmonary artery systolic pressure(PASP)(OR=2.2)are associated with higher odds of multiple vegetations.Of these moderate to severe valvular regurgitation(P=0.028),pacemaker lead(P=0.039)and impaired relaxation(P=0.028)were statistically significant.These patients were noted to have an increased association of recurrent admissions(OR=3.6),recurrent bacteremia(OR=2.4),embolic phenomenon(OR=2.5),intensive care unit stay(OR=2.8),hypotension(OR=2.1),surgical intervention(OR=2.8)and device removal(OR=4.8).Of this device removal(P=0.039)and recurrent admissions(P=0.017)were statistically significant.CONCLUSION This study highlights the associations of ECHO predictors and outcomes in patients with IE having multiple vegetations.ECHO features of moderate to severe regurgitation,presence of pacemaker lead,impaired LV relaxation,and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.展开更多
BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts p...BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.展开更多
Background: An abnormal vaginal discharge is a common complaint among women of reproductive age, and it can indicate serious conditions like pelvic inflammatory disease and cervical cancer. This study aimed to assess ...Background: An abnormal vaginal discharge is a common complaint among women of reproductive age, and it can indicate serious conditions like pelvic inflammatory disease and cervical cancer. This study aimed to assess the predictors of abnormal vaginal discharge in women of reproductive age group in Imo State, Southeast Nigeria. Methods: A cross-sectional study was conducted among 368 women of reproductive age group attending the clinic at Federal University Teaching Hospital Owerri, in Imo State, Nigeria. Respondents were recruited using a systematic sampling technique. Data were collected using a pre-tested interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of abnormal vaginal discharge. Statistical significance was set at p Results: The mean age of the respondents was 30 ± 4.5 years. Predictors of abnormal vaginal discharge were: age 36 - 45 years (OR: 4.5;95% C.I: 1.023 - 8.967, p = 0.041), being a student (OR: 2.4: 95% C.I: 1.496 - 7.336, p = 0.003), use of oral contraceptives (OR: 3.4;95% C.I: 1.068 - 6.932, p = 0.010), use of water cistern (OR: 4.7;C.I: 1.654 - 5.210, p = 0.028) anal hygiene practices (OR: 2.7;95% C.I: 1.142 - 4.809, p Conclusion: These findings suggest that targeted sexual and reproductive health interventions should be provided to reduce the risk of abnormal vaginal discharge in women of reproductive age group.展开更多
BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after ...BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after splenectomy in patient with cirrhosis.METHODS A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018.The incidence of PVT at 1 months,3 months,and 12 months after splenectomy in patients with cirrhosis was observed.The hematological indicators,biochemical and coagulation parameters,and imaging features were recorded at baseline and at each observation point.The univariable,multivariable,receiver operating characteristic curve and timedependent curve analyses were performed.RESULTS The cumulative incidence of PVT was 40.0%,46.6%,and 48.9%at 1 months,3 months,and 12 months after splenectomy.Multivariable analysis showed that portal vein diameter(PVD)≥14.5 mm and monthsdel end-stage liver disease(MELD)score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy(P<0.05).Time-dependent curve showed that the cumulative incidence of PVT was significantly different between patients with MELD score≤10 and>10(P<0.05).In addition,the cumulative incidence of PVT in the PVD≥14.5 mm group was significantly higher than that in the PVD<14.5 mm group(P<0.05).CONCLUSION Wider PVD and MELD score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy in patient with cirrhosis.展开更多
