Identify Risk Factors Research Articles

Subsequent Thyroid Carcinomas in Children and Adolescents Registered in the German MET Consortium (1997-2023).

Introduction: Among childhood cancer survivors, the cumulative incidence rate of differentiated thyroid carcinomas (DTCs) is estimated to be 8-11%. Although the association of DTC with prior radiotherapy is well-studied, the association with chemotherapy remains less understood. Most studies focused on young adults, leaving a knowledge gap on subsequent DTC occurring in childhood and adolescence. Methods: In this retrospective cohort study, we analyzed DTCs in children and adolescents under 18 years of age who were registered with the national multicenter Malignant Endocrine Tumor studies in Germany (1997-2023). We compared patients with first primary DTC to those with subsequent DTC that developed after a history of childhood cancer or hematopoietic stem cell transplantation (HSCT). In the subsequent DTC subgroup, we compared DTCs following chemotherapy only to those following chemo- and radiotherapy. Results: Of 505 patients with DTCs, 66 (13.1%) (38 male, 28 female) were subsequent DTCs. The median age at subsequent DTC diagnosis was 12.7 years (range, 5.1-17.9), with a median latency of 7.3 years (range, 2.2-15.6) from the first malignancy or HSCT. The 5-year overall survival (OS) and thyroid-related adverse event-free survival (EFS) estimates from the diagnoses of a subsequent DTC were 100.0% and 82.5%, respectively. Prior treatment included chemotherapy in 64 patients, with 18 receiving chemotherapy alone. In all, 46 subsequent DTC patients had a history of external radiotherapy, including 2 treated with radiotherapy only and 14 with total body irradiation. Two patients received 131I-metaiodobenzylguanidine treatment. Subsequent DTCs versus first DTCs were smaller in size but more frequently multifocal. Subsequent DTCs following chemotherapy only, compared with chemo- and radiotherapy, developed after a shorter latency (median 6.2 vs. 7.8 years), and were larger (median 1.86 vs. 1.18 cm). Patients with subsequent DTCs following chemotherapy only were younger at diagnosis (median 11.5 vs. 13.7 years). No differences were observed for OS and EFS. Conclusions: Presenting features of subsequent DTCs differ from primary counterparts, although the prognosis is not significantly different. Subsequent DTCs following chemotherapy only versus chemo- and radiotherapy DTCs were larger and diagnosed in younger patients after a shorter latency. More research is needed to identify risk factors and mechanisms potentially contributing to thyroid tumorigenesis post-chemotherapy.

Clinical characteristics and risk factors for adverse outcomes in omphalocele

Objective: To investigate the clinical characteristics of omphalocele, and to assess the risk factors associated with adverse outcomes. Methods: A retrospective cohort study was conducted. Clinical data of 224 patients diagnosed with omphalocele, who were hospitalized at Children's Hospital, Zhejiang University School of Medicine from January 2013 to December 2022, were collected. Based on their discharge outcomes, the patients were classified into 2 groups: favorable outcomes and unfavorable outcomes. Chi-square test or continuity correction χ2 test or Fisher exact probability method, and Mann-Whitney U test were used for intergroup comparisons. Logistic regression analysis was performed to identify risk factors associated with adverse outcomes in omphalocele. Results: Among the 224 patients with omphalocele, 126 were male. A total of 208 patients (92.9%) had favorable outcomes, while 16 patients (7.1%) had unfavorable outcomes. In the unfavorable outcomes group, 14 patients had giant omphaloceles, while 100 patients had giant omphaloceles in the favorable outcomes group. The rates of herniation of more than two intra-abdominal organs in the hernial sac, congenital heart defects, patent ductus arteriosus, pulmonary hypertension, sepsis and infection of the hernial sac, were all higher in the unfavorable outcomes group compared to the favorable outcomes group (all P<0.05). Patients with unfavorable outcomes had longer mechanical ventilation time, duration of oxygen use, duration of parenteral nutrition, hospital stays, and higher rates of parenteral nutrition-associated cholestasis compared to those with favorable outcomes (all P<0.01). Multivariate Logistic regression analysis indicated that pulmonary hypertension (OR=9.39, 95%CI 1.20-73.32), sepsis (OR=8.59, 95%CI 1.32-55.86), and congenital heart defects (OR=6.55, 95%CI 1.11-38.73) were all independent risk factors for adverse outcomes in omphalocele (all P<0.05). Conclusions: Infants with omphalocele are prone to complications such as cardiovascular malformations, infections, and pulmonary hypertension. Adverse outcomes in omphalocele are associated with pulmonary hypertension, sepsis, and congenital heart defects.

Mid-term Results Following Surgical Hip Dislocation for Residual Pediatric Deformities.

