Potential Clinical Risk Factors Research Articles (Page 1)

Relevance. In the context of economic instability and declining birth rates, reproductive health care is becoming particularly important. The problem of infertility, especially in cases of unexplained origin, requires a comprehensive study from both medical and social perspectives. Psychological factors are considered potential clinical risk factors that can reduce both female and male fertility and, once pregnancy occurs, may affect its course and perinatal outcomes. Aim of the study. To assess the psychological status of pregnant women with a history of psychosomatic infertility. Materials and methods. A total of 87 pregnant women were examined. They were divided into three groups according to the duration of infertility of unexplained origin in their medical history: Group 1 – 1.5–2.5 years (32 women, 36.8%), Group 2 – 2.6–4.5 years (34 women, 39.1%), and Group 3 – 4.6–5.5 years (21 women, 24.1%). The psychological state was assessed by trimester using the Hospital Anxiety and Depression Scale (HADS). Statistical processing of the results was performed with the Microsoft Excel statistical analysis package. Results. Analysis of the course of pregnancy in women with a history of unexplained infertility indicated a complicated course. The frequency of gestational complications increased with pregnancy duration and was higher in women who had experienced longer periods of infertility before conception. Assessment of the psychological state using the HADS revealed an increase in anxiety and depression among women who developed gestational complications. Throughout pregnancy, fluctuations in the severity of both anxiety and depressive symptoms were noted, ranging from normal (0–7) to subclinical (8–10) and clinically significant (≥11) levels. The results demonstrated a predominance of anxiety disorders over depressive ones. Changes in the psychological state of women with a history of infertility corresponded to changes in the type and frequency of gestational complications. Conclusion. The findings confirm the role of the maternal psychogenic state as a risk factor for gestational complications, emphasizing the need for timely assessment and correction both during preconception preparation and throughout pregnancy.

Risk modeling of imaging changes after proton beam therapy for childhood brain tumors.

Background: The preservation of reproductive organs in females with muscle-invasive bladder cancer (MIBC) might improve reproductive and sexual function. This study aimed to identify potential clinical risk factors for reproductive organ involvement (ROI) using preoperative data from transurethral resection of tumor (TURT) reports and imaging findings.Methods: This retrospective analysis was conducted on 143 women with bladder cancer who underwent radical cystectomy (RC) at Modarres and Labafinejad Medical Centers in Tehran, Iran, between 2010 and 2019. Demographic, clinical, and pathological data, along with follow-up reports, were collected from medical records and analyzed.Results: The mean age of the participants was 69.17±10.62 years, with an ROI rate of 16.8%. The vagina was the predominantly involved organ. Significant independent risk factors for ROI included clinical T stage (P=0.042), bladder neck or trigonal location of the tumor (P<0.001), tumor size> 5 cm (P=0.002),presence of carcinoma in situ (CIS) (P=0.014), lymphovascular invasion in TURT reports (P=0.002), and preoperative hydronephrosis in imaging (P<0.001). Patients with ROI demonstrated significantly lower 5-year survival rates than those without ROI, with overall survival rate of 20.8% versus 63.9% and cancer-specific survival rate of 19% versus 64.8%, respectively.Conclusion: This study represented a comprehensive analysis of preoperative TURT and imaging predictors of ROI. Clinical T stage, tumor location, maximum tumor size, concomitant CIS, presence of lymphovascular invasion, and hydronephrosis were identified as significant preoperative clinical factors associated with ROI. These findings might help guide surgical planning for organ preservation in female MIBC patients.

