BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and dep...BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and depression(PSD)do not receive sufficient attention.AIM To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.METHODS This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024.Based on assessments using the Hamilton Rating Scale for Anxiety(HAMA)and Hamilton Rating Scale for Depression(HAMD)at 2 weeks(±3 days)post-stroke,patients were classified into the PSD group(HAMA≥7 and/or HAMD≥7)and the non-PSD group(HAMA<7 and HAMD<7).Observation indicators included psychological assessment,demographic and clinical characteristics,stroke-related clinical indicators,neuroimaging assessments,and laboratory biomarkers.Multivariate logistic regression analysis was used to identify independent risk factors for PSD,and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.RESULTS Of the 112 patients,46(41.1%)were diagnosed with PSD.Multivariate analysis identified five independent risk factors:Female gender[Odds ratio(OR)=2.32,95%confidence interval(CI):1.56-3.45],history of mental disorders prior to stroke(OR=3.17,95%CI:1.89-5.32),infarct location in the frontal lobe or limbic system(OR=2.86,95%CI:1.73-4.71),stroke severity with National Institutes of Health Stroke Scale≥8 at admission(OR=2.54,95%CI:1.62-3.99),and low social support(Social Support Rating Scale<35,OR=2.18,95%CI:1.42-3.36).Subgroup analysis showed that depression patients more commonly had left hemisphere lesions(68.4%vs 45.2%),while anxiety patients more frequently presented with right hemisphere lesions(59.5%vs 39.5%).The PSD group exhibited larger infarct volumes(8.7 cm^(3) vs 5.3 cm^(3)),more severe white matter hyperintensities,and more pronounced frontal lobe atrophy.Analysis of inflammatory markers showed significantly elevated levels of interleukin-6(7.8 pg/mL vs 4.5 pg/mL)and tumor necrosis factor-alpha(15.6 pg/mL vs 9.8 pg/mL)in the PSD group,while hypothalamicpituitary-adrenal axis function assessment revealed higher cortisol levels(386.5±92.3 nmol/L vs 328.7±75.6 nmol/L)and flattened diurnal rhythm in the PSD group.CONCLUSION PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry,neuroinflammatory responses,and dysfunction of the hypothalamic-pituitary-adrenal axis.展开更多
BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.A...BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.AIM To determine the incidence of depression and its independent risk factors in patients with esophageal cancer and bone metastasis.METHODS A total of 100 consecutive eligible patients admitted between March 2022 and March 2025 were recruited.Depression was assessed with the Beck Depression Inventory-II;scores>4 defined the depression group(n=42)and scores≤4 the non-depression group(n=58).Demographic,clinical,and laboratory variables were compared between the groups.Multivariate logistic regression was used to identify independent risk factors.RESULTS Depression prevalence was 42.0%(42/100).Univariate analysis demonstrated significant differences in monthly per-capita household income,education level,social support,sleep disorders,and serum high-sensitivity C-reactive protein(all P<0.05);no differences were observed in sex,age,tumor characteristics,or other laboratory indices(all P>0.05).Multivariable analysis revealed the following independent risk factors for depression:Low income[odds ratio(OR)=2.66,95%confidence interval(CI):1.17-6.03],low education(OR=2.46,95%CI:1.08-5.61),low social support(OR=5.10,95%CI:1.81-14.39),sleep disorders(OR=2.79,95%CI:1.23-6.35),and elevated high-sensitivity C-reactive protein(OR=1.31 per unit increase,95%CI:1.18-1.46).CONCLUSION Depression is common among patients with esophageal cancer and bone metastasis.Low socioeconomic status,limited education,insufficient social support,sleep disturbances,and systemic inflammation were independent predictors.Interventions that address these modifiable factors may reduce depression risk in this population.展开更多
BACKGROUND Antenatal depression is a disabling mental disorder among pregnant women and may cause adverse outcomes for both the mother and the offspring.Early identification and intervention of antenatal depression ca...BACKGROUND Antenatal depression is a disabling mental disorder among pregnant women and may cause adverse outcomes for both the mother and the offspring.Early identification and intervention of antenatal depression can help to prevent adverse outcomes.However,there have been few population-based studies focusing on the association of social and obstetric risk factors with antenatal depression in China.AIM To assess the sociodemographic and obstetric factors of antenatal depression and compare the network structure of depressive symptoms across different risk levels based on a large Chinese population.METHODS The cross-sectional survey was conducted in Shenzhen,China from 2020 to 2024.Antenatal depression was assessed using the Chinese version of the Edinburgh Postnatal Depression Scale(EPDS),with a score of≥13 indicating the presence of probable antenatal depression.Theχ2 test and binary logistic regression were used to identify the factors associated with antenatal depression.Network analyses were conducted to investigate the structure of depressive symptoms across groups with different risk levels.RESULTS Among the 44220 pregnant women,the prevalence of probable antenatal depression was 4.4%.An age≤24 years,a lower level of education(≤12 years),low or moderate economic status,having a history of mental disorders,being in the first trimester,being a primipara,unplanned pregnancy,and pregnancy without pre-pregnancy screening were found to be associated with antenatal depression(all P<0.05).Depressive symptom networks across groups with different risk levels revealed robust interconnections between symptoms.EPDS8("sad or miserable")and EPDS4("anxious or worried")showed the highest nodal strength across groups with different risk levels.CONCLUSION This study suggested that the prevalence of antenatal depression was 4.4%.Several social and obstetric factors were identified as risk factors for antenatal depression.EPDS8("sad or miserable")and EPDS4("anxious or worried")are pivotal targets for clinical intervention to alleviate the burden of antenatal depression.Early identification of highrisk groups is crucial for the development and implementation of intervention strategies to improve the overall quality of life for pregnant women.展开更多
BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nu...BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.展开更多
BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatm...BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.展开更多
BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postope...BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postoperative complications,in-cluding pulmonary infections,due to weakened immune function and metabolic abnormalities.Postoperative pulmonary infection(PPI)is a predominant com-plication after thoracoscopic radical resection of LC,significantly affecting patient outcomes and increasing healthcare burdens.Determining risk factors for PPI in this vulnerable population is crucial for improving surgical outcomes and redu-cing infection rates.AIM To develop and validate a predictive model for PPI in elderly patients with dia-betes undergoing thoracoscopic radical resection for LC and to assess its reliability and validity.METHODS This retrospective study included 212 patients with LC who received treatment at our hospital from March 2015 to March 2022.General clinical information,sur-gical treatment details,and laboratory test results were collected and analyzed.Patients were grouped according to infection occurrence during the postoperative hospitalization period.Risk factors for PPIs were determined through logistic regression analysis,and a nomogram prediction model was established using R software to assess its predictive accuracy and performance.RESULTS Among the 212 patients[median age:72 years(interquartile range:60-82 years)],41 developed PPI(19.34%),with Gram-negative bacteria being the predominant pathogens(64.14%).Factors,such as age of≥70 years,presence of respiratory diseases,maximum tumor diameter of≥4 cm,stages II-III,receiving neoadjuvant chemotherapy of≥2 times preoperatively,surgery duration of≥3 hours,chest drainage tube placement duration of≥3.5 days,preoperative fasting blood glucose levels,hemoglobin A1c(HbA1c)levels,and multi-leaf resection,were markedly higher in the infection group than in the non-infection group.Conversely,forced expiratory volume in 1 second(FEV1)of≥80%and albumin(Alb)levels were lower in the infection group.Multivariate logistic regression analysis revealed that receiving neoadjuvant chemotherapy of≥2 times[odds ratio(OR)=2.987;P=0.036],maximum tumor diameter of≥4 cm(OR=3.959;P=0.013),multi-leaf resection(OR=3.18;P=0.036),preoperative FEV1 of≤80%(OR=3.305;P=0.029),and high HbA1c levels(OR=2.39;P=0.003)as key risk factors for PPI,whereas high Alb levels(OR=0.507;P<0.001)was protective.The nomogram model demonstrated excellent diagnostic ability(area under the curve=0.901,0.915),and calibration curves and decision curve analysis revealed good predictive performance and clinical applicability of the model.CONCLUSION The primary pathogens of PPI in elderly patients with diabetes and LC undergoing thoracoscopic radical resection are Gram-negative bacteria.The nomogram model,based on preoperative neoadjuvant chemotherapy cycles,maximum tumor diameter,range of resection,and preoperative FEV1,Alb,and HbA1c levels,shows high clinical value in predicting the risk of PPI in this patient population.展开更多
we critically review the authors’perspective and analyze the relevance of the results obtained in the original article of clinical research by Liu et al.We consider that additional factors associated with colon cance...we critically review the authors’perspective and analyze the relevance of the results obtained in the original article of clinical research by Liu et al.We consider that additional factors associated with colon cancer progression have recently been described in extensive clinical research,and should be included in this analysis to achieve a more accurate prognosis.These factors include inflammation,gut microbiota composition,immune status and nutritional balance,as they influence the post-surgical survival profile of patients with stage II colorectal cancer.We also address the clinical implementation and limitations of these analyses.Evaluation of the patient´s entire context is essential for selection of the most appropriate therapy.展开更多
Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2...Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2 days. However,untreated AMS can progress to life-threatening conditions such as high-altitude cerebral and pulmonary edema(HACE and HAPE, respectively)^([1]).展开更多
Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco ...Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco smoking,alco-hol consumption,and unhealthy diet.CRC screening methods vary considerably between countries and depend on incidence,economic resources and healthcare structure.Important aspects of screening include adherence,which can vary signi-ficantly across ethnic and socioeconomic groups.Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colono-scopy or radiologic imaging techniques.Technological capabilities for CRC scree-ning are rapidly evolving and include stool DNA test,liquid biopsy,virtual colo-nography,and the use of artificial intelligence.A CRC prevention strategy should be comprehensive and include active patient education along with targeted imple-mentation of screening.展开更多
BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double c...BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double center retrospective study included 530 patients diagnosed with AIG from July 2019 to July 2023.We collected clinical,biochemical,serological,and demographic data were of each patient.Logistic regression analyses,both multivariate and univariate,were conducted to pinpoint independent risk factors for GPs in patients with AIG patients.Receiver operating characteristic curves were utilized to establish the optimal cutoff values,sensitivity,and specificity of these risk factors for predicting GPs in patients with AIG.RESULTS Patients with GPs had a higher median age than those without GPs[61(52.25-69)years vs 58(47-66)years,P=0.006].The gastrin-17 levels were significantly elevated in patients with GPs compared with those without GPs[91.9(34.2-138.9)pmol/mL vs 60.9(12.6-98.4)pmol/mL,P<0.001].Additionally,the positive rate of parietal cell antibody(PCA)antibody was higher in these patients than in those without GPs(88.6%vs 73.6%,P<0.001).Multivariate and univariate analyses revealed that PCA positivity[odds ratio(OR)=2.003,P=0.017],pepsinogen II(OR=1.053,P=0.015),and enterochromaffin like cells hyperplasia(OR=3.116,P<0.001)were significant risk factors for GPs,while pepsinogen I was identified as a protective factor.CONCLUSION PCA positivity and enterochromaffin like cells hyperplasia are significant risk factor for the development of GPs in patients with AIG.Elevated gastrin-17 levels may also play a role in this process.These findings suggest potential targets for further research and therapeutic intervention in managing GPs in patients with AIG.展开更多
BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD i...BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.展开更多
Breast cancer is the most common cancer among women worldwide. The term epidemiology generally deals with the branch of medicine and treatment that deals with a specific incident. Thus, considering the topic of breast...Breast cancer is the most common cancer among women worldwide. The term epidemiology generally deals with the branch of medicine and treatment that deals with a specific incident. Thus, considering the topic of breast cancer, this particular study deals with the distribution, determinants, and frequency of the disease. Breast cancer incidence and death data are critical to determining healthcare priorities. Women’s cancer is the most common, accounting for 25.1 percent of all malignancies. According to this specific report, more than 42,000 women die from breast cancer each year. Hence, it is apparent that it is the second leading cause of death among women, especially in the US. Family history/genetics, reproductive, hormone, benign proliferative breast disease, and mammographic density are the four main risk factors for breast cancer that can be meaningfully categorized. These elements are briefly discussed, and the risk estimators are provided. Numerous screening technologies have found breast cancer;some are linked to an increased risk of breast cancer, such as ultrasound techniques and MRI scanning. Breast cancer is more common in developed countries, while relative mortality is highest in developing countries. Women’s education is recommended for early detection and treatment in all nations. Health policymakers must prioritize plans to control and prevent this malignancy and increase awareness of risk factors and early detection in less developed countries.展开更多
