Single Risk Research Articles

Associations of risk factors and the number of risk factors with the classification, GMFCS level and comorbidities with cerebral palsy: a retrospective study

ObjectiveThe objective was to explore the characteristics of risk factors in children with cerebral palsy (CP), focusing on the effects of single risk factors and the number of risk factors on the classification, GMFCS level, and comorbidities of children with CP.MethodsThe medical records of children with CP hospitalized from 2015 to 2023 were reviewed. The effects of nine risk factors, such as hyperbilirubinemia, asphyxia, and HIE, on the classification, GMFCS level and comorbidities of children with CP were studied.ResultsIn Part 1, among the 536 children with CP, 476 (88.8%) had obvious risk factors. Preterm birth and/or low birth weight were the most common risk factor (243 cases (45.3%)). CP combined with two risk factors was the most common, with 147 cases (27.4%). In Part 2, neonatal seizures were associated with epilepsy, and HIE and hyperbilirubinemia were associated with intellectual disability. Asphyxia was associated with high GMFCS levels and mixed CP. Preterm birth and/or low birth weight was associated with spastic diplegia, and hyperbilirubinemia was associated with involuntary movement. In Part 3, the number of risk factors in children with CP with epilepsy and/or hearing impairment seemed to be lower, but those with spastic quadriplegia were more likely to have more risk factors (≥ 4). In the six groups with 1–6 risk factors, intellectual disability and a GMFCS level ≥ level IV were more common in the various risk factor groups, but spastic hemiplegia and ataxia were less common.ConclusionMost children with CP have apparent risk factors, and the combination of two risk factors is relatively common. Preterm birth/low birth weight is the most common risk factor. The analysis of single risk factors revealed that the risk factors were related to the classification, GMFCS level and comorbidities. This correlation is consistent with the current research. Risk factors were more common in children with severe CP, high GMFCS levels, spastic quadriplegia, and intellectual disability.

Prevalence, type, and risk factors of intracranial hemorrhage in term neonates: a systematic review and meta-analysis.

Intracranial hemorrhage in the newborn poses a significant challenge to their well-being and subsequent development. In pre-term neonates, germinal matrix hemorrhage is the most common cause of intracranial hemorrhage with the prevalence varying from 20 to 59%. However, in term neonates, the prevalence and type of intracranial hemorrhage have not been well elucidated. The type of hemorrhage occurring in term neonates differs from those occurring in pre-term neonates. We conducted a systematic review to assess the prevalence, type, and risk factors of intracranial hemorrhage occurring in term neonates. We conducted a systematic review and meta-analysis by searching the PubMed and Embase databases. Inclusion criteria were studies reporting intracranial hemorrhage in term neonates (37weeks or more gestational age at the time of birth). Exclusion criteria were as follows: (1) studies which examined only a specific type of hemorrhage, (2) studies which examined only a single risk factor, (3) sample size < 20, (4) not in English language, and (5) full text not accessible/available. The studies which met the eligibility criteria were assessed and evaluated by two authors, and data was extracted using a predesigned template. The risk of bias in the included studies was assessed using the Joanna Briggs Institute bias assessment tool. The meta-analysis for prevalence, type of hemorrhage, and risk factor was conducted using MetaXL extension for Microsoft Excel. A total of 1226 records were identified in a database search of PubMed and Embase. After screening, 20 studies were included in the final analysis. The overall prevalence of intracranial hemorrhage in term neonates was 9.3% (95% CI, 4.9-14.9%). The prevalence of intracranial hemorrhage in asymptomatic patients was 5.8% (95% CI, 2.5-10.2%) and in symptomatic patients was 29.3% (95% CI, 15.3-44.8%). Sub-group analysis of the modality of detection shows that the prevalence of hemorrhage detection was higher with computed tomography/magnetic resonance imaging (CT/MRI) than with ultrasonography (USG). Extra-axial hemorrhage was the most common type of hemorrhage detected, comprising about 32.4% of the overall. The odds of having an intracranial hemorrhage was significantly higher with an instrumental delivery (OR = 3.75, 95% CI, 1.4-10.02). The present study shows that the prevalence of intracranial hemorrhage is relatively high in symptomatic and asymptomatic patients with extra-axial hemorrhage being the most common type of hemorrhage. The prevalence of hemorrhage varied according to the type of imaging used for detection and ideal imaging modality for evaluation, and the consequences of intracranial hemorrhage in term infants on development remain to be determined.