The nutritional status of patients with nasopharyngeal carcinoma (NPC) and importance of nutrition have not been reported in large cohort study. The nutritional status of patients with NPC for treatment remains poorly understood. Nutritional status has been found with this study aimed to investigate the nutritional status and potential clinical risk factors affecting the survival of patients with NPC. We conducted a multicenter, prospective, cross-sectional study on 1168 patients with primary and recurrent NPC at 17 academic centers between 2013 and 2021 using nutritional status data collected during the Investigation on Nutrition Status and its Clinical Outcome of Common Cancers cohort in China. Clinical outcomes and characteristics, including nutritional status, of the patients were also measured and recorded before the patient was admitted to the hospital to begin treatment. There were 1004 and 164 patients with primary and recurrent NPC, respectively. In the NRS2002 nutritional risk score analyses, 98% were at risk of malnutrition and 13.24% were at risk of severe malnutrition. Patients reported a reduction in food intake, and 11.16% showed significant weight loss. Malnutrition status and poor clinical outcomes in nasopharyngeal carcinoma are positively correlated (PG-SGA score ≥ 9, HR = 4.60, p < 0.0001; BMI < 18.5, HR = 2.06, p = 0.049) and suggest that the need for patients to undergo nutritional assessment prior to treatment and to improve nutritional status through interventions if necessary. The findings of this study suggest that most patients with NPC are malnourished. Malnutrition is significantly correlated with poor clinical outcomes. This study revealed that nutrition for patients with NPC is an important issue that needs attention, and it provides helpful information for patients' clinical management and surveillance.

ABSTRACTObjectiveTo identify antepartum risk factors for fetal or neonatal mortality and severe morbidity in pregnancies undergoing a universal late third‐trimester ultrasound scan in which there was no ultrasound evidence of small‐for‐gestational age (SGA) or fetal growth restriction (FGR).MethodsThis was a retrospective population‐based cohort study of singleton, non‐anomalous term pregnancies undergoing a universal ultrasound scan at 35 + 1 to 36 + 6 weeks' gestation at a major UK maternity unit, over a period of 7 years. Pregnancies complicated by SGA or FGR were excluded. The outcomes were: stillbirth; severe composite adverse outcome, including extended perinatal mortality and severe morbidity; and severe SGA, defined as birth weight < 3rd centile. Potential clinical, demographic and ultrasonographic risk factors were evaluated using univariate and multivariate logistic regression analysis.ResultsThe study population of 40 169 pregnancies comprised 88.9% of all eligible term pregnancies. There were 48 (0.1%) stillbirths, 221 (0.6%) cases of severe composite adverse outcome and 295 (0.7%) cases of severe SGA. Five (10.4%) stillborn infants weighed < 10th centile at delivery (adjusted odds ratio (aOR), 2.70 (95% CI, 1.06–6.92)); 23 (47.9%) cases of stillbirth were considered unexplained. Pre‐eclampsia was associated with stillbirth (odds ratio, 4.46 (95% CI, 1.99–9.96)) but no other antenatal factors, including ultrasound measures of fetal growth, showed a significant association with this outcome. Pre‐eclampsia constituted 9.6% of the population‐attributable fraction for stillbirth. Severe composite adverse outcome was associated only with pre‐existing diabetes (aOR, 2.82 (95% CI, 1.02–7.85)) and nulliparity (aOR, 1.56 (95% CI, 1.19–2.04)).ConclusionsThe potential to predict mortality and severe morbidity in fetuses without ultrasound evidence of SGA and FGR is poor. In these fetuses, the role of ultrasound in further reducing adverse outcomes at term is limited. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Abstract Study question Can we predict peritoneal endometriosis (PE) in women with pain symptoms who have no signs of endometriosis on examination or imaging studies? Summary answer A calculated score including dysmenorrhea, dysuria, dyspareunia, no pain outside of menses and presence of pain for &amp;gt;3 years can predict the presence of PE. What is known already Endometriosis is a common cause of chronic pelvic pain, characterized by dysmenorrhea, dyspareunia, dysuria and dyschezia. However, not all women with these symptoms have endometriosis. While endometriomas, deep infiltrating endometriosis lesions and adenomyosis can be detected with increasing accuracy through exams and with transvaginal ultrasound and/or MRI, it is not possible to accurately diagnose superficial peritoneal lesions using these methods. A clinical predictive model for assessing the risk of endometriosis, sparing the need for diagnostic surgery, would be useful. Study design, size, duration This prospective, multicentre, cross-sectional study was conducted between September 2022 and January 2024 at 18 endometriosis centers in Austria, Germany and Switzerland. The study enrolled 838 symptomatic women with suspected endometriosis scheduled for surgery. Clinical data including severity, timing and duration of specific symptoms, family history of endometriosis, and quality of life and sexual function were collected pre-operatively. All women underwent surgical assessment of endometriosis using the ASRM and #ENZIAN classifications by expert surgeons. Participants/materials, setting, methods Of the 838 participants, 79 were found to have only peritoneal endometriosis while 58 women had no signs of endometriosis or adenomyosis at surgery. We compared potential clinical risk factors that could differentiate these two groups. Factors were evaluated using univariate logistic regression analysis and a model was built to predict the presence of endometriosis using multivariate logistic regression analysis. Main results and the role of chance Women with peritoneal endometriosis and no endometriosis did not differ in age. Women without endometriosis reported the four main symptoms with a prevalence of dysmenorrhoea of 67.2%, dyschezia of 27.6% dysuria of 12.1%, and dyspareunia of 48.3%. Compared to those with peritoneal endometriosis with prevalences of 83.5%, 32.9%, 29.1%, and 67.1%, respectively. Dysmenorrhea (OR 2.47 [1.10-5.55]), dysuria (OR 2.99 [1.18-7.56]), dyspareunia (OR 2.18 [1.09-4.38]), and presence of pain for &amp;gt;3 years (OR 3.10 [1.52-6.32]) were associated with peritoneal endometriosis. Sexual function assessed with FSFI and quality of life assessed with EHP-30 did not differ between the two groups. A score for the presence of peritoneal endometrioses was derived from these parameters, assigning points for each symptom corresponding to the OR. The resulting ROC curve had an AUC of 0.74 (0.65, 0.82) for predicting peritoneal endometriosis. Limitations, reasons for caution The is a preliminary study with a relatively small number of subjects. While bootstrapping was used to internally validate the model. external validation of the model using a second population is in progress Wider implications of the findings The prediction model can be easily applied in clinical practice to estimate the probability of peritoneal endometriosis in women with symptoms but no clinical/ imaging signs of disease. If validated, it could decrease the number of diagnostic surgeries, either leading to targeted treatment or further evaluation for non-endometriosis causes. Trial registration number Yes

