Analysis Of Risk Factors Research Articles

Prediction of post-ESD esophageal stricture by a nomogram and risk factor analysis of ineffective oral steroids prophylaxis

Background and aimsSeveral risk models for esophageal stricture after endoscopic submucosal dissection have been developed. However, some of them did not include the use of steroids in the risk analysis. Glucocorticoid sensitivity mediated by glucocorticoid receptor expression has not been discussed in this condition.MethodsClinical and endoscopic characteristics were included in the logistic regression model to establish a nomogram for stenosis prediction. The score for each risk factor was estimated. Risk factors of ineffective oral steroid prophylaxis were analyzed and glucocorticoid receptor expressions were detected by immunohistochemistry.ResultsThree hundred fourteen patients of endoscopic submucosal dissection for esophageal superficial neoplasms were included to develop the nomogram. The circumferential range(≤ 3/4, 3/4–1 or the whole circumference), longitudinal diameter reached 4 cm (yes or not) and lesion location (the cervical and upper thoracic part, the middle thoracic part or the lower thoracic part) consisted of the nomogram. Patients have a high risk of esophageal stricture if they have a total point greater than 36. In the simplified risk score model, the corresponding cutoff score was 1. 92 patients with oral steroid prophylaxis were separately analyzed and the circumferential mucosal defect involving 7/8 or more was an independent risk factor of ineffective prevention (OR 12.2, 95%CI 5.27–28.11). The expression of glucocorticoid receptor β was higher in the stricture group (p = 0.042 for AOD; p = 0.016 for the scoring system).ConclusionsWe established a nomogram for esophageal stricture prediction. Depending on the characteristics of lesions, it is possible to estimate the risk of stricture under routine post-ESD treatments (no steroids or oral steroids). Alternative treatments should be considered if the risk is extremely high, especially for patients with mucosal defects involving 7/8 or more of circumference in which oral steroid treatment tends to be ineffective. The higher glucocorticoid receptor β may indicate potential glucocorticoid resistance.

Analysis of risk factors and different treatments for infections caused by carbapenem-resistant Acinetobacter baumannii in Shaanxi, China

BackgroundThe global threat of Carbapenem-resistant Acinetobacter baumannii (CRAB) has intensified as resistance to carbapenems continues to rise in recent decades. We aimed to explore risk factors, molecular epidemiology, and antimicrobial therapy of CRAB infection.MethodsThe clinical data of 110 patients infected with A. baumannii from December 2021 to December 2022 were retrospectively analyzed. Patients were divided into a carbapenem-resistance group (55 patients) and carbapenem-sensitive group (CSAB; 55 patients) based on resistance to carbapenem, and the risk factors of patients infected with CRAB were analyzed. Fifty-five patients with CRAB infection who received antimicrobial therapy were divided into a combination therapy group (45 patients) and a monotherapy group (10 patients), and differences between the two groups were compared. Whole-genome sequencing analysis was performed to assess resistance genes. Phylogenetic analysis was performed to explore the characteristics of CRAB isolates.ResultsAmong the total 110 patients, the rate of poor prognosis in the CRAB group was 43.6% (24/55). Mechanical ventilation (odds ratio [OR] = 5.364, 95% confidence interval [CI] 1.462–19.679, P = 0.011) and puncture (OR = 19.935, 95% CI 1.261–315.031, P = 0.012) were independent risk factors for CRAB infection. Of 55 patients in the antimicrobial regimen study, 45 received combination therapy (including dual, triple, or quadruple antibiotic therapy) and 10 received monotherapy. Univariate analysis revealed significant differences between the combination group and monotherapy group for admission to the intensive care unit and wound infection (P < 0.05). The CRAB strains of 26 patients taking carbapenem-based combination therapy were mainly ST208, ST1968, and ST195, among which patients with ST1968 strains had higher 28-day mortality. Furthermore, the blaOXA−23 gene was harbored in ST1968, ST195, and ST208.ConclusionsMortality was significantly higher in patients infected with CRAB than with CSAB. Mechanical ventilation and puncture were independent risk factors in predicting CRAB infections. The distribution of CRAB was dominated by ST208, ST1968, and ST195, among which patients with ST1968 had higher 28-day mortality. The blaOXA−23 gene appears to be widely disseminated.