This article documents socio-demographic predictors of anxiety and depression among Maasai women in resource poor settings in Northern Kenya.These findings emerged from the findings of a dissertation research that aim...This article documents socio-demographic predictors of anxiety and depression among Maasai women in resource poor settings in Northern Kenya.These findings emerged from the findings of a dissertation research that aimed to establish the treatment effectiveness of an eclectic model of psychoeducation(PE)in treating depressive and anxiety symptoms among the women.The study adopted a quasi-experimental research design which had an experimental group(EG)and control group(CG).The population for the study was 686 female members of Conservation Enterprise Groups(CEG)in Laikipia County,from which a sample of 200 were recruited for the study(EG,n=100 and CG,n=100),at 80%power and 30%effective size.The Beck’s Depression Inventory(BDI)and Beck’s Anxiety Inventory(BAI)tools were used to assess the symptoms of depression and anxiety,respectively.The PE was provided as an intervention treatment to the EG at the middle and end of the study,after which the respondents were tested for symptoms of depression.The study established the prevalence of depression as 26.7%and 31.3%for anxiety and disorders,among women in the region.Data was analyzed using SPSS Version 21.0.展开更多
Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Sahara...Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.展开更多
文摘Determining the predictors of screen media use will assist nurses and clinicians to identify the children that are in most need for intervention. There is limited literature regarding the predictors of screen media use among children. This study aimed to examine the association between selected predictors and screen media use among children aged 3 - 13. The findings of this study are based on 192 children aged 3 - 13 and their caregivers recruited from Facebook and WhatsApp groups. A descriptive cross-sectional design was employed. The participants filled a demographic questionnaire and the Problematic Media Use Measure Short Form to obtain data about parents’ and children characteristics, screen time and problematic use of media. The screen time for 83% of the children was more than two hours. Mobile ownership (beta (β) = 0.22) and conflict about mobile use (beta (β) = 0.16) have significantly predicted the child total screen time. Child age (beta (β) = 0.17) and conflict about mobile use (beta (β) = −0.33) have significantly predicted the problematic use of media. Most children in the current study exceeded the recommended screen time. There is an urgent need to implement interventions that mitigate children’s excessive use of media.
文摘Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan Hospital of Wuhan University (January 2022 to January 2024) analysed thyroid tumor characteristics using B-mode ultrasound, colour Doppler imaging, and CEUS post-RFA. Thyroid hormone levels were also assessed before RFA and at 1, 3, and 6 months after the procedure. Results: The study involved 72 patients with benign thyroid nodules, comprising 13 males and 59 females, with a mean age of 45.8 ± 12.1 years. Complete inactivation was achieved in 70.8% of nodules, while 29.2% showed partial inactivation. Nodules with complete inactivation exhibited more calcification (p = 0.040), whereas those with partial inactivation demonstrated higher vascularity (p Conclusion: In conclusion, this study found that therapeutic RFA effectively achieves high rates of complete inactivation in benign thyroid nodules, with the degree of inactivation mainly influenced by nodule vascularity and calcifications.
文摘Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predict recurrence after the first febrile seizure,and identify modifiable risk factors to mitigate recurrence risks.Methods:This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures,seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital.Data were collected via parent interviews,physical exams,and laboratory tests.The questionnaire covered demographics,antenatal,natal,and postnatal events,seizure history,family history,immunization,daycare attendance,and fever management.Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge.Laboratory tests assessed anemia,dyselectrolytemia,and hypoglycemia.Data were analyzed in SPSS Version 25 using descriptive statistics,t-tests,Chi-square tests,and odds ratios with 95%confidence intervals(CI),with significance set at P<0.05.Results:451 children were included in this study.Low birth weight(OR=2.60,95%CI=1.12-6.33,P=0.026),age at first episode>12 months(OR=0.28,95%CI=0.16-0.48,P0.001),family history of febrile seizure(OR=5.21,95%CI=2.92-9.28,P<0.001),no intermittent prophylaxis(OR=15.25,95%CI=7.05-32.90,P<0.001),treatment for fever(OR=0.26,95%CI=0.13-0.51)and low socioeconomic status(OR=5.87,95%CI=3.32-10.38)were significantly associated with recurrent febrile seizures.Conclusions:Low birth weight,age at first episode≤12 months,family history of febrile seizure,no intermittent prophylaxis,inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.
