BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different ...BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.展开更多
BACKGROUND Glaucoma,a condition frequently linked to severe depression,anxiety,and sleep disturbances,affects treatment adherence while potentially compromising effectiveness.AIM To explore illness uncertainty(IU),anx...BACKGROUND Glaucoma,a condition frequently linked to severe depression,anxiety,and sleep disturbances,affects treatment adherence while potentially compromising effectiveness.AIM To explore illness uncertainty(IU),anxiety,and depressive symptoms in primary glaucoma and to discuss underlying triggers.METHODS We recruited 120 primary glaucoma cases between January 2022 and November 2023.The Mishel Uncertainty in Illness Scale(MUIS)and the Hospital Anxiety and Depression Scale(HADS)[include HADS-anxiety subscale(HADS-A)and HADS-depression subscale(HADS-D)]subscales,were used to assess IU and emotional distress(anxiety/depression),respectively.The MUIS-HADS subscale interrelationships were determined by Pearson correlation.IU-associated determinants were identified using univariate and binary logistic regression analyses.RESULTS The cohort showed a mean MUIS score of 79.73±8.97,corresponding to a moderately high IU level.The HADS-A and HADS-D scores averaged 6.57±3.89 and 7.08±5.05 points,respectively,with 15.00%of participants showing anxiety symptoms and 24.17%exhibiting depressive signs.Significant positive connections were observed between MUIS and both HADS-A(r=0.359,P<0.001)and HADSD(r=0.426,P<0.001).Univariate analysis revealed that disease duration,insomnia,monthly household income per capita,and the presence of comorbid chronic conditions were significantly associated with anxiety or depression.Multivariate analysis identified insomnia as a risk factor and higher monthly household income as a protective factor.CONCLUSION Patients with primary glaucoma experience moderate IU levels,generally low anxiety,and mild depression.Specifically,the anxiety and depression risks were 15.00%and 24.17%,respectively.A significant positive correlation existed between IU and anxiety/depression in these patients.Additionally,insomnia or lower monthly household income elevated anxiety/depression risks,enabling reliable anxiety/depression risk categorization among patients.展开更多
BACKGROUND This study explores the 3-year survival outcomes and associated influencing factors in patients with primary gastric cancer treated via laparoscopic surgery,providing meaningful guidance for clinical manage...BACKGROUND This study explores the 3-year survival outcomes and associated influencing factors in patients with primary gastric cancer treated via laparoscopic surgery,providing meaningful guidance for clinical management.AIM To evaluate and analyze the 3-year survival outcomes and associated risk factors in patients with primary gastric cancer who underwent laparoscopic surgery.METHODS A total of 100 patients with primary gastric cancer who underwent laparoscopic surgery at our hospital between January 2019 and December 2021 were enrolled.These patients were monitored for 3 years,and their survival statuses were recorded.Patients were categorized into survival and non-survival groups based on their outcomes.Data on sex,age,American Society of Anesthesiologists classification,tumor size,depth of invasion,postoperative adjuvant radio-chemotherapy,postoperative carcinoembryonic antigen(CEA)levels,and other clinical parameters were collected and contrasted across groups to identify factors impacting 3-year survival.RESULTS After a 3-year follow-up,the survival rate was 73.00%(73 of 100 patients).No significant differences were observed in sex,tumor location,alcohol consumption,smoking status,tumor differentiation,histological type,intraoperative blood loss,or surgical outcomes between patients with varying prognoses(P>0.05).However,notable disparities were found in age,American Society of Anesthesiologists classification,tumor-node-metastasis(TNM)stage,tumor size,depth of invasion,lymph node metastasis,lymph node dissection,postoperative adjuvant radio-chemotherapy,postoperative CEA levels,surgical duration,extent of gastric resection,and postoperative complications(P<0.05).Multivariate logistic regression analysis identified age,TNM stage,tumor size,depth of invasion,lymph node metastasis,lymph node dissection,postoperative adjuvant radio-chemotherapy,postoperative CEA levels,surgical duration,extent of gastric resection,and postoperative complications as independent predictors of 3-year survival in patients with primary gastric cancer following laparoscopic surgery(P<0.05).CONCLUSION The 3-year survival outcome for patients undergoing laparoscopic surgery for primary gastric cancer was 73.00%.Key determinants of survival included age,TNM stage,tumor size,depth of invasion,and lymph node metastasis.This analysis of 3-year survival and its influencing factors offers novel perspectives for optimizing clinical interventions in patients with primary gastric cancer treated via laparoscopic surgery.展开更多
The study aims to determine the validity and reliability of the Wechsler Preschool and Primary Scale of Intelligence–Third Edition(WPPSI-III)scores in a sample of kindergarten and lower primary pupils from Khartoum S...The study aims to determine the validity and reliability of the Wechsler Preschool and Primary Scale of Intelligence–Third Edition(WPPSI-III)scores in a sample of kindergarten and lower primary pupils from Khartoum State,Sudan.It also aims to examine whether test’s factor structure in this sample replicated that of the original WPPSI-III.The study sample consisted of 384 kindergarten and primary school children in Khartoum State(females=50%mean age=4.14,SD=1.37),selected using stratified random sampling across its seven localities:Khartoum,Jebel Awliya,Khartoum Bahri,East Nile,Omdurman,Ombada,Karari.For concurrent validation,the children additionally completed the Goodenough Draw-a-Man Test,and the Colored Progressive Matrices.WPPSI-III scores demonstrated high internal consistency across the subtest items.Confirmatory factor analysis indicators for total,verbal,and performance intelligence were all excellent.The scale also showed weak to strong score stability ranging from 0.25(weak)to 0.88(strong)based on the Spearman-Brown equation,0.25 to 0.75 based on the Guttman split-half method.The Cronbach’s alpha coefficient scores ranged from 0.54 to 0.93.The WPPSI-III and Goodenough Draw-a-Man Test scores concurrent validity scores were poor(0.05)to modest(0.31),and while those with the Colored Progressive Matrices test were poor(r=0.04–0.18).Thesefindings provide evidence to suggest that the WPPSI-III is appropriate for research use with kindergarten and lower primary school students in Khartoum State,Sudan.展开更多
AIM:To identify risk factors for postoperative blindness in patients with primary rhegmatogenous retinal detachment(RRD)at their first presentation to a tertiary center,using a large clinical database to improve under...AIM:To identify risk factors for postoperative blindness in patients with primary rhegmatogenous retinal detachment(RRD)at their first presentation to a tertiary center,using a large clinical database to improve understanding of this adverse outcome.METHODS:Electronic health records of patients with primary RRD from the Eye Hospital of Wenzhou Medical University were retrospectively analyzed.Postoperative blindness was defined according to the World Health Organization(WHO)criteria for legal blindness.Potential risk factors included demographic characteristics,preoperative clinical features,and surgical variables.Univariable and multivariable logistic regression analyses were performed to calculate odds ratios(ORs)and 95%confidence intervals(CIs)for each risk factor.RESULTS:A total of 532 patients were included in the cohort,of whom 62(12.0%;28 males,34 females)developed postoperative blindness at the final follow-up.Among these 62 patients,30 had high myopia and 32 did not.The mean age of participants was 49.0±16.4y,with 275 subjects(52%)being male and 133 patients(25%)having the condition in the right eye.In the multivariable model for all patients,the following factors were associated with an increased risk of postoperative blindness:higher preoperative logarithm of the minimum angle of resolution visual acuity(logMAR VA;OR=1.09 per 0.1 logMAR unit increase,95%CI 1.03-1.15);inferior or superior retinal breaks(OR=2.42,95%CI 1.12-5.24);and macular holes or superior retinal breaks(OR=8.46,95%CI 3.45-20.75).In the subgroup of patients with high myopia,risk factors for postoperative blindness included:pseudophakia/aphakia versus phakia(OR=6.33,95%CI 1.41-28.31);macular holes or superior retinal breaks(OR=15.15,95%CI 3.07-74.85);and proliferative vitreoretinopathy(PVR;OR=21.41,95%CI 2.14-214.57).In the subgroup of patients without high myopia,increased risk of postoperative blindness was associated with:higher preoperative logMAR VA(OR=1.11 per 0.1 logMAR unit increase,95%CI 1.04-1.18);and inferior or superior retinal breaks(OR=2.90,95%CI 1.19-7.06).CONCLUSION:Using a large real-world clinical database,we identified distinct risk factors for postoperative blindness in patients with primary RRD-including differences between those with and without high myopia.These findings emphasize the need to target specific risk factors in clinical practice to mitigate and reduce the incidence of postoperative blindness in this patient population.展开更多