Mid-term results following surgical hip dislocation (SHD) for healed slipped capital femoral epiphysis (SCFE) and Perthes-related deformities are limited. This study aimed to characterize patient-reported outcome measures [including rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS)], report survivorship free from conversion to arthroplasty, and identify risk factors associated with composite failure. Twenty-seven patients (n=13 SCFE, n=14 Perthes) with minimum 2-year follow-up (mean 5.7y) who underwent primary SHD from 2011 to 2021 were retrospectively reviewed. Modified Harris Hip Score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) were collected preoperatively and at the latest follow-up. Composite failure was defined as not meeting any MCID/PASS threshold or conversion to arthroplasty. Continuous variables were analyzed using independent-sample t tests or the Wilcoxon Mann-Whitney test, where appropriate. Categorical variables were analyzed using χ2 or Fisher exact test, as indicated. Kaplan-Meier survivorship was determined. Mean mHHS improved from 56.2 to 77.2 (P=0.003) and from 63.0 to 86.3 (P<0.001), while iHOT-12 improved from 36.1 to 64.7 (P=0.008) and 36.8 to 77.2 (P<0.001) in SCFE and Perthes cohorts, respectively. MCID achievement for mHHS and iHOT-12 were 85.7% and 75.0% among SCFE, compared with 83.3% and 81.8% in Perthes. The proportion meeting PASS for mHHS and iHOT-12 was 30% for both in SCFE, compared with 61.5% and 83.3% in Perthes. 5- and 10-year survivorship free of conversion to arthroplasty was 100% and 80%, as well as 93% and 77% in the SCFE and Perthes cohorts, respectively. At mid-term follow-up, patients undergoing SHD for residual deformities related to chronic SCFE and Perthes demonstrated significant improvements in mHHS and iHOT-12, as well as relatively high rates of meeting MCID. SHD is an effective approach providing pain and functional benefit. Preoperative expectations, though, should be tempered in these cohorts, as some pre-existing damage limits the ability to completely normalize anatomy. Level III, retrospective comparative study.

Placental malaria and adverse pregnancy outcomes in Majang Zone of Gambella Region, Southwest Ethiopia: a histopathological and molecular study

BackgroundPlacental malaria (PM) is characterized by Plasmodium parasite sequestration in the placenta. It is responsible for various adverse pregnancy outcomes, including maternal anaemia and low birth weight (LBW). This study aimed to assess prevalence and risk factors of PM, and gestational malaria (GM), together with the prevalence of congenital malaria (CM), maternal anaemia, and LBW among parturient women attending delivery ward of Metti Health Centre (Metti HC) in Majang Zone of Gambella Region, Southwest Ethiopia.MethodsA cross-sectional study involving 180 parturient women attending delivery ward of Metti HC was conducted from November 2022-March 2023. Sociodemographic, obstetric, and anti-malarial intervention data were collected. Capillary, placental and cord blood, and placental biopsy were collected to diagnose malaria using rapid diagnostic test (RDT), microscopy, quantitative polymerase chain reaction (qPCR), and histopathology. Haemoglobin concentration and blood group of the mother and weight of the newborn were determined. Statistical analyses were done by SPSS Version 26.0. Multivariable logistic regression analysis and Chi-square test were done to identify risk factors. Results were presented in text, tables and graphs.ResultsThe prevalence of GM, PM, CM, maternal anaemia, and LBW was 24.4% (95% CI 18.1–30.1), 34.4% (95% CI 27.4–41.4), 5.0% (95% CI 2.4–8.8), 41.7% (95% CI 34.6–49.0) and 27.8% (95% CI 21.6–34.6), respectively. Risk factors of GM were: presence of malaria history within the previous year (AOR: 5.10; 95% CI 1.64–15.83), lack of indoor residual spray (IRS) within the previous year (AOR: 2.98; 95% CI 1.05–8.45), and lack of antenatal care (ANC) contact during the index pregnancy (AOR: 3.96; 95% CI 1.44–10.87). Risk factors of PM were: presence of malaria history within the previous year (AOR: 2.98; 95% CI 1.05–8.45), and lack of ANC contact during the index pregnancy (AOR: 4.83; 95% CI 1.91–12.18). The risk of CM (p < 0.001), maternal anaemia (p < 0.001) and LBW (p < 0.001) increased with GM and PM.ConclusionThere is high prevalence of GM, PM, maternal anaemia, and LBW in the study area. The presence of GM and PM increased the risk of maternal anaemia, CM, and LBW. The identified risk factors should be considered to mitigate malaria among parturient women and its adverse outcomes.

