BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifyi...BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.展开更多
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
BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospit...BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospital mortality.However,limited data exist on early predictors of mortality at ED admission.Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIM To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODS This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research,Chandigarh,India.CKD was diagnosed and staged following the Kidney Disease:Improving Global Outcomes guidelines.Data were extracted from medical records using a structured form.All consecutive patients aged≥18 years were included.Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTS Among 354 patients(mean age 49 years;58%males),60.5%had CKD stage 5,and 41.2%were on maintenance dialysis.Hypertension(74.9%)and diabetes(46.0%)were common comorbidities.Diabetic kidney disease was the primary etiology in 35.6%,while 43.2%had unknown causes.Infection(63.0%)was the most frequent cause for ED admission.In-hospital mortality was 29.1%(n=103).Independent mortality predictors were Glasgow coma scale(GCS)<15[hazard ratio(HR):1.822,P=0.017],hyperglycemia(HR:1.641,P=0.020),and low albumin(HR:1.270,P=0.028).Advanced age,Charlson comorbidity Index,quick Sequential Organ Failure Assessment,and neutrophilia were significant in univariate but not multivariate analysis.CKD stage,dialysis dependency,cardiovascular disease,and neutrophil-lymphocyte ratio were not predictive.CONCLUSION A low GCS,hyperglycemia,and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED,warranting early recognition and targeted interventions.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
BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and he...BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.展开更多
BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scen...BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scenario to decide whether to do a biopsy or not.Since non-diabetic kidney diseases(NDKD)are common,and some patients may have NDKD superimposed on diabetic kidney diseases(DKD),therefore,kidney biopsy may be warranted to rule out NDKD.AIM To determine the prevalence of NDKD,DKD,or mixed lesions,identify predictors of NDKD,and investigate renal and patient survival,as well as factors associated with these outcomes.METHODS This retrospective observational study was conducted on patients with biopsyproven NDKD,DKD,and mixed lesions(having both NDKD and DKD).Binary logistic regression models were constructed to identify predictors of NDKD.Kaplan-Meier survival analysis was performed to compare time to kidney failure and patient survival across the three histological groups.Multivariable Cox proportional hazards regression was used to identify clinical and pathological factors associated with kidney failure and all-cause mortality.RESULTS A total of 103 biopsies were analyzed.Sixty-four(62.1%)had NDKD alone or mixed lesions.The most common NDKD pathologies were interstitial nephritis in 12(29.2%),focal segmental glomerulosclerosis in 10(24.4%),and immune complex–mediated glomerulonephritis in five(12.2%)patients.Compared to DKD,NDKD was associated with significantly lower odds of proteinuria>3.5 g/day[odds ratio(OR),0.02;P=0.0015],retinopathy(OR=0.04;P=0.0067),and diabetes duration≥10 years(OR=0.01;P=0.0002).However,NDKD had higher odds of anemia(Hemoglobin<12 g/dL;OR=9.56;P=0.0107)and creatinine levels>180μmol/L(OR=18.68;P=0.0063).Kaplan-Meier analysis showed significant differences in renal survival(log-rank P=0.0033).Patients with NDKD have the best outcomes,while those with DKD have the worst.In a multivariable Cox regression analysis,increasing age,creatinine,arteriosclerosis,and severe interstitial fibrosis and tubular atrophy were independently associated with kidney failure.At the same time,the use of renin angiotensin system blockers was protective(hazard ratio=0.43,P=0.02).Kaplan-Meier curves for patient survival also differed significantly(log-rank P=0.018);patients in the mixed group showed the highest mortality,while those with NDKD showed the lowest.Mortality was independently associated with older age,hypoalbuminemia,diabetic retinopathy,arteriosclerosis,and higher creatinine.CONCLUSION NDKD and mixed lesions are frequent in diabetic patients.These histological lesions carry distinct prognostic implications.Clinical features such as a shorter diabetes duration,absence of retinopathy,anemia,and elevated creatinine levels suggest NDKD and warrant biopsy.NDKD had better renal and patient survival rates,while mixed lesions had the worst outcomes.Older age,hypoalbuminemia,retinopathy,arteriosclerosis,and elevated creatinine were key predictors of mortality.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
BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicti...BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicting therapeutic response is challenging and an area of active research.Gut microbiota has emerged as an important player in the pathogenesis of CD and also appears to be a promising biomarker for predicting therapeutic response.AIM To systematically review the literature on the current status of gut microbiota as a tool to predict response to treatment in adults with CD.METHODS We searched the literature database(PubMed,Scopus,and Cochrane database)from inception to August 2025.We screened for studies reporting on adult patients with CD receiving biologic or immunomodulator therapies,with baseline microbiome analyses performed prior to treatment.Papers reporting on baseline gut microbiota as a predictor of therapeutic response were finally included.The utility of bacterial diversity,microbial community structure,and the role of specific operational taxonomic units as biomarkers of therapeutic response was reviewed.The results were grouped based on the bacterial parameters studied and presented in separate tables.The quality of the included studies was assessed using the MINORS criteria.The review was registered prospectively in PROSPERO.RESULTS After applying the selection criteria,sixteen studies were included in this systematic review.The majority of the papers were from Europe and the United States.All except two papers assessed gut bacterial population using 16S rRNA gene sequencing.Ten of the sixteen studies were of high quality.Among the sixteen studies included,most identified an association between microbial taxa and treatment response,while the relation with alpha-diversity was inconsistent.The functional characteristics were reported in only four studies and were found to be useful.The best prediction was achieved when microbial characteristics were combined with clinical and other parameters,with area under the curve values up to 0.96.CONCLUSION The overall results suggest good performance of microbial parameters as a novel biomarker of therapeutic response.However,there are variations across individual studies,probably related to the methodology of assessing microbial communities and the therapeutic agent used.Future multicenter studies integrating microbial,clinical,and metabolomic data are warranted to develop predictive models for personalized therapy in CD.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
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
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
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
Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged f...Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged from 10%-30%due to sepsis,multi-organ failure,and systemic inflammatory response syndrome.Assessing the predictors of poor outcomes,including mortality,intensive care unit(ICU)admission,and hospital stay,is vital for early and effective intervention.We assessed the predictors of mortality and ICU admission in patients with AC.We conducted a literature search in PubMed/MEDLINE,Google Scholar,and Cochrane Library for relevant articles.The keywords used were acute cholangitis,biliary cholangitis,predictors,mortality,ICU admission,and Hospital stay.In addition,we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes.Old age,end-organ failure,red cell distribution width to albumin ratio,neutrophil-to-lymphocyte ratio,platelet-lymphocyte ratio,the need for ventilator support,diabetes,electrolyte imbalance,procalcitonin-to-albumin ratio,C-reactive protein-to-albumin,Glasgow Coma Scale,and systolic hypertension are predictors of poor outcomes in AC of varying etiology,and concurrent acute pancreatitis was not associated with ICU admission.展开更多
The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse r...The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse risk.Participants were SCC patients aged≥18 years who enrolled between June 2019 and December 2021,completed follow-up assessments at one and three months,and reported abstinence at one month.Short-term relapse was defined as self-reported smoking at the three-month follow-up.Treatments included counseling,first-line cessation medications,and traditional Chinese medicine(TCM).Logistic regression was used to identify factors associated with short-term relapse.Among 10,724 eligible SCC patients,11.6%experienced short-term relapse.Factors positively associated with relapse included the number of previous quit attempts(1–5 attempts:OR=1.422,95%CI:1.254–1.613,>5 attempts:OR=1.382,95%CI:1.057–1.808),high perceived difficulty in quitting(OR=1.297,95%CI:1.061–1.586),and moderate(OR=1.383,95%CI:1.174–1.629)or weak(OR=1.517,95%CI:1.251–1.841)willingness to quit.Factors negatively associated with relapse included having a college degree or higher(OR=0.796;95%CI:0.650–0.973),high confidence in quitting(OR=0.786;95%CI:0.629–0.983),and use of TCM(OR=0.276;95%CI:0.158–0.482).Enhancing self-efficacy in quitting appears crucial for preventing short-term relapse.The use of TCM may reduce relapse risk and warrants further investigation.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
Based on strong and weak forms of elastic wave equations, a Chebyshev spectral element method （SEM） using the Galerkin variational principle is developed by discretizing the wave equation in the spatial and time dom...Based on strong and weak forms of elastic wave equations, a Chebyshev spectral element method （SEM） using the Galerkin variational principle is developed by discretizing the wave equation in the spatial and time domains and introducing the preconditioned conjugate gradient （PCG）-element by element （EBE） method in the spatial domain and the staggered predictor/corrector method in the time domain. The accuracy of our proposed method is verified by comparing it with a finite-difference method （FDM） for a homogeneous solid medium and a double layered solid medium with an inclined interface. The modeling results using the two methods are in good agreement with each other. Meanwhile, to show the algorithm capability, the suggested method is used to simulate the wave propagation in a layered medium with a topographic traction free surface. By introducing the EBE algorithm with an optimized tensor product technique, the proposed SEM is especially suitable for numerical simulation of wave propagations in complex models with irregularly free surfaces at a fast convergence rate, while keeping the advantage of the finite element method.展开更多
文摘BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.
