Comparisons of global incidence and risk factor profiles of hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

The study of modifiable risk factors and preoperative optimization is critical to improving outcomes of total joint arthroplasty and lowering complications and the cost of care. Multiple attempts were made by the American Association of Hip and Knee Surgeons and the American Academy of Orthopaedic Surgeons to offer clinical practice guidelines based on the available literature. However, high-quality evidence to support that any comorbidity, including obesity, represents a modifiable risk for prosthetic joint infection was lacking. It is important to examine these guidelines, review the more recent literature, and discuss the practicality of evidence-based medicine when the quality of evidence is limited and also discuss the five conditions necessary to consider any disorder a modifiable risk factor.

Modifiable risk factors significantly influence both perioperative safety and long-term success in total joint arthroplasty. A structured, patient-focused model should be used for optimizing high-impact factors, including obesity, malnutrition, anemia, and poorly controlled diabetes. Practical guidance on anesthesia selection and surgical technique adjustments is important to accommodate body habitus and reduce surgical complexity. Targeted medication dosing strategies are needed to avoid undertreatment or toxic exposures in patients with altered pharmacokinetics. It is also important to underscore the value of robust behavioral interventions, such as smoking cessation and alcohol reduction, to lower wound complication rates and enhance overall recovery. Central sensitization of pain with an emphasis on using specific therapeutic approaches, including neuromodulators, will improve postoperative comfort and patient satisfaction. In addition, there are recommendations for mitigating infection risk, ranging from careful glycemic control to selective methicillin-resistant Staphylococcus aureus decolonization protocols. By addressing these modifiable elements, surgeons and their care teams can substantially decrease complication rates, optimize implant longevity, and promote enhanced functional outcomes.

Knee stiffness is a common complication after total knee arthroplasty with significant clinical consequences because limited range of motion negatively affects joint function and is associated with pain and disability. The prevention of stiffness is a goal in the perioperative setting, with the plan to optimize and modify risk factors whenever possible. Once stiffness develops, early identification and treatment may positively affect patient outcome. For persistent stiffness, additional surgical intervention may be required. It is important to present an overview of the pathophysiology of arthrofibrosis, the preoperative and perioperative risk factors for the development of arthrofibrosis and how to optimize patients to reduce this risk, and treatment options for stiffness in both the early and late postoperative periods.

Introduction: Diarrhoea is common in critically ill patients that may be caused due to many factors such as Clostridium difficile, drugs (e.g., laxatives, antibiotics) and enteral feeds. The incidence of diarrhoea in the Intensive Care Units (ICU) has ranged in the literature from 2-95%. This wide variation may be due to lack of consistent definitions applied across studies, and ineffective metrics in monitoring patient’s bowel habits in the ICU. Diarrhoea from any cause can place patients at risk for complications such as skin breakdown, dehydration, electrolyte disturbance, renal dysfunction, hypovolaemia, malnutrition, and contamination of wounds; therefore, diarrhoea should be recognised promptly. Aim: To identify the prevalence of diarrhoea, its risk factors and its association with selected variables among patients admitted in ICU for >24 hours. Materials and Methods: The present cross-sectional descriptive study was conducted with the purpose to acquire detailed information on diarrhoea and its associated risk factors in Apollo hospitals in northeastern region, India. The study was conducted for a period of six months (October 2023-March 2024) among ICU patients who stayed for >24 hours in adult ICU of a tertiary care hospital in northeastern region, India. The diarrhoea patients were included in the study as defined by World Gastroenterology Organisation. Patients admitted under Gastroenterology Department, diarrhoea on admission and advised to use laxatives (e.g., hepatic encephalopathy) were excluded from the study. Both descriptive and inferential statistics were used to analyse the study findings. Results: A total of 1219 patients were included in the study, out of which 50 (4.2%) patients were found to have diarrhoea. The age of the patients was found to be >65 years for 32% patients with diarrhoea. Majority (82%) of the patients with diarrhoea passed stool 3-6 times/day, 4% had positive results for C.difficile, 52% of patients stayed in the ICU for >14 days. Antibiotic or antifungal therapy was administered to all patients (100%) and all of them (100%) received empirical antibiotic therapy. A 90% of patients were on ventilator for 0-15 days. This study identified the non-modifiable risk factors including age >65 years {Risk Ratio (RR) 7.5, 95% CI 0.03-0.004}, ventilation (RR 7, 95% CI 0.14 - 0.02) and modifiable risk factor i.e., sepsis (RR 11.6, 95% CI 0.35 - 0.03). In contrast, antibiotic administration was found to have low risk (RR 0.04 95% CI 0.04 - 0) for causing diarrhoea. The study also identified that in critically ill patients, diarrhoea was significantly associated with ventilator use (p<0.01), sepsis (p<0.05), and an ICU stay longer than 14 days (p<0.05). Conclusion: According to the present study findings, diarrhoea is a frequent concern in the ICU and is associated with prolonged mechanical ventilation, increased length of ICU stays, skin breakdown and renal dysfunction. The results showed that 100% samples who had diarrhoea were on antibiotics. Hence further studies will be required to strengthen the use of antibiotics.