Risk factors for anxiety, depression, stress, and their comorbidities among nurses: a prospective cohort from 2020 to 2022

BackgroundNurses are at the forefront of healthcare delivery during the COVID-19, placing them at an increased risk for mental health issues. This study aimed to identify the risk factors for anxiety, depression, stress, and their comorbidities among nurses during the 2020–2022 period.MethodsA prospective cohort of nurses in Zunyi City, China, was followed from 2020 to 2022. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Perceived Stress Scale (PSS) were used to assess anxiety, depression, and stress, respectively. A self-reported questionnaire was utilized to collect data on demographic characteristics, lifestyle habits, socioeconomic status, work-related factors, and medical history. The Healthy Eating Index (HEI) was calculated to evaluate diet quality. Univariate and multivariate logistic regression analyses were conducted to examine the associations between risk factors and mental health outcomes.ResultsAmong the 516 participating nurses, the incidence rates of new-onset anxiety, depression, and stress were 27.1%, 33.9%, and 39.9%, respectively. Frontline experience with infected patients, night shift work, longer working hours, and higher body mass index were consistently associated with increased risks of anxiety, depression, and stress, whereas a higher healthy eating index score was linked to reduced odds of these mental health outcomes. Notably, higher BMI (≥ 28: OR = 1.67, 95% CI: 1.12–2.16, p = 0.011), night shifts (> 1/week: OR = 5.12, 95% CI: 3.64–5.99, p < 0.001), longer working hours (> 40/week: OR = 1.99, 95% CI: 1.66–2.89, p < 0.001), and frontline experience (OR = 6.11, 95% CI: 4.52–8.88, p < 0.001) significantly increased comorbidity risk, while higher HEI (> 3: OR = 0.51, 95% CI: 0.36–0.70, p < 0.001) reduced the risk.ConclusionOur study highlights the considerable mental health burden among nurses during the 2020–2022 period and identifies key risk factors associated with anxiety, depression, stress, and their comorbidities. These findings underscore the importance of providing targeted interventions and support for nurses, including workload management, work-life balance promotion, and healthy lifestyle encouragement, to mitigate the negative consequences of identified risk factors and improve mental health outcomes.

Comprehensive Analysis of Neurologic Complications Following Transradial Cerebral Angiography.

Transradial access (TRA) for cerebral angiography has become more popular due to fewer complications and greater patient comfort compared to transfemoral access. However, the frequency and nature of neurologic complications linked to TRA remain unclear. This study aimed to determine the incidence of symptomatic neurologic complications after transradial cerebral angiography, identify risk factors, and characterize clinical and imaging features of these complications. We retrospectively analyzed 1,679 consecutive cases of transradial cerebral angiography from a single institution between January 2018 and December 2020. Neurologic complications were defined as any symptomatic changes confirmed by diffusion-weighted imaging revealing ischemic lesions. A case-control matching method was used to enhance the reliability of the results. Clinical, procedural, and anatomical factors were examined for predictors of neurologic complications. Neurologic complications occurred in 1.0% (n=19) of cases, with 85% occurring within six hours post-procedure. No significant predictors of neurologic complications could be identified among the clinical, procedural, or anatomical factors assessed. Overall, 58% of patients experienced transient or reversible complications. Patients with permanent symptoms had mild to moderate disability (mRS scores of 1 or 2), with no severe disability (mRS score ≥3). Diffusion-weighted imaging commonly showed multifocal cortical or subcortical ischemic patterns, typically affecting the right middle cerebral artery territory or multiple territories, suggesting embolic mechanisms as a potential cause. Neurologic complications following transradial cerebral angiography were rare but occurred early in the post-procedural period. The observed ischemic patterns, particularly the right-sided predominance, suggest embolic mechanisms as a potential cause. However, further large-scale, multicenter prospective studies are essential to identify risk factors more clearly and enhance patient safety in this increasingly utilized transradial approach. ACA＝ anterior cerebral artery; ICAS＝ intracranial atherosclerotic stenosis; PCA＝ posterior cerebral artery; SCA＝ subclavian artery; TFA＝ transfemoral access; TRA＝ Transradial access; VAO＝ vertebral artery orifice; VBA＝ vertebrobasilar artery.

Risk Prediction and Management for Central Nervous System Infection After Resection for Gliomas—The 8-Year Experience from a Tertiary Medical Center

Objective: To identify risk factors for central nervous system infection (CNSI) following glioma resection and develop a predictive model. Methods: Retrospective analysis of 435 glioma resection cases was conducted to assess CNSI risk factors. A nomogram predictive model was constructed and validated internally and externally. CSF characteristics and antibiotic use in CNSI patients were summarized and the impact of CNSI on long-term prognosis was evaluated. Results: CNSI incidence was 14.9%. Independent risk factors included ventricular opening, postoperative systemic infection, maximum diameter ≥ 5 cm, and preoperative peripheral blood monocyte percentage ≥ 10%. The predictive model showed good performance (C statistic = 0.797, AUC = 0.731). CNSI patients had elevated CSF protein and leukocytes, with meropenem and vancomycin as primary antibiotics. CNSI had no significant impact on long-term prognosis. Conclusions: Key risk factors for CNSI were identified, and an effective predictive model was established, providing important references for clinical decision-making and CNSI management.

