Identify Risk Factors Research Articles

Establishing a nomogram for predicting necrotizing enterocolitis in premature infants: A retrospective multicenter cohort study

BackgroundTo construct a nomogram for predicting necrotizing enterocolitis (NEC) in preterm infants. MethodsA total of 4,724 preterm infants who were admitted into 8 hospitals between April 2019 and September 2020 were initially enrolled this retrospective multicenter cohort study. Finally, 1,092 eligible cases were divided into training set and test set based on a 7:3 ratio. A univariate logistic regression analysis was performed to compare the variables between the two groups. Stepwise backward regression, LASSO regression, and Boruta feature selection were utilized in the multivariate analysis to identify independent risk factors. Then a nomogram model was constructed based on the identified risk factors. ResultsRisk factors for NEC included gestational diabetes mellitus, gestational age, small for gestational age, patent ductus arteriosus, septicemia, red blood cell transfusion, intravenous immunoglobulin, severe feeding intolerance, and absence of breastfeeding. The nomogram model developed based on these factors showed well discriminative ability. Calibration and decision curve analysis curves confirmed the good consistency and clinical utility of the model. ConclusionsWe developed a nomogram model with strong discriminative ability, consistency, and clinical utility for predicting NEC. This model could be valuable for the early prediction of preterm infants at risk of developing NEC.

Microbial spectrum, management challenges, and outcome in patients with otogenic skull base osteomyelitis.

The study aimed to explore the spectrum and trend of causative microbial agents and to identify management challenges and the risk factors for poor outcomes in patients with confirmed otogenic skull base osteomyelitis. A retrospective observational study was conducted at a tertiary-care academic center from 1999 through 2019 and included 28 adult patients with confirmed otogenic skull base osteomyelitis. Relevant data was extracted from electronic and hard patient medical files. The microbial spectrum of involved microbes was identified and correlated to management options. Deterioration risk factors were investigated using suitable statistical analysis tests. Twenty-eight patients with confirmed skull base osteomyelitis were included; most were males (78.6%) and Saudis (78.6%). All patients were ≥50 years of age (mean ± SD is 69.0±10.2.4). Of 41 identified microbial isolates, 56% were bacterial, 44% were fungal. 32.1% of patients had polymicrobial infections, most patients (92.8%) had received ≥2 systemic antibiotics, 57.1% received systemic antibiotic combinations, and 32.1% underwent surgical interventions. The mean antibiotic and antifungal therapy duration was 58.3 and 45.8 days, respectively. The identified risk factors of deterioration were advanced age and concomitant cardiac failure, with P-values of .006 and .034, respectively. The study findings highlight the microbiological spectrum and trend of otogenic skull base osteomyelitis-causative microbes over two decades, present the management challenges, identify deterioration risk factors, and suggest tissue biopsy as the golden standard for accurately identifying causative microbes.

Patient and implant-related risk factors for implant failure of one-stage lateral sinus floor elevation: A 2- to 10-year retrospective study.

This retrospective study aimed to evaluate the early and late implant failure rates of one-stage lateral sinus floor elevation (LSFE)and to identify the patient and implant-related risk factors associated with these failures. All patients treated with one-stage LSFE from January 2014 to December 2021 were evaluated for inclusion. A total of 618 patients with 936 implants met the inclusion criteria. Clinical and radiographic information about patient and implants was collected. Univariate and multivariate Cox proportional hazards frailty regression models were performed to identify risk factors for early and late implant failure. The cumulative implant survival rate was 95.62% (95% CI 93.90%-97.68%), with 16 early implant failures and 25 late implant failures. The Cox analysis indicated that ≤3 mm residual bone height (RBH) was associated with a higher early failure rate. For late implant failure, smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors. Narrow sinus ostium, long infundibulum, and flat thickening of Schneiderian membrane might be non-independent risk factors for late implant failure. No significance was found in other variables, including age, periodontitis history, implant characteristics (position, diameter, length, protrusion length, marginal bone loss), surgeon experience, healing time, opposing dentition, and prosthesis. One-stage LSFE is a predictable treatment for patients with atrophic maxilla. ≤3 mm RBH increased the risk of early implant failure, while smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors for late implant failure.