Postoperative peri-lead edema (PLE) is an increasingly recognized complication of deep brain stimulation (DBS), a therapeutic intervention commonly used for neurological conditions such as Parkinson's disease (PD), essential tremor (ET), intractable focal epilepsy, and dystonia. In this study, we conducted a retrospective chart review to evaluate the incidence of PLE and explore potential clinical and demographic risk factors. A single physician performed DBS electrode placements. To check for complications, postoperative computed tomography (CT) scans were conducted on the day of surgery and approximately 12-15 days afterward. Data on age, gender, complications, edema size, electrode laterality, lead target, lead brand, indication, and use of robotic assistance versus Starfix were collected and analyzed statistically. 133 leads were implanted in 63 patients, with peri-lead edema (PLE) observed in 65 electrodes (48.87%). Minor postoperative complications, such as subarachnoid hemorrhage (SAH) and subdural hematoma (SDH), were noted in some patients. A few cases of severe PLE were recorded, with the most significant volume of edema reaching 85.11cm³. No statistically significant differences were found between PLE-positive and PLE-negative patients based on age, sex, lead target, indication, or robotic assistance versus Starfix. However, the use of Boston Scientific electrodes was significantly associated with PLE, with a p-value of 0.047. A logistic regression model (p = 0.013, R² = 0.219) correctly classified 63.2% of cases, with no significant predictors of PLE, but imaging complications (p = 0.057) and electrode brand (p = 0.086) approached significance, with Boston Scientific electrodes linked to higher PLE risk compared to Abbott electrodes (p = 0.027, OR = 3.729). PLE appears more prevalent than previously reported and generally presents with delayed onset post-surgery. This retrospective analysis identified the use of Boston Scientific electrodes as a potential risk factor for PLE. Further research, particularly more extensive studies, is necessary to clarify the underlying mechanisms of PLE, improve prevention strategies, and enhance our understanding of this complication.

Demographic and Clinical Risk Factors of Developing Clinically Recognized Varicose Veins in Older Adults.