Early onset of hypertension (HTN) raises the risk of cardiovascular disease (CVD), the leading cause of death in the U.S. For university students who do not follow healthy diets or lifestyles, high blood pressure (BP)...Early onset of hypertension (HTN) raises the risk of cardiovascular disease (CVD), the leading cause of death in the U.S. For university students who do not follow healthy diets or lifestyles, high blood pressure (BP) may be markedly prevalent. Researchers utilized a cross-sectional design to assess HTN prevalence and its risk factors among college students (N = 123). Self-administered surveys comprising four validated questionnaires: the Perceived Stress Scale (PSS), Rapid Eating Assessment for Participants-Shortened (REAPS), Dietary Approaches to Stop Hypertension Quality (DASH-Q), and the U.S. Adult Food Security Survey (FSS) were employed. Additionally, physical measurements were conducted, including height, weight, waist circumference (WC), and BP. Results indicated that 71.6% of students had elevated BP, with 24.4% classified as Stage 1 HTN and 23.6% as Stage 2 HTN. Notably, 60% of students reported low adherence to the DASH diet and a mean REAPS score of 26.3 out of 39. Students experiencing marginal food security had higher systolic blood pressure (SBP) 131.7 ± 16.8 mm Hg compared to those with high food security 123.03 ± 11.7 mm Hg (p = 0.028). Furthermore, REAPS scores showed a negative correlation with diastolic blood pressure (DBP) (β = −0.201, p = 0.03). Significant predictors for SBP included WC (β = 0.40, p β = −0.33, p β = 0.16, p = 0.046). The findings highlight the need for BP screenings and nutrition education programs to improve dietary habits among college students, which may help reduce HTN and its associated long-term risks for CVD.展开更多
Introduction: Considering a disease of postmenopausal women, there is a noted trend of increasing breast cancer cases among premenopausal women. Our study aimed to determine the main risk factors for breast cancer in ...Introduction: Considering a disease of postmenopausal women, there is a noted trend of increasing breast cancer cases among premenopausal women. Our study aimed to determine the main risk factors for breast cancer in women aged 40 and under. Materials and Methods: This was a case-control study with exhaustive sampling of all respondents with histological proof over a 12-month period, matched by age. For all statistical tests, we used a significance threshold of 5%. Additionally provided are the ORs and their 95% confidence intervals, the mean, and standard deviation. Results: We collected 65 cases and 130 controls. The frequency of breast cancer in women aged 40 and under was 35.5%. The mean age was 35.6 ± 4.5 years among cases compared to 32.1 ± 7.9 years among controls. A significantly positive association was detected in both univariate and multivariate analysis between age and breast cancer [(OR) = 10.30;95% CI (1.99 - 53.23)] and [(OR) = 7.53;95% CI (1.82 - 31.23)];family history of breast cancer and breast cancer [(OR) = 9.99;95% CI (1.43 - 69.58)];smoking and breast cancer [OR = 13.11;95% CI (1.05 - 163.30)];sedentary lifestyle and breast cancer [OR = 3.36;95% CI (1.01 - 11.17)];and night work and breast cancer [(OR) = 72.05;95% CI (8.15 - 637.25)]. Conclusion: Earlier systematic screening and regular follow-up should be conducted in young women in our context.展开更多
Necrotizing enterocolitis (NEC) in newborns is one of the life-threatening diseases. With the continuous advancement of perinatal medicine and neonatal intensive care technology, NEC has been on the rise year by year....Necrotizing enterocolitis (NEC) in newborns is one of the life-threatening diseases. With the continuous advancement of perinatal medicine and neonatal intensive care technology, NEC has been on the rise year by year. The etiology of NEC is not yet clear, and it may be the result of multiple risk factors working together, such as premature birth, infection, formula feeding, ischemia, hypoxia, dysbiosis of intestinal flora, and immune damage. Additionally, recent reports have documented factors such as immunoglobulin treatment for hemolytic jaundice, blood transfusion therapy, and rapid achievement of adequate feeding. This article comprehensively analyzes the current research progress on high-risk factors of NEC, and provides a reference for future prevention, diagnosis, and treatment directions.展开更多
BACKGROUND Patients with gastric cancer(GC)frequently experience notable psychological distress,which often manifests as anxiety and depression.Identifying key contributing factors is essential for developing effectiv...BACKGROUND Patients with gastric cancer(GC)frequently experience notable psychological distress,which often manifests as anxiety and depression.Identifying key contributing factors is essential for developing effective interventions to improve mental health outcomes.AIM To investigate the relationships between anxiety/depression,self-efficacy,and social support in patients with GC and identified significant risk factors.METHODS We enrolled 124 patients with GC undergoing treatment at Chongqing University Cancer Hospital between May 2021 and May 2024.Information regarding the patients’anxiety and depression evaluated by the hospital anxiety and depression scale(HADS),[including a subscale for anxiety(HADS-A)and a separate subscale for depression(HADS-D)]self-efficacy,measured by the general self-efficacy scale(GSES),and social support,assessed by the perceived social support scale(PSSS),was gathered.Relationships among HADS,GSES,and PSSS scores were determined through Pearson correlation analysis.Risk factors for anxiety and depression among patients with GC were identified using univariate and multivariate analyses,specifically binary logistic regression.RESULTS The obtained data demonstrated mild psychological distress(mean HADS-A:8.74±3.70;mean HADS-D:10.26±3.84),suboptimal self-efficacy levels(GSES:17.81±5.45),and moderate social support(PSSS:56.27±11.28).Correlational analysis revealed significant inverse relationships between psychological distress(anxiety and depression)and both social support and self-efficacy(P<0.01),with self-efficacy showing a strong positive association with social support(P<0.01).Univariate analysis revealed that gender,age,clinical stage,tumor size,GSES,and PSSS were closely associated with anxiety and depression in patients with GC.Multivariate logistic regression identified three independent predictors of these mood disturbances:Advanced age(≥60),large tumor size(≥3 cm),and diminished GSES scores(<18).CONCLUSION Our findings suggest that patients with GC generally experience mild anxiety and depression,which are closely related to low self-efficacy and insufficient social support.Age,tumor size,and low self-efficacy are independent predictors of anxiety and depression.In clinical practice,psychosocial interventions should be integrated,with a focus on high-risk populations,to improve patients’mental health.展开更多