基金supported by grants from the Joint Tackling Project of Pudong Health Committee of Shanghai(PW2022D08)Medical Discipline Construction Project of Pudong Health Committee of Shanghai(PWZxq2022-6)+1 种基金Health and Family Planning Research Project of Pudong Health Committee of Shanghai(PW2021A-38)Youth Scientific Research Cultivation Fund Project of Shanghai Oriental Hospital(DFPY2022020).
文摘Objective The geriatric nutritional risk index(GNRI)is widely used for nutritional assessment.Poor nutritional status is associated with complications and poor survival in cirrhotic patients.We aimed to investigate the value of the GNRI in predicting outcomes in cirrhotic patients.Methods This retrospective study included 420 cirrhotic patients from three centers between 2013 and 2017.Patients were divided into the high GNRI group(≥92)and low GNRI group(<92).Overall survival(OS)in the two groups was evaluated via the Kaplan‒Meier method.Cox proportional hazards model was used to estimate the value of the GNRI in predicting outcomes.Restricted cubic spline model was used to intuitively display the dose‒response associations between the GNRI and OS.A nomogram was constructed to predict OS.Results During the 2-year follow-up period,58(13.81%)patients died,and 262(62.38%)patients experienced episodes of complications.Compared with patients in the low GNRI group,those in the high GNRI group had lower mortality rates(18.73%vs.5.23%,P<0.001).The GNRI was an independent predictor of OS(hazard ratio[HR]=0.958,95%confidence interval[CI]0.929–0.988,P=0.007).The GNRI was associated with the cumulative incidence of ascites(HR=0.954,95%CI 0.940–0.969,P<0.001),spontaneous bacterial peritonitis(HR=0.928,95%CI 0.891–0.966,P<0.001),hepatic encephalopathy(HE;HR=0.944,95%CI 0.920–0.968,P<0.001),and hepatorenal syndrome(HRS)(HR=0.916,95%CI 0.861–0.974,P=0.005).Furthermore,6 independent factors were included to construct the nomogram for OS prediction,including GNRI,age,total bilirubin,serum sodium,history of HE and HRS.The C statistics of our model were 0.83(95%CI 0.75–0.90)and 0.80(95%CI 0.73–0.86)at 1 and 2 years,respectively.Patients whose GNRI score decreased within 3 and 6 months had poorer outcomes(P<0.001).Conclusions The lower GNRI score was associated with the higher cumulative incidence of complications and poorer OS of cirrhotic patients.The GNRI could be a helpful tool for assessing nutritional status and prognosis of these patients.
基金supported by the Natural Science Foundation of Hebei Province(F2024202019)the National Natural Science Foundation of China(32201072).
文摘A brain-computer interface(BCI)based on motor imagery(MI)provides additional control pathways by decoding the intentions of the brain.MI ability has great intra-individual variability,and the majority of MI-BCI systems are unable to adapt to this variability,leading to poor training effects.Therefore,prediction of MI ability is needed.In this study,we propose an MI ability predictor based on multi-frequency EEG features.To validate the performance of the predictor,a video-guided paradigm and a traditional MI paradigm are designed,and the predictor is applied to both paradigms.The results demonstrate that all subjects achieved>85%prediction precision in both applications,with a maximum of 96%.This study indicates that the predictor can accurately predict the individuals’MI ability in different states,provide the scientific basis for personalized training,and enhance the effect of MI-BCI training.
