Failure Factors Research Articles

Comparison of Outcomes of Deep Sclerectomy, Canaloplasty, and Viscocanaloplasty: A Multi-Centred Study.

Deep sclerectomy (DS) and canaloplasty provide better intraocular pressure (IOP) control than viscocanalostomy. DS required less glaucoma medications but more interventions to reach target IOP. To compare real-world outcomes of three non-penetrating glaucoma surgery (NPGS) techniques. Retrospective, cohort study of consecutive patients undergoing canaloplasty (CP), deep sclerectomy (DS), and viscocanalostomy (VC), across nine European glaucoma units. Four intraocular pressure (IOP) criteria were used to define success at 2-year follow-up: (A)IOP≤21mmHg and ≥20% reduction; (B)IOP≤18mmHg and ≥20% reduction; (C)IOP≤15mmHg and ≥25% reduction; (D)IOP≤12mmHg and ≥30% reduction. Secondary outcomes included IOP control, BCVA, number of medications over time, risk factors for failure, complications, and post-operative interventions. Success was distinguished as qualified or complete, if reached with or without antiglaucoma medications, respectively. 600 eyes (545 patients) undergoing standalone CP (201 eyes), DS (200 eyes), and VC (199 eyes) were included. Qualified success rates of CP, DS, and VP at 24 months were, respectively: (Criterion A) 85.1%, 67.6% and 64.6%; (Criterion B) 85.1%, 66.1% and 58.6%; (Criterion C) 76.6%, 55.5% and 39.0%; (Criterion D) 27.7%, 28.5% and 22.1%. Success rates were significantly different across the three techniques (P=0.04 or below), except for complete success according to criterion A (P=0.07). Mean IOP(±SD) reduced from 25.2(±6.9), 20.5(±6.7), and 22.7(±7.2)mmHg pre-operatively to 13.1(±3.1), 12.9(±4.5), and 14.7(±4.6)mmHg at post-operative year 2 in the CP, DS, and VC groups respectively (P<0.001 between pre-operative and post-operative time points for all groups). All three NPGS provide sustained IOP reduction, but DS and CP provide better success rates and IOP control. Success rates were low for the most stringent cut-offs, suggesting that other techniques such as trabeculectomy may be indicated when a very low target IOP is demanded.

Geroscience in heart failure: the search for therapeutic targets in the shared pathobiology of human aging and heart failure

Age is a major risk factor for heart failure, but one that has been historically viewed as non-modifiable. Emerging evidence suggests that the biology of aging is malleable, and can potentially be intervened upon to treat age-associated chronic diseases, such as heart failure. While aging biology represents a new frontier for therapeutic target discovery in heart failure, the challenges of translating Geroscience research to the clinic are multifold. In this review, we propose a strategy that prioritizes initial target discovery in human biology. We review the rationale for starting with human omics, which has generated important insights into the shared (patho)biology of human aging and heart failure. We then discuss how this knowledge can be leveraged to identify the mechanisms of aging biology most relevant to heart failure. Lastly, we provide examples of how this human-first Geroscience approach, when paired with rigorous functional assessments in preclinical models, is leading to early-stage clinical development of gerotherapeutic approaches for heart failure.

The clinical value of short-term insemination: a retrospective analysis of 3496 patients

BackgroundThe safety and effectiveness of short-term insemination remain a subject of controversy. This study aims to investigate the impact of short-term insemination on both embryo quality and pregnancy outcomes and whether it is necessary to apply short-term insemination to all patients underwent in vitro fertilization (IVF).MethodsA retrospective analysis was conducted on 3,496 patients from two centers over the period January 2016 to December 2022. Of these, 1307 patients underwent IVF, 1656 patients were treated with short-term IVF, 166 patients received early rescue intracytoplasmic sperm injection (R-ICSI) and 367 patients were treated with ICSI. The clinical and neonatal outcomes were compared between the two groups.ResultsThe rate of high-quality embryos was significantly lower in the short-term IVF group compared to the routine IVF group (59.89% vs. 68.16%) (P = 0.000), the rate of blastocyst formation was significantly lower in the short-term IVF group compared to the routine IVF group (44.99% vs. 61.34%) (P = 0.000). There were no significant differences in clinical outcomes or neonatal outcomes between the two groups, irrespective of whether fresh or frozen embryos were used (both P > 0.05). The incidence of ≥ 3PN demonstrated no significant difference between the early R-ICSI and ICSI groups (1.04% vs. 0.66%) (P = 0.114), furthermore, the clinical outcomes were similar in both groups, for both fresh and frozen embryos (both P > 0.05).ConclusionsFor patients with primary fertility, short-term IVF combined with early R-ICSI can effectively prevent potential low fertilization or fertilization failure, reduce the risk of patients with no transferable embryo, avoid the waste of resources and had no adverse effects on neonatal outcomes. However, short-term IVF reduced the oocytes utilization rate in one single oocyte pick-up cycle, for patients with no risk factors for fertilization failure, the overnight fertilization is still one of the most important ways of insemination worthy of affirmation.Trial registrationNA.