BACKGROUND The pathogenesis of primary biliary cholangitis(PBC)remains unclear.Ursodeoxycholic acid(UDCA)is the only first-line clinical treatment,but approximately 40%of patients exhibit a poor response.AIM To identi...BACKGROUND The pathogenesis of primary biliary cholangitis(PBC)remains unclear.Ursodeoxycholic acid(UDCA)is the only first-line clinical treatment,but approximately 40%of patients exhibit a poor response.AIM To identify novel biomarkers for PBC to predict the efficacy of UDCA and enhance treatment.METHODS Microarray expression profiling datasets were downloaded from the Gene Expression Omnibus and analyzed to identify differentially expressed genes between PBC patients and healthy controls.Immunohistochemistry was performed to validate key genes in liver tissues of the participants.Logistic regression was employed to evaluate prognostic risk factors,receiver operating characteristic curves were used to assess predictive performance,and correlations between key genes and clinicopathological characteristics were analyzed.RESULTS By bioinformatic analysis,13 genes primarily associated with the progression of PBC were identified,and tumor necrosis factor alpha-induced protein 3(TNFAIP3)was selected for further investigation.Then expression of TNFAIP3 in PBC patients was significantly elevated compared to healthy controls on immunohistochemistry(P<0.0001).Multivariate Cox regression analysis indicated that both TNFAIP3 and fatigue were independent risk factors for response to UDCA in PBC patients(P<0.05).The area under the curve for TNFAIP3 and fatigue were 0.691 and 0.704,respectively,while their combination showed a significantly higher area under the curve of 0.848.The expression of TNFAIP3 was also correlated with age,albumin,total bilirubin,alkaline phosphatase and splenomegaly(P<0.05).CONCLUSION TNFAIP3 and fatigue are independent risk factors for response to UDCA in Chinese patients with PBC.TNFAIP3 may be a potential biomarker or therapeutic target for PBC.These findings offer new insights into the pathogenesis of PBC.展开更多
In this article,the author comment on the article by Zang et al.Tumor necrosis factor alpha-induced protein 3(TNFAIP3)was examined in this study as a novel biomarker to predict the efficiency of ursodeoxycholic acid(U...In this article,the author comment on the article by Zang et al.Tumor necrosis factor alpha-induced protein 3(TNFAIP3)was examined in this study as a novel biomarker to predict the efficiency of ursodeoxycholic acid(UDCA)and thereby improved primary biliary cholangitis(PBC)treatment.Differentially expressed genes in PBC patients and healthy controls(HCs)were detected using microarray expression analysis.PBC patients and HCs were examined for predictive performance and associations between important genes and clinicopathological features using immunohistochemistry,logistic regression,and receiver operating characteristic curve methods.Thirteen genes linked to the development of PBC were detected by the bioinformatic research.TNFAIP3 was chosen for additional examination from these 13 genes.TNFAIP3 was shown to be more expressed in PBCs patients than in HCs using immunohistochemical method.TNFAIP3 and fatigue have a significant impact on UDCA in PBC patients in multivariate cox regression analysis.Additionally,there was a correlation between TNFAIP3 expression and splenomegaly,alkaline phosphatase,albumin,total bilirubin,and age.In conclusion,TNFAIP3 and fatigue have significant impact on UDCA in PBC.These findings provide a new view on PBC pathophysiology and suggest that TNFAIP3 may be a suitable biomarker or therapeutic target for the disease.展开更多
BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is cruc...BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.AIM To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC,with a focus on strict adherence to indications.METHODS Clinical data of 106 cases undergoing LCBDE+PDC in the Hepatobiliary and Pancreatic Surgery Department(Division 1)of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected.Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage.The change in surgical time was analyzed using the cumulative summation(CUSUM)method,and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.RESULTS Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage(P<0.05).The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage(P<0.05),with statistical significance.The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve(P=0.023).CONCLUSION With a good assessment of duodenal papilla sphincter function,unobstructed bile-pancreatic duct convergence,exact stone clearance,and sufficient surgical experience to complete the learning curve,PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.展开更多
BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholan...BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholangiocarcinoma.Although PSC predominantly affects adults,the incidence in pediatric patients is rising.For individuals in the advanced stages of liver disease,liver transplantation(LT)is the sole curative treatment option.However,the recurrence of PSC in the transplanted liver,known as recurrent PSC(rPSC),remains a significant concern.AIM To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.METHODS A literature search was carried out across databases,including PubMed,Embase,Cochrane Library,and Scopus,covering studies published from 1990 through 2024.The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies.Statistical analyses were conducted using RevMan 5.3 software,where the risk of recurrence was quantified using hazard ratios(HR)with 95%CI.RESULTS A total of nine reports with 2524 pediatric patients with PSC were included in this analysis.The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant,including concurrent inflammatory bowel disease(IBD),elevated liver enzyme levels,and the presence of PSCautoimmune hepatitis(AIH)overlap syndrome(all P<0.05).No statistically significant association was found between acute allograft rejection,Epstein-Barr virus infection,and the risk of rPSC recurrence in the pediatric liver transplant recipients.CONCLUSION The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT,including IBD,elevated liver enzyme levels,and PSC-AIH overlap syndrome.展开更多
Objective To explore the relationship between psychological factors and efficacy of acupuncture on primary dysmenorrhea. Methods Sixty cases of primary dysmenorrhea were observed. Before acupuncture treatment, the sel...Objective To explore the relationship between psychological factors and efficacy of acupuncture on primary dysmenorrhea. Methods Sixty cases of primary dysmenorrhea were observed. Before acupuncture treatment, the self-designed confidence questionnaire was used to assess patients＇ confidence in acupuncture efficacy. Visual Analogue Scale （VAS） was adopted to assess patients＇ tension level during acupuncture. Self-rating anxiety scale （SAS） and self-rating depression scale （SDS） were applied to assess the situations of patients＇ anxiety and depression. Eysenck＇s personality questionnaire （EPQ） and Cattell sixteen personality factors questionnaire （16PF） were provided to assess the personal characters of patients. Pain intensity, pain duration and accompanied symptoms were recorded before and after acupuncture treatment so as to assess the efficacy. Canonical correlation analysis was used to analyze the relationship between the psychological factors and acupuncture efficacy on primary dysmenorrhea. Results There were significant differences in grading of dysmenorrhea, pain intensity score and pain duration after treatment as compared statistically with those before treatment （all P〈0.001）. The standardized coefficients of dominance （r=0.679 7） and anxiety （r=-0.590 6） in personality factors and the reduction of pain duration （r=-0.904 2） among efficacy indices were the highest. The overall correlation coefficients were all lower between the indices of psychological factors and canonical variables of dysmenorrhea efficacy. Conclusion Acupuncture efficacy on primary dysmenorrhea has a certain correlation with dominance and anxiety of patients＇ personality factors. But, the psychological factors do not play a leading role in acupuncture treatment.展开更多