Background and objective Treatment in ICUs became extremely difficult due to the growing number of coronavirus disease 2019 (COVID-19) patients at the height of the pandemic. Consequently, prompt patient triage depends on the early categorization of severe cases in such scenarios. This study aimedto provide an evidence-based strategy to ensure the best use of resources by triaging patients based on objective risk factors. Methods This retrospective observational study comprised 500 inpatients (>age 18 years) who were hospitalized between March 20 and April 19, 2020, at the Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC) in Peshawar, Pakistan. The clinical, laboratory, and radiological parameters were assessed. Real-time polymerase chainreaction (RT-PCR) findings were used to confirm the diagnosis of COVID-19. Results A total of 19 potential clinical and laboratory risk factors associated with ICU admissions were identified. At least one comorbidity among chronic lung disease, cardiovascular disease (CVD), and diabetes was the factor with the strongest association with ICU admission with a univariable odds ratio (OR) of over 27, followed by renal disease and other COVID-19 sequelae such as diarrhea,respiratory rate (>24 breaths/minute), and positive RT-PCR (vs. negative) with an univariable OR between 9 and 15. Furthermore, a multivariate logistic regression model was further developed with five risk factors, including comorbidity, presence of chronic lung disease, presence of diabetes, and RT-PCR(positive vs. negative), male sex (vs. female), and older age (65.0-80.5 years), suggesting a good fit of the model to the data shown by the area under the receiver operator characteristic curve (AUC) of 0.943 (95% CI: 0.917, 0.969). Additionally, a chest CTscan showed the typical COVID-19 pneumonia with pulmonary involvement of 30-40%, which was further evaluated by the COVID-19 Reporting and Data System (CO-RADS). The typical COVID-19 pneumonia was on a scale of four (15/25) or five (19/25) lung lesions. Conclusions Based on our findings, this approach could be used to screen the severe cases of COVID-19 patients and help them to be treated in ICUs on time while preventing others from unnecessarily using ICUsin the setting of limited medical resources, such as the outbreak of a pandemic.

Introduction: Incidence of neuroendocrine neoplasms (NENs) is rising globally, yet clinical and genetic factors remain poorly understood. Evidence for the role of obesity is conflicted, and studies on prospectively collected data are sparse. We aimed to identify clinical and germline genetic risk factors associated with NEN in the UK Biobank. Methods: Cases of NEN were identified in the UK Biobank’s cancer registry data (N∼500,000). Using a combination of ICD-O3 codes for cancer site and histology, NEN cases were stratified into neuroendocrine tumour (NET), neuroendocrine carcinoma (NEC), and small/large cell lung cancer (SLCLC). A Cox proportional hazards model was used to test for an association between clinical phenotypes and increased NEN risk, and a gene burden test in Regenie was used to test for causal variants in the exome sequencing data. Results: We identified 704 NET, 340 NEC, and 550 SLCLC cases. Obesity (BMI or waist-hip ratio) and lower cholesterol (LDL, HDL, or total) had a significantly significant association with NEN risk; however, the effect size was marginal. Smoking and HbA1c were associated only with SLCLC. Air pollution was not significantly associated when adjustment was made for socio-economic status. We replicated a known germline association between loss of function variants in MEN-1 and NEC, but did not detect any novel association in exome variants. Conclusion: This is the first large prospective population-based study to identify potential clinical and genetic risk factors for NEN and define a novel phenotype in the UK Biobank. More research is needed to establish whether these relationships are causal. The exome study was underpowered, and future work in this area should focus on meta-analysing multiple large datasets.

During critical illness, patients experience significant and rapid onsets of muscle wasting and dysfunction with loss of strength, mass, and power. These deficits often persist long after the ICU, leading to impairments in physical function including reduced exercise capacity and increased frailty and disability. While there are numerous studies describing the epidemiology of impaired muscle and physical function in the ICU, there are significantly fewer data investigating mechanisms of prolonged and persistent impairments in ICU survivors. Additionally, while several potential clinical risk factors associated with poor physical recovery have been identified, there remains a dearth of interventions that have effectively improved outcomes long-term among survivors. In this article, we aim to provide a thorough, evidence-based review of the current state of knowledge regarding muscle dysfunction and physical function after critical illness with a focus on post-ICU and post-hospitalization phase of recovery.