Risk factor analysis and prediction model construction for severe adenovirus pneumonia in children

BackgroundSevere adenovirus pneumonia in children has a high mortality rate, but research on risk prediction models is lacking. Such models are essential as they allow individualized predictions and assess whether children will likely progress to severe disease.MethodsA retrospective analysis was performed on children with adenovirus pneumonia who were hospitalized at the Children’s Hospital of Nanjing Medical University from January 2017 to March 2024. The patients were grouped according to clinical factors, and the groups were compared using Ridge regression and multiple logistic regression to identify risk factors associated with severe adenovirus pneumonia. A prediction model was constructed, and its value in clinical application was evaluated.Results699 patients were included in the study, with 284 in the severe group and 415 in the general group. Through the screening of 44 variables, the final risk factors for severe adenovirus pneumonia in children as the levels of neutrophils (OR = 1.086, 95% CI: 1.054‒1.119, P < 0.001), D-dimer (OR = 1.005, 95% CI: 1.003‒1.007, P < 0.001), fibrinogen degradation products (OR = 1.341, 95% CI: 1.034‒1.738, P = 0.027), B cells (OR = 1.076, 95%CI: 1.046‒1.107, P < 0.001), and lactate dehydrogenase (OR = 1.008, 95% CI: 1.005‒1.011, P < 0.001). The value of the area under the receiver operating characteristic curve was 0.974, the 95% CI was 0.963–0.985, and the P-value of the Hosmer-Lemeshow test was 0.547 (P > 0.05), indicating that the model had strong predictive power.ConclusionIn this study, the clinical variables of children with adenovirus pneumonia were retrospectively analyzed to identify risk factors for severe disease. A prediction model for severe disease was constructed and evaluated, showing good application value.

Leptospirosis seroprevalence and associated risk factors in dairy goats in the Brazilian semi-arid region

Leptospira spp. infection is a worldwide zoonosis that causes economic losses to goat rearing, mainly due to reproductive disorders. Hence, the objective of this research was to determine the seroprevalence and associated risk factors of leptospirosis in a goat milk-producing region in the states of Paraiba and Pernambuco, Northeast Brazil. The microscopic agglutination test was used as serological method and risk factor analysis was carried out using univariable and multivariable analyses. Out of the 937 animals sampled, 102 (10.9 %; 95 % CI = 8.9–12.9 %) were seropositive for Leptospira spp. and the most frequent serogroups were Ballum (41.2 %; 95 % CI = 31.6–50.7 %), Icterohaemorrhagiae (25.5 %, 95 % CI = 17–33.9 %) and Semaranga (23.5 %, 95 % CI = 15.3–31.8 %), with antibody titres ranging from 1:50 to 1:200. Thirty-four of 51 herds (66.7 %; 95 % CI = 53.7–79.6 %) had at least one seropositive animal. The risk factor identified in the multivariable two-level random effect binary logistic regression was the animal being an adult (odds ratio = 4.2; 95 % CI = 1.93–9.13; P < 0.001). Our results provide important information on the epidemiology and risk factors associated with goat leptospirosis seroprevalence in one of the main Brazilian goat milk-producing regions. Furthermore, the need for adopting sanitary control measures, especially those involving sanitary management practices, is highlighted.

Endophthalmitis Rates following Secondary Intraocular Lens Surgeries: An 11-year Medicare Fee-For-Service Analysis.