Model Predicting the Risk of Endometrial Hyperplasia Developing into Endometrial Cancer.

This study retrospectively analyzed the medical records of 200 patients with endometrial hyperplasia to predict the risk of concurrent endometrial cancer. Patients were categorized into either the endometrial cancer group or the endometrial hyperplasia group based on post-hysterectomy pathology. The investigation compared general information, tumor indices, fertility history, preoperative endometrial sampling methods, comorbidities, and clinical symptoms between the groups to identify risk factors for endometrial hyperplasia complicating endometrial cancer. (1) Of the 200 patients, 68 (34.0%) were diagnosed with concurrent endometrial cancer post-hysterectomy. Among these, 60 (88.24%) had endometrioid adenocarcinoma, while 8 (11.76%) had other types. Stage I was identified in 58 patients (85.29%) and Stage II in 10 patients (14.71%). High differentiation was observed in 57 cases (83.82%), moderate differentiation in 7 cases (10.29%), and poor differentiation in 4 cases (5.89%), indicating that most endometrial cancers complicated by hyperplasia were early-stage, well-differentiated endometrioid carcinomas; (2) Univariate analysis revealed statistically significant differences in age, menopausal status, length of menopause, and preoperative endometrial pathology of severe atypical hyperplasia between the groups; (3) Multivariate analysis indicated significant differences for age ≥ 53.5 years (OR: 4.307, 95% CI: 2.018-9.192, p < 0.05), menopausal status (OR: 5.250, 95% CI: 2.449-11.252, p < 0.05), and severe atypical endometrial hyperplasia (OR: 4.817, 95% CI: 1.260-18.419, p < 0.05); (4) Significant differences were observed among patients with endometrial hyperplasia when stratified by the presence of zero, one, two, or three high-risk factors. In conclusion, patients aged ≥ 53.5 years, those who are menopausal, and those with severe atypical endometrial hyperplasia preoperatively are at higher risk for endometrial cancer. The risk increases with the number of high-risk factors present in patients with atypical endometrial hyperplasia.

256. PROGNOSIS AND RISK FACTORS FOR SUPRACLAVICULAR LYMPH NODE METASTASIS IN PATIENTS WITH MIDDLE AND LOWER THORACIC ESOPHAGEAL CANCER

Abstract Background Whether supraclavicular lymph node metastases (#104 LNM) in patients with thoracic esophageal cancer are classified as distant or regional metastases differs between Western countries and East Asia. Therefore, in Japan, 3FL is a standard procedure, but in Western countries, 3FL may be rarely practiced. We aimed to determine the frequency and prognosis of #104 LNM compared with other regional LN stations and to identify risk factors for #104 LNM in patients with advanced thoracic esophageal cancer to investigate value of treatment of #104 LNM. Methods The study cohort of 567 eligible patients with esophageal cancer had undergone subtotal esophagectomy radically from 2003 to 2020. LN metastasis was defined as pathologically proven metastasis or positron emission tomography positive LNs. The effectiveness of LN dissection was assessed using an efficacy index (EI) that we calculated by multiplying the rate of metastasis (%) to each LN station by the 5-year overall survival (OS) rate of each patient and then dividing by 100. In order to clarify the indication for 3FL, risk factors for #104 LNM were determined by multivariable logistic regression. Results Among of 567 patients, 66 (11.6%) had #104 LNM. #104 LNM occurred in 31.7%, 10.7%, and 5.6% of patients with upper, middle, and lower thoracic lesions respectively. All patients had squamous cell carcinoma. Neoadjuvant chemotherapy was administered to 71% of patients, and chemo-radiation to 11%. The 5-year OS was 45.8%. The EI for #104 LNs (5.3) was like that for #101 LNs. Risk factors were age &amp;lt;65 years, upper lesion, clinical stage N2–3, and #101/106rec LNM. When assessing only middle and lower lesions, the 5-year OS of patients was 38% (EI 3.1), similar to that for #101 and #8/9/11 LNs, with similar risk factors to overall population. Conclusions The EI of patients with #104 LNM was similar to that of patients with other regional LNM such as #101 and #8/9/11 LNs, Therefore, patients with #104LNM were worth treated LN dissection. However, we recommend 3FL exclusively for patients with #104 LNM or those at high risk of metastasis due to the overall metastatic rate not being high.