文摘BACKGROUND Dissection of the right paraesophageal lymph node(RPELN)in managing papillary thyroid carcinoma remains a contentious issue.This meta-analysis assesses previously established and novel risk factors associated with RPELN metastasis.AIM To evaluate previously established and novel risk factors associated with RPELN metastasis in patients with papillary thyroid carcinoma papillary thyroid carcinoma through a comprehensive meta-analysis.METHODS We searched MEDLINE(via PubMed),ScienceDirect,Scopus and EMBASE up to December 2024.Studies were assessed using the Newcastle-Ottawa Scale.Statistical analysis was conducted with RevMan version 5.4,using the Q-test and I2-test for heterogeneity.Sensitivity was evaluated with the leave-one-out method,and publication bias with the Egger regression test and funnel plot.RESULTS Of 2444 articles retrieved,26 were included in our meta-analysis with 16427 patients.The RPELN metastasis rate was 12.98%[95%confidence interval(CI):12.46%-13.50%].The pooled results suggested that age<55 years[odds ratio(OR)=1.71,95%CI:1.35-2.16,P<0.00001],sex(OR=0.60,95%CI:0.54-0.67,P<0.00001),tumor size 1 cm(OR=3.37,95%CI:2.69-4.21,P<0.00001),multifocality(OR=1.81,95%CI:1.49-2.20,P<0.00001),capsular invasion(OR=2.94,95%CI:2.05-4.20,P<0.00001),vascular invasion(OR=2.16,95%CI:1.56-2.99,P<0.00001),extra-thyroid extension(OR=3.30,95%CI:1.82-5.98,P<0.0001),central lymph node metastasis(OR=7.77,95%CI:4.73-12.76,P<0.00001),lateral lymph node metastasis(OR=6.94,95%CI:6.11-7.89,P<0.00001),Hashimoto thyroiditis(OR=0.79,95%CI:0.69-0.92,P=0.002),micro-calcifications(OR=2.29,95%CI:1.20-4.37,P=0.01),and echogenicity(OR=0.62,95%CI:0.40-0.98,P=0.04)should be considered with RPELN metastasis.CONCLUSION The male<55,tumor size>1 cm,multifocality,capsular and vascular invasion,extrathyroidal extension,lymph node metastasis,and Hashimoto thyroiditis were significantly associated with RPELN metastasis and should be carefully assessed during dissection.
文摘BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has assessed the relationship between TN and adenomatous colonic polyps.AIM To assess the association between adenomatous colonic polyps,thyroid-stimulating hormone,and TN.METHODS We searched PubMed,MEDLINE,Cochrane Library,EBSCO,and the first 100 articles in Google for articles published in English from inception until April 2025.We included prospective cohorts,retrospective studies,case-control studies,and cross-sectional studies.The keywords thyroid nodules,adenomatous colon polyps,thyroid volume,metabolic syndrome,insulin resistance,and thyroid malignancy were used.RESULTS Out of 237 articles,25 full texts were reviewed,and 5 full texts were included in the final meta-analysis.No relationship was found between TN,colonic polyps,and thyroid-stimulating hormone levels[odd ratio(OR):1.78,95%confidence interval(CI):0.55-5.74,P=0.33].Colonic polyps were more common among patients with TN when addressing heterogeneity(OR:0.42,95%CI:0.30-0.52,P<0.001 and OR:0.08,95%CI:0.70-0.86,P=0.85).CONCLUSION TN were similar among patients with and without adenomatous colonic polyps.However,TN was more common among colon polyps when addressing the heterogeneity.Thyroid-stimulating hormone was not different between those with and without TN.Age,sex,adiposity,and smoking effects might explain the higher rate observed by the included studies.Further studies controlling for the same are needed.
文摘Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF.Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very elderly,680 patients)and those under 85 years.Results Compared to patients<85 years,very elderly patients were more frequently women,had more hypertension and disease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardial infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41%vs.25%,P<0.001).The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estimated survival of less than 6 months assessed by the physician in charge of the patient care.Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.