To assess postoperative endophthalmitis (POE) rates and risk factors after secondary intraocular lens (IOL) implantation for preoperative aphakia and IOL exchange combined with or without vitrectomy. Medicare fee for service (FFS) beneficiaries, United States. Retrospective study. Medicare FFS beneficiaries who underwent IOL exchange or secondary IOL implantation for preoperative aphakia between January 1, 2011 - November 19, 2022 were identified. POE rates were calculated overall and separately for each surgical category - secondary IOL for aphakia versus IOL exchange, with subsets for concurrent anterior or posterior vitrectomy. Multi-variate analysis of potential risk factors was implemented. 97,152 patients were included. The 42-day POE rates for secondary IOL implantation for aphakia and for IOL exchange were 0.35% and 0.28% overall, 0.31% and 0.30% when combined with posterior vitrectomy, and 0.84% and 0.42% with anterior vitrectomy. The risk of POE increased when secondary IOL surgery was combined with anterior vitrectomy compared to no vitrectomy (adjusted odds ratio [aOR] 1.849; p<0.001) and with higher Charlson comorbidity indexes compared to 0: 1-2 (aOR 1.495; p=0.01), 3-4 (aOR 1.591; p=0.01), 5-6 (aOR 1.617; p=0.046), ≥7 (aOR 3.290; p<0.001). Risk was decreased for IOL exchange compared to secondary IOL implantation for preoperative aphakia (aOR 0.783; p=0.04). The overall POE rate for all secondary IOL surgeries was 0.31% during the 11-year period. We hypothesize that absence of the posterior capsular barrier would explain the higher POE rates compared with cataract surgery, especially if a concurrent vitrectomy was performed with the secondary IOL procedure.

Prospective Analysis of Dietary Risk Factors Involved in the Occurrence of Irritable Bowel Sydrome among Students in Ivory Coast

This is a prospective cross-sectional study, with a descriptive and analytical aim, with the main objective of analyzing the dietary risk factors involved in the occurrence of irritable bowel syndrome among students in Côte d'Ivoire. This investigation follows the work of Amoikon et al., (2016) who revealed among students an unbalanced, unstructured and poorly hydrated diet with a high prevalence of abdominal irritation syndrome. Thus, a new food and health consumption survey was carried out from October 15, 2016 to February 17, 2017, in a population of 1,228 student volunteers, with an average age of 22.5 years, dominated by males. It revealed a high prevalence of intestinal irritation syndrome (47.7%) and dietary imbalance. After analyzing the relationship between eating habits and pathology, it turned out that high consumption of red meat, soft drinks, non-alcoholic exciting products, spicy products and low water consumption were the factors risk of the occurrence of the pathology among the respondents. To this end, it would be important to carry out nutritional education sessions on university campuses across the country, with a view to improving their eating habits, their food security and their health conditions.

The Relationship Between Physical Activity and Non-Modifiable Risk Factors on Alzheimer's Disease and Brain Health Markers: A UK Biobank Study.

Modifiable (physical activity) and non-modifiable (sex and genotype) risk factors interact to affect Alzheimer's disease (AD) risk. Further investigation is necessary to understand if these factors influence brain volume and cognition. The study aimed to assess the effect of physical activity, APOE genotype, and sex on AD risk, brain volume, and cognition. UK Biobank data from 2006 to 2023 was accessed. Physical activity was measured by accelerometers, and International Physical Activity Questionnaire. Outcomes were AD incidence; brain volume (ventricular cerebrospinal fluid and total brain); and cognition (executive function, memory, visuospatial ability, processing speed, and reaction time). Logistic and linear regression models were conducted. 69,060 participants met inclusion criteria (mean age: 62.28 years, SD: 7.84; 54.64% female). Higher self-reported (OR = 0.63, 95% CI [0.40, 1.00], p = 0.047) and accelerometer-assessed (OR = 0.96 [0.93, 0.98], p = 0.002) physical activity was associated with lower disease incidence. Smaller ventricular cerebrospinal fluid volume (β= - 65.43 [- 109.68, - 17.40], p = 0.007), and larger total brain volume (β= 4398.46 [165.11, 8631.82], p < 0.001) was associated with increased accelerometer-assessed and self-reported physical activity respectively. Both brain volume analyses were moderated by sex. Increased accelerometer-assessed physical activity levels were associated with faster reaction time (β= - 0.43 [- 0.68, - 0.18], p = 0.001); though poorer visuospatial ability (β= - 0.06 [- 0.09, - 0.03], p < 0.001), and executive function (β= 0.49 [0.31, 0.66], p < 0.001; β= 0.27 [0.10, 0.45], p = 0.002) was related to self-reported physical activity levels. Higher levels of physical activity reduce AD risk independently of non-modifiable risk factors. Moderation of sex on brain volume highlighted the importance of incorporating non-modifiable risk factors in analysis.