Pulmonary complications post allogeneic haematopoietic stem cell transplant in children.

Haematopoietic stem cell transplant (HCT) is a cellular therapy that, whilst curative for a child's underlying disease, carries significant risk of mortality, including because of pulmonary complications. The aims of this study were to describe the burden of pulmonary complications post-HCT in a cohort of Australian children and identify risk factors for the development of these complications. Patients were identified from the HCT databases at two paediatric transplant centres in Australia. Medical records were reviewed, and demographics, HCT characteristics and pulmonary complications documented. Relative risk ratio was used to identify risk factors for developing pulmonary complications prior to first transplant episode, and survival analysis performed to determine hazard ratio. In total, 243 children underwent transplant during the study period, and pulmonary complications occurred in 48% (117/243) of children. Infectious complications were more common (55%) than non-infective complications (18%) and 26% of patients developed both. Risk factors for the development of pulmonary complications included the following: diagnoses of MPAL (RR 2.16, P = 0.02), matched unrelated donor (RR1.34, P = 0.03), peripheral blood (RR 1.36, P = 0.028) or cord blood (RR 1.73, P = 0.012) as the stem cell source and pre-existing lung disease (RR1.72, P < 0.0001). Children with a post-HCT lung complication had a significantly increased risk of mortality compared with those who did not (HR 3.9, P < 0.0001). This study demonstrates pulmonary complications continue to occur frequently in children post-HCT and contribute significantly to mortality. Highlighting the need for improved strategies to identify patients at risk pre-transplant and enhanced treatments for those who develop lung disease.

Risk factors for acute respiratory distress syndrome in sepsis patients: A meta-analysis

BackgroundAcute Respiratory Distress Syndrome (ARDS) is a critical complication of sepsis, associated with high morbidity and mortality. Identifying risk factors for ARDS among sepsis patients is essential for early intervention and improving outcomes. MethodsWe conducted a comprehensive meta-analysis, reviewing studies that examined the association between various risk factors and ARDS development in sepsis patients. Databases such as PubMed, EMBASE, Cochrane Library, Medline, CINAHL, and Web of Science were searched up to January 2024, without language restrictions. Eligible studies included observational cohorts and case-control studies. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated using a random-effects model. Heterogeneity was assessed through I2 statistics, and publication bias was evaluated via the Luis Furuya-Kanamori (LFK) index. Results15 studies with more than 40,000 participants were analyzed. Significant risk factors for ARDS included pulmonary infection (OR: 2.696, 95 % CI: 1.655 to 4.390), septic shock (OR: 2.627, 95 % CI: 1.850 to 3.731), and pancreatitis (OR: 3.734, 95 % CI: 2.958 to 4.712). No significant associations were found between the development of ARDS in septic patients and the following risk factors: sex (OR: 1.106, 95%CI: 0.957–1.279), smoking status (OR: 1.214, 95%CI: 0.835–1.765), or steroid use (OR: 0.901, 95%CI: 0.617–1.314). APACHE-II and SOFA scores were predictive of ARDS development, emphasizing their utility in clinical assessments. ConclusionPulmonary infection, septic shock, and pancreatitis significantly increase ARDS risk in sepsis patients. Our findings advocate for targeted management of these risk factors to mitigate ARDS development, emphasizing the importance of personalized care in sepsis management.