Determinants of Success in Revision Cochlear Implant Surgeries: A Comprehensive Evaluation of Patient, Surgical, and Radiological Factors

Background/Objectives: This study aims to evaluate factors influencing revision cochlear implant surgeries, including patient demographics, surgical techniques, and radiological findings. The main aim was to identify factors influencing surgical success to inform clinical treatment and enhance patient outcomes. Methods: This cross-sectional study included adult patients over the age of 18 who underwent revision cochlear implant surgery due to implant-related complications. Data were collected from systematic chart reviews of electronic medical records, including demographics, surgical techniques, radiological output from standard high-resolution CT and MRI, and intraoperative data. The primary outcome was surgical success, defined by improved auditory function, stable device positioning, and absence of postoperative complications. Statistical analyses, including multivariate logistic regression, were conducted to identify independent predictors of surgical success. Results: A total of 188 patients were included, with a mean age of 45.67 years. Younger age, shorter duration of implant use, modified surgical techniques, and absence of co-morbidities are key factors contributing to surgical success. Modified surgical techniques were associated with better outcomes (39.29% vs. 68.75%, OR: 2.78, 95% CI: 1.25–6.14, p = 0.012). Radiological patterns significantly affected outcomes, with normal findings associated with higher success rates. In contrast, abnormalities such as electrode migration (OR: 2.14, 95% CI: 1.12–4.09, p = 0.021) and ossification (r = −0.51, β = −0.44, adjusted R2 = 0.25, p &lt; 0.01) were correlated with poorer results. Smoking status, when comparing smokers to non-smokers, was associated with unfavorable outcomes (20.00% vs. 45.83%, OR: 2.01, 95% CI: 1.01–4.01, p = 0.048), and a history of previous surgeries (21.43% vs. 37.50%, OR: 1.95, 95% CI: 1.03–3.71, p = 0.033) was significantly associated with unfavorable outcomes. Conclusions: Statistically, significantly better outcomes are positively correlated with the duration of the first cochlear implant experience and negatively with prior otologic pathology and nonauditory environmental influences on surgical success. Younger age, modified surgical techniques, and normal radiological findings were related to better outcomes; complications such as electrode migration and ectopic ossification were strong predictive factors for surgical failure. These findings underscore the need for tailored surgical approaches and early intervention to enhance outcomes in revision cochlear implant surgeries.

Unveiling Risk Factors for Treatment Failure in Patients with Graves' Disease: A Nationwide Cohort Study in Korea.

Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves' disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice. We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years. Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments ≥10 mCi had 37% lower failure rates than doses <10 mCi. ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.

Profit and Reliability Analysis of a Gas Production Unit with the Concept of Optimal Age Replacement Policy: A Copula Approach

Abstract This paper presents a comparative study of reliability analysis of a gas production plant, before and after applying optimal age replacement policy for a specific machine. The gas production plant has six machines connected in the series configuration a sulfur (S) shaft, coal pit, reaction furnace, sulfur separation machine, adiabatic reactor, and cooling machine. Here, the optimal age replacement policy has been applied to the cooling machine as this machine is working under a wear-out period, i.e., it has completed its prescribed age (say T) and is still operational. Two different situations have been discussed to analyze the performance variation of the system (i) when the model is working with high risk because the cooling machine is operational even after completion of its prescribed age (ii) when the old cooling machine is replaced by a new one after completing the age, T. The failure of any machine can cause the model failure. Additionally, a situation of employee walkout is also considered a responsible factor for model failure. Supplementary variable technique and copula methodology have been applied to solve the Markov model.