BACKGROUND Ischemic stroke(IS)survivors face an elevated risk of epileptic seizures,and recurrent seizures following the first episode often signal worsening functional outcomes.AIM To investigate risk factors associa...BACKGROUND Ischemic stroke(IS)survivors face an elevated risk of epileptic seizures,and recurrent seizures following the first episode often signal worsening functional outcomes.AIM To investigate risk factors associated with seizure recurrence after a first episode in patients with IS and explore their associations with cognitive function,anxiety,and depression.METHODS A total of 100 patients with IS admitted to Shaanxi Provincial People’s Hospital between January 2017 and January 2024 were enrolled in this study.After a 1-5-year follow-up,patients were categorized into recurrence(n=43)and nonrecurrence(n=57)groups.Their medical records were collected and analyzed using univariate and multivariate analyses to determine potential predictors of seizure recurrence.Variables with statistical significance in the univariate analysis were incorporated into a binary logistic regression model for multivariate analysis.The risk model’s predictive performance was evaluated using the receiver operating characteristic curve.How independent risk factors,identified in multivariate analysis,related to cognitive[Montreal Cognitive Assessment(MoCA)]and emotional[Self-Rating Anxiety Scale(SAS)/Self-Rating Depression Scale(SDS)]outcomes,were assessed.RESULTS Recurrent seizures were significantly associated with age,stroke severity(National Institutes of Health Stroke Scale),late-onset seizures,electroenceph-alogram abnormalities,cortical involvement,hemorrhagic infarction,and extensive cerebral infarctions,with lateonset seizures,cortical involvement,and hemorrhagic infarction serving as independent predictors.The risk model revealed an area under the curve of 0.732,with 88.37%specificity and 42.11%sensitivity.These three were also correlated with lower MoCA scores and higher SAS and SDS scores.CONCLUSION In patients with IS,recurrent seizures after the first episode can be independently predicted by late-onset seizures,cortical involvement,and hemorrhagic cerebral infarction-factors also correlating with cognitive impairment and emotional distress.These findings underscore the need for close clinical monitoring and targeted interventions(e.g.,cognitive rehabilitation and psychological support)to mitigate seizure recurrence in high-risk individuals.展开更多
BACKGROUND Anxiety complicates recovery in esophagectomy patients undergoing esophagectomy,while preoperative depressive symptoms may further delay surgeryassociated malnutrition resolution,highlighting a critical nee...BACKGROUND Anxiety complicates recovery in esophagectomy patients undergoing esophagectomy,while preoperative depressive symptoms may further delay surgeryassociated malnutrition resolution,highlighting a critical need for psychological intervention.AIM To explore the correlation of anxiety and depression with mindfulness levels in patients undergoing esophagectomy for esophageal cancer and analyze associated risk factors.METHODS A total of 120 patients with esophageal cancer,all of whom underwent esophagectomy in The Affiliated Yongchuan Hospital of Chongqing Medical University between September 2022 and September 2024,were enrolled.The hospital anxiety and depression scale(HADS)was utilized to evaluate the anxiety(HADS-anxiety subscale,HADS-A)and depression(HADS-depression subscale,HADS-D)levels of these patients,and the Mindful Attention Awareness Scale(MAAS)was employed to assess their mindfulness levels.The relationships among anxiety,depression,and mindfulness levels were analyzed,and both univariate and multivariate analyses were conducted to identify the risk factors for anxiety and depression in these patients.RESULTS Data revealed that the mean HADS-A score of patients undergoing esophagectomy was(10.43±4.24)points,and 40.00%,35.00%,and 10.83%of the patients had mild,moderate,and severe anxiety,respectively.The mean HADS-D score https://www.wjgnet.com 2 September 19,2025 Volume 15 Issue 9 was(9.20±4.66)points,and 37.50%,23.33%,and 9.17%of the patients had mild,moderate,and severe depression,respectively.Patients with negative or mild anxiety(or depression)exhibited significantly higher MAAS scores than those with moderate or severe anxiety(or depression).The HADS-A and HADS-D scores showed a strong and negative correlation with the MAAS score.Univariate and multivariate analyses demonstrated that sex(P=0.006),age(P=0.017),per capita monthly household income(P=0.005),and educational level(P=0.004)were all independently associated with the exacerbation of anxiety in patients undergoing esophagectomy.Age(P=0.026),living status(P=0.005),per capita monthly household income(P=0.024),educational level(P=0.002),and postoperative complications(P<0.001)were all independently related to the aggravation of depression in such patients.CONCLUSION This study indicated a significant negative correlation among anxiety,depression,and mindfulness levels in patients undergoing esophagectomy.Sex,age,per capita monthly household income,and educational level were risk factors for anxiety in patients undergoing esophagectomy,whereas age,living status,per capita monthly household income,educational level,and postoperative complications were risk factors for depression.展开更多
BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factor...BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factors of POD is crucial,as it can significantly affect patients’prognosis and healthcare costs.AIM To systematically evaluate the incidence and risk factors of POD following organ transplantation to facilitate clinical prevention and optimize patient management and prognosis.METHODS Multiple databases such as PubMed and their reference lists were comprehensively searched using a combination of keywords related to organ transplantation and POD.Relevant observational studies on patients who had undergone solid organ transplantation and randomized controlled trials containing relevant analyses were included.Duplicated,data-deficient,non-English,and non-original data studies were excluded.Data were extracted independently by two researchers and then cross-checked.The Newcastle-Ottawa scale was used to evaluate the quality of the included studies.RevMan 5.3 was employed for data analysis.The pooled incidence of POD was calculated according to the data type,and the fixed or random effect model was employed to analyze risk factors based on heterogeneity.Subsequently,sensitivity analysis and publication bias assessments were performed.RESULTS A total of 39 relevant literatures were included.The overall incidence of POD in the organ transplant group was 20%[95%confidence interval(CI):18%-22%];liver transplant group,22%(95%CI:17%-26%);lung transplant group,34%(95%CI:23%-45%);and kidney transplant group,6%(95%CI:2%-10%).Primary graft dysfunction increased the POD risk,with a pooled odds ratio(OR)(95%CI)of 1.78(1.09-2.91).A history of hepatic encephalopathy increased the POD risk,with a pooled OR(95%CI)of 3.19(2.30-4.43).The higher the Acute Physiology and Chronic Health Evaluation II score,the greater the POD risk,with a pooled OR(95%CI)of 1.52(1.09-2.12).A history of alcohol abuse increased the POD risk,with a pooled OR(95%CI)of 2.84(1.74-4.65).Thus,the higher the model for end-stage liver disease score,the greater the POD risk,with a pooled OR(95%CI)of 2.49(1.14-5.43).POD was more likely to develop in patients with preoperative infections,with a pooled OR(95%CI)of 2.78(1.56-4.97).The use of diuretics increased the POD risk,with a pooled OR(95%CI)of 2.36(1.38-4.04).CONCLUSION In this study,the overall incidence of POD in patients who underwent organ transplantation is 20%.The incidence varies among different types of organ transplantation,and multiple factors can increase the POD risk.展开更多