Air pollution and disease progression in a University of Michigan amyotrophic lateral sclerosis cohort.

Aging, dementia, and care models: Global perspectives with insights from India.

National and regional burden of early-onset type 2 diabetes mellitus in the Americas from 1990 to 2023, attributable to modifiable risk factors, and projections to 2050: a systematic analysis for the global burden of disease study 2023.

Long-term cognitive outcomes following post-TAVR stroke: A propensity-matched analysis from the TriNetX network.

Non-coding RNA biomarkers in cardiovascular disease.

From pathogenesis to precision medicine: Targeting immune imbalance in multiple sclerosis.

Attitude toward aging and elderliness and death anxiety in geriatric individuals with chronic diseases in Turkey: Artificial neural network prediction.

Patient-specific risk factors play a significant role in determining the outcome of total joint arthroplasty. Optimizing risk factors that are modifiable can improve surgical results. The proper assessment of these factors preoperatively is critical in determining a plan of intervention. Clear, evidence-based guidelines are evolving regarding the best assessment tools for deciding the necessity of and the proper degree of intervention. It is important to review current research on the assessment of modifiable risk factors. A thorough understanding of the definition, assessment, and current investigation surrounding the assessment of these modifiable risk factors is critical to optimizing total joint arthroplasty.

The practice of patient optimization seems to be straightforward, logical, and not controversial, but ethical issues may arise. This most commonly occurs when the desire for risk reduction competes with concerns regarding access to care. There is no uniformity in how patient optimization is defined or achieved, and thus the outcomes of optimization programs are highly variable. The ethical tenets of beneficence, nonmaleficence, autonomy, and justice can help to guide decision making. The framework proposed helps the surgeon to consider a potentially modifiable risk factor that involves three questions: (1) What is the relationship between the risk factor and complications? (2) Is this risk factor modifiable, and to what degree can it be changed or improved? (3) If the risk factor is modified, does this actually result in reduced risk? To demonstrate application of this framework and the ethical tenets, we consider body mass index as a possible optimizable risk factor for total joint arthroplasty.

Peri-conceptional maternal vulnerability risk score and embryonic growth: the Rotterdam Periconception Cohort.

Association of hypertension and genetic variants in MYH9 and BMPR1B with increased proteinuria in sickle cell disease.

In patients with advanced chronic kidney disease (CKD), risk factor reversals occur where obesity and elevated LDL cholesterol paradoxically associate with improved survival. This review synthesizes recent advances in understanding these obesity and lipid paradoxes, integrating insights from body composition, inflammation, and metabolism. Observational studies have shown stage-specific survival advantages of obesity, mainly in hemodialysis populations and among patients with inflammation. The lipid paradox is also largely explained by the confounding effects of inflammation, which suppresses cholesterol levels. Beyond quantitative assessment, emerging evidence emphasizes that assessments of body composition and lipid quality are stronger predictors of clinical outcomes. For severely obese patients, integrative strategies using lifestyle, nutritional therapy, and pharmacologic agents may modulate inflammation, reducing the risk of protein-energy wasting. Weight loss from GLP-1 receptor agonists or bariatric surgery may improve kidney transplant eligibility but requires careful individual assessment to balance this benefit with the risk of malnutrition. The obesity and lipid paradoxes in CKD are not merely anomalies nor statistical fallacies to be adjusted for, but manifestations of CKD's distinct metabolic milieu. Their recognition highlights the need for individualized approaches beyond conventional risk factor modification. By integrating assessment of body composition, nutrition, and inflammation, precision nephrology can provide tailored interventions that improve prognosis.