The role of toxoplasma, rubella, cytomegalo virus, herpes virus infection as a risk factor for sensory hearing loss in children

Toxoplasma, rubella, cytomegalovirus and herpes virus infection (TORCH) are syndromes that are considered risk factors for deafness.. This study aims to prove the risk factors which play the most significant role in the incidence of Sensory Hearing Loss in children. This used a case-control design, conducted at JIH Yogyakarta Hospital started from December 2023 to June 2024. All participants aged less than 5 years underwent oto-acoustic emission (OAE) examination, then determined presence or absence toxoplasma, rubella, cytomegalovirus and herpes virus using the electrochemiluminescence immunoassay (ECLIA) method. The inclusion criteria for the case group were: 1) patients diagnosed with sensory hearing loss (SHL), while the control group was normal. The exclusion criteria for the case and control groups there were non-infectious risk factors. Based on a type I error of 5% and type II error of 20%. The recommended sample size is 18 samples per group. Statistical analysis used stratified statistical analysis. The results of this study show that the combination of rubella + CMV had the greatest odds ratio (OR: 8) of sensory hearing loss, CMV OR: 0.62, herpes simplex virus OR: 0.28, combination of rubella + herpes simplex virus OR: 0.28, toxoplasma + CMV OR: 0.28, rubella obtained OR: 1 .5, and the combination of rubella + CMV + herpes simplex virus OR: 0.1. Based on these results the combination of rubella + CMV had the greatest OR compared to the combination of other risk factors and single risk factor.

Comprehensive analysis and risk assessment of fine road dust in Abbottabad city (Pakistan) with heavy traffic for potentially toxic elements

Human activities have far-reaching impact on natural ecosystems, causing increasing disturbances and disruptions to the delicate balance of the environment. Poor land use planning, urbanization, infrastructure development, and unplanned tourism exacerbate contamination and degradation in tourist destinations, yet the pollution of potentially toxic elements (PTEs) in these environments remains inadequately explored. To address this issue, we investigated the concentrations of acid-digested PTEs in road dust in Abbottabad city (Pakistan) with heavy traffic. The current study also evaluated PTE associated pollution, ecological and health risks, and potential sources of these elements. The average concentrations (in mg kg–1) of PTEs in road dust were highest for Fe (15540), followed by Mn (304), Zn (139), Cu (50.0), Pb (21.5), Cr (13.0), Ni (10.3), Co (6.66), and Cd (0.236). The levels of Co, Cr, Mn, Ni, and Fe were below the upper continental crust (UCC) averages, while Cd, Cu, Pb, and Zn exceeded them. Spatially, Cd, Cu, Pb, and Zn were found at higher levels near traffic hotspots, bus stands and automobile workshops. Road dust in Abbottabad exhibited unpolluted to moderate pollution levels (geo-accumulation index), with Cd, Cu, Zn, and Pb at 23% of the sites. The enrichment factor results indicated a significant anthropogenic influence, with Cd being significantly enriched and Zn, Cu, and Pb moderately enriched. The contamination factor results revealed moderate contamination by (Cd: 2.62, Zn: 2.08, Cu: 1.79, Pb: 1.27). Single metal risk index showed that 61% of the sites posed considerable to very high ecological risks due to Cd, which was highlighted as a significant concern. The absolute principal component scores-multiple linear regression model identified three factors contributing to PTE pollution: lithogenic (Co, Fe, Mn, Ni), traffic-related (Cd, Cu, Pb, Zn), and mixed sources (Cr), with contributions of 52.8%, 35.8%, and 11.4%, respectively. The PTE hazard quotient and total hazard index values for children and adults were below the safe risk level of 1, indicating no non-carcinogenic health risks. The cumulative carcinogenic risk values to the residents were also within acceptable limits. However, children's susceptibility to non-carcinogenic risks is higher due to their behavior and lower body weight. This study highlights the accumulation of PTEs in Abbottabad's environment, which poses challenges to long-term sustainability, particularly amid unplanned tourism. Therefore, urgent measures are necessary to mitigate PTE pollution and preserve tourist spots and public health.

The Effects of High-Intensity Interval Training on Cardiometabolic Health in Children and Adolescents: A Systematic Review and Meta-Analysis.