Anti-Human Leukocyte Antigen Antibody Detection from Terasaki’s Humoral Theory to Delisting Strategies in 2024

The human leukocyte antigen (HLA) system plays a critical role in transplant immunology, influencing outcomes through various immune-mediated rejection mechanisms. Hyperacute rejection is driven by preformed donor-specific antibodies (DSAs) targeting HLAs, leading to complement activation and graft loss within hours to days. Acute rejection typically occurs within six months post-transplantation, involving cellular and humoral responses, including the formation of de novo DSAs. Chronic rejection, a key factor in long-term graft failure, often involves class II DSAs and complex interactions between the innate and adaptive immune systems. Advancements in HLA antibody detection, particularly single antigen bead (SAB) assays, have improved the sensitivity and characterization of DSAs. However, these assays face challenges like false positives from denatured antigens and false negatives due to low antibody titers or complement competition. Furthermore, molecular mismatch (MM) analysis has emerged as a potential tool for refining donor–recipient compatibility but faces some issues such as a lack of standardization. Highly sensitized patients with calculated panel-reactive antibodies (cPRA) of 100% face barriers to transplantation. Strategies like serum dilution, novel therapies (e.g., Imlifidase), and delisting approaches could refine immunological risk assessment and delisting strategies are essential to expand transplant opportunities for these patients.

Prostatic Artery Embolization in Elderly Comorbid Patients with Benign Prostatic Hyperplasia: Safety, Efficacy, and Predictive Factors of Clinical Failure

Prostatic Artery Embolization in Elderly Comorbid Patients with Benign Prostatic Hyperplasia: Safety, Efficacy, and Predictive Factors of Clinical Failure

EMOTIONAL SURVIVAL PERSONALITY MICROSTRUCTURE ONCS: THE NEUROBIOLOGICAL ORIGINS OF PERSONALITY DISORDERS AND DYSFUNCTIONAL PARENTING

According to the World Health Organization (WHO), the burden of Mental Disorders (MD) problems increases with the years. According to the WHO, in developed countries, around 50% of patients with MD do not receive treatment effectively.1 Currently, in the scientific community, there is little research approach to Personality Disorders (PD), and in professional practice, diagnosis and treatment are two factors of technical failure.2 PD is defined in the current psychiatric diagnosis system as characterized by generalized patterns, inflexible and stable of thought, feeling, behavior and interaction with others that cause significant suffering to the individual himself and the people in his life

Unveiling the path to success: critical factors for success and failure of university startups

This study aims to identify the factors that influence the success and failure of university-incubated startups. A systematic review methodology based on the Methodi Ordinatio framework was employed. The research was conducted on the Science Direct, Scopus, and Web of Science databases, totaling 108 articles. After removing duplicates and articles unrelated to the theme, 43 studies remained. Applying the InOrdinatio equation refined the selection to 30 articles, reaching the saturation point of the research corpus. It was found that the maturity of innovation departments, entrepreneurial culture, intellectual property management, institutional adaptability, entrepreneurship-oriented education, gender equity, and governmental support are essential for the success of these startups. Conversely, the main challenges to failure include legal difficulties, the need to enhance educational and institutional support, restricted access to funding, the absence of mentoring networks, and the importance of aligning universities with the broader entrepreneurial ecosystem. It is concluded that the success of university-incubated startups results from a multifactorial set, essentially depending on an integrated innovative ecosystem, institutional and governmental support, and robust entrepreneurial training. At the same time, failure often reflects inadequate funding and mentorship.

Patient Age and Activity Level, Posterior Tibial Slope, and Use of Allograft Are Significant Risk Factors for ACLR Failure: A Systematic Review

Patient Age and Activity Level, Posterior Tibial Slope, and Use of Allograft Are Significant Risk Factors for ACLR Failure: A Systematic Review

Evaluating Failure Rates of Primary Quadriceps Tendon Repairs Across Different Surgical Techniques.