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BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospital mortality.However,limited data exist on early predictors of mortality at ED admission.Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIM To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODS This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research,Chandigarh,India.CKD was diagnosed and staged following the Kidney Disease:Improving Global Outcomes guidelines.Data were extracted from medical records using a structured form.All consecutive patients aged≥18 years were included.Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTS Among 354 patients(mean age 49 years;58%males),60.5%had CKD stage 5,and 41.2%were on maintenance dialysis.Hypertension(74.9%)and diabetes(46.0%)were common comorbidities.Diabetic kidney disease was the primary etiology in 35.6%,while 43.2%had unknown causes.Infection(63.0%)was the most frequent cause for ED admission.In-hospital mortality was 29.1%(n=103).Independent mortality predictors were Glasgow coma scale(GCS)<15[hazard ratio(HR):1.822,P=0.017],hyperglycemia(HR:1.641,P=0.020),and low albumin(HR:1.270,P=0.028).Advanced age,Charlson comorbidity Index,quick Sequential Organ Failure Assessment,and neutrophilia were significant in univariate but not multivariate analysis.CKD stage,dialysis dependency,cardiovascular disease,and neutrophil-lymphocyte ratio were not predictive.CONCLUSION A low GCS,hyperglycemia,and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED,warranting early recognition and targeted interventions.
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.
文摘BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.
文摘BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scenario to decide whether to do a biopsy or not.Since non-diabetic kidney diseases(NDKD)are common,and some patients may have NDKD superimposed on diabetic kidney diseases(DKD),therefore,kidney biopsy may be warranted to rule out NDKD.AIM To determine the prevalence of NDKD,DKD,or mixed lesions,identify predictors of NDKD,and investigate renal and patient survival,as well as factors associated with these outcomes.METHODS This retrospective observational study was conducted on patients with biopsyproven NDKD,DKD,and mixed lesions(having both NDKD and DKD).Binary logistic regression models were constructed to identify predictors of NDKD.Kaplan-Meier survival analysis was performed to compare time to kidney failure and patient survival across the three histological groups.Multivariable Cox proportional hazards regression was used to identify clinical and pathological factors associated with kidney failure and all-cause mortality.RESULTS A total of 103 biopsies were analyzed.Sixty-four(62.1%)had NDKD alone or mixed lesions.The most common NDKD pathologies were interstitial nephritis in 12(29.2%),focal segmental glomerulosclerosis in 10(24.4%),and immune complex–mediated glomerulonephritis in five(12.2%)patients.Compared to DKD,NDKD was associated with significantly lower odds of proteinuria>3.5 g/day[odds ratio(OR),0.02;P=0.0015],retinopathy(OR=0.04;P=0.0067),and diabetes duration≥10 years(OR=0.01;P=0.0002).However,NDKD had higher odds of anemia(Hemoglobin<12 g/dL;OR=9.56;P=0.0107)and creatinine levels>180μmol/L(OR=18.68;P=0.0063).Kaplan-Meier analysis showed significant differences in renal survival(log-rank P=0.0033).Patients with NDKD have the best outcomes,while those with DKD have the worst.In a multivariable Cox regression analysis,increasing age,creatinine,arteriosclerosis,and severe interstitial fibrosis and tubular atrophy were independently associated with kidney failure.At the same time,the use of renin angiotensin system blockers was protective(hazard ratio=0.43,P=0.02).Kaplan-Meier curves for patient survival also differed significantly(log-rank P=0.018);patients in the mixed group showed the highest mortality,while those with NDKD showed the lowest.Mortality was independently associated with older age,hypoalbuminemia,diabetic retinopathy,arteriosclerosis,and higher creatinine.CONCLUSION NDKD and mixed lesions are frequent in diabetic patients.These histological lesions carry distinct prognostic implications.Clinical features such as a shorter diabetes duration,absence of retinopathy,anemia,and elevated creatinine levels suggest NDKD and warrant biopsy.NDKD had better renal and patient survival rates,while mixed lesions had the worst outcomes.Older age,hypoalbuminemia,retinopathy,arteriosclerosis,and elevated creatinine were key predictors of mortality.
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.