High-intensity interval training (HIIT) interventions are typically prescribed according to several laboratory-based parameters and fixed reference intensities to accurately calibrate exercise intensity. Repeated all-out printing efforts, or sprint interval training, is another form of HIIT that is prescribed without individual reference intensity as it is performed in maximal intensities. No previous study has performed a systematic review and meta-analysis to investigate the effect of HIIT and SIT on cardiometabolic health markers in children and adolescents. Moreover, previous studies have focused on single risk factors and exercise modalities, which may restrict their ability to capture a complete picture of the factors that could be affected by different interval interventions. The present study aimed to conduct a novel meta-analysis on the effects of HIIT and SIT on multiple cardiometabolic health markers in children and adolescents. An electronic search was conducted in three main online databases including PubMed, Web of Science, and Scopus were searched from inception to July 2024 to identify randomized and non-randomized control trials comparing HIIT and SIT versus the non-exercise control group in children and adolescents with mean age ranges from 6 to 18 years old on cardiometabolic health markers including fasting glucose and insulin, insulin resistance, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), systolic blood (SBP) and diastolic blood (DBP) pressures. Standardized mean differences (SMD), weighted mean differences (WMD), and confidence were calculated using a random effect model. HIIT decreased insulin, insulin resistance, TG, TC, LDL, and SBP and increased HDL but did not decrease glucose and DBP. Furthermore, subgroup analyses show that insulin and insulin resistance were decreased by sprint interval training (SIT) and in those with obesity. Lipid profile mainly is improved by SIT and in those with obesity. Also, SBP was decreased by SIT and in those with obesity. Our results prove that HIIT is an effective intervention for improving cardiometabolic health in children and adolescents, mainly those with obesity. Specifically, SIT is an effective interval training mode in children and adolescents.

Abstract IA027: Age-related stromal changes drive breast cancer tumor progression

Abstract Age is the single largest risk factor for the development of cancer, but how age impacts the molecular mechanisms that drive cancer remain poorly understood. While it is clear that age-related accumulation of cell autonomous mutations contributes to tumorigenesis, the central role age-related changes in the tumor microenvironment play in the transformation process is becoming more fully appreciated. Underscoring the importance of an aged microenvironment in cancer development are findings that senescent fibroblasts, which accumulate with age, directly stimulate preneoplastic and neoplastic cell growth and tumor progression. Investigations into how senescent fibroblasts promote tumorigenesis revealed that they express a plethora of growth factors, extracellular matrix remodeling enzymes, chemokines, and cytokines collectively referred to as the senescence associated secretory phenotype (SASP). Chemotherapy induces similar changes that can negatively impact a patient’s quality of life. We will discuss how these changes impact tumor progression and therapy-induced bone loss. Citation Format: Sheila A. Stewart. Age-related stromal changes drive breast cancer tumor progression [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr IA027.

Social connection and suicidal thoughts and behaviors in the Million Veteran Program cohort

People with lower levels of social connection are at increased risk for suicidal thoughts and behaviors. This extends to populations at greater risk of death by suicide, including U.S. military veterans. Despite this well-established association, it is unclear which measures of social connection are most useful in identifying veterans who could benefit from intervention to prevent suicide. To this end, we used data from the Million Veteran Program (MVP) to investigate the measures of social connection most strongly associated with suicidal thoughts and behaviors. Our sample included 264,626 veterans who reported on three measures of social connection—marital status, household size, and perceived social support—and were assessed for suicidal thoughts and behaviors using electronic health records. Veterans who were partnered (OR = 0.78, 95% CI [0.76–0.80], p < .001), living with others (OR = 0.71, 95% CI [0.70–0.73], p < .001), or reported higher levels of social support (OR = 0.67, 95% CI [0.65–0.69], p < .001), were less likely to have suicidal thoughts and behaviors. These associations varied by veterans’ age, sex, and era of military service. When combined into a single risk score, lower levels of social connection were associated with greater likelihood of suicidal thoughts and behaviors (β = 1.42, 95% CI [1.40–1.43], p < .001). Social support, particularly positive social interactions, showed the strongest associations with suicidal thoughts and behaviors in elastic net regression models. Common measures of social connection, particularly social support, could be useful in assessing suicide risk and treatment needs for veterans.

Exploring the Complexity of Falls in People With Multiple Sclerosis: A Qualitative Study.