Risk Factors for Late-Onset Psychosis: A Case-Control Study.

The onset of schizophrenia occurs after the age of 40 in up to 20% of cases. We aim to depict risk factors for first-episode psychosis after the age of 40 by comparing late-onset psychosis (LOP) patients to healthy age-matched controls. In this case-control study using electronic health records, 142 individuals aged 40-65 years with an encounter for a first episode of psychosis between 2013 and 2021 were included. Four controls (N = 568) were matched to each case on age, sex, race, and year of encounter. Potential risk factors for the primary analysis were captured via structured data and text-mining of medical notes. Conditional logistic regression models were used to assess the odds of LOP with potential risk factors. After adjusting for all variables in the main analysis, odds for LOP were increased by immigration (OR 3.30, 95% CI, 1.56-6.98), depression (OR 3.58, 95% CI, 2.01-6.38), anxiety (OR 2.12, 95% CI, 1.20-3.75), cannabis use (OR 3.00, 95% CI, 1.36-6.61), alcohol use disorder (OR 5.46, 95% CI, 2.41-12.36), polysubstance use (OR 4.22, 95% CI, 1.30-13.7), severe trauma (OR 2.29, 95% CI, 1.08-4.48), and caregiver burden (OR 15.26, 95% CI, 3.85-60.48). Life stressors along with the effects of substance use and other psychiatric conditions may confer some risk to the development of LOP. Replication is required in independent prospective studies. Further research is necessary to truly parse out which of these factors belong on the causal pathway.

Therapy for Dupuytren’s Disease: Collagenase Therapy—A Long-Term Follow-Up Study

Background: Dupuytren’s disease (DD) is a systemic connective tissue disorder of the palm. It particularly affects men of Northern European or Caucasian origin over the age of 55. In addition to the classical surgical therapy via limited fasciectomy, Dupuytren’s contracture can also be treated minimally invasively. A relatively new treatment method is the use of collagenase injections (Xiapex) to reduce the contracture of the fingers. The data regarding the long-term success of this therapy are currently limited. Methods: In this monocentric retrospective study, we examined 35 patients who were treated with collagenase (Xiapex) for Dupuytren’s contracture in the long fingers. Following the manufacturer’s recommendations, the injection was administered intralesionally, and the cord was ruptured through the passive extension of the finger under local anesthesia with Mepivacain the following day. The clinical follow-up examination was conducted after an average of 5.7 years. The stages of Dupuytren’s disease were documented using the Tubiana classification. Additionally, parameters of finger extension ability, differentiated by metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints, as well as patient-specific risk parameters, were evaluated Results: The long-term results of collagenase therapy after an average of 5.7 years showed a significant improvement in the contracture of the affected fingers. In the MCP joints, the flexion contracture decreased from 42° to 17° (p ≤ 0.001), and in the PIP joints, it decreased from 56° to 33° (p ≤ 0.001). The primary recurrence rate was 11% for the MCP joints and 19% for the PIP joints, respectively. The analysis of risk factors showed a significant risk for worse long-term outcomes in patients with diabetes and those with nicotine abuse. Conclusions: Collagenase therapy for Dupuytren’s disease achieved significant long-term improvements in contracture in both MCP and PIP joints. In accordance with general risk factors for DD, patients with diabetes and those with nicotine abuse are at risk of worse long-term outcomes. Overall, it is a time-saving, low-risk, and straightforward technique for treating the disabling contracture component of this disease.