Women with gestational diabetes (GDM) have increased risk of hypertensive disorders in pregnancy (HDP). However, knowledge remains limited for women with high-risk metabolic profiles, regardless of GDM diagnosis. This study aimed to evaluate the prevalence of HDP among women at high risk for GDM, while simultaneously identifying potential predictive clinical risk factors of HDP. Pregnant women who performed a 75-gr Oral Glucose Tolerance Test for the selective screening (based on pre-pregnancy risk factors) of GDM were prospectively enrolled (October 2019-June 2022). The development of HDPwas assessed. Logistic regression and ROC-curve analysis were used to identify predictive risk factors for HDP. Of the 398 women enrolled (53.5% with GDM), 30 (8%) developed HDP. Women developing HDP had more frequently a family history of type 2 diabetes, a personal history of GDM or preeclampsia, and showed higher pregestational BMI and first-trimester fasting plasma glucose. Moreover, at GDM screening, they had higher fasting and 1-hour glucose levels, and higher systolic and diastolic blood pressure. At logistic regression, systolic and diastolic blood pressure were the strongest risk factors for HDP. The risk increased for systolic blood pressure ≥ 127 mmHg (61% sensitivity, 86% specificity, PPV:27%, NPV:86%) and diastolic blood pressure ≥ 82 mmHg (57% sensitivity, 92% specificity, PPV:38%, NPV:96%). Women at high risk for GDM with poor metabolic profile have higher prevalence of HDP. Systolic and diastolic blood pressure at the time of GDM screening may identify women with higher risk of developing HDP, regardless of GDM diagnosis.

The risk of thrombosis and bleeding in myelofibrosis (MF) has been historically underappreciated. We sought to investigate potential molecular and clinical risk factors for venous (VTE) and arterial (ATE) thrombotic events as well as bleeding episodes. Data from 246 consecutive MF patients were analyzed. Driver mutations were tested in 191 patients. In total, 181 mutations were found in 177 MF patients: 118 (61.8%) patients showed JAK2-V617F, 50 patients (26.2%) showed CALR, and 6 patients (3.1%) showed MPL mutations. Two patients were JAK2-V617F and MPL positive and one patient was positive for all three genes. Fourteen (7.3%) patients were triple negative. The JAK2-V617F allele burden was assessed in 63 JAK2-V617F-mutated patients, revealing a median of 35.6% (range: 5.0-96.0). At the time of MF diagnosis and during follow-up, 84 thrombotic events (52 VTEs and 32 ATEs) were observed, corresponding to 6.6% of patients per year. A significant association was found between JAK2-V617F mutation (OR: 2.5, 95% CI: 1.1-5.6) and prior VTE (OR: 7.6, 95% CI: 2.1-27.1) with an increased risk of VTE. Patients with prefibrotic MF had a higher rate of ATE than patients with overt MF. Hemorrhagic events occurred in 34 (13.8%) patients, corresponding to 3.8% of patients per year. Fibrosis grade 3 was associated with bleeding risk (OR: 3.4, 95% CI: 1.2-9.2, p = 0.02). The presence of the JAK2-V617F mutation, regardless of allele burden, and prior thrombosis were strongly associated with an increased risk of VTE. Patients with prefibrotic MF might be considered at high risk for developing ATE.

Retrospective Analysis of Thromboprophylaxis Use during Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma

Background Arteriovenous-fistula (AVF) are crucial for hemodialysis access, yet they frequently experience early failure. While studies have identified potential patient and clinical risk factors, these findings remain inconsistent. This inconsistency might be attributed to the varying definitions of “early failure”. Our retrospective cohort study aimed to evaluate how common risk factors predict four frequently early-failure criteria: thrombosis/stenosis, <500 ml/min blood flow, <5 mm vein diameter, and ≥6 mm deep vein. We also assessed how well these risk factors predict early failure defined as meeting at least one of these criteria. Additionally, we examined the predictive ability of vein-distensibility, a previously overlooked factor in AVF failure. Methods Consecutive patients with first-time AVF employing standard minimum preoperative artery- and vein-diameters (1.8–2.0 mm) who underwent first Doppler-ultrasound (DUS) at ≤4 months in 2016–2022 were identified. Early AVF failure was defined as the presence of at least one of the following conditions on the first DUS: poor blood flow (Qa), poor vein diameter, poor vein depth, and thrombosis/stenosis. Factors associated with early AVF failure were explored with multivariate analyses. Results 105 patients were eligible and 63 (60%) had an early AVF failure. The only strong predictor of early failure was low vein-distensibility (Odds ratio = 0.57, 95% confidence intervals [CIs] = 0.38–0.83, p = 0.005). Female sex only predicted too-deep veins (Odds ratio = 14.29, 95% CIs = 2.00–100, p = 0.024). Conclusions venous distensibility may be a useful early-failure determinant when minimum preoperative vessel-diameter limits are met. Moreover, the female sex is associated with too-deep AVF veins.