This study examined the impact of the operative and peri-operative factors on the long-term prognosis of patients with primary liver cancer undergoing hepatectomy. A total of 222 patients with primary liver cancer who...This study examined the impact of the operative and peri-operative factors on the long-term prognosis of patients with primary liver cancer undergoing hepatectomy. A total of 222 patients with primary liver cancer who underwent hepatectomy were followed up from January 1986 to December 2010 at Chinese PLA General Hospital. The post-operative complication rate was 14.0% for all cases, 13.7% for hepatocellular carcinoma（HCC）, 10.0% for cholangiocarcinoma. The 1-, 3-, 5- and 10-year overall survival rates in patients with primary liver cancer after resection were 76.6%, 57.6%, 41.4%, and 21.0%. The survival rates were significantly higher in the HCC group than in the cholangiocarcinoma group（P=0.000）, in the non-anatomical resection group than in the anatomical resection group（P=0.005）, in the female group than in the male group（P=0.002）, in patients receiving no blood transfusion than in those who were given intra-operative blood transfusion（P=0.000）, in patients whose intra-operative blood loss was less than 400 m L than in those who intra-operatively lost more than 400 m L（P=0.000）. No significant difference was found in the survival rate between the HBs Ag-positive group and the HBs Ag-negative group（P=0.532）. Our study showed that anatomical resection, blood loss and blood transfusion were predictors of poor survival after hepatectomy for primary liver cancer patients, and concomitant hepatitis B virus infection bore no relation with the post-resection survival.展开更多
AIM:To examine the clinical features and analyze prognostic factors in a prospective study of primary biliary cirrhosis(PBC) patients.METHODS:From 1995 to 2010,PBC patients without hepatic decompensation seen at the P...AIM:To examine the clinical features and analyze prognostic factors in a prospective study of primary biliary cirrhosis(PBC) patients.METHODS:From 1995 to 2010,PBC patients without hepatic decompensation seen at the Peking Union Medical College Hospital were enrolled.Clinical signs and manifestations(pruritus,persistent fatigue,jaundice and pain in the right hypochondrium),laboratory parameters(auto-antibodies for autoimmune hepatic disease,biliary and hepatic enzymes,immunoglobulin,bilirubin,and albumin) and imaging findings were recorded at entry and at specific time points during follow-up.Cox regression and Kaplan-Meier analyses,respectively,assessed the risk factors for hepatic decompensation and survival.RESULTS:Two hundred and sixty-two PBC patients were enrolled with a median follow-up of 75.2 mo(range,21-201 mo).The 240 patients were aged 51.5 ± 10.2 years at diagnosis and 91.6% were female.Two hundred and forty-five(93.5%) were seropositive for anti-mitochondrial antibodies.At presentation,170 patients(64.9%) were symptomatic,while 96 patients(36.6%) had extra-hepatic autoimmune disease.During the follow-up period,62(23.7%) patients developed hepatic decompensation of whom four underwent liver transplantation and 17 died.The cumulative survival rate and median survival time were 83.9% and 181.7 mo,respectively.Cox regression analysis revealed that an incomplete ursodeoxycholic acid(UDCA) response or inconsistent treatment [P < 0.001;hazard risk(HR) 95%CI = 2.423-7.541],anti-centromere antibodies(ACA) positivity(P < 0.001;HR 95%CI = 2.516-7.137),alanine aminotransferase ratio(AAR) elevations(P < 0.001;HR 95%CI = 1.357-2.678),and histological advanced liver disease(P = 0.006;HR 95%CI = 1.481-10.847) were predictors of hepatic decompensation.The clinical features and survival of PBC in China are consistent with those described in Western countries.CONCLUSION:Incomplete UDCA response or inconsistent treatment,ACA positivity,AAR elevations,and advanced histological stage are predictors of decompensation.展开更多
AIM： To evaluate the risk factors for primary liver carcinoma （PLC） in Chinese population.METHODS： Chinese Biomedical Literature Database, China Hospital Knowledge Database and MEDLINE were searched. All the relat...AIM： To evaluate the risk factors for primary liver carcinoma （PLC） in Chinese population.METHODS： Chinese Biomedical Literature Database, China Hospital Knowledge Database and MEDLINE were searched. All the related literatures were screened, and the risk factors for PLC in Chinese population were studied. Heterogeneity was evaluated by odds ratio （OR） q test. Combined OR and its 95% confidence interval （95%CI）were calculated, the association between the investigated risk factors and PLC was determined. Validity and bias of the findings were evaluated by sensitivity analysis and funnel plot analysis respectively.RESULTS： Fifty-five of one hundred and ninety identified studies were accepted according to the inclusive criteria. Ten factors related to PLC were demonstrated by sensitive analysis and funnel plot analysis. They were cirrhosis （OR = 11.97, P= 0.000）, HBV infection （OR = 11.34, P= 0.000）,HCV infection （OR = 4.28, P = 0.000）, family history of liver cancer （OR = 3.49, P = 0.000）, unstable emotion （OR = 2.20, P = 0.000）, depressed characters （OR = 3.07,P = 0.000）, aflatoxin （OR = 1.80, P = 0.000）, alcoholic （OR = 1.88, P = 0.000）, intake of musty food （OR =1.87,P = 0.000） and drinking contaminated water from pond （OR = 1.77, P = 0.003）.CONCLUSION： The main risk factors for PLC in China are liver diseases, family history of liver carcinoma, poor psychic status, aflatoxin, and some unhealthy behaviors.展开更多
Primary ciliary dyskinesia （PCD） is an autosomal-recessive disorder resulting from the loss of normal ciliary function. Symptoms include neonatal respiratory distress, chronic sinusitis, bronchiectasis, situs invers...Primary ciliary dyskinesia （PCD） is an autosomal-recessive disorder resulting from the loss of normal ciliary function. Symptoms include neonatal respiratory distress, chronic sinusitis, bronchiectasis, situs inversus, and infertility. However, only 15 PCD-associated genes have been identified to cause male infertility to date. Owing to the genetic heterogeneity of PCD, comprehensive molecular genetic testing is not considered the standard of care. Here, we provide an update of the progress on the identification of genetic factors related to PCD associated with male infertility, summarizing the underlying molecular mechanisms, and discuss the clinical implications of these findings. Further research in this field will impact the diagnostic strategy for male infertility, enabling clinicians to provide patients with informed genetic counseling, and help to adopt the best course of treatment for developing directly targeted personalized medicine.展开更多
Glaucoma, one of the leading causes of irreversible blindness in the adult population worldwide, is a progressive optic neuropathy. Primary open angle glaucoma (POAG) is the most commonly reported type of glaucoma in ...Glaucoma, one of the leading causes of irreversible blindness in the adult population worldwide, is a progressive optic neuropathy. Primary open angle glaucoma (POAG) is the most commonly reported type of glaucoma in population based prevalence studies worldwide. Elevated intraocular pressure is a well-known major risk factor for POAG. In addition, there is growing evidence that other risk factors like age, gender, race, refractive error, heredity and systemic factors may play a role in glaucoma pathogenesis. Many studies found that high myopia has been associated with POAG, however, direct and convincing evidences are still lacking. The aim of this review is to summarize the evidences implicating high myopia as a risk factor in the pathogenesis of POAG.展开更多
BACKGROUND In rare instances,primary liver cancer can be associated with intraocular metastasis(IOM).AIM To investigate the correlation between a diverse range of clinical characteristics and IOM in diabetic patients ...BACKGROUND In rare instances,primary liver cancer can be associated with intraocular metastasis(IOM).AIM To investigate the correlation between a diverse range of clinical characteristics and IOM in diabetic patients with primary liver cancer,and to determine potential risk factors in predicting IOM.METHODS We recruited a total of 722 diabetic patients with primary liver cancer.The differences between the IOM and non-intraocular metastasis(NIOM)groups in these patients were assessed using the chi-squared test and Student’s t-test.Binary logistic regression analysis was subsequently used to determine risk factors.Finally,the diagnostic value of IOM in this cohort with primary liver cancer was analyzed by receiver operating characteristic(ROC)curve analysis.RESULTS In all,13 patients had IOM.There were no remarkable intergroup differences with respect to age,sex,histopathological sub-types,or blood biochemical parameters.However,the IOM group had significantly higher alpha-fetoprotein(AFP)and cancer antigen 125(CA125)values than the NIOM group.Binary logistic regression identified AFP and CA125 to be significant risk factors for IOM in diabetic patients with primary liver cancer.ROC curve analysis showed that the area under the curve values for AFP and CA125 were 0.727 and 0.796,with the cut-off values of 994.20 ng/mL and 120.23 U/mL,respectively.The sensitivity and specicity for AFP were 92.3%and 59.9%,while those for CA125 were 84.6%and 70.1%,respectively.CONCLUSION Elevated AFP and CA125 represent significant risk factors for IOM in diabetic patients with primary liver cancer.展开更多