The complexity of falls in people with multiple sclerosis (MS) needs further exploration to develop strategies to reduce fall risk. The aim of this study is to explore and describe factors contributing to falls and the complexity of fall situations in people with MS. This longitudinal study used individual interviews shortly after prospective reporting of falls. Manifest analysis was used to describe frequency, place, and time of falls. The International Classification of Functioning, Disability and Health (ICF) was used for deductive content analyses to describe fall-inducing factors. Participants were adults with MS (N = 33) who had experienced falls during the past year and who did not use walking aids. The 25 participants who fell during the study period reported 94 falls, mainly during the day (61%) and outdoors (56%). Fall situations were complex, with interaction between triggering and circumstantial factors related to all domains in the ICF, the impact of preceding factors, and fluctuating symptoms. The complexity of fall situations can be more clearly understood and managed by considering the preceding activities and circumstances in addition to describing single risk factors. This may facilitate discussions of fall risk between health care professionals and people with MS. Individualized fall risk assessments and interventions that strengthen self-management are recommended.

Oral potentially malignant disorders: leukoplakia, erythroplakia, oral submucosal fibrosis. Systematic review of associated risk factors

Introduction. Oral potentially malignant disorders (OPMD) represent a heterogeneous group of oral mucosal disorders associated with an increased risk of malignant transformation. The specialty literature indicates that tobacco consumption in various forms, such as smoking products containing tobacco, reverse smoking, chewing tobacco, alcohol consumption, consumption of areca (betel) nuts, are the factors most often involved in the development of OPMD. The aim of the study. Systematic review of scientific researches and clinical trials on risk factors involved in the development of leukoplakia, erythroplakia and oral submucosal fibrosis. Material and methods. To carry out the systematic review, scientific researches and clinical studies from the last 5 years available on the platforms PubMed, Embase, Scopus and Cochrane Library were analyzed. The identification of the studies was based on the presence in them of the terms specific to the topic of the systematic review and the data analysis was carried out by 2 doctors - dento-alveolar surgeons independently. Results. 16 articles that met the inclusion criteria were analyzed, with a total of 3874 patients, 5 articles - risk factors of leukoplasia, 2 articles - risk factors of erythroplasia, 4 articles risk factors of oral submucosal fibrosis and 5 articles included studies of risk factors for two or all three forms of OPMD examined. Conclusion. The mucosa of the oral cavity is constantly subjected to external aggressions in the case of patients with harmful habits such as the consumption of tobacco, alcohol or other products with a carcinogenic effect that prove to be high risk factors in the development of oral lesions with malignant potential.Oral potentially malignant disorders (OPMD) represent a heterogeneous group of oral mucosal lesions associated with an increased risk of malignant transformation into invasive forms of oral cavity cancer. A systematic review of the prevalence of oral potentially malignant disorders by Mello FW et al. in 2018 [14], reports that approximately 4.5% of the world’s population presents OPMD, the study being based on the presence at the given stage of scientific researches from different geographical regions. Leukoplakia, erythroplakia and oral submucosal fibrosis represent 3 of the most common types of oral potentially malignant disorders [20]. At the current stage, the specialty literature assert the fact that OPMD are polyetiological, rarely being involved only on a single risk factor in their development [6]. Tobacco consumption in various forms, such as smoking products containing tobacco, reverse smoking, chewing tobacco, alcohol consumption, consumption of areca (betel) nuts, are the factors most often incriminated in the development of oral potentially malignant disorders Chewing tobacco is a major risk factor for all three previously mentioned entities, while smoking tobacco products increases the risk of predominantly developing leukoplakia, chewing areca nuts is associated with the development of oral submucosal fibrosis and the combination of alcohol consumption and smoking creates premises for the development of erythroplakia [5]. Among other risk factors associated with the occurrence of OPDM, we distinguish, sexual transmission of the human papillomavirus (HPV, with a predilection for type 16), chronic inflammation of the mucosa and trauma of the oral mucosa caused by teeth or prosthetics, the presence of various types of metals in the oral cavity with the formation of galvanic currents, poor oral hygiene, vitamin and iron deficiencies, oral candidiasis and syphilis, congenital immunodeficiencies as well as those acquired posttransplant, HIV infection, ultraviolet radiation and last but not least, genetic predisposition [12]. It is important to note that a clinical patient diagnosed with one of the entities of oral potentlly malignant disorders has an increased risk of developing oral cancer and the screening of patients and the early detection of these lesions, as well as the exclusion of risk factors, remain the most effective methods to prevent malignant transformations. The aim of this study was to make a systematic review the current scientific researches and clinical studies on the risk factors implicated in the development of leukoplakia, erythroplakia and oral submucosal fibrosis.

Risks of foodborne pathogens associated with animal contamination of raw-agricultural commodities: A review.