Quadriceps tendon ruptures occur infrequently in the general population. Biomechanical data suggest advantages with the use of suture anchor fixation for major tendon repair. Clinical studies of quadriceps tendon repair have been limited to small case series. To evaluate clinical failure following primary quadriceps tendon repair with transosseous tunnel or suture anchor repair. Cohort study; Level of evidence, 3. The Military Health System Data Repository was queried to identify all adult patients who underwent primary quadriceps tendon repair in the Military Health System between 2014 and 2018. Patients were excluded if they had incomplete records, polytrauma, open injury, prior ipsilateral total knee arthroplasty did not undergo quadriceps tendon repair, or underwent revision repair. Follow-up was obtained by manual chart review of both orthopaedic and nonorthopaedic records, recording any evidence of ongoing knee issues. Univariate analysis was performed to determine associations between potential risk factors and repair failure. Multicollinearity was assessed between potential risk factors, and candidate variables were included in multivariate logistic regression models to determine independent risk factors for repair failure. Following application of inclusion/exclusion criteria, 245 knees in 234 patients were included. Mean age of the cohort was 52 years. Patients were predominantly male (223/234; 95%) and military retirees (143/234; 61%). Transosseous tunnel repair was the most frequently employed surgical technique (147/245; 60%), followed by suture anchor repair (78/245; 32%). Repair failure requiring revision surgery occurred in 11% of knees (27/245). Surgical-site infection following index surgery was associated with eventual rerupture (P = .02). There was no difference in failure rate between transosseous tunnel repair and suture anchor repair (12.2% vs 9.0%; P = .51). Among knees undergoing suture anchor repair, no difference in failure was found between knot-tying and knotless suture anchor fixation (P = .73). We observed no difference in failure of primary quadriceps tendon repair between transosseous tunnel and suture anchor repair types or between the 2 main suture anchor implant subtypes (knotless vs knot-tying anchors). A greater than previously reported rerupture rate was observed, indicating the need for continued investigation into optimal surgical techniques.

Exploring Mortality and Prognostic Factors of Heart Failure with In-Hospital and Emergency Patients by Electronic Medical Records: A Machine Learning Approach.

As HF progresses into advanced HF, patients experience a poor quality of life, distressing symptoms, intensive care use, social distress, and eventual hospital death. We aimed to investigate the relationship between morality and potential prognostic factors among in-patient and emergency patients with HF. A case series study: Data are collected from in-hospital and emergency care patients from 2014 to 2021, including their international classification of disease at admission, and laboratory data such as blood count, liver and renal functions, lipid profile, and other biochemistry from the hospital's electrical medical records. After a series of data pre-processing in the electronic medical record system, several machine learning models were used to evaluate predictions of HF mortality. The outcomes of those potential risk factors were visualized by different statistical analyses. In total, 3871hF patients were enrolled. Logistic regression showed that intensive care unit (ICU) history within 1week (OR: 9.765, 95% CI: 6.65, 14.34; p-value < 0.001) and prothrombin time (OR: 1.193, 95% CI: 1.098, 1.296; <0.001) were associated with mortality. Similar results were obtained when we analyzed the data using Cox regression instead of logistic regression. Random forest, support vector machine (SVM), Adaboost, and logistic regression had better overall performances with areas under the receiver operating characteristic curve (AUROCs) of >0.87. Naïve Bayes was the best in terms of both specificity and precision. With ensemble learning, age, ICU history within 1week, and respiratory rate (BF) were the top three compelling risk factors affecting mortality due to HF. To improve the explainability of the AI models, Shapley Additive Explanations methods were also conducted. Exploring HF mortality and its patterns related to clinical risk factors by machine learning models can help physicians make appropriate decisions when monitoring HF patients' health quality in the hospital.

Drug-Induced Sleep Endoscopy Predicts Subjective Outcomes of Adenotonsillectomy.

Persistent obstructive sleep apnea (OSA) after adenotonsillectomy (AT) has been reported in 20%-30% of children. The aim of this study was to determine the predictive value of drug-induced sleep endoscopy (DISE) at the time of AT on subjective AT outcomes. This was a prospective cohort study of children aged 2-18 years being treated with AT for sleep disordered breathing (SDB) with one or more risk factors for AT failure: age >7 years, obesity, severe baseline OSA, Black race. All underwent DISE at the time of AT. Potential predictors of subjective AT outcome included age, sex, obesity, and DISE patterns. Multivariable linear regression was used to model predictors of post-AT Pediatric Sleep Questionnaire (PSQ) and OSA-18 outcomes. Pre- and post-AT PSQ/OSA-18 responses were available from 194 children. Mean age was 9.3 ± 3.5 years, with 59% obese, 50% female, and 67% White. After AT, mean PSQ score decreased from 0.60 ± 0.19 to 0.28 ± 0.22, p < 0.001 and mean OSA-18 score decreased from 66 ± 21 to 37 ± 18, p < 0.001. The most frequent sites of obstruction were the tonsils (92%), nasal airway (77%), adenoids (64%), and velopharynx (65%). Multivariable regression modeling demonstrated worse outcomes with obesity, male gender, and multilevel obstruction that included the nasal airway and tongue base in addition to adenotonsillar obstruction. Persistent OSA and symptom burden after AT was common in this population. Obesity, male gender, and multilevel obstruction during DISE were all associated with worse subjective outcomes. 3 Laryngoscope, 135:377-384, 2025.