BACKGROUND: We previously showed that insulin-like growth factor binding protein-related protein 1 (IGFBPrP1) is a novel mediator in liver fibrosis. Transforming growth factor beta 1 (TGF beta 1) is known as the stron...BACKGROUND: We previously showed that insulin-like growth factor binding protein-related protein 1 (IGFBPrP1) is a novel mediator in liver fibrosis. Transforming growth factor beta 1 (TGF beta 1) is known as the strongest effector of liver fibrosis. Therefore, we aimed to investigate the detailed interaction between IGFBPrP1 and TGF beta 1 in primary hepatic stellate cells (HSCs). METHODS: We overexpressed TGF beta 1 or IGFBPrP1 and inhibited TGF beta 1 expression in primary HSCs for 6, 12, 24, 48, 72, and 96 hours to investigate their interaction and observe the accompanying expressions of a-smooth muscle actin (alpha-SMA), collagen I, fibronectin, and phosphorylated-mothers against decapentaplegic homolog 2/3 (p-Smad2/3). RESULTS: We found that the adenovirus vector encoding the TGF beta 1 gene (AdTGF beta 1) induced IGFBPrP1 expression while that of alpha-SMA, collagen I, fibronectin, and TGF beta 1 increased gradually. Concomitantly, AdIGFBPrP1 upregulated TGF beta 1, alpha-SMA, collagen I, fibronectin, and p-Smad2/3 in a time-dependent manner while IGFBPrP1 expression was decreased at 96 hours. Inhibition of TGF beta 1 expression reduced the IGFBPrP1-stimulated expression of alpha-SMA, collagen I, fibronectin, and p-Smad2/3. CONCLUSIONS: These findings for the first time suggest the existence of a possible mutually regulation between IGFBPrP1 and TGF beta 1, which likely accelerates liver fibrosis progression. Furthermore, IGFBPrP1 likely participates in liver fibrosis in a TGF beta 1-depedent manner, and may act as an upstream regulatory factor of TGF beta 1 in the Smad pathway.展开更多
BACKGROUND Alpha-fetoprotein(AFP)is one of the diagnostic standards for primary liver cancer(PLC);however,AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.AIM To evaluate the effects of high-ri...BACKGROUND Alpha-fetoprotein(AFP)is one of the diagnostic standards for primary liver cancer(PLC);however,AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.AIM To evaluate the effects of high-risk factors and the diagnostic value of AFP in stratified PLC.METHODS In total,289 PLC cases from 2013 to 2019 were selected for analysis.First,the contributions of high-risk factors in stratifying PLC were compared according to the following criteria:Child–Pugh score,clinical stage of liver cirrhosis,tumor size,and Barcelona Clinic Liver Cancer(BCLC)stage.Then,the diagnostic value of AFP was evaluated in different stratifications of PLC by receiver operating characteristic curves.For PLC cases in which AFP played little role,the diagnostic values of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA 19-9),gamma-glutamyl transferase(GGT),and AFP were analyzed.RESULTS The roles of high-risk factors differed in stratified PLC.The incidence of smoking and drinking history was higher in PLC with Child–Pugh scores of C(P<0.0167).The hepatitis B virus(HBV)infection rate in PLC with cirrhosis was more than in PLC without cirrhosis(P<0.0167).Small tumors were more prone to cirrhosis than large tumors(P<0.005).BCLC stage D PLC was more likely to be associated with HBV infection and cirrhosis(P<0.0083).AFP levels were higher in PLC with cirrhosis,diffuse tumors,and BCLC stage D disease.In diagnosing PLC defined as Child–Pugh A,B,and C,massive hepatoma,diffuse hepatoma,BCLC stage B,C,and D,and AFP showed significant diagnostic value[all area under the curve(AUC)>0.700].However,these measures were meaningless(AUC<0.600)in small hepatomas and BCLC A stage PLC,but could be replaced by the combined detection of CEA,CA 19-9,GGT,and AFP(AUC=0.810 and 0.846,respectively).CONCLUSION Stratification of PLC was essential for precise diagnoses and benefited from evaluating AFP levels.展开更多
BACKGROUND Breast cancer is the most common malignancy in women all around the world.According to the latest statistics in 2018,there were more than 2.08 million new breast cancer cases all around the world and more t...BACKGROUND Breast cancer is the most common malignancy in women all around the world.According to the latest statistics in 2018,there were more than 2.08 million new breast cancer cases all around the world and more than 620000 deaths;the proportion of breast cancer deaths in women with cancer is 15%.By studying age,clinicopathological characteristics and molecular classification,age at menarche,age at birth,number of births,number of miscarriages,lactation time,surgical history of benign breast lesions,history of gynecological diseases,and other factors,we retrospectively summarized and compared the disease history of patients with primary breast cancer and patients with benign thyroid tumors admitted to our hospital in the past 10 years to explore the clinicopathological characteristics and risk factors for primary breast cancer.AIM To investigate the clinical and pathological features and risk factors for primary breast cancer treated at our center in order to provide a reference for the prevention and treatment of breast cancer in the Zhuhai-Macao region.METHODS Through a retrospective case-control study,149 patients with primary breast cancer diagnosed and treated at Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2013 to March 2020 were included as a case group,and 165 patients with benign breast tumors diagnosed and treated from January 2019 to March 2020 were included as a control group.The data collected included age,age at menarche,age at first birth,number of births,number of miscarriages,lactation time,history of surgery for benign breast lesions,history of familial malignant tumors,history of gynecological diseases,history of thyroid diseases,and the tumor characteristics of the patients in the case group including pathological diagnosis,pathological type,tumor size,lymph node metastasis,distant metastasis,stage,and molecular classification,among others.In the case group,the chi-square test was used to analyze the clinical and pathological features of patients in three age groups(<40,40-59,and≥60 years).A multifactor logistic regression analysis was used to analyze correlations between the two groups.RESULTS Among 149 patients with primary breast cancer,the average age was 48.20±12.06 years,and the proportion of patients at 40-59 years old was the highest,accounting for 61.8%of cases.The molecular type was mainly luminal B type,accounting for 69.2%of cases,and at the time of diagnosis,the tumor stage was mainly stage I/II,accounting for 62.4%of cases.There were no statistically significant differences in the distributions of tumor location,pathological type,tumor size,lymph node metastasis,stage,or molecular classification among the three age groups(<40,40-59,and≥60 years)(P≥0.05).The differences in the distribution of distant metastasis among the three age groups(<40,40-59,and≥60 years)were statistically significant(P<0.01).The differences in lactation time,history of familial malignant tumors,history of gynecological diseases,and history of thyroid diseases between the two groups were not statistically significant(P≥0.05).The differences in age at disease diagnosis,age at menarche,and history of surgery for benign breast lesions were statistically significant(P<0.01).The difference in age at first birth was also statistically significant(P<0.05).CONCLUSION The highest incidence of breast cancer in the Zhuhai-Macao region is present among women aged 40-59 years.There is a larger proportion of stage I/II patients,and the luminal B type is the most common molecular subtype.Distant metastasis occurs mainly in the≥60-year-old group at the first diagnosis;increased age,late age at menarche,and late age at first birth may be risk factors for primary breast cancer,and a history of surgery for benign breast lesions may be a protective factor for primary breast cancer.展开更多
In this study, the horizontal and vertical distribution of primary production(PP) and its monthly variations were described based on field data collected from the Daya Bay in January–December of 2016. The relationshi...In this study, the horizontal and vertical distribution of primary production(PP) and its monthly variations were described based on field data collected from the Daya Bay in January–December of 2016. The relationships between PP and environmental factors were analyzed using a general additive model(GAM). Significant seasonal differences were observed in the horizontal distribution of PP, while vertical distribution showed a relatively consistent unimodal pattern. The monthly average PP(calculated by carbon) ranged from 48.03 to 390.56 mg/(m~2·h),with an annual average of 182.77 mg/(m~2·h). The highest PP was observed in May and the lowest in November.Additionally, the overall trend in PP was spring>summer>winter>autumn, and spring PP was approximately three times that of autumn PP. GAM analysis revealed that temperature, bottom salinity, phytoplankton, and photosynthetically active radiation(PAR) had no significant relationships with PP, while longitude, depth, surface salinity, chlorophyll a(Chl a) and transparency were significantly correlated with PP. Overall, the results presented herein indicate that monsoonal changes and terrestrial and offshore water systems have crucial effects on environmental factors that are associated with PP changes.展开更多
基金Supported by the National Natural Science Foundation of China,No.82402789Beijing Jishuitan Hospital Youcai Plan,No.KYYC202402+2 种基金Beijing Jishuitan Research Funding,No.HL202402and Beijing Natural Science Foundation,No.L232062No.L222063.