文摘BACKGROUND Ischemic stroke is one of the leading global causes of disability and death.Despite advances in modern medical technology that improve acute treatment and rehabilitation measures,post-stroke anxiety and depression(PSD)do not receive sufficient attention.AIM To systematically evaluate risk factors and early identification markers for PSD for more precise screening and intervention strategies in clinical practice.METHODS This retrospective study analyzed clinical data from 112 patients with ischemic stroke admitted between January 2022 and December 2024.Based on assessments using the Hamilton Rating Scale for Anxiety(HAMA)and Hamilton Rating Scale for Depression(HAMD)at 2 weeks(±3 days)post-stroke,patients were classified into the PSD group(HAMA≥7 and/or HAMD≥7)and the non-PSD group(HAMA<7 and HAMD<7).Observation indicators included psychological assessment,demographic and clinical characteristics,stroke-related clinical indicators,neuroimaging assessments,and laboratory biomarkers.Multivariate logistic regression analysis was used to identify independent risk factors for PSD,and receiver operating characteristic curve analysis was used to evaluate the diagnostic value of potential biomarkers.RESULTS Of the 112 patients,46(41.1%)were diagnosed with PSD.Multivariate analysis identified five independent risk factors:Female gender[Odds ratio(OR)=2.32,95%confidence interval(CI):1.56-3.45],history of mental disorders prior to stroke(OR=3.17,95%CI:1.89-5.32),infarct location in the frontal lobe or limbic system(OR=2.86,95%CI:1.73-4.71),stroke severity with National Institutes of Health Stroke Scale≥8 at admission(OR=2.54,95%CI:1.62-3.99),and low social support(Social Support Rating Scale<35,OR=2.18,95%CI:1.42-3.36).Subgroup analysis showed that depression patients more commonly had left hemisphere lesions(68.4%vs 45.2%),while anxiety patients more frequently presented with right hemisphere lesions(59.5%vs 39.5%).The PSD group exhibited larger infarct volumes(8.7 cm^(3) vs 5.3 cm^(3)),more severe white matter hyperintensities,and more pronounced frontal lobe atrophy.Analysis of inflammatory markers showed significantly elevated levels of interleukin-6(7.8 pg/mL vs 4.5 pg/mL)and tumor necrosis factor-alpha(15.6 pg/mL vs 9.8 pg/mL)in the PSD group,while hypothalamicpituitary-adrenal axis function assessment revealed higher cortisol levels(386.5±92.3 nmol/L vs 328.7±75.6 nmol/L)and flattened diurnal rhythm in the PSD group.CONCLUSION PSD is a complex neuropsychiatric consequence of stroke involving disruption of the frontal-limbic circuitry,neuroinflammatory responses,and dysfunction of the hypothalamic-pituitary-adrenal axis.
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
文摘BACKGROUND Esophageal cancer is highly malignant and frequently metastasizes to bones.Concomitant depression worsens prognosis;however,its incidence and determinants in this specific population remain poorly defined.AIM To determine the incidence of depression and its independent risk factors in patients with esophageal cancer and bone metastasis.METHODS A total of 100 consecutive eligible patients admitted between March 2022 and March 2025 were recruited.Depression was assessed with the Beck Depression Inventory-II;scores>4 defined the depression group(n=42)and scores≤4 the non-depression group(n=58).Demographic,clinical,and laboratory variables were compared between the groups.Multivariate logistic regression was used to identify independent risk factors.RESULTS Depression prevalence was 42.0%(42/100).Univariate analysis demonstrated significant differences in monthly per-capita household income,education level,social support,sleep disorders,and serum high-sensitivity C-reactive protein(all P<0.05);no differences were observed in sex,age,tumor characteristics,or other laboratory indices(all P>0.05).Multivariable analysis revealed the following independent risk factors for depression:Low income[odds ratio(OR)=2.66,95%confidence interval(CI):1.17-6.03],low education(OR=2.46,95%CI:1.08-5.61),low social support(OR=5.10,95%CI:1.81-14.39),sleep disorders(OR=2.79,95%CI:1.23-6.35),and elevated high-sensitivity C-reactive protein(OR=1.31 per unit increase,95%CI:1.18-1.46).CONCLUSION Depression is common among patients with esophageal cancer and bone metastasis.Low socioeconomic status,limited education,insufficient social support,sleep disturbances,and systemic inflammation were independent predictors.Interventions that address these modifiable factors may reduce depression risk in this population.
基金Supported by the Joint Funds of the National Natural Science Foundation of China,No.U23A20434National Natural Science Foundation of China,No.82301738,No.82371535,and No.82171518+1 种基金the National Key Research and Development Program of China,No.2021YFF1201204the Science and Technology Innovation Program of Hunan Province,No.2023RC3083.
文摘BACKGROUND Antenatal depression is a disabling mental disorder among pregnant women and may cause adverse outcomes for both the mother and the offspring.Early identification and intervention of antenatal depression can help to prevent adverse outcomes.However,there have been few population-based studies focusing on the association of social and obstetric risk factors with antenatal depression in China.AIM To assess the sociodemographic and obstetric factors of antenatal depression and compare the network structure of depressive symptoms across different risk levels based on a large Chinese population.METHODS The cross-sectional survey was conducted in Shenzhen,China from 2020 to 2024.Antenatal depression was assessed using the Chinese version of the Edinburgh Postnatal Depression Scale(EPDS),with a score of≥13 indicating the presence of probable antenatal depression.Theχ2 test and binary logistic regression were used to identify the factors associated with antenatal depression.Network analyses were conducted to investigate the structure of depressive symptoms across groups with different risk levels.RESULTS Among the 44220 pregnant women,the prevalence of probable antenatal depression was 4.4%.An age≤24 years,a lower level of education(≤12 years),low or moderate economic status,having a history of mental disorders,being in the first trimester,being a primipara,unplanned pregnancy,and pregnancy without pre-pregnancy screening were found to be associated with antenatal depression(all P<0.05).Depressive symptom networks across groups with different risk levels revealed robust interconnections between symptoms.EPDS8("sad or miserable")and EPDS4("anxious or worried")showed the highest nodal strength across groups with different risk levels.CONCLUSION This study suggested that the prevalence of antenatal depression was 4.4%.Several social and obstetric factors were identified as risk factors for antenatal depression.EPDS8("sad or miserable")and EPDS4("anxious or worried")are pivotal targets for clinical intervention to alleviate the burden of antenatal depression.Early identification of highrisk groups is crucial for the development and implementation of intervention strategies to improve the overall quality of life for pregnant women.
文摘BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.
文摘BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.