Usefulness of Portable Ultrasound for the Diagnosis of Hepatic Steatosis and Degree of Agreement With Macroscopic and Microscopic Findings of the Hepatic Graft Accepted for Transplantation.

The viability of the liver pre-transplant depends on the type of donor, age, medical history, circumstances of death, result of analytics, and complementary exploration of the abdominal cavity. Abdominal ultrasound is the initial option for the assessment of previously unknown liver disease, such as the qualitative determination of hepatic steatosis . The presence of hepatic steatosis is considered a risk factor for graft failure after liver transplantation, therefore, at the time of clinical assessment of the donor or its presence in the macroscopic assessment in the operating room can be cause for rejection of the organ by the transplant teams. The objective is the usefulness of ultrasound for the diagnosis of hepatic steatosis and degree of agreement with macroscopic and microscopic findings of the hepatic graft accepted for transplantation. We analyzed the results of ultrasound in the population of donors accepted for assessment of the hepatic graft for transplantation and the correlation with the macroscopic finding determined by surgery in the operating room and with the microscopic finding determined by histology in the transplanted grafts. The determinations made describe the demographic variables of the different types of donors, probability of presenting hepatic steatosis, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the use of ultrasound and degree of agreement with macroscopic and microscopic findings. Of the grafts evaluated, hepatic steatosis was described by ultrasound in 48 of 299 cases (16.05%) and by macroscopic aspect in 79 of 299 cases (26.4%). Coinciding in 29 of 79 (36.70%) of the cases (kappa = 0.328, P = .000). The 63.21% (189/299) of the livers evaluated were valid for transplantation. Of the valid grafts, 9.6% presented steatosis by ultrasound, 8.4% by macroscopy, and 21.4% by histology. An ultrasound that reports hepatic steatosis implies an increase of 1.87 of log-odds that the donor presents macroscopic steatosis (95% confidence interval [CI] = 3.34-12.65, P = .000) according to the binary logistic regression model. The sensitivity of ultrasound for hepatic steatosis based on microscopy was 29%, specificity 91%, PPV 66%, and NPV 68%. Given the moderate or low agreement among ultrasound, macroscopy, and histology, the bedside portable ultrasound for the diagnosis of hepatic steatosis seems to be a method that undervalues the presence of hepatic steatosis in potential donors accepted for liver transplantation.

Predictors of surgical failure in pediatric lesional temporal lobe epilepsy surgery.

Epilepsy surgery can potentially cure pharmacoresistant temporal lobe epilepsy (TLE) in children. However, surgical failures, where patients continue to experience seizures, still exist. We evaluated outcomes in pediatric patients after resective temporal lobe surgery to identify risk factors for failure. Data on pediatric patients with TLE who underwent surgery were prospectively collected at our institution. Minimum follow-up (FU) was three years after surgery. Resections were stratified into extended resections, i.e., anterior temporal lobectomies, and sparing resections, i.e., lesionectomies and selective amygdalohippocampectomies. Ongoing seizures and relapses within the first three years were considered surgical failures. We included 96 patients after 43 sparing and 52 extended resections from 1993 to 2019 with a median FU of 10.1years (range 3.0 to 28.3years). Pathohistology most frequently revealed epilepsy-associated tumors (44.8%), hippocampal sclerosis (37.5%), and focal cortical dysplasias (12.5%). One year postoperatively, 69.8% were seizure free, increasing to 78.5% after five and 72.9% after 10years. Sparing resections increased the odds for surgical failure in a multivariate analysis (odds ratio: 4.63, P=0.006). Preoperative focal onset to bilateral tonic-clonic seizures increased the likelihood of seizure relapses (hazard ratio: 3.89, P=0.006) and contributed to higher odds of surgical failure (odds ratio: 2.79, P=0.002). Pediatric patients with TLE undergoing surgery have high rates of long-lasting favorable seizure outcomes. Resection strategy is a prognostic factor for early surgical success in favor of larger resections. Relapses were more frequent in children with focal onset to bilateral tonic-clonic seizures beforesurgery.