文摘AIM:To identify optical coherence tomography(OCT)features present at the diagnosis of neovascular age-related macular degeneration(nAMD)that could predict retinal atrophy(RA)and visual performance in patients treated with intravitreal aflibercept.METHODS:OCT data collected at the time of nAMD diagnosis(T0),after the first(T1)and third(T2)intravitreal aflibercept injection,and 5y post-diagnosis(T3)were analyzed.The study included 46 eyes from patients undergoing treatment.The association of OCT features with RA and visual acuity(VA)development over time were evaluated.RESULTS:Patients with RA at T3 exhibited worse VA(35.19±5.7 vs 8.90±2.3,P<0.001)and a lower rate of improvement or stability at T2(90.48%vs 56.00%,P=0.019)and T3(85.71%vs 8.00%,P<0.001).The development of RA at T3 was linked with type 2 macular neovascularization(MNV;4.76%vs 36.00%,P=0.013),thinner outer nuclear layer(ONL,88.89±7.82μm vs 71.38±14.14μm,P=0.033),presence of intraretinal fluid(IRF,42.86%vs 80.00%,P=0.014),presence of IRF without subretinal fluid at T0(SRF,4.76%vs 32.00%,P=0.027),and reduced central foveal thickness at T3(CFT,190.14±22.79μm vs 124.32±14.35μm,P<0.001).The presence of SRF with or without IRF at the diagnosis was comparable between the two groups(90.48%vs 68.00%;P=0.084).CONCLUSION:Type 2 MNV,reduces ONL and CFT,and IRF presence at baseline may signal a higher risk of RA in treatment-naive nAMD patients,underscoring the importance of these OCT features in early risk assessment and management strategies.
文摘This editorial delves into the potential of systemic immune indicators(SIIs)as early predictors of renal damage in children with newly diagnosed type 1 diabetes mellitus.By exploring the recent study published by Cao et al,this article aims to highlight the importance of early detection and intervention.This study compre-hensively analyzes various SIIs,examining their correlation with renal compli-cations in newly diagnosed type 1 diabetic children.The findings reveal a sig-nificant association between immune system dysregulation and the onset of renal damage,suggesting that certain immune indicators can be early markers for predicting renal complications.This editorial emphasizes the clinical implications and applications of utilizing SIIs for early detection in pediatric diabetes care.It underscores the importance of innovative diagnostic approaches and illustrates real-world applications and outcomes.Additionally,it addresses the challenges and considerations in adopting these indicators and outlines future research directions to enhance diabetes management in children.
文摘Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.
基金supported by National Institute of Health Research and Development,Ministry of Health(No.024-11-416176).
文摘Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of"the Bogor Cohort Study on Non-Communicable Disease Risk Factors".Data were collected by interview method with structured questionnaires,physical measurements three times a year,and laboratory examination every two years during a 10-year follow-up(2011-2021,without examination in 2020).The incidence of stroke is based on anamnesis results and examination by a neurologist.Other stroke predictor variables include characteristics,biological conditions,and risk behavior.We analysed 4445 stroke-free samples with Cox proportional hazard regression test.Results:During the 10-year observation,stroke incidence was 440 person-years per 100000 population(95%CI 370-530).During the follow-up of ten years,the main predictor of stroke was mental-emotional disorders with HR 4.2(95%CI 2.8-6.3)after adjustment by age,hypertension,obesity,abdominal obesity,and high LDL-cholesterol levels.Conclusions:Mental-emotional disorders are the strongest predictor of stroke incidence.Hence,psychological factors must be controlled in a stroke prevention program.
基金Supported by the Open Project Grant for Clinical Medical Center of Yunnan Province,No.2019LCZXKF-NM03Medical Leader Training Grant,No.L-201624and Yunnan Province Ten Thousand Talents:“Medical Expert”grant,No.YNWR-MY-2019-020.