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology.

Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2). Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.

Exploring the potential of epigenetic clocks in aging research

The process of aging is a notable risk factor for numerous age-related illnesses. Hence, a reliable technique for evaluating biological age or the pace of aging is crucial for understanding the aging process and its influence on the progression of disease. Epigenetic alterations are recognized as a prominent biomarker of aging, and epigenetic clocks formulated on this basis have been shown to provide precise estimations of chronological age. Extensive research has validated the effectiveness of epigenetic clocks in determining aging rates, identifying risk factors for aging, evaluating the impact of anti-aging interventions, and predicting the emergence of age-related diseases. This review provides a detailed overview of the theoretical principles underlying the development of epigenetic clocks and their utility in aging research. Furthermore, it explores the existing obstacles and possibilities linked to epigenetic clocks and proposes potential avenues for future studies in this field

Factors related to the occurrence of fetal birth defects and the construction of a Nomogram model.

To explore the influencing factors of fetal birth defects (BD) and construct a nomogram model. A total of 341 newborns admitted to Meizhou people's hospital from September 2021 to September 2023 were randomly grouped into a modeling group (239 cases) and a validation group (102 cases). The modeling group fetuses were separated into BD and non-BD groups. Multivariate logistic regression analyzed risk factors for BD; R software constructed a nomogram model; Receiver operating characteristic (ROC) curve evaluated the model's discrimination for BD. The top 5 types of BD were congenital heart disease, polydactyly/syndactyly, cleft lip/palate, ear malformation, and foot malformation, with incidence rates of 23.81%, 20.63%, 12.70%, 11.11%, and 7.94%, respectively. BD incidence was 26.36% (63/239). Significant differences between BD and non-BD groups were found in maternal age, gestational age, history of adverse pregnancy/childbirth, gestational hypertension, adverse emotions during pregnancy, and folic acid intake duration (P<0.05). Logistic regression showed maternal age (OR: 4.125), gestational age (OR: 3.066), adverse pregnancy history (OR: 10.628), gestational hypertension (OR: 5.658), adverse emotions (OR: 5.467), and folic acid intake duration (OR: 4.586) were risk factors for BD (P<0.05). The modeling group's ROC AUC was 0.938, calibration curve slope close to 1, H-L test =8.342, P=0.692; external validation AUC was 0.961, calibration slope close to 1, H-L test =7.634, P=0.635. Identified risk factors include maternal age, gestational age, adverse pregnancy history, gestational hypertension, adverse emotions, and folic acid intake duration. The nomogram model shows good discrimination and consistency for evaluating neonatal BD risk.

320. RISK FACTORS FOR BENIGN ANASTOMOTIC STENOSIS AFTER ESOPHAGEAL CANCER SURGERY

Abstract Background Benign strictures occur frequently following an esophagectomy, causing dysphagia, problems with eating, and a diminished overall quality of life. The aim of this study is to identify risk factors associated with anastomotic stenosis specified for anastomotic technique following esophagectomy for cancer. Methods This retrospective study included patients with esophageal and gastroesophageal junction cancer who underwent esophagectomy in a tertiary referral center between 2012 and 2022. Intrathoracic and cervical anastomoses were analyzed separately. Benign anastomotic stenosis was defined as the occurrence of postoperative dysphagia for which at least 1 endoscopic anastomotic dilation was needed. Possible predictive factors for anastomotic stenosis were analyzed with uni- and multivariate logistic regression. Results This study included 902 patients: 605 with an intrathoracic and 297 with a cervical anastomosis. Anastomotic stenosis was observed in 18.4% and 49.8% (p&amp;lt;0.001). Patients respectively requiring a median 4 and 7 dilations (p=0.001). Median of time to anastomotic stenosis was 99 and 78 days (p=0.001). In multivariate analysis of intrathoracic anastomosis, anastomotic leakage was a significant risk factor for stenosis (OR 2.034; 95% CI [1.116-3.708]). In patients without anastomotic leakage, stapler size 29mm was a negative predictor (OR 0.444; 95% CI [1.116-3.708]), immunosuppressants (OR 3.492; 95% CI [1.186-10.279]) and chronic pulmonary disease were significant risk factors (OR 2.717; 95% CI [1.293-5.707]). In multivariate analysis of cervical anastomosis, circular stapled anastomosis was a negative predictor (OR 0.350 95% [CI 0.188-0.652]) for stenosis. Conclusion This study identified the most important risk factors for anastomotic stricture after esophagectomy. Anastomotic leakage, the circular stapler diameter, and the circular stapled technique are factors that could be surgical modifiable, while patients taking immunosuppressants and with chronic pulmonary disease should be counseled for higher risk of stenosis.