Pathogenesis of Barrett's Esophagus: Evolving and Emerging Mechanisms.

Introduction/background/objectives Type 2 diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia, associated with insulin resistance and/or impaired insulin secretion, with high morbidity and mortality. Its global prevalence has been increasing significantly and is projected to exceed 1,3 billion cases by 2050. In Portugal, in 2021, approximately 14% of adults (20–79 years) were living with diabetes. Several risk factors are well established, such as family history, obesity, and unhealthy lifestyle habits. However, less recognized determinants such as sleep disturbances and night shift work are emerging as potential determinants. Circadian rhythm disruption, reduced melatonin secretion, and increased cortisol levels are plausible pathophysiological mechanisms supporting this association. This evidence-based review aims to assess whether night shift work is associated with an increased risk of developing type 2 diabetes mellitus. Methodology A literature search was conducted in Medline, Cochrane Library, EBSCO, and Web of Science databases to identify umbrella reviews, meta-analyses, systematic reviews, and clinical trials published between January 2010 and February 2025, in Portuguese, English, or Spanish. Inclusion criteria followed the PICO framework: adults aged ≥18 years, without previous diagnosis of type 2 diabetes mellitus, exposed to night shift work, compared with non-exposed workers, with incident type 2 diabetes mellitus as the outcome. Narrative reviews, opinion, duplicates or papers included in selected studies, articles inconsistent with the objective, and studies in pregnant were excluded. The level of evidence and strength of recommendation were assessed using the Strength of Recommendation Taxonomy. Contents/results Four articles met inclusion criteria, namely one meta-analysis of cohort studies, one umbrella review and two cohort studies, encompassing a total sample of more than one million participants from diverse geographic and occupational settings. Overall, a positive association was observed between night shift work and the risk of developing type 2 diabetes mellitus, with dose-response relationships reported in some studies. Discussion and Conclusion This review highlights that night shift work is associated with an increased risk of type 2 diabetes mellitus (Strength of Recommendation “B”). Recognition of night shift work as a modifiable risk factor may guide occupational health policies, encourage early metabolic screening, and support preventive interventions aimed at mitigating the impact of this exposure. KEYWORDS: Diabetes Mellitus, Type 2; Shift Work Schedule, Night Shift Work, Occupational Health, Occupational Medicine, Occupational Health Nursing.

Background and Objectives: Female breast cancer (FBC) is an increasing public health concern in Iran, with notable geographic disparities that necessitate comprehensive burden assessments at national and provincial levels. This study presented the national and subnational burden and changes in FBC burden from 2010 to 2021 in Iran in comparison with global data. Materials and Methods: The GBD (2021) data on female BC were extracted from the Global Health Data Exchange (GHDx) query tool. Age-standardized incidence, deaths, prevalence, and adjusted years of life with disabilities (DALYs) rates (per 100,000) of FBC were extracted. Data were extracted globally, by continents, for Iran and its provinces, from 2010 to 2021. Results: Although the global FBC burden indicators remained almost stable, in Iran, there was a nearly twofold rise in incidence and prevalence and notable rises in mortality and DALYs. This study showed significant variation at the provincial level; Tehran, Qom, and Alborz consistently had the highest incidence, prevalence, mortality, and DALY rates, whereas Sistan and Baluchistan, Chahar Mahaal and Bakhtiari, Kohgiluyeh and Boyer-Ahmad, and Zanjan had the lowest rates. During 2010–2021, the provinces of Golestan, Ardebil, Sistan and Baluchistan, West Azarbayejan, Kohgiluyeh and Boyer-Ahmad, and North Khorasan experienced the most increasing trend in BC burden, while Yazd and Semnan showed smaller increases or modest decreases. Conclusions: The rising FBC burden in Iran underscores the urgent need to strengthen cancer registries, expand screening programs, ensure equitable resource distribution, and implement targeted regional interventions focused on modifiable risk factors and early detection to reduce health disparities nationwide.