文摘BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postoperative complications,in-cluding pulmonary infections,due to weakened immune function and metabolic abnormalities.Postoperative pulmonary infection(PPI)is a predominant com-plication after thoracoscopic radical resection of LC,significantly affecting patient outcomes and increasing healthcare burdens.Determining risk factors for PPI in this vulnerable population is crucial for improving surgical outcomes and redu-cing infection rates.AIM To develop and validate a predictive model for PPI in elderly patients with dia-betes undergoing thoracoscopic radical resection for LC and to assess its reliability and validity.METHODS This retrospective study included 212 patients with LC who received treatment at our hospital from March 2015 to March 2022.General clinical information,sur-gical treatment details,and laboratory test results were collected and analyzed.Patients were grouped according to infection occurrence during the postoperative hospitalization period.Risk factors for PPIs were determined through logistic regression analysis,and a nomogram prediction model was established using R software to assess its predictive accuracy and performance.RESULTS Among the 212 patients[median age:72 years(interquartile range:60-82 years)],41 developed PPI(19.34%),with Gram-negative bacteria being the predominant pathogens(64.14%).Factors,such as age of≥70 years,presence of respiratory diseases,maximum tumor diameter of≥4 cm,stages II-III,receiving neoadjuvant chemotherapy of≥2 times preoperatively,surgery duration of≥3 hours,chest drainage tube placement duration of≥3.5 days,preoperative fasting blood glucose levels,hemoglobin A1c(HbA1c)levels,and multi-leaf resection,were markedly higher in the infection group than in the non-infection group.Conversely,forced expiratory volume in 1 second(FEV1)of≥80%and albumin(Alb)levels were lower in the infection group.Multivariate logistic regression analysis revealed that receiving neoadjuvant chemotherapy of≥2 times[odds ratio(OR)=2.987;P=0.036],maximum tumor diameter of≥4 cm(OR=3.959;P=0.013),multi-leaf resection(OR=3.18;P=0.036),preoperative FEV1 of≤80%(OR=3.305;P=0.029),and high HbA1c levels(OR=2.39;P=0.003)as key risk factors for PPI,whereas high Alb levels(OR=0.507;P<0.001)was protective.The nomogram model demonstrated excellent diagnostic ability(area under the curve=0.901,0.915),and calibration curves and decision curve analysis revealed good predictive performance and clinical applicability of the model.CONCLUSION The primary pathogens of PPI in elderly patients with diabetes and LC undergoing thoracoscopic radical resection are Gram-negative bacteria.The nomogram model,based on preoperative neoadjuvant chemotherapy cycles,maximum tumor diameter,range of resection,and preoperative FEV1,Alb,and HbA1c levels,shows high clinical value in predicting the risk of PPI in this patient population.
基金Supported by Consejo Nacional de Investigaciones Científicas y Técnicas,No.PIP11220200103061COAgencia Nacional de promoción Científica y Tecnológica,No.PICT-2020-SERIEA-03440Universidad Nacional del Sur,No.PGI 24/B303 and No.PGI 24/ZB01.
文摘we critically review the authors’perspective and analyze the relevance of the results obtained in the original article of clinical research by Liu et al.We consider that additional factors associated with colon cancer progression have recently been described in extensive clinical research,and should be included in this analysis to achieve a more accurate prognosis.These factors include inflammation,gut microbiota composition,immune status and nutritional balance,as they influence the post-surgical survival profile of patients with stage II colorectal cancer.We also address the clinical implementation and limitations of these analyses.Evaluation of the patient´s entire context is essential for selection of the most appropriate therapy.
文摘Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2 days. However,untreated AMS can progress to life-threatening conditions such as high-altitude cerebral and pulmonary edema(HACE and HAPE, respectively)^([1]).
文摘Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco smoking,alco-hol consumption,and unhealthy diet.CRC screening methods vary considerably between countries and depend on incidence,economic resources and healthcare structure.Important aspects of screening include adherence,which can vary signi-ficantly across ethnic and socioeconomic groups.Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colono-scopy or radiologic imaging techniques.Technological capabilities for CRC scree-ning are rapidly evolving and include stool DNA test,liquid biopsy,virtual colo-nography,and the use of artificial intelligence.A CRC prevention strategy should be comprehensive and include active patient education along with targeted imple-mentation of screening.
基金Supported by the Health Technology Project of Pudong New District Health Commission,No.PW2020D-12.
文摘BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double center retrospective study included 530 patients diagnosed with AIG from July 2019 to July 2023.We collected clinical,biochemical,serological,and demographic data were of each patient.Logistic regression analyses,both multivariate and univariate,were conducted to pinpoint independent risk factors for GPs in patients with AIG patients.Receiver operating characteristic curves were utilized to establish the optimal cutoff values,sensitivity,and specificity of these risk factors for predicting GPs in patients with AIG.RESULTS Patients with GPs had a higher median age than those without GPs[61(52.25-69)years vs 58(47-66)years,P=0.006].The gastrin-17 levels were significantly elevated in patients with GPs compared with those without GPs[91.9(34.2-138.9)pmol/mL vs 60.9(12.6-98.4)pmol/mL,P<0.001].Additionally,the positive rate of parietal cell antibody(PCA)antibody was higher in these patients than in those without GPs(88.6%vs 73.6%,P<0.001).Multivariate and univariate analyses revealed that PCA positivity[odds ratio(OR)=2.003,P=0.017],pepsinogen II(OR=1.053,P=0.015),and enterochromaffin like cells hyperplasia(OR=3.116,P<0.001)were significant risk factors for GPs,while pepsinogen I was identified as a protective factor.CONCLUSION PCA positivity and enterochromaffin like cells hyperplasia are significant risk factor for the development of GPs in patients with AIG.Elevated gastrin-17 levels may also play a role in this process.These findings suggest potential targets for further research and therapeutic intervention in managing GPs in patients with AIG.
基金Supported by National Key Research and Development Program of China,No.2022YFC3600903Key Discipline Project under Shanghai's Three-Year Action Plan for Strengthening the Public Health System(2023-2025),No.GWVI-11.1-44.
文摘BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.
文摘Breast cancer is the most common cancer among women worldwide. The term epidemiology generally deals with the branch of medicine and treatment that deals with a specific incident. Thus, considering the topic of breast cancer, this particular study deals with the distribution, determinants, and frequency of the disease. Breast cancer incidence and death data are critical to determining healthcare priorities. Women’s cancer is the most common, accounting for 25.1 percent of all malignancies. According to this specific report, more than 42,000 women die from breast cancer each year. Hence, it is apparent that it is the second leading cause of death among women, especially in the US. Family history/genetics, reproductive, hormone, benign proliferative breast disease, and mammographic density are the four main risk factors for breast cancer that can be meaningfully categorized. These elements are briefly discussed, and the risk estimators are provided. Numerous screening technologies have found breast cancer;some are linked to an increased risk of breast cancer, such as ultrasound techniques and MRI scanning. Breast cancer is more common in developed countries, while relative mortality is highest in developing countries. Women’s education is recommended for early detection and treatment in all nations. Health policymakers must prioritize plans to control and prevent this malignancy and increase awareness of risk factors and early detection in less developed countries.