文摘BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicting therapeutic response is challenging and an area of active research.Gut microbiota has emerged as an important player in the pathogenesis of CD and also appears to be a promising biomarker for predicting therapeutic response.AIM To systematically review the literature on the current status of gut microbiota as a tool to predict response to treatment in adults with CD.METHODS We searched the literature database(PubMed,Scopus,and Cochrane database)from inception to August 2025.We screened for studies reporting on adult patients with CD receiving biologic or immunomodulator therapies,with baseline microbiome analyses performed prior to treatment.Papers reporting on baseline gut microbiota as a predictor of therapeutic response were finally included.The utility of bacterial diversity,microbial community structure,and the role of specific operational taxonomic units as biomarkers of therapeutic response was reviewed.The results were grouped based on the bacterial parameters studied and presented in separate tables.The quality of the included studies was assessed using the MINORS criteria.The review was registered prospectively in PROSPERO.RESULTS After applying the selection criteria,sixteen studies were included in this systematic review.The majority of the papers were from Europe and the United States.All except two papers assessed gut bacterial population using 16S rRNA gene sequencing.Ten of the sixteen studies were of high quality.Among the sixteen studies included,most identified an association between microbial taxa and treatment response,while the relation with alpha-diversity was inconsistent.The functional characteristics were reported in only four studies and were found to be useful.The best prediction was achieved when microbial characteristics were combined with clinical and other parameters,with area under the curve values up to 0.96.CONCLUSION The overall results suggest good performance of microbial parameters as a novel biomarker of therapeutic response.However,there are variations across individual studies,probably related to the methodology of assessing microbial communities and the therapeutic agent used.Future multicenter studies integrating microbial,clinical,and metabolomic data are warranted to develop predictive models for personalized therapy in CD.
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Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged from 10%-30%due to sepsis,multi-organ failure,and systemic inflammatory response syndrome.Assessing the predictors of poor outcomes,including mortality,intensive care unit(ICU)admission,and hospital stay,is vital for early and effective intervention.We assessed the predictors of mortality and ICU admission in patients with AC.We conducted a literature search in PubMed/MEDLINE,Google Scholar,and Cochrane Library for relevant articles.The keywords used were acute cholangitis,biliary cholangitis,predictors,mortality,ICU admission,and Hospital stay.In addition,we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes.Old age,end-organ failure,red cell distribution width to albumin ratio,neutrophil-to-lymphocyte ratio,platelet-lymphocyte ratio,the need for ventilator support,diabetes,electrolyte imbalance,procalcitonin-to-albumin ratio,C-reactive protein-to-albumin,Glasgow Coma Scale,and systolic hypertension are predictors of poor outcomes in AC of varying etiology,and concurrent acute pancreatitis was not associated with ICU admission.
文摘The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse risk.Participants were SCC patients aged≥18 years who enrolled between June 2019 and December 2021,completed follow-up assessments at one and three months,and reported abstinence at one month.Short-term relapse was defined as self-reported smoking at the three-month follow-up.Treatments included counseling,first-line cessation medications,and traditional Chinese medicine(TCM).Logistic regression was used to identify factors associated with short-term relapse.Among 10,724 eligible SCC patients,11.6%experienced short-term relapse.Factors positively associated with relapse included the number of previous quit attempts(1–5 attempts:OR=1.422,95%CI:1.254–1.613,>5 attempts:OR=1.382,95%CI:1.057–1.808),high perceived difficulty in quitting(OR=1.297,95%CI:1.061–1.586),and moderate(OR=1.383,95%CI:1.174–1.629)or weak(OR=1.517,95%CI:1.251–1.841)willingness to quit.Factors negatively associated with relapse included having a college degree or higher(OR=0.796;95%CI:0.650–0.973),high confidence in quitting(OR=0.786;95%CI:0.629–0.983),and use of TCM(OR=0.276;95%CI:0.158–0.482).Enhancing self-efficacy in quitting appears crucial for preventing short-term relapse.The use of TCM may reduce relapse risk and warrants further investigation.
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 the National Natural Science Foundation of China(Grant No.40774099,10874202)the National High Technology Research and Development Program of China(Grant No.2008AA06Z205)
文摘Based on strong and weak forms of elastic wave equations, a Chebyshev spectral element method （SEM） using the Galerkin variational principle is developed by discretizing the wave equation in the spatial and time domains and introducing the preconditioned conjugate gradient （PCG）-element by element （EBE） method in the spatial domain and the staggered predictor/corrector method in the time domain. The accuracy of our proposed method is verified by comparing it with a finite-difference method （FDM） for a homogeneous solid medium and a double layered solid medium with an inclined interface. The modeling results using the two methods are in good agreement with each other. Meanwhile, to show the algorithm capability, the suggested method is used to simulate the wave propagation in a layered medium with a topographic traction free surface. By introducing the EBE algorithm with an optimized tensor product technique, the proposed SEM is especially suitable for numerical simulation of wave propagations in complex models with irregularly free surfaces at a fast convergence rate, while keeping the advantage of the finite element method.