Pathogens that cause foodborne illness can contaminate raw-agricultural produce via animal intrusion and defecation in production fields. The Food and Drug Administration's Produce Safety Rule and related guidance cite published research on animal intrusion risk and risk-reduction practices. However, additional relevant research has been published since their release. Research on animal contamination often focuses on a single risk factor. This review summarizes current research on multiple risk factors and provides a basis for understanding how these factors may interact to influence risk to produce from animal contamination, providing regulators and educators with science-based information to inform education and outreach to growers. This review may also aid researchers by identifying future research needs. We conclude that when managing risks from animal contamination, a multi-pronged approach is necessary. This approach considers a range of factors, including animal type, nature of feces, rain and irrigation events, meteorology, and worker training. We also created an online tool that conveys the findings of this review in a succinct and digestible format for growers and regulatory and educational partners.

A single risk assessment for the most common diseases of ageing, developed and validated on 10 cohort studies

BackgroundWe aimed to develop risk tools for dementia, stroke, myocardial infarction (MI), and diabetes, for adults aged ≥ 65 years using shared risk factors.MethodsData were obtained from 10 population-based cohorts (N = 41,755) with median follow-up time (years) for dementia, stroke, MI, and diabetes of 6.2, 7.0, 6.8, and 7.4, respectively. Disease-free participants at baseline were included, and 22 risk factors (sociodemographic, medical, lifestyle, laboratory biomarkers) were evaluated. Two risk tools (DemNCD and DemNCD-LR based on Fine and Gray sub-distribution and logistic regression [LR], respectively) were developed and validated. Predictive accuracies of these risk tools were assessed using Harrel’s C-statistics and area under the curve (AUC) and 95% confidence interval (CI). Model calibration was conducted using Hosmer–Lemeshow goodness of fit test along calibration plots.ResultsBoth the DemNCD and DemNCD-LR resulted in similar predictive accuracy for each outcome. The overall AUC (95% CI) for dementia, stroke, MI, and diabetes risk tool were 0·68 (0·65, 0·70), 0·58 (0·54, 0·61), 0·65 (0·61, 0·68), and 0·68 (0·64, 0·72), respectively, for males. For females, these figures were 0·65 (0·63, 0·67), 0·55 (0·52, 0·57), 0·65 (0·62, 0·68), and 0·61 (0·57, 0·65).ConclusionsThe DemNCD is the first tool to predict both dementia and multiple cardio-metabolic diseases using comprehensive risk factors and provided similar predictive accuracy to existing risk tools. It has similar predictive accuracy as tools designed for single outcomes in this age-group. DemNCD has the potential to be used in community and clinical settings as it includes self-reported and routinely available clinical measures.

Genetic predisposition of metabolic syndrome independent of weight in premature atherosclerosis

Abstract Background Family history is a significant predictor of premature atherosclerotic cardiovascular events, which suggest that a genetic susceptibility underlies the development of premature atherosclerosis. Rather than the influence of single classic risk factors, such as hypertension, diabetes and dyslipidemia, these risk factors could be part of an underlying genetic insulin resistance or metabolic syndrome Methods Data on patients and their first degree family members visiting premature atherosclerosis clinic in a university medical centre, from 2007 until 2023 was analyzed. We divided them in controls (CACs=0 and Age &amp;gt;40 years), subclinical ASCVD (sASCVD) (CAC score ≥80th percentile) and premature ASCVD (PAS). We used principal component analysis (PCA) for clustering the predictor variables and generalized linear mixed model (GLMM) to analyze the mutual relationship between different clusters. The model performance was further validated in predicting the premature ASCVD. Result There were 1551 individuals divided across control (n=438), sASCVD (n=309) and PAS (804). We found 12 variables univariate significantly related to sASCVD. Using a principal component analysis (PCA) approach, these variables were loaded across 4 clusters which were defined as 1. Metabolic (elevated glucose or diabetes, elevated blood pressure or Hypertension, elevated Triglycerides, elevated waist circumference and elevated LDL-C); 2. Liver (elevated ALAT, elevated GGT, elevated triglycerides, decreased thrombocytes) 3. Inflammatory (decreased HDL-C, elevated Triglycerides and elevated leucocyte count) and 4. Lipid (elevated Lp(a) and elevated LDL-C). After mutual correction and model building, the metabolic (OR; 95% CI) (1.82; 1.48-2.27) and Liver clusters (1.20; 1.00-1.45) were only found to be significantly associated with risk of sASCVD. However, we did not find any association of inflammatory (1.19; 0.98-1.44) and lipid cluster (1.19; 0.99-1.41) with risk of sASCVD. Besides, association of these clusters with risk of sASCVD significantly varies among families suggested from variance of intercept when family was kept as a random effect in GLMM model and no interaction was noticed with BMI. We checked the performance of this model on premature atherosclerosis cohort and found model had a good discriminatory (AUC, 0.762; 0.735-0.790; P=0.001) ability for predicting PAS [Figure 1]. Conclusion In conclusion, our findings are suggestive of a significant association between metabolic syndrome factors and an increased risk of sASCVD in individuals with family history of premature atherosclerosis, regardless of weight. This association suggests the potential genetic predisposition towards premature atherosclerosis driving the observed metabolic parameters clustering in these individuals. Besides, the model demonstrated robust discriminatory power to predict premature atherosclerosis.ROC curve for premature atherosclerosis