Temporal trends in antimicrobial resistance of medically important pathogens on Curaçao

BackgroundThe Caribbean lacks recent comprehensive antimicrobial resistance data to inform clinicians and decision-makers. This study aims to provide a snapshot of susceptibility trends for pathogens on Curaçao, an island in the southern Caribbean.MethodsWe analyzed susceptibility data of bacterial pathogens isolated from samples submitted from patients attending general practitioners, outpatient clinics and those who were hospitalized between January 2018 and December 2023. Samples originating from blood, urine, genital tract, soft tissue, and lungs were included. Susceptibility testing was performed by VITEK2 according using the European Committee on Antimicrobial Susceptibility Testing criteria.ResultsIn total, 13,528 patients contributed to 22,876 first isolates. Of all infections in adults with Staphylococcus aureus, 14% (95% confidence interval 10–18%) were methicillin-resistant S. aureus (MRSA) in blood, and up to 27% (20–35%) in soft-tissue cultures. For Escherichia coli and Klebsiella pneumoniae, resistance levels were up to 27% (95% CI 22–32%) for cefuroxime and up to 18% (95% CI 18–28%) for third-generation cephalosporins. The addition of gentamicin to empirical therapy with cefuroxime increased coverage only moderately, especially in K. pneumoniae (16%, 95% CI 12–20%). Resistance to amoxicillin-clavulanic acid was up to 47% (95% CI 43–50%), to ciprofloxacin 34% (95% CI 31–37%) and to cotrimoxazole 37% (95% CI 34–39) in urine cultures from outpatients. In contrast, low levels of carbapenem resistant Enterobacterales and Pseudomonas aeruginosa were observed.ConclusionsAntimicrobial resistance is high and widespread across several important antibiotic classes. The widespread occurrence of MRSA and resistance to third-generation cephalosporins highlights the importance of identifying risk factors, enabling more effective guidance for antimicrobial stewardship.

Factors associated with anxiety and fear of falling in older adults: A rapid systematic review of reviews.

Anxiety disorders are prevalent amongst older adults and negatively impact their quality-of-life and health. Anxiety disorders often go undetected or are misattributed to age-related changes. The aim of this systematic review of reviews, was to synthesize existing evidence on risk factors associated with anxiety in older adults to improve opportunities for early detection and intervention. A rapid systematic review of reviews was performed. Studies were included if they were systematic reviews, specific to older adults, reported modifiable or non-modifiable factors associated with increased or decreased frequency of anxiety, and reported on anxiety disorders or symptoms of anxiety (including fear of falling). 27 papers met criteria for inclusion. A total of 77 unique risk and protective factors across demographic, health, environmental, and psychosocial domains were identified. Recurrently identified risk factors for anxiety included female sex, health (e.g., multimorbidity, sensory impairments), physical functions (e.g., impaired balance, history of falls), psychological factors (e.g., fear of falling, depression), social isolation, and sleep disturbances, whereas good physical health and balance confidence were protective. This review reinforces the multifaceted and complex nature of anxiety in older adults. The results synthesized, highlight risk factors that should prompt detection of older adults for anxiety disorders and provide valuable insight for the development of tailored detection tools that better identify older adults at risk. Future research should address methodological limitations and include more diverse populations to improve opportunities for early detection and intervention in this vulnerable population.

Incidence of and Risk Factors for Cutaneous Malignant Neoplasms After Blood or Marrow Transplant.

Cutaneous malignant neoplasms are the most common subsequent neoplasm after blood or marrow transplant (BMT), but a full assessment among survivors is lacking. To identify risk factors for subsequent cutaneous malignant neoplasms using the BMT Survivor Study (BMTSS). This retrospective cohort study included patients who underwent transplant from 1974 to 2014 at City of Hope, University of Minnesota, or University of Alabama at Birmingham and survived 2 years or longer, as well as a comparison cohort of siblings. Both groups completed the BMTSS survey. Data analysis took place from October 2022 to October 2024. Demographics, pre-BMT and BMT-related therapeutic exposures, chronic graft-vs-host disease (cGVHD), and posttransplant immunosuppression. Incident cutaneous malignant neoplasms (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], and melanoma) after BMT. Exposures were evaluated for association with subsequent neoplasms using proportional subdistribution hazards models (reported as subdistribution hazard ratio [SHR] and 95% CI). Among the 3880 BMT survivors (median [range] age at BMT, 44.0 [0-78.0] years; 2165 [55.8%] male; 190 [4.9%] Black, 468 [12.1%] Hispanic, 2897 [74.7%] non-Hispanic White, and 325 [8.4%] of other race [including Asian and Pacific Islander] and multiracial) who were followed up for a median (range) of 9.5 (2.0-46.0) years, 605 developed 778 distinct cutaneous neoplasms (BCC, 321; SCC, 231; melanoma, 78; and unknown type, 148). The 30-year cumulative incidence of any cutaneous malignant neoplasm was 27.4% (BCC, 18.0%; SCC, 9.8%; and melanoma, 3.7%). Seventy-year cumulative probabilities of BCC, SCC, and melanoma were considerably higher in BMT survivors than siblings (18.1% vs 8.2%, 14.7% vs 4.2%, and 4.2% vs 2.4%, respectively). Among BMT survivors, risk factors for subsequent cutaneous malignant neoplasms included age of 50 years and older at BMT (BCC: SHR, 1.76; 95% CI, 1.36-2.29; SCC: SHR, 3.37; 95% CI, 2.41-4.72), male sex (BCC: SHR, 1.39; 95% CI, 1.10-1.75; SCC: SHR, 1.85; 95% CI, 1.39-2.45), pre-BMT monoclonal antibody exposure (BCC: SHR, 1.71; 95% CI, 1.27-2.31), allogeneic BMT with cGVHD (BCC: SHR, 1.48; 95% CI, 1.06-2.08; SCC: SHR, 2.61; 95% CI, 1.68-4.04 [reference: autologous BMT]), post-BMT immunosuppression (BCC: SHR, 1.63; 95% CI, 1.24-2.14; SCC: SHR, 1.48; 95% CI, 1.09-2.02; melanoma: SHR, 1.90; 95% CI, 1.16-3.12), and transplant at City of Hope (BCC: SHR, 3.55; 95% CI, 2.58-4.89; SCC: SHR, 3.57; 95% CI, 2.34-5.47 [reference: University of Minnesota]) or University of Alabama at Birmingham (BCC: SHR, 2.35; 95% CI, 1.35-4.23; SCC: SHR, 2.63; 95% CI, 1.36-5.08 [reference: University of Minnesota]). Race and ethnicity other than non-Hispanic White were protective for BCC (Black: no cases; Hispanic: SHR, 0.27; 95% CI, 0.16-0.44; other race and multiracial: SHR, 0.26; 95% CI, 0.14-0.50 [reference: non-Hispanic White]) and SCC (Black: SHR, 0.17; 95% CI, 0.04-0.67; Hispanic: SHR, 0.28; 95% CI, 0.16-0.50; other race and multiracial: SHR, 0.13; 95% CI, 0.05-0.37 [reference: non-Hispanic White]). Total body irradiation was associated with BCC risk among those younger than 50 years at BMT (SHR, 1.92; 95% CI, 1.27-2.92). In this cohort study, the high risk of cutaneous malignant neoplasms and malignant-specific risk factors suggest a need for personalized patient counseling and posttransplant dermatologic surveillance.