P140 PREVALENCE OF HYPERTENSION IN A RURAL COMMUNITY IN THE FEDERAL CAPITAL TERRITORY ABUJA (GBESSA) NORTH CENTRAL NIGERIA

Background: High Blood pressure, once rare, is rapidly becoming a major public health burden in sub-Saharan Africa. This has been attributed to acculturation of the populace who are rapidly adopting modern lifestyle changes. Aim This study aimed to describe the prevalence and identify risk factors for hypertension in rural community in the Federal capital territory in Nigeria. Methods A cross sectional survey of 491 households with 1,739 adults aged 18 years and above was carried out. Information about health and lifestyle was obtained from structured questionnaire interviews, followed by assessment of blood pressure (BP) and anthropometry. Results: There were 18.1% (95% confidence interval (CI), 16.0-20.6% participants with hypertension (defined as a systolic BP-140, diastolic BP-90mmHg or on antihypertensives medication). This prevalence of Hypertension was found to rise with age. Between the sexes males recorded a higher prevalence of 19.6% compared to 17.4%: females but this was not statistically ×2 P-value =0.34. Single and widowed subjects recorded high prevalence of 32.2% and 30.0% of Hypertension while students had low rate of 5.6%. The prevalence of Hypertension was 20.5% among farmers.Whereas, obesity (measured by WHR), alcohol intake, cigarette smoking, and family history of hypertension had no valid statistical evidence, chewing tobacco/ snuff, previously diagnosed diabetes mellitus or family history of diabetes showed statistically significant differences. Conclusion: This findings underscore the need for public health campaign at community levels to prevent increasing blood pressure and it's sequelae. This will involve campaigns to maintain the age- long tradition of exercise, avoidance of smoking, alcohol and weight maintenance.

Quantitative Risk Analysis of Road Transportation of Hazardous Materials in Coastal Areas

Given the complex climate conditions in coastal areas and their role as key transportation hubs for hazardous chemicals, this study proposes a method to quantitatively and comprehensively evaluate transportation risks. Initially, accident data were analyzed to identify risk factors from five aspects: human, vehicle, materials, environment, and management, based on system safety theory. Subsequently, a risk analysis model was developed using Decision-making Trial and Evaluation Laboratory, interpretive structural model theory, and Bayesian theory to quantitatively assess accident risk levels. The model was applied to a case involving a hazardous chemical accident on a cross-sea bridge, where Bayesian backward reasoning was used to analyze the sensitivity and importance of risk factors. This approach facilitated the key risk factors affecting the safety of hazardous chemical transportation systems. Notably, the study incorporated scenarios involving hazardous material transport vehicles crossing sea bridges into the risk assessment framework, offering valuable insights for management authorities. It also considered the impact of strong side winds-a factor often overlooked-in hazardous material transport. The validation process demonstrated that the method accurately quantifies the risk of hazardous chemical transportation and identifies the key factors influencing accident occurrence. The research highlights that strong gusts of wind significantly impact safety, and human factors are crucial in the overall risk system.

Importance of Dyslipidemias in Very Premature Coronary Artery Disease in India: A Registry-based Study.