Coupled Analysis of Risk Factor for Tailing Pond Dam Failure Accident Based on N–K Model and SNA

The failure of tailings pond dams represents a complex coupled system involving various risk factors, including human, governance, facilities, and environmental aspects. It is crucial to identify key risk factors at the system level to enhance the safety management of tailings ponds. We analyzed 74 cases of tailings pond dam failure accidents, both domestically and internationally, from the perspectives of human, governance, facility, and environment. We employed the 2–4 Model to identify and extract the causes of dam failures, summarizing these into four primary risk factors and 40 secondary risk factors, while constructing a risk coupling mechanism model. The natural killing (N–K) model was implemented to analyze the risk coupling values of primary risk factors and quantify these couplings. The N–K model facilitated an analysis of the risk coupling values of first-level risk factors, while social network analysis (SNA) was employed to visualize the relationships among second-level risk factors and assess the centrality and accessibility of nodes within the risk factor network. The out-degree of the risk nodes was corrected by integrating the N–K model with the SNA, leading to the identification of key risk factors associated with tailings pond dam failures and the formulation of corresponding safety prevention and control strategies. The findings indicate that managing multi-risk factor coupling is an effective approach to mitigating the occurrence of tailings pond dam failure accidents. Notably, unfavorable environmental risk factors significantly contribute to the coupling of human–governance–facility–environmental risks, necessitating targeted management strategies. Furthermore, inadequate safety supervision, weak safety awareness, inadequate receipt and inspection, and irregular operation represent additional key risk factors requiring focused prevention and control efforts.

Analysis of bleeding outcomes in patients with hypoproliferative thrombocytopenia in the A-TREAT clinical trial.

Despite prophylactic platelet transfusions, hypoproliferative thrombocytopenia is associated with bleeding; historical risk factors include hematocrit (HCT) 25%, activated partial thromboplastin time 30 s, international normalized ratio 1.2, and platelets 5000/μL. We performed a post hoc analysis of bleeding outcomes and risk factors in participants with hematologic malignancy and hypoproliferative thrombocytopenia enrolled in the American Trial to Evaluate Tranexamic Acid Therapy in Thrombocytopenia (A-TREAT) and randomized to receive either tranexamic acid (TXA) or placebo. World Health Organization (WHO) grade 2+ bleeding occurred in 46% of 330 participants, with no difference between the TXA (44%) and placebo (47%) groups (p = 0.66). Overall, the most common sites of bleeding were oronasal (18%), skin (17%), gastrointestinal (11%), and genitourinary (11%). Among participants of childbearing potential, 28% experienced vaginal bleeding. Platelets ≤5000/μL and HCT < 21% (after adjusting for severe thrombocytopenia) were independently associated with increased bleeding risk (HR 3.78, 95% CI 2.16-6.61; HR 2.67, 95% CI 1.35-5.27, respectively). Allogeneic stem cell transplant was associated with nonsignificant increased risk of bleeding versus chemotherapy alone (HR 1.34, 95% CI 0.94-1.91). The overall rate of WHO grade 2+ bleeding was similar to previous reports, albeit with lower rates of gastrointestinal bleeding. Vaginal bleeding was common in participants of childbearing potential. Platelets ≤5000/μL remained a risk factor for bleeding. Regardless of platelet count, bleeding risk increased with HCT < 21%, suggesting a red blood cell transfusion threshold above 21% should be considered to mitigate bleeding. More investigation is needed on strategies to reduce bleeding in this population.

Curve-centered plaques raise the risk of peri-operative neurological and cardiovascular complications during angioplasty and stenting for severe carotid stenosis.