文摘BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.
文摘BACKGROUND Glaucoma,a condition frequently linked to severe depression,anxiety,and sleep disturbances,affects treatment adherence while potentially compromising effectiveness.AIM To explore illness uncertainty(IU),anxiety,and depressive symptoms in primary glaucoma and to discuss underlying triggers.METHODS We recruited 120 primary glaucoma cases between January 2022 and November 2023.The Mishel Uncertainty in Illness Scale(MUIS)and the Hospital Anxiety and Depression Scale(HADS)[include HADS-anxiety subscale(HADS-A)and HADS-depression subscale(HADS-D)]subscales,were used to assess IU and emotional distress(anxiety/depression),respectively.The MUIS-HADS subscale interrelationships were determined by Pearson correlation.IU-associated determinants were identified using univariate and binary logistic regression analyses.RESULTS The cohort showed a mean MUIS score of 79.73±8.97,corresponding to a moderately high IU level.The HADS-A and HADS-D scores averaged 6.57±3.89 and 7.08±5.05 points,respectively,with 15.00%of participants showing anxiety symptoms and 24.17%exhibiting depressive signs.Significant positive connections were observed between MUIS and both HADS-A(r=0.359,P<0.001)and HADSD(r=0.426,P<0.001).Univariate analysis revealed that disease duration,insomnia,monthly household income per capita,and the presence of comorbid chronic conditions were significantly associated with anxiety or depression.Multivariate analysis identified insomnia as a risk factor and higher monthly household income as a protective factor.CONCLUSION Patients with primary glaucoma experience moderate IU levels,generally low anxiety,and mild depression.Specifically,the anxiety and depression risks were 15.00%and 24.17%,respectively.A significant positive correlation existed between IU and anxiety/depression in these patients.Additionally,insomnia or lower monthly household income elevated anxiety/depression risks,enabling reliable anxiety/depression risk categorization among patients.
文摘BACKGROUND This study explores the 3-year survival outcomes and associated influencing factors in patients with primary gastric cancer treated via laparoscopic surgery,providing meaningful guidance for clinical management.AIM To evaluate and analyze the 3-year survival outcomes and associated risk factors in patients with primary gastric cancer who underwent laparoscopic surgery.METHODS A total of 100 patients with primary gastric cancer who underwent laparoscopic surgery at our hospital between January 2019 and December 2021 were enrolled.These patients were monitored for 3 years,and their survival statuses were recorded.Patients were categorized into survival and non-survival groups based on their outcomes.Data on sex,age,American Society of Anesthesiologists classification,tumor size,depth of invasion,postoperative adjuvant radio-chemotherapy,postoperative carcinoembryonic antigen(CEA)levels,and other clinical parameters were collected and contrasted across groups to identify factors impacting 3-year survival.RESULTS After a 3-year follow-up,the survival rate was 73.00%(73 of 100 patients).No significant differences were observed in sex,tumor location,alcohol consumption,smoking status,tumor differentiation,histological type,intraoperative blood loss,or surgical outcomes between patients with varying prognoses(P>0.05).However,notable disparities were found in age,American Society of Anesthesiologists classification,tumor-node-metastasis(TNM)stage,tumor size,depth of invasion,lymph node metastasis,lymph node dissection,postoperative adjuvant radio-chemotherapy,postoperative CEA levels,surgical duration,extent of gastric resection,and postoperative complications(P<0.05).Multivariate logistic regression analysis identified age,TNM stage,tumor size,depth of invasion,lymph node metastasis,lymph node dissection,postoperative adjuvant radio-chemotherapy,postoperative CEA levels,surgical duration,extent of gastric resection,and postoperative complications as independent predictors of 3-year survival in patients with primary gastric cancer following laparoscopic surgery(P<0.05).CONCLUSION The 3-year survival outcome for patients undergoing laparoscopic surgery for primary gastric cancer was 73.00%.Key determinants of survival included age,TNM stage,tumor size,depth of invasion,and lymph node metastasis.This analysis of 3-year survival and its influencing factors offers novel perspectives for optimizing clinical interventions in patients with primary gastric cancer treated via laparoscopic surgery.
基金The authors extend their appreciation to the Ongoing Research Funding Program,number(ORF2025R705),King Saud University,Riyadh,Saudi Arabia,for funding this work.
文摘The study aims to determine the validity and reliability of the Wechsler Preschool and Primary Scale of Intelligence–Third Edition(WPPSI-III)scores in a sample of kindergarten and lower primary pupils from Khartoum State,Sudan.It also aims to examine whether test’s factor structure in this sample replicated that of the original WPPSI-III.The study sample consisted of 384 kindergarten and primary school children in Khartoum State(females=50%mean age=4.14,SD=1.37),selected using stratified random sampling across its seven localities:Khartoum,Jebel Awliya,Khartoum Bahri,East Nile,Omdurman,Ombada,Karari.For concurrent validation,the children additionally completed the Goodenough Draw-a-Man Test,and the Colored Progressive Matrices.WPPSI-III scores demonstrated high internal consistency across the subtest items.Confirmatory factor analysis indicators for total,verbal,and performance intelligence were all excellent.The scale also showed weak to strong score stability ranging from 0.25(weak)to 0.88(strong)based on the Spearman-Brown equation,0.25 to 0.75 based on the Guttman split-half method.The Cronbach’s alpha coefficient scores ranged from 0.54 to 0.93.The WPPSI-III and Goodenough Draw-a-Man Test scores concurrent validity scores were poor(0.05)to modest(0.31),and while those with the Colored Progressive Matrices test were poor(r=0.04–0.18).Thesefindings provide evidence to suggest that the WPPSI-III is appropriate for research use with kindergarten and lower primary school students in Khartoum State,Sudan.
文摘AIM:To identify risk factors for postoperative blindness in patients with primary rhegmatogenous retinal detachment(RRD)at their first presentation to a tertiary center,using a large clinical database to improve understanding of this adverse outcome.METHODS:Electronic health records of patients with primary RRD from the Eye Hospital of Wenzhou Medical University were retrospectively analyzed.Postoperative blindness was defined according to the World Health Organization(WHO)criteria for legal blindness.Potential risk factors included demographic characteristics,preoperative clinical features,and surgical variables.Univariable and multivariable logistic regression analyses were performed to calculate odds ratios(ORs)and 95%confidence intervals(CIs)for each risk factor.RESULTS:A total of 532 patients were included in the cohort,of whom 62(12.0%;28 males,34 females)developed postoperative blindness at the final follow-up.Among these 62 patients,30 had high myopia and 32 did not.The mean age of participants was 49.0±16.4y,with 275 subjects(52%)being male and 133 patients(25%)having the condition in the right eye.In the multivariable model for all patients,the following factors were associated with an increased risk of postoperative blindness:higher preoperative logarithm of the minimum angle of resolution visual acuity(logMAR VA;OR=1.09 per 0.1 logMAR unit increase,95%CI 1.03-1.15);inferior or superior retinal breaks(OR=2.42,95%CI 1.12-5.24);and macular holes or superior retinal breaks(OR=8.46,95%CI 3.45-20.75).In the subgroup of patients with high myopia,risk factors for postoperative blindness included:pseudophakia/aphakia versus phakia(OR=6.33,95%CI 1.41-28.31);macular holes or superior retinal breaks(OR=15.15,95%CI 3.07-74.85);and proliferative vitreoretinopathy(PVR;OR=21.41,95%CI 2.14-214.57).In the subgroup of patients without high myopia,increased risk of postoperative blindness was associated with:higher preoperative logMAR VA(OR=1.11 per 0.1 logMAR unit increase,95%CI 1.04-1.18);and inferior or superior retinal breaks(OR=2.90,95%CI 1.19-7.06).CONCLUSION:Using a large real-world clinical database,we identified distinct risk factors for postoperative blindness in patients with primary RRD-including differences between those with and without high myopia.These findings emphasize the need to target specific risk factors in clinical practice to mitigate and reduce the incidence of postoperative blindness in this patient population.