文摘BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amino acids(AAAs:Tyrosine,tryptophan,phenylalanine)show high sensitivity and specificity in predicting diabetes in animals and predict T2DM 10-19 years before T2DM onset in clinical studies.However,improvement is needed to support its clinical utility.AIM To evaluate the effects of body mass index(BMI)and sex on BCAAs/AAAs in new-onset T2DM individuals with varying body weight.METHODS Ninety-seven new-onset T2DM patients(<12 mo)differing in BMI[normal weight(NW),n=33,BMI=22.23±1.60;overweight,n=42,BMI=25.9±1.07;obesity(OB),n=22,BMI=31.23±2.31]from the First People’s Hospital of Yunnan Province,Kunming,China,were studied.One-way and 2-way ANOVAs were conducted to determine the effects of BMI and sex on BCAAs/AAAs.RESULTS Fasting serum AAAs,BCAAs,glutamate,and alanine were greater and high-density lipoprotein(HDL)was lower(P<0.05,each)in OB-T2DM patients than in NW-T2DM patients,especially in male OB-T2DM patients.Arginine,histidine,leucine,methionine,and lysine were greater in male patients than in female patients.Moreover,histidine,alanine,glutamate,lysine,valine,methionine,leucine,isoleucine,tyrosine,phenylalanine,and tryptophan were significantly correlated with abdominal adiposity,body weight and BMI,whereas isoleucine,leucine and phenylalanine were negatively correlated with HDL.CONCLUSION Heterogeneously elevated amino acids,especially BCAAs/AAAs,across new-onset T2DM patients in differing BMI categories revealed a potentially skewed prediction of T2DM development.The higher BCAA/AAA levels in obese T2DM patients would support T2DM prediction in obese individuals,whereas the lower levels of BCAAs/AAAs in NW-T2DM individuals may underestimate T2DM risk in NW individuals.This potentially skewed T2DM prediction should be considered when BCAAs/AAAs are to be used as the T2DM predictor.
基金Supported by Jiangsu Province Chinese Medicine Science and Technology Development Program,No.ZT202119.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophageal strictures,particularly local injection of triamcinolone acetonide(TA),is a relatively effective method to prevent esophageal strictures.However,even with steroid prophylaxis,stenosis still occurs in up to 45%of patients.Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.AIM To identify the predictors of esophageal strictures after steroids application.METHODS Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion-and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study.The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.RESULTS A total of 120 patients were included in the analysis.In the oral prednisone and oral prednisone combined with local tretinoin injection groups,the stenosis rates were 44/53(83.0%)and 56/67(83.6%),respectively.Among them,univariate analysis showed that the lesion circumference(P=0.01)and submucosal injection solution(P=0.04)showed significant correlation with the risk of stenosis formation.Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports,such as additional chemoradiotherapy and tumor location.We identified a lesion circumference<5/6(OR=0.19;P=0.02)and submucosal injection of sodium hyaluronate(OR=0.15;P=0.03)as independent predictors of on esophageal stricture formation.CONCLUSION Steroid prophylaxis effectively prevents stenosis.Moreover,the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures.Additional interventions should be considered in high-risk patients.
文摘BACKGROUND Infective endocarditis(IE)is a life-threatening infection with an annual mortality of 40%.Embolic events reported in up to 80%of patients.Vegetations of>10 mm size are associated with increased embolic events and poor prognosis.There is a paucity of literature on the association of multiple vegetations with outcome.AIM To study the echocardiographic(ECHO)features and outcomes associated with the presence of multiple vegetations.METHODS In this retrospective,single-center,cohort study patients diagnosed with IE were recruited from June 2017 to June 2019.A total of 84 patients were diagnosed to have IE,of whom 67 with vegetation were identified.Baseline demographic,clinical,laboratory,and ECHO parameters were reviewed.Outcomes that were studied included recurrent admission,embolic phenomenon,and mortality.RESULTS Twenty-three(34%)patients were noted to have multiple vegetations,13(56.5%)were male and 10(43.5%)were female.The mean age of these patients was 50.Eight(35%)had a prior episode of IE.ECHO features of moderate to severe valvular regurgitation[odds ratio(OR)=4],presence of pacemaker lead(OR=4.8),impaired left ventricle(LV)relaxation(OR=4),and elevated pulmonary artery systolic pressure(PASP)(OR=2.2)are associated with higher odds of multiple vegetations.Of these moderate to severe valvular regurgitation(P=0.028),pacemaker lead(P=0.039)and impaired relaxation(P=0.028)were statistically significant.These patients were noted to have an increased association of recurrent admissions(OR=3.6),recurrent bacteremia(OR=2.4),embolic phenomenon(OR=2.5),intensive care unit stay(OR=2.8),hypotension(OR=2.1),surgical intervention(OR=2.8)and device removal(OR=4.8).Of this device removal(P=0.039)and recurrent admissions(P=0.017)were statistically significant.CONCLUSION This study highlights the associations of ECHO predictors and outcomes in patients with IE having multiple vegetations.ECHO features of moderate to severe regurgitation,presence of pacemaker lead,impaired LV relaxation,and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.