Home visiting programmes can support child development and reduce inequalities, but failure to identify the most vulnerable families can undermine such efforts. We examined whether there are strong predictors of poor child development that could be used to screen pregnant women in primary health care settings to target early interventions in a Brazilian population. Considering selected predictors, we assessed coverage and focus of a large-scale home visiting programme named Primeira Infância Melhor (PIM). We undertook a prospective cohort study on 3603 children whom we followed from gestation to age four years. We then used 27 potential socioeconomic, psychosocial, and clinical risk factors measurable during pregnancy to predict child development, which was assessed by the Battelle Developmental Inventory (BDI) at the age of four years. We compared the results from a Bonferroni-adjusted conditional inference tree with exploratory linear regression and principal component analysis (PCA), and we conducted external validation using data from a second cohort from the same population. Lastly, we assessed PIM coverage and focus by linking 2015 cohort data with PIM databases. The decision tree analyses identified maternal schooling as the most important variable for predicting BDI, followed by paternal schooling. Based on these variables, a group of 214 children who had the lowest mean BDI (BDI = -0.48; 95% confidence interval (CI) = -0.63, -0.33) was defined by mothers with ≤5 years and fathers with ≤4 years of schooling. Maternal and paternal schooling were also the strongest predictors in the exploratory analysis using regression and PCA, showing linear associations with the outcome. However, their capacity to explain outcome variance was low, with an adjusted R2 of 5.3% and an area under the receiver operating characteristic curve of 0.62 (95% CI = 0.60, 0.64). External validation showed consistent results. We also provided an online screening tool using parental schooling data to support programme's targeting. PIM coverage during pregnancy was low, but the focus was adequate, especially among families with longer enrolment, indicating families most in need received higher dosage. Information on maternal and paternal schooling can improve the focus of home visiting programmes if used for initial population-level screening of pregnant women in Brazil. However, enrolment decisions require complementary information on parental resources and direct interactions with families to jointly decide on inclusion.

BackgroundThis study aimed to identify the prognostic-related differentially expressed ferroptosis-associated genes (DEFAGs) in papillary renal cell carcinoma (PRCC).MethodsData encompassing simple nucleotide variation, transcriptome profiles, and relevant clinical information of PRCC patients were sourced from The Cancer Genome Atlas (TCGA) database. The expression matrix of ferroptosis-associated genes (FAGs) was analyzed using the "limma" package in R to identify differentially expressed DEFAGs. Lasso regression analysis, along with univariate and multivariate Cox proportional hazards regressions, was employed to identify independent prognostic-related DEFAGs and formulate a nomogram. Additionally, we examined potential independent survival-related clinical risk factors and compared immune cell infiltration and tumor mutation burden (TMB) differences between high- and low-risk patient groups.ResultsA cohort of 321 patients were analyzed, revealing twelve FAGs significantly influencing the overall survival (OS) of PRCC patients. Among them, two mRNAs (GCLC, HSBP1) emerged as independent prognostic-related DEFAGs. Smoking status, tumor stage, and risk score were identified as independent clinical risk factors for PRCC. Furthermore, notable disparities in immune cell infiltration and function were observed between high- and low-risk groups. GCLC and HSBP1 were associated with various immune cells and functions, TMB, and immune evasion.ConclusionThis finding revealed two independent prognostic-related DEFAGs in PRCC and established a robust prognostic model, offering potential therapeutic targets and promising insights for the management of this disease.