Premature coronary artery disease (CAD) is an important cause of death in India. To identify risk factors in patients with premature CAD, we performed a registry-based study. Consecutive patients admitted for percutaneous coronary intervention (PCI) from October 2020 to June 2021 were recruited. The patients were classified into three groups-group I (very premature CAD < 40 years), group II (premature CAD 40-59 years), and group III (nonpremature CAD > 60 years). Major risk factors were determined, and intergroup comparison was performed. A total of 627 patients were enrolled (men 541, women 86). Group I had 79 (12.4%), group II had 420 (66.9%), and group III had 128 (20.4%) patients. The prevalence of risk factors in groups I, II, and III, respectively, were-CAD family history in 45.1, 41.1, and 26.6% (p = 0.005), current smoking/tobacco use in 29.1, 21.0, and 10.2% (p = 0.002), hypertension in 31.6, 43.6, and 59.4% (p < 0.001), and diabetes in 22.8, 34.3, and 46.1% (p < 0.001). High total cholesterol (>170 mg/dL) was present in 50.0, 38.0, and 29.9% (p = 0.005), nonhigh-density lipoprotein (HDL) cholesterol (>100 mg/dL) in 76.9, 64.4, and 54.5% (p = 0.001), low-density lipoprotein (LDL) cholesterol (>70 mg/dL) in 85.9, 76.8, and 76.4% (p = 0.167), triglycerides (>150 mg/dL) in 56.4, 45.3, and 33.1% (p = 0.001), and very low density lipoprotein (VLDL) cholesterol (>30 mg/dL) in 24.4, 10.4, and 9.4% (p = 0.005). Age- and sex-adjusted odds ratios (OR) and 95% confidence intervals (CI) for smoking/tobacco use in groups I and II compared to group III, respectively, were 3.17 (1.60-6.27) and 2.59 (1.51-4.46); high total cholesterol 2.39 (1.29-4.13) and 1.42 (0.92-2.17); high non-HDL cholesterol 2.70 (1.45-5.03) and 1.48 (0.99-2.20); and high triglycerides 2.57 (1.44-4.58) and 1.64 (1.08-2.49). Important coronary risk factors in very premature and premature CAD in India are a family history of CAD, any tobacco use, and dyslipidemias (raised total, LDL, non-HDL, and VLDL cholesterol and triglycerides).

Inaccurate Clinical Stage is Common and Associated With Poor Survival in Patients With Lung Cancer

IntroductionClinical staging in lung cancer has implications for treatment planning and prognosis. We sought to determine the rate of inaccurate clinical stage (relative to pathologic), identify risk factors for inaccuracy, and evaluate the association of inaccuracy on survival. We hypothesized that inaccurate staging was associated with poor survival. MethodsIn this retrospective cohort study, adult patients who received surgical resection without neoadjuvant treatment for nonsmall cell lung cancer from 2004 to 2020 in the National Cancer Database were categorized by accuracy of clinical stage (relative to pathologic stage). Multivariate models were used to determine risk factors for inaccuracy. The association between inaccuracy and overall survival was also analyzed. ResultsWe identified 255,598 patients with lung cancer, including 84,543 patients (33.1%) who were inaccurately staged. Stage inaccuracy was associated with higher tumor, node, metastasis stage (T-category 3: odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.15-1.28; N-category 2: OR = 2.6, 95% CI 2.47-2.79), greater quantity of lymph nodes evaluated, and more extensive resection (extended lobectomy/bilobectomy: OR = 1.3, 95% CI 1.20-1.37; pneumonectomy: OR = 1.6, 95% CI 1.54-1.74). Patients undergoing robotic surgery were less likely to be inaccurately staged (OR = 0.89, 95% CI 0.852-0.939). Inaccurate staging was associated with worse overall survival (5-y 67.5% accurate versus 55.4% inaccurate, P < 0.001). Inaccurate staging was also associated with worse survival in a multivariate Cox model (hazard ratio [HR] = 1.3, 95% CI 1.29-1.33). Both “understaging” (path > clinical) and “overstaging” (clinical > path) were associated with inferior survival. ConclusionsInaccurate clinical stage (relative to pathologic) occurs in one-third of patients receiving surgery for lung cancer. Inaccuracy is associated with poor survival. Quality improvement initiatives should focus on improving clinical staging accuracy.