Carotid artery stenting is an alternative interventional treatment to carotid endarterectomy. However, preprocedural considerations and anatomical risk factor analyses for carotid artery stenting are currently insufficient. Therefore, we investigated the high-risk anatomical appearance of carotid artery stenting from the neurointerventionist perspective to predict periprocedural complications. We retrospectively reviewed patients with carotid stenosis who underwent carotid artery stenting at a comprehensive stroke center between January 2012 and December 2021. We compared the demographic characteristics, medical history, and anatomical appearance of the stenotic segment in patients with and without complications. We analyzed a total of 148 patients (64 women [43.2%]; median age, 73.0 [interquartile range, 65.5-79.0]). Complications occurred in 39 of the 148 patients, primarily minor and transient. Of baseline or procedural characteristics, a high initial National Institutes of Health Stroke Scale score (p = 0.04), symptomatic stenosis (p = 0.01), and curve-centered plaque of the proximal ICA (p = 0.01) were significantly associated with carotid artery stenting complications in unadjusted analysis. Curve-centered plaque remained an independent risk factor for carotid artery stenting complications after adjustment (odds ratio 2.23[1.02-4.88], p = 0.04). High-risk vascular anatomical features, such as curve-centered plaque, are associated with a high frequency of periprocedural complications of carotid artery stenting. Tailored patient selection for carotid stenosis is crucial to prevent complications. Patients with curve-centered plaque should consider alternative treatment options such as carotid endarterectomy to achieve optimal clinical results.

Risk factors for postpartum depression

Postpartum depression has become an increasingly urgent problem of modern medicine and psychology. This condition is a mental disorder that causes emotional, behavioral, and physical changes associated with the postpartum period. Despite the presence of a wide range of signs, the diagnosis of postpartum depression remains challenging for specialists. A woman experiencing this type of depression may find it difficult to realize her condition on her own and seek help. However, even if properly diagnosed, the fact of having postpartum depression can be a negative experience for a woman. Young mothers often feel fear or shame in front of family members and the society and hide their diagnosis. This creates additional barriers to getting the necessary help and support. This review aimed to identify and analyze risk factors of depressive disorders in women in the postpartum period and investigate some manifestations of postpartum depression. The scientific databases CyberLeninkа, eLibrary, and PubMed were used. The articles were searched for the following keywords: “postpartum period,” “depressive disorder,” “postpartum depression,” “postpartum depression and risk factors,” and “development of depressive disorders in the postpartum period.” The study included articles published over the past 5 years. After sampling by annotations and keywords, 53 articles were analyzed: 6 Russian and 47 English speakers. The risk factors described in modern domestic and foreign literature were analyzed and were classified as unmodified and modifiable, which was further characterized as modifiable by the mother and/or her family and modifiable only by healthcare.

Analyzing risk factors and constructing a predictive model for superficial esophageal carcinoma with submucosal infiltration exceeding 200 micrometers

ObjectiveSubmucosal infiltration of less than 200 μm is considered an indication for endoscopic surgery in cases of superficial esophageal cancer and precancerous lesions. This study aims to identify the risk factors associated with submucosal infiltration exceeding 200 micrometers in early esophageal cancer and precancerous lesions, as well as to establish and validate an accompanying predictive model.MethodsRisk factors were identified through least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression. Various machine learning (ML) classification models were tested to develop and evaluate the most effective predictive model, with Shapley Additive Explanations (SHAP) employed for model visualization.ResultsPredictive factors for early esophageal invasion into the submucosa included endoscopic ultrasonography or magnifying endoscopy> SM1(P<0.001,OR = 3.972,95%CI 2.161–7.478), esophageal wall thickening(P<0.001,OR = 12.924,95%CI,5.299–33.96), intake of pickled foods(P=0.04,OR = 1.837,95%CI,1.03–3.307), platelet-lymphocyte ratio(P<0.001,OR = 0.284,95%CI,0.137–0.556), tumor size(P<0.027,OR = 2.369,95%CI,1.128–5.267), the percentage of circumferential mucosal defect(P<0.001,OR = 5.286,95%CI,2.671–10.723), and preoperative pathological type(P<0.001,OR = 4.079,95%CI,2.254–7.476). The logistic regression model constructed from the identified risk factors was found to be the optimal model, demonstrating high efficacy with an area under the curve (AUC) of 0.922 in the training set, 0.899 in the validation set, and 0.850 in the test set.ConclusionA logistic regression model complemented by SHAP visualizations effectively identifies early esophageal cancer reaching 200 micrometers into the submucosa.