基金Supported by the National Natural Science Foundation of China,No.81671600 and No.81241094Natural Science Foundation of Shandong Province,China,No.ZR2016HM13 and No.ZR2023MH066Qingdao Medical and Health Scientific Research Project,China,No.2024-WJKY160.
文摘BACKGROUND The pathogenesis of primary biliary cholangitis(PBC)remains unclear.Ursodeoxycholic acid(UDCA)is the only first-line clinical treatment,but approximately 40%of patients exhibit a poor response.AIM To identify novel biomarkers for PBC to predict the efficacy of UDCA and enhance treatment.METHODS Microarray expression profiling datasets were downloaded from the Gene Expression Omnibus and analyzed to identify differentially expressed genes between PBC patients and healthy controls.Immunohistochemistry was performed to validate key genes in liver tissues of the participants.Logistic regression was employed to evaluate prognostic risk factors,receiver operating characteristic curves were used to assess predictive performance,and correlations between key genes and clinicopathological characteristics were analyzed.RESULTS By bioinformatic analysis,13 genes primarily associated with the progression of PBC were identified,and tumor necrosis factor alpha-induced protein 3(TNFAIP3)was selected for further investigation.Then expression of TNFAIP3 in PBC patients was significantly elevated compared to healthy controls on immunohistochemistry(P<0.0001).Multivariate Cox regression analysis indicated that both TNFAIP3 and fatigue were independent risk factors for response to UDCA in PBC patients(P<0.05).The area under the curve for TNFAIP3 and fatigue were 0.691 and 0.704,respectively,while their combination showed a significantly higher area under the curve of 0.848.The expression of TNFAIP3 was also correlated with age,albumin,total bilirubin,alkaline phosphatase and splenomegaly(P<0.05).CONCLUSION TNFAIP3 and fatigue are independent risk factors for response to UDCA in Chinese patients with PBC.TNFAIP3 may be a potential biomarker or therapeutic target for PBC.These findings offer new insights into the pathogenesis of PBC.
文摘In this article,the author comment on the article by Zang et al.Tumor necrosis factor alpha-induced protein 3(TNFAIP3)was examined in this study as a novel biomarker to predict the efficiency of ursodeoxycholic acid(UDCA)and thereby improved primary biliary cholangitis(PBC)treatment.Differentially expressed genes in PBC patients and healthy controls(HCs)were detected using microarray expression analysis.PBC patients and HCs were examined for predictive performance and associations between important genes and clinicopathological features using immunohistochemistry,logistic regression,and receiver operating characteristic curve methods.Thirteen genes linked to the development of PBC were detected by the bioinformatic research.TNFAIP3 was chosen for additional examination from these 13 genes.TNFAIP3 was shown to be more expressed in PBCs patients than in HCs using immunohistochemical method.TNFAIP3 and fatigue have a significant impact on UDCA in PBC patients in multivariate cox regression analysis.Additionally,there was a correlation between TNFAIP3 expression and splenomegaly,alkaline phosphatase,albumin,total bilirubin,and age.In conclusion,TNFAIP3 and fatigue have significant impact on UDCA in PBC.These findings provide a new view on PBC pathophysiology and suggest that TNFAIP3 may be a suitable biomarker or therapeutic target for the disease.
基金Supported by the Wannan Medical College Teaching Hospital Special Application for Scientific Research,No.WK2023JXYY036the Anhui Provincial Translational Clinical Medical Research Special Application,No.202204295107020062.
文摘BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.AIM To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC,with a focus on strict adherence to indications.METHODS Clinical data of 106 cases undergoing LCBDE+PDC in the Hepatobiliary and Pancreatic Surgery Department(Division 1)of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected.Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage.The change in surgical time was analyzed using the cumulative summation(CUSUM)method,and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.RESULTS Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage(P<0.05).The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage(P<0.05),with statistical significance.The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve(P=0.023).CONCLUSION With a good assessment of duodenal papilla sphincter function,unobstructed bile-pancreatic duct convergence,exact stone clearance,and sufficient surgical experience to complete the learning curve,PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.
文摘BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholangiocarcinoma.Although PSC predominantly affects adults,the incidence in pediatric patients is rising.For individuals in the advanced stages of liver disease,liver transplantation(LT)is the sole curative treatment option.However,the recurrence of PSC in the transplanted liver,known as recurrent PSC(rPSC),remains a significant concern.AIM To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.METHODS A literature search was carried out across databases,including PubMed,Embase,Cochrane Library,and Scopus,covering studies published from 1990 through 2024.The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies.Statistical analyses were conducted using RevMan 5.3 software,where the risk of recurrence was quantified using hazard ratios(HR)with 95%CI.RESULTS A total of nine reports with 2524 pediatric patients with PSC were included in this analysis.The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant,including concurrent inflammatory bowel disease(IBD),elevated liver enzyme levels,and the presence of PSCautoimmune hepatitis(AIH)overlap syndrome(all P<0.05).No statistically significant association was found between acute allograft rejection,Epstein-Barr virus infection,and the risk of rPSC recurrence in the pediatric liver transplant recipients.CONCLUSION The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT,including IBD,elevated liver enzyme levels,and PSC-AIH overlap syndrome.
基金Supported by the National Key Basic Research Program (973 Program): 2006 CB 504502
文摘Objective To explore the relationship between psychological factors and efficacy of acupuncture on primary dysmenorrhea. Methods Sixty cases of primary dysmenorrhea were observed. Before acupuncture treatment, the self-designed confidence questionnaire was used to assess patients＇ confidence in acupuncture efficacy. Visual Analogue Scale （VAS） was adopted to assess patients＇ tension level during acupuncture. Self-rating anxiety scale （SAS） and self-rating depression scale （SDS） were applied to assess the situations of patients＇ anxiety and depression. Eysenck＇s personality questionnaire （EPQ） and Cattell sixteen personality factors questionnaire （16PF） were provided to assess the personal characters of patients. Pain intensity, pain duration and accompanied symptoms were recorded before and after acupuncture treatment so as to assess the efficacy. Canonical correlation analysis was used to analyze the relationship between the psychological factors and acupuncture efficacy on primary dysmenorrhea. Results There were significant differences in grading of dysmenorrhea, pain intensity score and pain duration after treatment as compared statistically with those before treatment （all P〈0.001）. The standardized coefficients of dominance （r=0.679 7） and anxiety （r=-0.590 6） in personality factors and the reduction of pain duration （r=-0.904 2） among efficacy indices were the highest. The overall correlation coefficients were all lower between the indices of psychological factors and canonical variables of dysmenorrhea efficacy. Conclusion Acupuncture efficacy on primary dysmenorrhea has a certain correlation with dominance and anxiety of patients＇ personality factors. But, the psychological factors do not play a leading role in acupuncture treatment.