Legalitas Pendaftaran Investasi Asing pada Sistem Online Single Submission Risk Based Approach (Oss-RBA) di Indonesia

This study aims to find out and analyze the legality of foreign investment registration in the online single submission risk based approach (Oss-RBA) system in Indonesia. This research is a normative research using primary, secondary and tertiary legal materials collected by tracing or searching and documentation studies, the legal materials that have been collected are processed and analyzed in several stages, namely inventory, identification, classification and systematization. The results of the study show that (1) Law Number 25 of 2007 concerning investment has been in compliance with TRIMs. (2) Foreign investment business licenses in the Oss-RBA system are not considered to violate TRIM's because they are not regulated in the illustration of the violation of the TRIM's agreement.

The Use of a Single Risk Assessment Tool for Mortality and Numerous Hospital-Acquired Conditions.

Quality assessment organizations leverage numerous patient safety measures to evaluate hospital performance, resulting in significant financial, administrative, and operational burdens on health systems. Low-intensity approaches that allow for reliable risk stratification of patients can reduce the required investment. The Braden score is a routinely performed bedside nursing evaluation validated to assess risk for hospital-acquired pressure injury. We hypothesized that the tool can be used to evaluate risk for other hospital-related adverse outcomes, including mortality, catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI). We found that abnormal Braden scores have significant association with numerous adverse outcome measures, including mortality, CLABSI, CAUTI, and iatrogenic hypoglycemia. Because of its frequency of reevaluation, we have found preliminary evidence that leveraging this tool can reduce harm by quickly identifying the most at-risk patients for various types of iatrogenic harm. We conclude that in the face of increasing automation and technical applications, for example, artificial intelligence-driven tools, highly reliable clinician bedside physical examination and evaluation can still have significant, low-cost, and high-value impact in improving patient safety.

Characterization of Patients with Poor Clinical Outcome after Adult Spinal Deformity Surgery: A Multivariate Analysis of Mean 8-Year Follow-Up Data.

Background/Objective: Limited data exist regarding the long-term clinical outcomes and related factors after adult spinal deformity (ASD) surgery. This study aims to characterize patients who experienced poor clinical outcomes during long-term follow-up after ASD surgery. Methods: Patients who underwent ASD surgery with ≥5-vertebra fusion including the sacrum and ≥5-year follow-up were included. They were divided into two groups according to the Oswestry Disability Index (ODI) at the last follow-up: group P (poor outcome, ODI > 40) and group NP (non-poor outcome, ODI ≤ 40). Clinical variables, including patient factors, surgical factors, radiographic parameters, and mechanical complications (proximal junctional kyphosis [PJK] and rod fracture), were compared between the groups. Results: A total of 105 patients were evaluated, with a mean follow-up of 100.6 months. The mean age was 66.3 years, and 94 patients (89.5%) were women. There were 52 patients in group P and 53 patients in group NP. Univariate analysis showed that low T-score, postoperative correction relative to age-adjusted pelvic incidence-lumbar lordosis, T1 pelvic angle (TPA) at last follow-up, and PJK development were significant factors for poor clinical outcomes. Multivariate analysis identified PJK as the single independent risk factor (odds ratio [OR] = 3.957 for PJK development relative to no PJK, OR = 21.141 for revision surgery for PJK relative to no PJK). Conclusions: PJK development was the single independent factor affecting poor clinical outcomes in long-term follow-up. Therefore, PJK prevention appears crucial for achieving long-term success after ASD surgery.