Occurrence of Malnutrition among Seniors in Poland Depending on the Place of Residence: An Analysis of Socioeconomic and Health Risk Factors.

The aging population in Poland poses significant socioeconomic and health challenges, particularly regarding malnutrition among seniors. This study examines the impact of place of residence on the nutritional status and related health outcomes of older adults. Data were collected from 338 community-dwelling seniors and those in long-term care facilities. The results indicate that long-term care residents exhibited significantly higher frailty and depression levels and poorer nutritional status, functional fitness, gait, and balance compared to those in communities. Self-reported quality of life did not differ significantly between groups. Regardless of residence, having a family correlated with better nutritional status, quality of life, and functional fitness and lower frailty and depression levels. Malnutrition was significantly associated with reduced functional fitness across all residences, and well-nourished individuals in care facilities had lower functional fitness than those who were at home. Community-dwelling residents had significantly lower frailty levels, with frailty negatively correlating with nutritional status. Normal nutritional status was linked to higher balance and gait scores, indicating a lower fall risk, with the risk further reduced for those living in community settings. Additionally, normal nutritional status correlated with lower depression levels and higher quality of life, with malnourished individuals experiencing better quality of life in community-dwelling settings. These findings underscore the critical role of residence and family support in elderly nutrition and health outcomes.

Development and external validation of a nomogram for predicting lymph node metastasis in 1-3cm lung adenocarcinoma.

Aim: This study aimed to investigate the risk factors for lymph node metastasis in 1-3cm adenocarcinoma and develop a new nomogram to predict the probability of lymph node metastasis.Materials & methods: This study collected clinical data from 1656 patients for risk factor analysis and an additional 500 patients for external validation. The logistic regression analyses were employed for risk factor analysis. The least absolute shrinkage and selection operator regression was used to select variables, and important variables were used to construct the nomogram and an online calculator.Results: The nomogram for predicting lymph node metastasis comprises six variables: tumor size (mediastinal window), consolidation tumor ratio, tumor location, lymphadenopathy, preoperative serum carcinoembryonic antigen level and pathological grade. According to the predicted results, the risk of lymph node metastasis was divided into low-risk group and high-risk group. We confirmed the exceptional clinical efficacy of the model through multiple evaluation methods.Conclusion: The importance of intraoperative frozen section is increasing. We discussed the risk factors for lymph node metastasis and developed a nomogram to predict the probability of lymph node metastasis in 1-3cm adenocarcinomas, which can guide lymph node resection strategies during surgery.

A Systematic Review of Resilience in At-Risk Youth for Psychotic Disorders: An Analysis of Protective and Risk Factors from Recent Literature.

Psychotic disorders in youth pose significant challenges for mental health services, necessitating a detailed understanding of the interplay between risk factors and resilience. This systematic review aimed to assess how resilience factors might buffer the adverse effects of risk factors on the development of psychosis among youth, thereby informing targeted interventions. Studies were selected based on criteria including a focus on individuals aged up to 25 years old at risk for psychosis, the examination of both risk factors and resilience, and the use of validated instruments for measuring outcomes. Literature searches were conducted across several databases, such as PubMed, Scopus, and Web of Science. Data extraction emphasized odds ratios (ORs) and hazard ratios (HRs) for risk factors, including familial, developmental, and socio-environmental influences. The review included and analyzed nine studies, encompassing a diverse sample of 140,972 participants. Significant findings indicate that highly supportive familial and community environments significantly reduce the risk of psychosis onset. For instance, children with strong family support and engagement in structured activities demonstrated a 40% lower incidence of developing psychotic symptoms [p < 0.05]. Furthermore, the presence of neurobehavioral deficits, such as impaired verbal memory and attention, emerged as significant predictors of psychosis, with these children exhibiting a threefold increase in risk compared to their peers [OR = 3.2, 95% CI: 2.1-4.8, p < 0.01]. Resilience factors play a critical role in mitigating the impact of psychosocial and neurobiological risks in the development of psychosis among youths. Interventions enhancing resilience could potentially alter the trajectory of psychosis development, emphasizing the need for early and targeted psychosocial interventions to support at-risk populations. This study underscores the importance of fostering resilience through both individual-focused and community-based strategies to prevent the onset of psychotic disorders in vulnerable young populations.