External Validation of the ISGPS Complexity Grading System for Minimally Invasive Pancreatoduodenectomy: Insights from the IGOMIPS registry.

To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD). Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise. Data from MIPD cases reported in the IGOMIPS registry (October 2019-February 2024) were analyzed, with severe postoperative complications as the primary outcome. Logistic regression was used to identify risk factors for complications. Of the 771 MIPD cases, 426 (55.3%) were analyzed. A pancreatic duct size ≤3mm was the only significant risk factor for severe complications (OR=2.22, P=0.0001). Most cases (n=255; 59.9%) were classified as grade C complexity, whereas 22 (5.1%) were classified as grade A. Severe postoperative complications increased with complexity (grade A, 31.8%; grade B, 36.3%; grade C, 48.6%; P=0.0091). For grade A complexity, the outcomes were consistent across surgeons and centers. Grade B outcomes were similar between grade B and C centers but superior to grade A centers. In grade C cases, outcomes were comparable between grade A and B centers, with improvements at grade C centers. Grade A ISGPS experience correlated strongly with mismatches between planned and performed procedures (grade A, 15.0%; grade B, 3.0%; grade C, 3.1%; P<0.0001), including total pancreatectomy (grade A, 11.5%; grade B, 1.2%; grade C, 3.1%; P=0.0005). The ISGPS complexity grading system effectively predicted MIPD outcomes, supporting better patient selection and alignment of complexity with surgical expertise.

Antiplatelet Prophylaxis Reduces the Risk of Early Hepatic Artery Thrombosis Following Liver Transplantation in High-Risk Patients

The prevention of hepatic artery thrombosis (HAT) is pivotal for graft survival immediately after liver transplantation (LT). This study aimed to identify risk factors (RF) for early HAT (eHAT) and assess the benefit of antiplatelet prophylaxis (AP). This retrospective single-center study included 836 adult patients who underwent LT between 2007 and 2022. AP was administered for 3 months in N = 127 patients for surgical reasons. In total, 836 patients underwent LT, of whom 5.5% developed eHAT. In multivariable analysis, arterial anastomotic redo (aHR = 4.33), arterial reconstruction (aHR = 3.72) and cryptogenic liver cirrhosis (aHR = 4.25) were independent RFs for eHAT and AP appeared to be protective (aHR = 0.18). Indeed, in patients with at least one RF who received AP (RF+AP+, n = 94), the eHAT rate was significantly lower (3.2% vs. 21.3%, p &amp;lt; 0.001) than in those with RF who did not receive AP (RF+AP−, n = 89). The effect was even more pronounced when focusing on surgical RF alone (i.e., redo and/or reconstruction) with an additional improvement in 1 year graft survival of 85.3% vs. 70.4%, p = 0.02. AP did not pose an increased risk of bleeding. In conclusion, the main RFs for eHAT include arterial anastomotic redo, arterial reconstruction and cryptogenic liver cirrhosis as LT indications. Our results suggest that AP may protect against eHAT development in these high-risk patients.