To identify potential clinical and preoperative CT risk factors that can predict the development of metachronous contralateral inguinal hernia (MCIH) after unilateral inguinal hernia repair (IHR). This study included unilateral inguinal hernia patients seen from 2016 to 2019 who underwent CT and subsequent IHR and had at least five years of follow-up. Preoperative CT scans were retrospectively reviewed for the presence of asymmetric spermatic cord fat and weakness of the transversalis fascia. The correlations of each CT feature and other clinical characteristics with the development of MCIH were calculated. The Kaplan-Meier model and multiple logistic regression were used to evaluate the associations among CT features, clinical variables and MCIH. A total of 677 male patients aged > 40 years were included in the study cohort. After more than 5 years of follow-up, 162 patients developed MCIH, representing an incidence of 23.9%. Patients with radical prostatectomy or peritoneal dialysis [P < 0.0001, HR 4.189 (95% CI 2.369 to 7.406)], primary left-sided IHR [P = 0.0032, HR 1.626 (95% CI 1.177 to 2.244)], and direct, femoral or pantaloon hernias were predisposed to MCIH. Asymmetric spermatic cord fat [P = 0.0002, HR 1.203 (95% CI 0.8785 to 1.648)] and weakness of the transversalis fascia [P < 0.0001, HR 7.914 (95% CI 5.666 to 11.05)] on preoperative CT were also identified as risk facts and demonstrated to be independent predictive factors for MCIH development. Asymmetric spermatic cord fat and weakness of the transversalis fascia were predictive factors for MCIH development. For decision making regarding prophylactic contralateral IHR at the time of index surgery, preoperative CT findings as well as clinical characteristics should be considered.

We evaluated whether socioeconomic status (SES), race/ethnicity, and their interaction were associated with the presentation of advanced stage at diagnosis in embryonal tumors. Children 0 to 19 years of age diagnosed with embryonal tumors between 2006 and 2018 were identified from the US Surveillance, Epidemiology, and End Results program database specialized with Census Tract SES/Rurality. SES quintile was derived from a composite index for census tracts. We performed logistic regression to estimate odds ratios (ORs) and 95% confidence intervals by SES and race/ethnicity, adjusting for sex, age, and diagnosis year. Overall, no significant associations were found between either SES or race/ethnicity and the risk of presenting with advanced stage at diagnosis, although patterns of risk reductions were observed in atypical teratoid/rhabdoid tumors and embryonal rhabdomyosarcoma with increasing SES. In the stratified analysis, decreased odds of presenting with advanced-stage embryonal rhabdomyosarcoma were observed for Hispanics with higher SES (OR: 0.24, 95% Confidence Interval: 0.08-0.75) compared with Hispanics with lower SES. Future studies incorporating individual-level SES, cancer-specific staging information, and potential demographic, clinical, epidemiological, and genetic risk factors are warranted to confirm our findings.

Objective. Identify the potential clinical and anamnestic risk factors for spontaneous late miscarriages and assess the effectiveness of natural physical factors to correct them. Materials and methods. At the first stage of the study, we conducted a retrospective analysis, the main group included 70 patients with a history of miscarriages, the comparison group consisted of 70 women without reproductive loss. In the second stage, 9 patients in the main group were treated with radono and peloid therapy. Histological verification was carried out by an endometrial histology study. The results were entered into the MS Excel database and processed using the IBM SPSS Statistics 27 program. The significance of the differences was evaluated using Shapiro-Wilk criteria, Mann-Whitney, Pearson's chi-square, Yates’ chi-square and Fisher's test. Differences were considered statistically significant at p&lt;0.05 Results. Women with a history of miscarriages were significantly more likely to have chronic pelvic inflammatory disease (р=0.016), urinary infections (р=0.03), specific infections (р=0.02), bacterial vaginosis (р=0.007) and upper respiratory tract infections during pregnancy (р=0.03). After sanatorium treatment, regression of chronic endometritis markers was observed by immunohistochemical analysis of the endometrium. Conclusion. Infectious and inflammatory factors play a significant role in the etiology of spontaneous late miscarriages. During radon and peloid therapy, regression of chronic endometritis markers regression that can be used in preconception care in patients with reproductive losses.