Risk of recurrence after a first unprovoked seizure with different risk factors: A 10-year prospective cohort study

ObjectiveTo evaluate the recurrence risk following a first unprovoked seizure using both single-factor and multiple-factor approaches, as well as to further analyze the potential risk factors associated with recurrence. MethodsIn a prospective cohort study, a total of 201 individuals who experienced their initial unprovoked seizure were recruited from January 2010 to December 2019. The cumulative recurrence rates were calculated by Kaplan–Meier survival curves. Multivariate analyses for recurrence risk were conducted utilizing the Cox regression model. Additionally, interaction effects were evaluated by quantifying the attributable proportion due to interaction (AP). ResultsThe cumulative recurrence rates were as follows: 29.4 % at 6 months, 35.8 % at 1 year, 41.1 % at 2 years, 47.9 % at 5 years, and 57.5 % at 10 years. Notably, the majority of recurrences, specifically 61.2 %, manifested within the initial 6 months following the onset, with 74.4 % occurring within the first year, and 82.6 % within the initial 2 years. The recurrence risk of patients with epileptic abnormal discharges on VEEG, nocturnal seizure, abnormal MRI, prior brain insult and focal seizure was 71.9 %, 61.4 %, 61.5 %, 75.0 %, and 69.7 %, respectively. Epileptiform discharges (RR 2.5, 95 % CI 1.4–4.3, P=0.001) and prior brain insult (RR 2.1, 95 % CI 1.2–3.7, P=0.007) were predictors of recurrence. Interaction analysis showed the combination of epileptiform discharges and prior brain insult was associated with a 7-fold increased risk of recurrence (RR 7.0, 95 %CI 3.5–14.2)，with AP estimated at 0.34, the combination of epileptiform discharges and nocturnal seizure was associated with a 4-fold increased risk of recurrence(RR 4.3, 95 %CI 2.4–7.4), with AP estimated at −0.25,and the combination of prior brain insult and nocturnal seizures was associated with a 4-fold increased risk of recurrence(RR 4.1, 95 %CI 1.9–8.9), with AP estimated at −0.03. ConclusionsPatients with epileptiform discharges VEEG, nocturnal seizures, abnormal MRI findings, prior brain insult, or focal seizures exhibited a substantial recurrence rate. Specifically, the presence of epileptiform discharges in VEEG recordings, and a history of prior brain insult were identified as independent risk factors associated with recurrence following an initial unprovoked seizure. Notably, individuals with multiple risk factors exhibited a significantly higher recurrence risk compared to those with no or a single risk factor.

Homocysteine Blood Levels and Mandatory Folic Acid Fortification in Serbia.

The current study aims to investigate the blood Hcy levels in patients with CAD and hypertension in Serbia, a country with a high incidence and mortality of both diseases. The level of Hcy in the Serbian population was assessed in 123 patients with chronic coronary artery disease (CAD) and hypertension. There were 53 patients with chronic CAD and 70 patients with hypertension (HTA), but without CAD. The Hcy levels were high in both groups of patients (the mean Hcy level of 16.0 ± 7.0 μmol/L) without a statistical difference between the patients in the CAD (14.9 ± 7.3 μmol/L) and hypertension (16.7 ± 6.7 μmol/L) groups. Hypercholesterolemia was found in 81% of the patients with CAD and 92.0% of the patients with HTA, as a common concern across both clinical conditions. It was also found that not a single conventional risk factor (diabetes, hypertension, the smoking status, the family history of CAD, and hyperlipidemia) may individually influence Hcy levels. By contrast, the low levels of vitamin B12 may be related to the high levels of Hcy. Given the fact that it is known that various factors interact and influence Hcy levels and associated cardiovascular risks, specific dietary habits, lifestyle and the other Serbia-specific possible factors were done.

Efficacy and safety of venetoclax combined with decitabine, modified HA regimen and DLI in the treatment of relapsed pediatric AML/MDS after allogeneic hematopoietic stem cell transplantation