Risk factors for complications of Mycoplasma pneumoniae pneumonia in hospitalized children in China: a systematic review and meta-analysis

BackgroundMycoplasma pneumoniae pneumonia (MPP) is a common respiratory disease in children. Some patients may develop long-term respiratory issues such as chronic cough and wheezing due to complications. These complications increase the health burden for children with MPP, highlighting the need to understand their risk factors in order to improve disease prognosis. This study aims to assess the risk factors for complications in hospitalized children with MPP in China.MethodsA comprehensive review of Chinese and English databases was conducted up to April 2024 to retrieve studies focusing on complications in hospitalized children with MPP. Pooled effect sizes were calculated using random-effects or fixed-effects models. Statistical analyses were performed using R software and RevMan 5.3.ResultsThis meta-analysis encompassed a total of 17 studies. We analyzed multiple risk factors associated with complications, including prolonged fever (OR: 3.79, aOR: 1.64), pleural effusion (OR: 3.71, aOR: 6.70), extensive lung infiltration (OR: 5.52, aOR: 3.57), ≥ 2/3 consolidation in a single lung lobe (OR: 4.29, aOR: 4.52), right upper lung lesion (OR: 4.84, aOR: 3.57), extrapulmonary manifestations (OR: 3.20, aOR: 1.89), hypoxemia (OR: 7.58, aOR: 12.43), delayed administration of glucocorticoids (OR: 7.93, aOR: 6.67), and delayed administration of macrolides (OR: 2.75, aOR: 3.84).ConclusionHospitalized children with SMPP and RMPP may have a higher risk of complications, and it is important to identify risk factors early and provide appropriate treatment to minimize complications. The current level of evidence is relatively low and may not accurately reflect the actual clinical situation in China. Further high-quality studies are needed to validate and clarify these findings.Trial registrationOur protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024534397).

Renal survival and treatment of adult patients with Primary Focal Segmental glomerulosclerosis: A historical cohort study of the National Greek Registry.

Primary Focal and Segmental glomerulosclerosis (FSGS) is one of the most common causes of idiopathic nephrotic syndrome. Our aim was to describe a large cohort of patients with primary FSGS, identify risk factors associated with worse renal survival and assess the impact of different immunosuppressive regiments on renal survival. This was a historical cohort study of adults who were diagnosed with primary FSGS from March 26, 1982, to September 16, 2020. The primary outcome was progression to ESRD. We included 579 patients. The mean age was 46 (±15) years of age, with 378 (65%) males and median 24-hour proteinuria was 3.8 (2-6) g. In multivariable analysis only eGFR (HR: 0.97 per ml/min increase, 95% CIs 0.95-0.98) and remission status (complete remission (HR: 0.03, 95% CIs 0.003-0.22) and partial remission (HR: 0.28, 95% CIs 0.13-0.61) compared to no remission) were associated with renal survival. Among patients who received immunosuppression compared to those that did not, there was a higher percentage of complete remission (121 (41%) vs. 40 (24%), p<0.001), and higher percentage of relapses (135 (64%) vs. 27 (33%), p<0.001). Immunosuppression and its type (glucocorticoids vs. cyclosporine ± glucocorticoids) were not associated with renal survival. In primary FSGS, complete and partial remission were associated with improved renal survival. Further randomized studies are needed to assess the efficacy of different therapeutic agents and guide treatment.

Pregnancy complications associated with maternal near-miss in an undeveloped province in south-central China, 2012–2022

ObjectiveTo explore the relationship between pregnancy complications and maternal near-miss (MNM).MethodsData were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012–2022. The MNM ratio refers to the number of MNM per 1000 live births, and maternal mortality refers to the number of maternal deaths per 100,000 live births. Chi-square trend tests (χ2trend) were used to determine trends in proportions by year. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM.ResultsOur study included 780,359 women with 731,185 live births, a total of 2461 MNMs, and 52 maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23–3.50), and the maternal mortality was 7.11 per 100,000 live births (95%CI: 5.18–9.04). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). From 2012 to 2022, the proportion of coagulation/hematological dysfunction among MNM increased from 49.14% in 2012 to 86.39% in 2022, which was the only cause of MNM that showed an increased trend (χ2trend = 7.43, P = 0.01). Results of multivariate logistic regression analysis showed that 10 pregnancy complications were risk factors for MNM: hemorrhage disorder (aOR = 21.50, 95%CI: 19.64–23.54), infections (aOR = 1.91, 95%CI: 1.64–2.22), hypertension (aOR = 4.50, 95%CI: 4.08–4.98), heart disease (aOR = 14.96, 95%CI: 11.51–19.44), embolic disease (aOR = 171.70, 95%CI: 94.08-313.36), liver disease (aOR = 1.54, 95%CI: 1.25–1.90), anaemia (aOR = 4.72, 95%CI: 4.29–5.19), renal disease (aOR = 5.44, 95%CI: 4.00-7.40), pulmonary disease (aOR = 14.85, 95%CI: 8.33–26.50), and connective tissue disease (aOR = 5.15, 95%CI: 3.06–8.66).ConclusionThe MNM ratio was relatively low in Hunan Province. Several pregnancy complications increased the risk of MNM. It is helpful for clinical counseling and public health policies, which may contribute to preventing MNM.