文摘This study examined the impact of the operative and peri-operative factors on the long-term prognosis of patients with primary liver cancer undergoing hepatectomy. A total of 222 patients with primary liver cancer who underwent hepatectomy were followed up from January 1986 to December 2010 at Chinese PLA General Hospital. The post-operative complication rate was 14.0% for all cases, 13.7% for hepatocellular carcinoma（HCC）, 10.0% for cholangiocarcinoma. The 1-, 3-, 5- and 10-year overall survival rates in patients with primary liver cancer after resection were 76.6%, 57.6%, 41.4%, and 21.0%. The survival rates were significantly higher in the HCC group than in the cholangiocarcinoma group（P=0.000）, in the non-anatomical resection group than in the anatomical resection group（P=0.005）, in the female group than in the male group（P=0.002）, in patients receiving no blood transfusion than in those who were given intra-operative blood transfusion（P=0.000）, in patients whose intra-operative blood loss was less than 400 m L than in those who intra-operatively lost more than 400 m L（P=0.000）. No significant difference was found in the survival rate between the HBs Ag-positive group and the HBs Ag-negative group（P=0.532）. Our study showed that anatomical resection, blood loss and blood transfusion were predictors of poor survival after hepatectomy for primary liver cancer patients, and concomitant hepatitis B virus infection bore no relation with the post-resection survival.
基金Supported by National Science Technology Pillar Program in the 11th Five-Year Plan,No. 2008BAI59B03Research Special Fund for the Public Welfare Industry of Health,No.201202004
文摘AIM:To examine the clinical features and analyze prognostic factors in a prospective study of primary biliary cirrhosis(PBC) patients.METHODS:From 1995 to 2010,PBC patients without hepatic decompensation seen at the Peking Union Medical College Hospital were enrolled.Clinical signs and manifestations(pruritus,persistent fatigue,jaundice and pain in the right hypochondrium),laboratory parameters(auto-antibodies for autoimmune hepatic disease,biliary and hepatic enzymes,immunoglobulin,bilirubin,and albumin) and imaging findings were recorded at entry and at specific time points during follow-up.Cox regression and Kaplan-Meier analyses,respectively,assessed the risk factors for hepatic decompensation and survival.RESULTS:Two hundred and sixty-two PBC patients were enrolled with a median follow-up of 75.2 mo(range,21-201 mo).The 240 patients were aged 51.5 ± 10.2 years at diagnosis and 91.6% were female.Two hundred and forty-five(93.5%) were seropositive for anti-mitochondrial antibodies.At presentation,170 patients(64.9%) were symptomatic,while 96 patients(36.6%) had extra-hepatic autoimmune disease.During the follow-up period,62(23.7%) patients developed hepatic decompensation of whom four underwent liver transplantation and 17 died.The cumulative survival rate and median survival time were 83.9% and 181.7 mo,respectively.Cox regression analysis revealed that an incomplete ursodeoxycholic acid(UDCA) response or inconsistent treatment [P < 0.001;hazard risk(HR) 95%CI = 2.423-7.541],anti-centromere antibodies(ACA) positivity(P < 0.001;HR 95%CI = 2.516-7.137),alanine aminotransferase ratio(AAR) elevations(P < 0.001;HR 95%CI = 1.357-2.678),and histological advanced liver disease(P = 0.006;HR 95%CI = 1.481-10.847) were predictors of hepatic decompensation.The clinical features and survival of PBC in China are consistent with those described in Western countries.CONCLUSION:Incomplete UDCA response or inconsistent treatment,ACA positivity,AAR elevations,and advanced histological stage are predictors of decompensation.
文摘AIM： To evaluate the risk factors for primary liver carcinoma （PLC） in Chinese population.METHODS： Chinese Biomedical Literature Database, China Hospital Knowledge Database and MEDLINE were searched. All the related literatures were screened, and the risk factors for PLC in Chinese population were studied. Heterogeneity was evaluated by odds ratio （OR） q test. Combined OR and its 95% confidence interval （95%CI）were calculated, the association between the investigated risk factors and PLC was determined. Validity and bias of the findings were evaluated by sensitivity analysis and funnel plot analysis respectively.RESULTS： Fifty-five of one hundred and ninety identified studies were accepted according to the inclusive criteria. Ten factors related to PLC were demonstrated by sensitive analysis and funnel plot analysis. They were cirrhosis （OR = 11.97, P= 0.000）, HBV infection （OR = 11.34, P= 0.000）,HCV infection （OR = 4.28, P = 0.000）, family history of liver cancer （OR = 3.49, P = 0.000）, unstable emotion （OR = 2.20, P = 0.000）, depressed characters （OR = 3.07,P = 0.000）, aflatoxin （OR = 1.80, P = 0.000）, alcoholic （OR = 1.88, P = 0.000）, intake of musty food （OR =1.87,P = 0.000） and drinking contaminated water from pond （OR = 1.77, P = 0.003）.CONCLUSION： The main risk factors for PLC in China are liver diseases, family history of liver carcinoma, poor psychic status, aflatoxin, and some unhealthy behaviors.
文摘Primary ciliary dyskinesia （PCD） is an autosomal-recessive disorder resulting from the loss of normal ciliary function. Symptoms include neonatal respiratory distress, chronic sinusitis, bronchiectasis, situs inversus, and infertility. However, only 15 PCD-associated genes have been identified to cause male infertility to date. Owing to the genetic heterogeneity of PCD, comprehensive molecular genetic testing is not considered the standard of care. Here, we provide an update of the progress on the identification of genetic factors related to PCD associated with male infertility, summarizing the underlying molecular mechanisms, and discuss the clinical implications of these findings. Further research in this field will impact the diagnostic strategy for male infertility, enabling clinicians to provide patients with informed genetic counseling, and help to adopt the best course of treatment for developing directly targeted personalized medicine.
文摘Glaucoma, one of the leading causes of irreversible blindness in the adult population worldwide, is a progressive optic neuropathy. Primary open angle glaucoma (POAG) is the most commonly reported type of glaucoma in population based prevalence studies worldwide. Elevated intraocular pressure is a well-known major risk factor for POAG. In addition, there is growing evidence that other risk factors like age, gender, race, refractive error, heredity and systemic factors may play a role in glaucoma pathogenesis. Many studies found that high myopia has been associated with POAG, however, direct and convincing evidences are still lacking. The aim of this review is to summarize the evidences implicating high myopia as a risk factor in the pathogenesis of POAG.
基金Supported by The National Natural Science Foundation of China,No.81400372 and 81660158the Key Research and Development Plan of Jiangxi Province,No.20181BBG70004+2 种基金the Young Scientists Fund of Jiangxi Province,No.20161ACB21017 and 20151BAB215016the Science and Technology Plan Project of Jiangxi Province,No.20151BBG70223and the Distinguished Young Scientists Fund of Jiangxi Province,No.20192BCBL23020.
文摘BACKGROUND In rare instances,primary liver cancer can be associated with intraocular metastasis(IOM).AIM To investigate the correlation between a diverse range of clinical characteristics and IOM in diabetic patients with primary liver cancer,and to determine potential risk factors in predicting IOM.METHODS We recruited a total of 722 diabetic patients with primary liver cancer.The differences between the IOM and non-intraocular metastasis(NIOM)groups in these patients were assessed using the chi-squared test and Student’s t-test.Binary logistic regression analysis was subsequently used to determine risk factors.Finally,the diagnostic value of IOM in this cohort with primary liver cancer was analyzed by receiver operating characteristic(ROC)curve analysis.RESULTS In all,13 patients had IOM.There were no remarkable intergroup differences with respect to age,sex,histopathological sub-types,or blood biochemical parameters.However,the IOM group had significantly higher alpha-fetoprotein(AFP)and cancer antigen 125(CA125)values than the NIOM group.Binary logistic regression identified AFP and CA125 to be significant risk factors for IOM in diabetic patients with primary liver cancer.ROC curve analysis showed that the area under the curve values for AFP and CA125 were 0.727 and 0.796,with the cut-off values of 994.20 ng/mL and 120.23 U/mL,respectively.The sensitivity and specicity for AFP were 92.3%and 59.9%,while those for CA125 were 84.6%and 70.1%,respectively.CONCLUSION Elevated AFP and CA125 represent significant risk factors for IOM in diabetic patients with primary liver cancer.