Preoperative Prognostic Stratification and Prediction of Long-term Outcomes after Pancreatoduodenectomy for Distal Cholangiocarcinoma

BackgroundPatients with distal cholangiocarcinoma (DCC) frequently receive adjuvant chemotherapy in preoperative and postoperative settings, but prediction of prognostic risk at the time of treatment selection remains challenging. MethodsThis single-center retrospective study enrolled DCC patients who underwent initial pancreatoduodenectomy (PD) between 2009 and 2022. Preoperative clinical parameters were collected, and Cox regression analysis was used to identify risk factors for overall survival (OS). ResultsAmong 170 patients examined, the median tumor depth was 10 mm, and 37% of the patients were diagnosed with pT3. Overall, 46% of patients had lymph node metastasis. The median and 5-year OS was 58.2 months and 50%, respectively. Multivariate analysis revealed tumor size on computed tomography (CT) ≥15 mm and main pancreatic duct (MPD) dilatation (≥3 mm) as independent risk factors for OS among various preoperative parameters; the prognosis was stratified based on these two parameters. Patients with one risk factor had similar outcomes (5-year OS: 39%) to pStage IIB DCC (pT2N1 or pT3), while those with two risk factors had a prognosis akin to pStage IIIA (pN2), with a high early recurrence rate of 64% (5-year OS: 8%). Among non-risk group patients with low carbohydrate antigen (CA)19-9 levels (<37 U/mL), the prognosis was comparable (5-year OS: 72%) to those with pStage I DCC. ConclusionA simple stratification approach was developed to predict long-term postoperative outcomes. To improve poor prognosis, intensive therapy, including neoadjuvant chemotherapy, should be considered for patients with two risk factors.

Clinical course and risk factors for post-operative onset lateral hinge fracture following medial opening-wedge distal tibial tuberosity osteotomy

PurposeThis study aimed to investigate the clinical outcomes of and risk factors for post-operative onset lateral hinge fracture (LHF) following medial opening-wedge distal tibial tuberosity osteotomy (DTO). MethodsA total of 68 patients who underwent DTO were stratified into non-LHF and post-operative onset LHF groups. The groups were compared in terms of radiographic parameters, including the hip–knee–ankle (HKA) angle, and were clinically evaluated using the Knee Society Score (KSS) and 2011KSS. Multiple logistic regression analysis was performed to identify risk factors for post-operative onset LHF. ResultsThe non-LHF and post-operative onset LHF groups included 53 and 15 patients, respectively. The post-operative HKA angle was significantly smaller (valgus) in the post-operative onset LHF group than in the non-LHF group (P ​= ​0.005). Knee and function scores were significantly lower in the post-operative onset LHF group than the non-LHF group at 6 months (P ​= ​0.002 for each comparison). All 2011KSS subscores were significantly lower in the post-operative onset LHF group than the non-LHF group at 6 months (P ​= ​0.001, 0.010, 0.013, and 0.013, respectively). Post-operative HKA angle was a risk factor for post-operative onset LHF (odds ratio ​= ​0.589, 95% confidence interval 0.392–0.886; P ​= ​0.011). ConclusionsPost-operative weight bearing may be delayed to prevent post-operative onset LHF, especially in patients with post-operative large valgus knee alignment.