文摘Early onset of hypertension (HTN) raises the risk of cardiovascular disease (CVD), the leading cause of death in the U.S. For university students who do not follow healthy diets or lifestyles, high blood pressure (BP) may be markedly prevalent. Researchers utilized a cross-sectional design to assess HTN prevalence and its risk factors among college students (N = 123). Self-administered surveys comprising four validated questionnaires: the Perceived Stress Scale (PSS), Rapid Eating Assessment for Participants-Shortened (REAPS), Dietary Approaches to Stop Hypertension Quality (DASH-Q), and the U.S. Adult Food Security Survey (FSS) were employed. Additionally, physical measurements were conducted, including height, weight, waist circumference (WC), and BP. Results indicated that 71.6% of students had elevated BP, with 24.4% classified as Stage 1 HTN and 23.6% as Stage 2 HTN. Notably, 60% of students reported low adherence to the DASH diet and a mean REAPS score of 26.3 out of 39. Students experiencing marginal food security had higher systolic blood pressure (SBP) 131.7 ± 16.8 mm Hg compared to those with high food security 123.03 ± 11.7 mm Hg (p = 0.028). Furthermore, REAPS scores showed a negative correlation with diastolic blood pressure (DBP) (β = −0.201, p = 0.03). Significant predictors for SBP included WC (β = 0.40, p β = −0.33, p β = 0.16, p = 0.046). The findings highlight the need for BP screenings and nutrition education programs to improve dietary habits among college students, which may help reduce HTN and its associated long-term risks for CVD.
文摘Introduction: Considering a disease of postmenopausal women, there is a noted trend of increasing breast cancer cases among premenopausal women. Our study aimed to determine the main risk factors for breast cancer in women aged 40 and under. Materials and Methods: This was a case-control study with exhaustive sampling of all respondents with histological proof over a 12-month period, matched by age. For all statistical tests, we used a significance threshold of 5%. Additionally provided are the ORs and their 95% confidence intervals, the mean, and standard deviation. Results: We collected 65 cases and 130 controls. The frequency of breast cancer in women aged 40 and under was 35.5%. The mean age was 35.6 ± 4.5 years among cases compared to 32.1 ± 7.9 years among controls. A significantly positive association was detected in both univariate and multivariate analysis between age and breast cancer [(OR) = 10.30;95% CI (1.99 - 53.23)] and [(OR) = 7.53;95% CI (1.82 - 31.23)];family history of breast cancer and breast cancer [(OR) = 9.99;95% CI (1.43 - 69.58)];smoking and breast cancer [OR = 13.11;95% CI (1.05 - 163.30)];sedentary lifestyle and breast cancer [OR = 3.36;95% CI (1.01 - 11.17)];and night work and breast cancer [(OR) = 72.05;95% CI (8.15 - 637.25)]. Conclusion: Earlier systematic screening and regular follow-up should be conducted in young women in our context.
文摘Necrotizing enterocolitis (NEC) in newborns is one of the life-threatening diseases. With the continuous advancement of perinatal medicine and neonatal intensive care technology, NEC has been on the rise year by year. The etiology of NEC is not yet clear, and it may be the result of multiple risk factors working together, such as premature birth, infection, formula feeding, ischemia, hypoxia, dysbiosis of intestinal flora, and immune damage. Additionally, recent reports have documented factors such as immunoglobulin treatment for hemolytic jaundice, blood transfusion therapy, and rapid achievement of adequate feeding. This article comprehensively analyzes the current research progress on high-risk factors of NEC, and provides a reference for future prevention, diagnosis, and treatment directions.
文摘BACKGROUND Patients with gastric cancer(GC)frequently experience notable psychological distress,which often manifests as anxiety and depression.Identifying key contributing factors is essential for developing effective interventions to improve mental health outcomes.AIM To investigate the relationships between anxiety/depression,self-efficacy,and social support in patients with GC and identified significant risk factors.METHODS We enrolled 124 patients with GC undergoing treatment at Chongqing University Cancer Hospital between May 2021 and May 2024.Information regarding the patients’anxiety and depression evaluated by the hospital anxiety and depression scale(HADS),[including a subscale for anxiety(HADS-A)and a separate subscale for depression(HADS-D)]self-efficacy,measured by the general self-efficacy scale(GSES),and social support,assessed by the perceived social support scale(PSSS),was gathered.Relationships among HADS,GSES,and PSSS scores were determined through Pearson correlation analysis.Risk factors for anxiety and depression among patients with GC were identified using univariate and multivariate analyses,specifically binary logistic regression.RESULTS The obtained data demonstrated mild psychological distress(mean HADS-A:8.74±3.70;mean HADS-D:10.26±3.84),suboptimal self-efficacy levels(GSES:17.81±5.45),and moderate social support(PSSS:56.27±11.28).Correlational analysis revealed significant inverse relationships between psychological distress(anxiety and depression)and both social support and self-efficacy(P<0.01),with self-efficacy showing a strong positive association with social support(P<0.01).Univariate analysis revealed that gender,age,clinical stage,tumor size,GSES,and PSSS were closely associated with anxiety and depression in patients with GC.Multivariate logistic regression identified three independent predictors of these mood disturbances:Advanced age(≥60),large tumor size(≥3 cm),and diminished GSES scores(<18).CONCLUSION Our findings suggest that patients with GC generally experience mild anxiety and depression,which are closely related to low self-efficacy and insufficient social support.Age,tumor size,and low self-efficacy are independent predictors of anxiety and depression.In clinical practice,psychosocial interventions should be integrated,with a focus on high-risk populations,to improve patients’mental health.