文摘Background: An abnormal vaginal discharge is a common complaint among women of reproductive age, and it can indicate serious conditions like pelvic inflammatory disease and cervical cancer. This study aimed to assess the predictors of abnormal vaginal discharge in women of reproductive age group in Imo State, Southeast Nigeria. Methods: A cross-sectional study was conducted among 368 women of reproductive age group attending the clinic at Federal University Teaching Hospital Owerri, in Imo State, Nigeria. Respondents were recruited using a systematic sampling technique. Data were collected using a pre-tested interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of abnormal vaginal discharge. Statistical significance was set at p Results: The mean age of the respondents was 30 ± 4.5 years. Predictors of abnormal vaginal discharge were: age 36 - 45 years (OR: 4.5;95% C.I: 1.023 - 8.967, p = 0.041), being a student (OR: 2.4: 95% C.I: 1.496 - 7.336, p = 0.003), use of oral contraceptives (OR: 3.4;95% C.I: 1.068 - 6.932, p = 0.010), use of water cistern (OR: 4.7;C.I: 1.654 - 5.210, p = 0.028) anal hygiene practices (OR: 2.7;95% C.I: 1.142 - 4.809, p Conclusion: These findings suggest that targeted sexual and reproductive health interventions should be provided to reduce the risk of abnormal vaginal discharge in women of reproductive age group.
基金Supported by the National Natural Science Foundation of China,No.81800528Natural Science Foundation of Gansu Province,No.20JR5RA364Key Research and Development Project of Gansu Province,No.20YF2FA011。
文摘BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after splenectomy in patient with cirrhosis.METHODS A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018.The incidence of PVT at 1 months,3 months,and 12 months after splenectomy in patients with cirrhosis was observed.The hematological indicators,biochemical and coagulation parameters,and imaging features were recorded at baseline and at each observation point.The univariable,multivariable,receiver operating characteristic curve and timedependent curve analyses were performed.RESULTS The cumulative incidence of PVT was 40.0%,46.6%,and 48.9%at 1 months,3 months,and 12 months after splenectomy.Multivariable analysis showed that portal vein diameter(PVD)≥14.5 mm and monthsdel end-stage liver disease(MELD)score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy(P<0.05).Time-dependent curve showed that the cumulative incidence of PVT was significantly different between patients with MELD score≤10 and>10(P<0.05).In addition,the cumulative incidence of PVT in the PVD≥14.5 mm group was significantly higher than that in the PVD<14.5 mm group(P<0.05).CONCLUSION Wider PVD and MELD score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy in patient with cirrhosis.
文摘This article documents socio-demographic predictors of anxiety and depression among Maasai women in resource poor settings in Northern Kenya.These findings emerged from the findings of a dissertation research that aimed to establish the treatment effectiveness of an eclectic model of psychoeducation(PE)in treating depressive and anxiety symptoms among the women.The study adopted a quasi-experimental research design which had an experimental group(EG)and control group(CG).The population for the study was 686 female members of Conservation Enterprise Groups(CEG)in Laikipia County,from which a sample of 200 were recruited for the study(EG,n=100 and CG,n=100),at 80%power and 30%effective size.The Beck’s Depression Inventory(BDI)and Beck’s Anxiety Inventory(BAI)tools were used to assess the symptoms of depression and anxiety,respectively.The PE was provided as an intervention treatment to the EG at the middle and end of the study,after which the respondents were tested for symptoms of depression.The study established the prevalence of depression as 26.7%and 31.3%for anxiety and disorders,among women in the region.Data was analyzed using SPSS Version 21.0.
文摘Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.