Risk Factors for Failure to Eradicate Infection after Single Arthroscopic Debridement in Septic Arthritis of a Native Knee Joint

Risk Factors for Failure to Eradicate Infection after Single Arthroscopic Debridement in Septic Arthritis of a Native Knee Joint

Risk factors for methotrexate treatment failure in tubal ectopic pregnancy: a retrospective cohort study

BackgroundEctopic pregnancy (EP) accounts for approximately 2% of all pregnancies, with tubal ectopic pregnancies (TEPs) being the most common type. Methotrexate (MTX) is a noninvasive and effective medical management option for TEP, but failure rates range from 10 to 36%, posing challenges in clinical practice. Identifying risk factors for MTX treatment failure is crucial to improve patient outcomes and guide clinical decision-making. This study aimed to determine the risk factors associated with MTX failure in TEP patients and support personalized treatment strategies.MethodsThis retrospective study included female patients who were diagnosed with TEP at Peking Union Medical College Hospital (PUMCH) between January 2016 and December 2022. Patients received MTX treatment initially, with dosing intervals and protocols varying according to clinical practice. MTX treatment failure was defined as the need for surgery after MTX administration. The study included two groups: patients who failed MTX treatment (n = 91) and those who succeeded in treatment (n = 268). Univariate and multivariate logistic regression analyses were performed to identify significant predictors of MTX treatment failure. A nomogram was developed to visualize the predictive factors.ResultsA total of 359 patients were included, with 268 (74.7%) succeeding with MTX and 91 (25.3%) required surgery. Specifically, 282 patients (78.6%) received 1-dose MTX, whereas 77 (21.4%) received 2-dose MTX. Univariate analysis revealed that gravidity, previous EP, gestational age, pretreatment β-human chorionic gonadotropin (β-hCG) level, number of MTX treatments, and presence of a visible yolk sac in ultrasound were significant predictors (all P < 0.05). Multivariate analysis confirmed that higher gravidity (odds ratio (OR) = 1.2487, 95% confidence interval (CI): 1.0103 – 1.5433, P = 0.040) and elevated pretreatment β-hCG levels (OR = 1.0006, 95% CI: 1.0004 – 1.0008, P < 0.001) were independent risk factors. Number of MTX treatments was a significant protective factor (OR = 0.4409, 95% CI: 0.2153 – 0.9025, P = 0.025). The nomogram incorporating these six risk factors was developed.ConclusionHigher gravidity and elevated β-hCG levels were significant predictors of MTX failure, while more MTX doses provided a protective effect. These findings underscore the importance of personalized MTX treatment strategies to improve outcomes in TEP. However, the limitations of this study, including its retrospective and single-center design, suggest that further prospective multicenter studies are needed to validate these results.Trial registrationThe trial is registered at http://www.chictr.org.cn. [registration number: ChiCTR2400081314; registration date: 2024–02-28 (prospectively registered)].

Correlation between microRNA-21 expression and overweight/obesity.

Obesity and overweight are chronic conditions characterized by excessive adiposity that negatively impact health. They are among the most significant risk factors for respiratory failure, diabetes mellitus, cardiovascular disease, and hypertension. Genetic factors may contribute to some of these conditions, but they are mainly associated with the lifestyle in the majority. However, neither genetics nor lifestyle can fully explain all cases. Recent studies have proven that microRNA-21 causes the systemic hypertension, many cardiac pathologies, and some cancers. MicroRNA-21 is viewed as an important future biomarker for many critical conditions. We explored the role of microRNA-21 in the causation of overweight and obesity. There is conflicting data about this association in the literature. Determining if there is an association may help us in better understanding and managing this condition.

Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic Fusion

Objective: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target.Methods: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of &gt;28° plus a difference in PJA of &gt;22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF.Results: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001–1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001–1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205–19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109–1.164; p&lt;0.001) were significant risk factors for PJF development.Conclusion: A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.