Objective: To investigate the efficacy and safety of venetoclax combined with the decitabine, cytarabine, and homoharringtonine (HHT) regimen and donor lymphocyte infusion (DLI) for the preventive and salvage therapy of pediatric acute myeloid leukemia (AML) /myelodysplastic syndrome (MDS) after allogeneic hematopoietic stem cell transplantation (HSCT) . Methods: A total of 29 relapsed pediatric/minimal residual disease-positive AML after HSCT were recruited at the Peking University Institute of Hematology from January 1, 2021, to June 1, 2023. They were treated with the above combination regimen and administered with DLI after 24-48 hours at the end of chemotherapy, and the treatment response and adverse reactions were regularly assessed. Results: The overall response rate (ORR) was 75.8%, CR rate was 88.9% (8/9) in the hematologic relapse group, and MRD negativity rate was 61.1% (11/18) in the MRD-positive group. The incidence of agranulocytosis, anemia, and thrombocytopenia with a classification above grade 3 were 100%, 82.7%, and 100%, respectively. The median time of the granulocyte deficiency period was 15 days. Acute graft-versus-host diseases (aGVHD) with a classification of grades Ⅲ-Ⅳ occurred in 11.1% of the patients after DLI, while moderate or severe cGVHD occurred in 7.4% of the patients. The single risk factor for ORR was MNC counts of less than 10×10(8)/kg, and the relapse occurred within 100 days. At a median follow-up of 406 days, the 1-year OS was 65%, and the 1-year OS was 57% in the group with no reaction (P=0.164) compared with 71% in the group who had an overall reaction. Conclusion: The combined regimen based on the DAC, VEN, and modified HA regimen showed a high response rate in the salvage therapy for pediatric AML after the relapse of HSCT. However, bridging to transplantation should be performed immediately after remission to result in a long survival rate.

Sex-specific associations between total and regional Fat-to-muscle Mass ratio and cardiometabolic risk: findings from the China National Health Survey

BackgroundThe fat-to-muscle mass ratio (FMR), integrating the antagonistic effects of fat and muscle mass, has been suggested as a valuable indicator to assess cardiometabolic health independent of overall adiposity. However, the specific associations of total and regional FMR with cardiometabolic risk are poorly understood. We aimed to examine sex-specific associations of total and regional FMR with single and clustered cardiometabolic risk factors (CRFs).Methods13,505 participants aged 20 years and above were included in the cross-sectional study. Fat mass and muscle mass were assessed using a bioelectrical impedance analysis device. FMR was estimated as fat mass divided by muscle mass in corresponding body parts (whole body, arm, leg, and trunk). Clustered CRFs was defined as the presence of two or more risk factors, including hypertension, elevated blood glucose, dyslipidemia, insulin resistance (IR), and hyperuricemia. IR was assessed by the triglyceride glucose (TyG) index. Multivariable logistic regression models were applied to explore the associations of FMR in the whole body and body parts with single and clustered CRFs.ResultsThe odds ratios (ORs) increased significantly for all single and clustered CRFs with the per quartile increase of total and regional FMR in both sexes (P for trend < 0.001), following adjustment for confounders. Among the regional parts, FMRs of the legs presented the strongest associations for clustered CRFs in both men and women, with adjusted OR of 8.54 (95% confidence interval (CI): 7.12–10.24) and 4.92 (95% CI: 4.24–5.71), respectively. Significant interactions (P for interaction < 0.05) were identified between age and FMRs across different body parts, as well as between BMI status and FMRs in different regions for clustered CRFs. Restricted cubic splines revealed significant non-linear relationships between FMRs of different body parts and clustered CRFs in both sexes (P for nonlinear < 0.05).ConclusionsFMRs in the whole body and different regions were significantly associated with single and clustered CRFs in the general Chinese population. The association between FMR and clustered CRFs was more pronounced in youngers than in the elderly.

Which organic contaminants should be paid more attention: Based on an improved health risk assessment framework

The increasing chemical pollution of the drinking water is widely concerned. Large number of organic contaminants cannot be removed by conventional water treatment technology due to their low concentration, and long-term exposure may pose significant risks to human health. Which organic contaminants in drinking water should be given more attention has been a topic of great concern in recent years. To identify the organic contaminants that need attention, this research proposes an improved health risk screening method to quantitatively analyze the risks of accumulation, persistence, toxicity, and antibiotic resistance. Compared with conventional method, 26 compounds were added to the improved screening list, including 9 DBPs (e.g., NDMA), 3 antibiotics (e.g., oxytetracycline), PFNA and other compounds. Overall, antibiotics and plasticizers rose in the risk rankings. From the perspective of the proportion of total risk value, a single risk plays a decisive role (more than 99%) in the ranking. This change suggests that antibiotic resistance and the accumulation of organic matter are as important as their toxic risks to humans. 58 compounds were recommended for the priority control organic contaminants list in drinking water. This list provides the necessary information for authoritative regulations to monitor, control, assess, and manage the risks of environmentally relevant compounds in drinking water in China.