Management of intensive care unit withdrawal syndrome

Intensive care unit (ICU) patients frequently develop physical and psychological dependence on analgesic and sedative medications, which can lead to Iatrogenic withdrawal syndrome (IWS) upon discontinuation or tapering. The incidence of IWS in adult ICU patients varies significantly, with reported rates ranging from 12% to 100%. Identified risk factors for IWS include advanced age, obesity, medication dosage, and duration of exposure. The clinical manifestations of IWS are varied and include increased excitability of the central nervous system, gastrointestinal disturbances, and sympathetic nervous system hyperactivity. Preventive and therapeutic strategies for IWS encompass individualized medication regimens, structured withdrawal protocols, and a combination of pharmacological and non-pharmacological interventions. This review emphasizes the critical need for heightened awareness and improved management strategies to mitigate the incidence of IWS in ICU patients.

Peripheral neuropathy, an independent risk factor for falls in the elderly, impairs stepping as a postural control mechanism: A case-cohort study.

Peripheral neuropathies perturbate the sensorimotor system, causing difficulties in walking-related motor tasks and, eventually, falls. Falls result in functional dependency and reliance on healthcare, especially in older persons. We investigated if peripheral neuropathy is a genuine risk factor for falls in the elderly and if quantification of postural control via posturography is helpful in identifying subjects at risk of falls. Seventeen older persons with a clinical polyneuropathic syndrome of the lower limbs and converging electrophysiology were compared with 14 older persons without polyneuropathy. All participants were characterized via quantitative motor and sensory testing, neuropsychological assessment, and self-questionnaires. Video-nystagmography and caloric test excluded vestibulocochlear dysfunction. For further analysis, all subjects were stratified into fallers and non-fallers. Overall, 28 patients underwent computerized dynamic posturography for individual fall risk assessment. Regression analyses were performed to identify risk factors and predictive posturography parameters. Neuropathy is an independent risk factor for falls in the elderly, while no differences were observed for age, gender, weight, frailty, DemTect test, timed "Up & Go" test, and dizziness-related handicap score. In computerized dynamic posturography, fallers stepped more often to regain postural control in challenging conditions, while the Rhythmic Weight Shift test showed a lack of anterior-posterior bidirectional voluntary control. Our study confirms peripheral neuropathy as a risk factor for older persons' falls. Fallers frequently used stepping to regain postural control. The voluntary control of this coping movement was impaired. Further investigations into these parameters' value in predicting the risk of falls in the elderly are warranted.

Preditores de progressão da doença renal policística autossômica dominante: uma coorte brasileira de centro único

Abstract Introduction: Identifying risk factors for autosomal dominant polycystic kidney disease (ADPKD) progression is important. However, studies that have evaluated this subject using a Brazilian sample is sparce. Therefore, the aim of this study was to identify risk factors for renal outcomes and death in a Brazilian cohort of ADPKD patients. Methods: Patients had the first medical appointment between January 2002 and December 2014, and were followed up until December 2019. Associations between clinical and laboratory variables with the primary outcome (sustained decrease of at least 57% in the eGFR from baseline, need for dialysis or renal transplantation) and the secondary outcome (death from any cause) were analyzed using a multiple Cox regression model. Among 80 ADPKD patients, those under 18 years, with glomerular filtration rate &lt;30 mL/min/1.73 m2, and/or those with missing data were excluded. There were 70 patients followed. Results: The factors independently associated with the renal outcomes were total kidney length – adjusted Hazard Ratio (HR) with a 95% confidence interval (95% CI): 1.137 (1.057–1.224), glomerular filtration rate – HR (95% CI): 0.970 (0.949–0.992), and serum uric acid level – HR (95% CI): 1.643 (1.118–2.415). Diabetes mellitus - HR (95% CI): 8.115 (1.985–33.180) and glomerular filtration rate - HR (95% CI): 0.957 (0.919–0.997) were associated with the secondary outcome. Conclusions: These findings corroborate the hypothesis that total kidney length, glomerular filtration rate and serum uric acid level may be important prognostic predictors of ADPKD in a Brazilian cohort, which could help to select patients who require closer follow up.