文摘BACKGROUND Ischemic stroke(IS)survivors face an elevated risk of epileptic seizures,and recurrent seizures following the first episode often signal worsening functional outcomes.AIM To investigate risk factors associated with seizure recurrence after a first episode in patients with IS and explore their associations with cognitive function,anxiety,and depression.METHODS A total of 100 patients with IS admitted to Shaanxi Provincial People’s Hospital between January 2017 and January 2024 were enrolled in this study.After a 1-5-year follow-up,patients were categorized into recurrence(n=43)and nonrecurrence(n=57)groups.Their medical records were collected and analyzed using univariate and multivariate analyses to determine potential predictors of seizure recurrence.Variables with statistical significance in the univariate analysis were incorporated into a binary logistic regression model for multivariate analysis.The risk model’s predictive performance was evaluated using the receiver operating characteristic curve.How independent risk factors,identified in multivariate analysis,related to cognitive[Montreal Cognitive Assessment(MoCA)]and emotional[Self-Rating Anxiety Scale(SAS)/Self-Rating Depression Scale(SDS)]outcomes,were assessed.RESULTS Recurrent seizures were significantly associated with age,stroke severity(National Institutes of Health Stroke Scale),late-onset seizures,electroenceph-alogram abnormalities,cortical involvement,hemorrhagic infarction,and extensive cerebral infarctions,with lateonset seizures,cortical involvement,and hemorrhagic infarction serving as independent predictors.The risk model revealed an area under the curve of 0.732,with 88.37%specificity and 42.11%sensitivity.These three were also correlated with lower MoCA scores and higher SAS and SDS scores.CONCLUSION In patients with IS,recurrent seizures after the first episode can be independently predicted by late-onset seizures,cortical involvement,and hemorrhagic cerebral infarction-factors also correlating with cognitive impairment and emotional distress.These findings underscore the need for close clinical monitoring and targeted interventions(e.g.,cognitive rehabilitation and psychological support)to mitigate seizure recurrence in high-risk individuals.
基金Supported by Yongchuan District Natural Science Foundation,No.2022yc-jckx20050。
文摘BACKGROUND Anxiety complicates recovery in esophagectomy patients undergoing esophagectomy,while preoperative depressive symptoms may further delay surgeryassociated malnutrition resolution,highlighting a critical need for psychological intervention.AIM To explore the correlation of anxiety and depression with mindfulness levels in patients undergoing esophagectomy for esophageal cancer and analyze associated risk factors.METHODS A total of 120 patients with esophageal cancer,all of whom underwent esophagectomy in The Affiliated Yongchuan Hospital of Chongqing Medical University between September 2022 and September 2024,were enrolled.The hospital anxiety and depression scale(HADS)was utilized to evaluate the anxiety(HADS-anxiety subscale,HADS-A)and depression(HADS-depression subscale,HADS-D)levels of these patients,and the Mindful Attention Awareness Scale(MAAS)was employed to assess their mindfulness levels.The relationships among anxiety,depression,and mindfulness levels were analyzed,and both univariate and multivariate analyses were conducted to identify the risk factors for anxiety and depression in these patients.RESULTS Data revealed that the mean HADS-A score of patients undergoing esophagectomy was(10.43±4.24)points,and 40.00%,35.00%,and 10.83%of the patients had mild,moderate,and severe anxiety,respectively.The mean HADS-D score https://www.wjgnet.com 2 September 19,2025 Volume 15 Issue 9 was(9.20±4.66)points,and 37.50%,23.33%,and 9.17%of the patients had mild,moderate,and severe depression,respectively.Patients with negative or mild anxiety(or depression)exhibited significantly higher MAAS scores than those with moderate or severe anxiety(or depression).The HADS-A and HADS-D scores showed a strong and negative correlation with the MAAS score.Univariate and multivariate analyses demonstrated that sex(P=0.006),age(P=0.017),per capita monthly household income(P=0.005),and educational level(P=0.004)were all independently associated with the exacerbation of anxiety in patients undergoing esophagectomy.Age(P=0.026),living status(P=0.005),per capita monthly household income(P=0.024),educational level(P=0.002),and postoperative complications(P<0.001)were all independently related to the aggravation of depression in such patients.CONCLUSION This study indicated a significant negative correlation among anxiety,depression,and mindfulness levels in patients undergoing esophagectomy.Sex,age,per capita monthly household income,and educational level were risk factors for anxiety in patients undergoing esophagectomy,whereas age,living status,per capita monthly household income,educational level,and postoperative complications were risk factors for depression.
基金Supported by the Health Commission of Guangxi Zhuang Autonomous Region Self-Funded Research Projects,No.Z20180575 and No.Z-A20231058.
文摘BACKGROUND Postoperative delirium(POD)is a concerning complication of organ transplantation.With organ transplantation offering hope to patients with end-stage organ disease,understanding the incidence and risk factors of POD is crucial,as it can significantly affect patients’prognosis and healthcare costs.AIM To systematically evaluate the incidence and risk factors of POD following organ transplantation to facilitate clinical prevention and optimize patient management and prognosis.METHODS Multiple databases such as PubMed and their reference lists were comprehensively searched using a combination of keywords related to organ transplantation and POD.Relevant observational studies on patients who had undergone solid organ transplantation and randomized controlled trials containing relevant analyses were included.Duplicated,data-deficient,non-English,and non-original data studies were excluded.Data were extracted independently by two researchers and then cross-checked.The Newcastle-Ottawa scale was used to evaluate the quality of the included studies.RevMan 5.3 was employed for data analysis.The pooled incidence of POD was calculated according to the data type,and the fixed or random effect model was employed to analyze risk factors based on heterogeneity.Subsequently,sensitivity analysis and publication bias assessments were performed.RESULTS A total of 39 relevant literatures were included.The overall incidence of POD in the organ transplant group was 20%[95%confidence interval(CI):18%-22%];liver transplant group,22%(95%CI:17%-26%);lung transplant group,34%(95%CI:23%-45%);and kidney transplant group,6%(95%CI:2%-10%).Primary graft dysfunction increased the POD risk,with a pooled odds ratio(OR)(95%CI)of 1.78(1.09-2.91).A history of hepatic encephalopathy increased the POD risk,with a pooled OR(95%CI)of 3.19(2.30-4.43).The higher the Acute Physiology and Chronic Health Evaluation II score,the greater the POD risk,with a pooled OR(95%CI)of 1.52(1.09-2.12).A history of alcohol abuse increased the POD risk,with a pooled OR(95%CI)of 2.84(1.74-4.65).Thus,the higher the model for end-stage liver disease score,the greater the POD risk,with a pooled OR(95%CI)of 2.49(1.14-5.43).POD was more likely to develop in patients with preoperative infections,with a pooled OR(95%CI)of 2.78(1.56-4.97).The use of diuretics increased the POD risk,with a pooled OR(95%CI)of 2.36(1.38-4.04).CONCLUSION In this study,the overall incidence of POD in patients who underwent organ transplantation is 20%.The incidence varies among different types of organ transplantation,and multiple factors can increase the POD risk.