基金supported by a grant from the Shanxi Province Foundation for Returness(2012-4)
文摘BACKGROUND: We previously showed that insulin-like growth factor binding protein-related protein 1 (IGFBPrP1) is a novel mediator in liver fibrosis. Transforming growth factor beta 1 (TGF beta 1) is known as the strongest effector of liver fibrosis. Therefore, we aimed to investigate the detailed interaction between IGFBPrP1 and TGF beta 1 in primary hepatic stellate cells (HSCs). METHODS: We overexpressed TGF beta 1 or IGFBPrP1 and inhibited TGF beta 1 expression in primary HSCs for 6, 12, 24, 48, 72, and 96 hours to investigate their interaction and observe the accompanying expressions of a-smooth muscle actin (alpha-SMA), collagen I, fibronectin, and phosphorylated-mothers against decapentaplegic homolog 2/3 (p-Smad2/3). RESULTS: We found that the adenovirus vector encoding the TGF beta 1 gene (AdTGF beta 1) induced IGFBPrP1 expression while that of alpha-SMA, collagen I, fibronectin, and TGF beta 1 increased gradually. Concomitantly, AdIGFBPrP1 upregulated TGF beta 1, alpha-SMA, collagen I, fibronectin, and p-Smad2/3 in a time-dependent manner while IGFBPrP1 expression was decreased at 96 hours. Inhibition of TGF beta 1 expression reduced the IGFBPrP1-stimulated expression of alpha-SMA, collagen I, fibronectin, and p-Smad2/3. CONCLUSIONS: These findings for the first time suggest the existence of a possible mutually regulation between IGFBPrP1 and TGF beta 1, which likely accelerates liver fibrosis progression. Furthermore, IGFBPrP1 likely participates in liver fibrosis in a TGF beta 1-depedent manner, and may act as an upstream regulatory factor of TGF beta 1 in the Smad pathway.
基金Supported by High-End Talent Funding Project in Hebei Province,No.A202003005Hebei Provincial Health Commission Office,No.G2019074+1 种基金Science and Technology Research Project of Hebei Higher Education Institutions(ZD2018090)Natural Science Foundation of Hebei Province,No.H2019209355。
文摘BACKGROUND Alpha-fetoprotein(AFP)is one of the diagnostic standards for primary liver cancer(PLC);however,AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.AIM To evaluate the effects of high-risk factors and the diagnostic value of AFP in stratified PLC.METHODS In total,289 PLC cases from 2013 to 2019 were selected for analysis.First,the contributions of high-risk factors in stratifying PLC were compared according to the following criteria:Child–Pugh score,clinical stage of liver cirrhosis,tumor size,and Barcelona Clinic Liver Cancer(BCLC)stage.Then,the diagnostic value of AFP was evaluated in different stratifications of PLC by receiver operating characteristic curves.For PLC cases in which AFP played little role,the diagnostic values of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA 19-9),gamma-glutamyl transferase(GGT),and AFP were analyzed.RESULTS The roles of high-risk factors differed in stratified PLC.The incidence of smoking and drinking history was higher in PLC with Child–Pugh scores of C(P<0.0167).The hepatitis B virus(HBV)infection rate in PLC with cirrhosis was more than in PLC without cirrhosis(P<0.0167).Small tumors were more prone to cirrhosis than large tumors(P<0.005).BCLC stage D PLC was more likely to be associated with HBV infection and cirrhosis(P<0.0083).AFP levels were higher in PLC with cirrhosis,diffuse tumors,and BCLC stage D disease.In diagnosing PLC defined as Child–Pugh A,B,and C,massive hepatoma,diffuse hepatoma,BCLC stage B,C,and D,and AFP showed significant diagnostic value[all area under the curve(AUC)>0.700].However,these measures were meaningless(AUC<0.600)in small hepatomas and BCLC A stage PLC,but could be replaced by the combined detection of CEA,CA 19-9,GGT,and AFP(AUC=0.810 and 0.846,respectively).CONCLUSION Stratification of PLC was essential for precise diagnoses and benefited from evaluating AFP levels.
文摘BACKGROUND Breast cancer is the most common malignancy in women all around the world.According to the latest statistics in 2018,there were more than 2.08 million new breast cancer cases all around the world and more than 620000 deaths;the proportion of breast cancer deaths in women with cancer is 15%.By studying age,clinicopathological characteristics and molecular classification,age at menarche,age at birth,number of births,number of miscarriages,lactation time,surgical history of benign breast lesions,history of gynecological diseases,and other factors,we retrospectively summarized and compared the disease history of patients with primary breast cancer and patients with benign thyroid tumors admitted to our hospital in the past 10 years to explore the clinicopathological characteristics and risk factors for primary breast cancer.AIM To investigate the clinical and pathological features and risk factors for primary breast cancer treated at our center in order to provide a reference for the prevention and treatment of breast cancer in the Zhuhai-Macao region.METHODS Through a retrospective case-control study,149 patients with primary breast cancer diagnosed and treated at Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2013 to March 2020 were included as a case group,and 165 patients with benign breast tumors diagnosed and treated from January 2019 to March 2020 were included as a control group.The data collected included age,age at menarche,age at first birth,number of births,number of miscarriages,lactation time,history of surgery for benign breast lesions,history of familial malignant tumors,history of gynecological diseases,history of thyroid diseases,and the tumor characteristics of the patients in the case group including pathological diagnosis,pathological type,tumor size,lymph node metastasis,distant metastasis,stage,and molecular classification,among others.In the case group,the chi-square test was used to analyze the clinical and pathological features of patients in three age groups(<40,40-59,and≥60 years).A multifactor logistic regression analysis was used to analyze correlations between the two groups.RESULTS Among 149 patients with primary breast cancer,the average age was 48.20±12.06 years,and the proportion of patients at 40-59 years old was the highest,accounting for 61.8%of cases.The molecular type was mainly luminal B type,accounting for 69.2%of cases,and at the time of diagnosis,the tumor stage was mainly stage I/II,accounting for 62.4%of cases.There were no statistically significant differences in the distributions of tumor location,pathological type,tumor size,lymph node metastasis,stage,or molecular classification among the three age groups(<40,40-59,and≥60 years)(P≥0.05).The differences in the distribution of distant metastasis among the three age groups(<40,40-59,and≥60 years)were statistically significant(P<0.01).The differences in lactation time,history of familial malignant tumors,history of gynecological diseases,and history of thyroid diseases between the two groups were not statistically significant(P≥0.05).The differences in age at disease diagnosis,age at menarche,and history of surgery for benign breast lesions were statistically significant(P<0.01).The difference in age at first birth was also statistically significant(P<0.05).CONCLUSION The highest incidence of breast cancer in the Zhuhai-Macao region is present among women aged 40-59 years.There is a larger proportion of stage I/II patients,and the luminal B type is the most common molecular subtype.Distant metastasis occurs mainly in the≥60-year-old group at the first diagnosis;increased age,late age at menarche,and late age at first birth may be risk factors for primary breast cancer,and a history of surgery for benign breast lesions may be a protective factor for primary breast cancer.
基金The National Natural Science Foundation of China under contract No.41506136the Scientific Research Foundation of Third Institute of Oceanography,SOA under contract No.2015005
文摘In this study, the horizontal and vertical distribution of primary production(PP) and its monthly variations were described based on field data collected from the Daya Bay in January–December of 2016. The relationships between PP and environmental factors were analyzed using a general additive model(GAM). Significant seasonal differences were observed in the horizontal distribution of PP, while vertical distribution showed a relatively consistent unimodal pattern. The monthly average PP(calculated by carbon) ranged from 48.03 to 390.56 mg/(m~2·h),with an annual average of 182.77 mg/(m~2·h). The highest PP was observed in May and the lowest in November.Additionally, the overall trend in PP was spring>summer>winter>autumn, and spring PP was approximately three times that of autumn PP. GAM analysis revealed that temperature, bottom salinity, phytoplankton, and photosynthetically active radiation(PAR) had no significant relationships with PP, while longitude, depth, surface salinity, chlorophyll a(Chl a) and transparency were significantly correlated with PP. Overall, the results presented herein indicate that monsoonal changes and terrestrial and offshore water systems have crucial effects on environmental factors that are associated with PP changes.