The impact of preoperative fasting time on patients undergoing partial nephrectomy and analysis of risk factors for postoperative hemorrhage.

This study investigates the impact of preoperative fasting time on patients undergoing partial nephrectomy and analyzes the risk factors for postoperative hemorrhage to provide clinical reference for physicians treating patients undergoing partial nephrectomy. A retrospective analysis was conducted on 74 patients who underwent partial nephrectomy for renal tumors between January 2022 and March 2024. Baseline and perioperative data were collected. The effects of long-term and short-term preoperative fasting on patients undergoing partial nephrectomy were compared. Additionally, univariate and multivariate logistic regression analyses were performed to identify risk factors for hemorrhagic complications following partial nephrectomy. Among the patients in this study, 26 (35.14%) underwent short-term preoperative fasting, while 48 (64.86%) underwent long-term preoperative fasting. The hemoglobin difference in the short-term fasting group was 21.08 ± 12.44 ml, compared to 13.65 ± 11.69 ml in the long-term fasting group, showing a statistically significant difference (p = 0.020). Differences in serum calcium (p = 0.003), serum magnesium (p = 0.031), and serum phosphorus (p = 0.001) between the short-term and long-term fasting groups were also statistically significant. Univariate and multivariate regression analyses identified the type of surgery (p = 0.050) and preoperative fasting time (p < 0.001) as independent risk factors for postoperative hemorrhage following partial nephrectomy. Patients undergoing partial nephrectomy with short-term preoperative fasting experience a more significant decrease in hemoglobin compared to those with long-term fasting. The type of surgery and preoperative fasting time are independent risk factors for postoperative hemorrhage in patients undergoing partial nephrectomy.

Clinical Impact of Radiologist’s Alert System on Patient Care for High-risk Incidental CT Findings: A Machine Learning-Based Risk Factor Analysis

Rationale and ObjectivesEfficient communication between radiologists and clinicians ordering computed tomography (CT) examinations is crucial for managing high-risk incidental CT findings (ICTFs). Herein, we introduced a Radiologist’s Alert and Patient Care Follow-up System (APCFS) for high-risk ICTFs. This study aimed to analyze the ICTFs detected by this system and the factors associated with them. Materials and MethodsThis retrospective study was approved by the institutional review board. We analyzed 52,331 CT examinations conducted between 2019 and 2021. In cases where high-risk ICTFs were identified, radiologists utilized APCFS to prompt ordering clinicians for further patient care. We assessed the frequency, affected body organs, presence or absence of therapeutic interventions, and diagnoses of high-risk ICTFs. An automated machine learning platform was employed to analyze the factors associated with high-risk ICTFs. ResultsAmong the 52,331 CT examinations, 507 (0.96%) revealed high-risk ICTFs, primarily affecting the lung (18.0%). Of these 507 high-risk ICTFs, 117 (23.1%) underwent therapeutic interventions, while 362 (71.4%) required only follow-up. Of the 117 cases undergoing interventions, 61 (52.1%) required surgery. Of the 219 high-risk ICTFs leading to a confirmed diagnosis, 146 (66.7%) were neoplastic lesions, including 88 (60.3%) malignancies, and 73 (33.3%) were non-neoplastic lesions. The top three risk factors associated with high-risk ICTFs in the regularized logistic regression model were the imaging protocol (especially aortic valve implantation planning protocol), imaging area (especially whole-body imaging), and clinical department (especially cardiology). ConclusionUtilizing APCFS, high-risk ICTFs were detected in approximately 1% of all CT examinations, likely associated with specific imaging protocols, areas, and clinical departments.

Iatrogenic urinary injuries in colorectal surgery: outcomes and risk factors from a nationwide cohort.

Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures. Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI. Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2-1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0-1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2-2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1-15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4-0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4-2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI. While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.