Retrospective cohort study on diseases and risk factors associated with death in hospitalized neonatal foals.

The care of sick neonatal foals is labor-intensive and costly. Prediction of risk of death upon admission is often difficult but might support decision-making. To determine diseases and risk factors associated with death in neonatal hospitalized foals. Two hundred twenty-two hospitalized foals, ≤7 days old. Retrospective cohort study. Clinical and laboratory variables were evaluated for their association with death by means of Cox survival analysis and by classification and regression tree (CART) analysis. Most prevalent diseases were sepsis (43.9%), enteritis (14.0%), and omphalitis (9.0%). Case fatality rate was 33.3%. Neonatal sepsis significantly increased the risk of death (hazard ratio [HR] = 1.9; 95% confidence interval [CI] = 1.2-3.0; P = .009). Multivariable Cox regression in foals ≤7 days old revealed comatose mental state (HR = 2.9; 95% CI = 1.1-8.1; P = .04), L-lactatemia (≥373.8 mg/L [4.2 mmol/L]; HR = 4.4; 95% CI = 1.7-11.7; P = .003) and increased serum amyloid A (SAA; ≥2054 μg/mL; HR = 3.9; 95% CI = 1.2-12.7; P = .02) as risk factors for death, with a sensitivity and specificity of 7.5% and 95.7%, respectively. The CART analysis highlighted L-lactatemia, comatose mental state, and hypercapnia as risk factors for death, with a sensitivity of 38.1% and specificity of 86.1% after validation. In this study sample, sepsis was associated with the highest risk of death. Identified risk factors such as SAA, L-lactate, and comatose mental state might guide veterinarians and owners in better decision-making for economic or welfare reasons. Frequently measured laboratory variables, such as blood glucose concentration and Immunoglobulin G, were not sensitive and specific enough to provide reliable decision support for survival estimation.

Clinical Outcomes of Respiratory Syncytial Virus Infection Among Pediatric Immunocompromised Hosts.

Pediatric immunocompromised patients are at an increased risk of severe respiratory syncytial virus (RSV) infection. Here, we aimed to describe the clinical course and outcomes of RSV infection in immunocompromised children. This single-center study at St. Jude Children's Research Hospital involved immunocompromised children ≤21years old with a positive RSV clinical test from 2007 to 2019. Demographic and clinical characteristics, laboratory values, treatment delays for underlying conditions, and outcomes were gathered from electronic medical records. Multivariate models identified risk factors predictive of severe RSV-lower respiratory tract infection (LRTI). A total of 391 patients, predominantly children over 2years old (median age: 5), were included in the study. Acute lymphoblastic leukemia (ALL) was the most prevalent underlying disease. Most patients (85.7%) exhibited upper respiratory tract infections, while approximately 6% progressed to LRTIs. Over half of the patients (58.8%) required hospitalization, and one-third experienced modifications or delays in their underlying disease treatment due to RSV infection. Severe RSV infections were observed in 15.9% of patients. All-cause mortality was 2.6%, with 0.7% of deaths attributed to RSV. One-third of patients experienced a delay in treatment for their underlying disease due to RSV infection, a phenomenon not well understood but potentially significant. Many immunocompromised children with RSV require hospitalization, including those over 2years old. RSV imposes a significant burden on immunocompromised children of all ages, affecting their cancer treatment plans both directly and indirectly.

A Two-Center Study of a Prognostic Model Related to Acute Kidney Injury After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Development of a New Predictive Dynamic Nomogram.

The purpose of this study was to develop a straightforward, easy-to-use online dynamic nomogram for the identification of children who are at high risk of developing acute kidney injury (AKI) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This was a two-center study in which 242 children in Henan Provincial Children's Hospital composed the training cohort, and 115 children in the First Affiliated Hospital of Zhengzhou University composed the validation cohort. Kaplan-Meier survival analysis was used to compare survival between children with nonacute kidney injury (NAKI) and children with AKI. Multivariate logistic regression analysis was used to identify risk factors for AKI in children who underwent HSCT. The selected variables were utilized to construct nomograms, which were validated via the concordance index (C-index), decision curve analysis, calibration curve analysis, and receiver operating characteristic (ROC) curve analysis. Cumulative survival was significantly lower in children with AKI than in children without kidney injury (p<0.01). Eight variables were included in the nomogram: hepatic veno-occlusive disease (HVOD), graft-versus-host disease (GVHD), ferritin, C-reactive protein (CRP), Cytomegalovirus infection (CMV), thrombotic microangiopathy (TMA), human leukocyte antigen (HLA), and nephrotoxic drugs. The nomogram calibration curves in the training and validation cohorts were highly comparable to the standard curves. The areas under the curve (AUCs) of the prediction model were 0.963 and 0.910 in the training cohort and validation cohort, respectively. The decision curve analysis (DCA) revealed that the model had a significant clinical benefit. The occurrence of AKI affects the prognosis of children who undergo HSCT. We developed a dynamic online nomogram for predicting AKI in children who underwent allo-HSCT on the basis of eight variables. The predictive value and clinical benefit of the nomogram model were acceptable.

Development and validation of a nomogram for predicting the risk of obstructive coronary artery disease in rheumatoid arthritis patients based on LDL-C, Th17 cells, and IL-17

ObjectiveThis study aims to develop and validate a nomogram model for predicting the risk of obstructive coronary artery disease (CAD) in patients with rheumatoid arthritis (RA), incorporating low-density lipoprotein cholesterol (LDL-C), Th17 cells, and interleukin (IL)-17 levels. The proposed model seeks to enable personalized cardiovascular risk assessment for RA patients, thereby optimizing clinical management strategies.MethodsA total of 120 patients with rheumatoid arthritis (RA) who were treated at the Second Hospital of Shanxi Medical University between January 2019 and September 2023 were enrolled in this study. Based on coronary angiography results, patients were categorized into the RA-obstructive CAD group and the RA-non-obstructive CAD group. Additionally, 53 healthy controls (HC group) were included. Clinical characteristics, laboratory parameters, peripheral blood lymphocyte subsets, and cytokine levels were collected for analysis. Univariate logistic regression was used to identify risk factors associated with RA-obstructive CAD. These variables were further refined using a random forest model for optimal selection. Finally, multivariate logistic regression analysis was performed with the selected variables to develop a nomogram model, which was subsequently validated to assess its performance.ResultsCompared with the RA-non-obstructive CAD group, the RA-obstructive CAD group demonstrated significantly elevated levels of immune cell subsets, such as Th17 cells, and cytokines, including IL-17, IL-2, and IL-4, along with a reduction in Treg cells. (2) In the training cohort, univariate and multivariate logistic regression analyses identified LDL-C (OR = 0.04, P &amp;lt; 0.001), Th17 cells (OR = 0.76, P = 0.005), and IL-17 (OR = 0.75, P = 0.001) as independent risk factors for obstructive CAD in RA patients. Subsequently, a predictive nomogram model for RA-obstructive CAD risk was developed based on these indicators, incorporating LDL-C, Th17 cells, and IL-17.ConclusionThis study developed a predictive nomogram for RA-obstructive CAD by combining traditional risk factors, such as LDL-C, with immune biomarkers Th17 and IL-17. The model demonstrated robust predictive accuracy, enabling more precise risk assessment of CAD in RA patients. It offers clinicians a valuable tool for advancing cardiovascular risk management in RA, underscoring its significant potential for clinical application.

Risk Factors and Postoperative Outcomes in Pouchitis Following Restorative Proctocolectomy: An 18-Year Single-Center Study

Background/Objectives: Restorative proctocolectomy with ileo-anal pouch anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC). However, complications like pouchitis can occur. This study aimed to describe patients who underwent IPAA for inflammatory bowel disease (IBD) at Padua Hospital from 2005 to 2023 and identify risk factors for pouchitis. Secondary objectives included evaluating the effectiveness of biological therapy in chronic antibiotic-refractory pouchitis (CARP), Crohn’s disease of the pouch (CDP), and Crohn’s-like inflammation of the pouch (CDLPI), and assessing risk factors for pouch failure. Methods: This retrospective, observational study included 109 patients whose data were collected from medical records. Univariate logistic regression was used to analyze associations between preoperative and postoperative factors and outcomes such as acute pouchitis and pouch failure. The effectiveness of biological therapy was assessed by measuring changes in the Pouchitis Disease Activity Index (PDAI) and the Modified Pouchitis Disease Activity Index (mPDAI) over a 12-month treatment period. Results: Univariate logistic regression revealed significant associations between preoperative extraintestinal manifestations (OR 3.569, 95% CI 1.240–10.720), previous diagnosis of Crohn’s disease (OR 10.675, 95% CI 1.265–90.089), and transmural inflammation at cross-sectional imaging before surgery (OR 3.453, 95% CI 1.193–9.991) with an acute pouchitis risk. Pouch failure was significantly associated with a previous diagnosis of Crohn’s disease (OR 9.500, 95% CI 1.821–49.571) and post-surgical fistulas (OR 41.597, 95% CI 4.022–430.172). Biological therapy led to a significant reduction in the PDAI score in patients with CARP, decreasing from a median of 10 to 4 (p = 0.006). Similarly, in patients with CDP or CDLPI, the mPDAI score was significantly reduced from a median of 9 to 1 (p = 0.034), with remission achieved in 5/6 (83.3%) of these patients. Conclusions: This study provides valuable insights into the management of IPAA patients and highlights the importance of early identification and treatment of risk factors for pouchitis and failure. Biological therapy demonstrated significant effectiveness in reducing disease activity in patients with CARP, CDP, and CDLPI, suggesting its role as a crucial component in managing these complications.