Liver cancer is a major public health issue in five East Asian countries, with metabolic factors becoming primary drivers. Based on the Global Burden of Disease (GBD) 2023 database, we extracted the total number and age-standardized mortality rates, years lived with disability (YLDs), years of life lost (YLLs) and disability-adjusted life years (DALYs) related to liver cancer attributable to metabolic risks (LC-MR). We analyzed the disease burden of LC-MR and trends across five East Asian countries from 1990 to 2023, examining patterns by sex and age as well as key drivers across different nations, and projected future trends through 2053. In 2023, Mongolia exhibited the highest age-standardized rates for LC-MR, while China ranked first in the total absolute number of cases. From 1990 to 2023, the overall disease burden showed a downward trend in Japan and Republic of Korea, whereas an upward trend was observed in Mongolia, Democratic People's Republic of Korea, and China. Significant sex and age disparities were observed across all countries in that males bore a higher burden and the burden generally shifted towards the elderly population. Decomposition analysis revealed that the changes in disease burden in Japan and Republic of Korea were primarily driven by population ageing, whereas the main drivering factors were epidemiological changes and population growth in Mongolia and Democratic People's Republic of Korea. Projections of disease burden for 2053 indicate that the disparities among countries would further widen. Therefore, strengthening metabolic risk interventions and implementing targeted prevention strategies for high-risk populations, especially the aging population, is crucial for reducing the regional burden of LC-MR, given the risk disparities across different countries.
Influenza seasons may be associated with increased anxiety-related expressions on social media. Social media can reflect population-level emotional expression patterns in real time. The aim of the study is to characterize diurnal and full-season dynamics of anxiety-related language during the 2023-2024 influenza season in China and its association with influenza activity. We retrieved Sina Weibo posts in February 2025 covering September 4, 2023, to April 28, 2024. Posts containing Diagnostic and Statistical Manual of Mental Disorders (DSM)-based anxiety terms were cleaned and deduplicated (N=169,728 → 106,440). We first linked weekly influenza incidence with anxiety-related postings. Then, we plotted diurnal patterns by epidemiologic phase, conducted supplementary within-sample hourly normalization analyses, and modeled longitudinal symptom trajectories using ARIMA (autoregressive integrated moving average) and supplementary ARIMAX (autoregressive integrated moving average with exogenous regressors) time-series models. Anxiety-related posts closely followed influenza activity, surging during the outbreak and peak phases and remaining elevated even after influenza declined. Initial Spearman correlation analyses showed significant negative associations for irritability (r=-0.413; P=.02) and restlessness or feeling keyed up or on edge (r=-0.396; P=.02). However, supplementary ARIMAX analyses further revealed that being easily fatigued and difficulty concentrating or mind going blank exhibited more stable positive temporal associations with influenza activity after controlling for autocorrelation and lagged effects. Diurnal patterns shifted across stages, showing mild early-evening variation during the outbreak, clear morning peaks with secondary afternoon and evening rises during prevalence and decline, and morning-afternoon concentration in the end stage. Supplementary within-sample hourly normalization analyses showed that the major diurnal structures remained generally stable after normalization. ARIMA time-series analysis revealed that irritability and being easily fatigued consistently dominated the discussions, whereas others remained at relatively low levels. Out-of-sample forecasting based on a chronological 80% training and 20% testing split suggested generally stable short-term trajectories, with being easily fatigued showing a slight increase. This study demonstrates how social media can capture diurnal and seasonal fluctuations of anxiety symptoms associated with influenza activity, advancing understanding of affective dynamics in population health.
Emergency medicine has experienced growth as a research discipline, with psychiatric emergencies representing an area of expansion. The increasing volume of psychiatric presentations to emergency departments necessitates analysis of scientific output in this domain. This study examines publication trends, geographic distribution, and thematic priorities in psychiatric emergency medicine research over the past decade. We conducted a bibliometric analysis of articles published between January 2014 and December 2023. Data were extracted from the Web of Science Core Collection database using the search terms "Emergency Medicine" AND "Psychiatry." Analysis included publication trends, geographic distribution, journal metrics according to Bradford Law, keyword frequency analysis, and thematic mapping. Statistical analyses employed IBM SPSS Statistics 25 and bibliometric software. The analysis identified 862 publications authored by 5111 individuals from 67 countries. Annual publication volume increased from 52 articles in 2014 to 126 articles in 2023. The United States contributed 488 publications (56.7%), followed by Turkey (46 publications, 5.3%), Canada (44, 5.1%), Australia (40, 4.7%), and Iran (33, 3.8%). Four core journals accounted for 37.0% of publications: American Journal of Emergency Medicine (117 articles), Pediatric Emergency Care (75), Academic Emergency Medicine (66), and Journal of Emergency Medicine (61). Mean citation rate was 11.5 per article. Keyword analysis identified 6 primary research themes: pediatric psychiatric emergencies, substance use, suicide and self-harm, consultation models, emergency department management, and geriatric psychiatric emergencies. Temporal analysis revealed increased research focus on vulnerable populations including children and older adults after 2017. Psychiatric emergency medicine research demonstrated consistent growth over the decade studied. Publication output was concentrated geographically, with limited international collaboration. Research priorities evolved toward pediatric and geriatric populations. Findings provide insight into current research landscape and may inform future research directions and resource allocation in psychiatric emergency care.
Characterize how the rates of induced abortion differ by clinical and social patient characteristics. Retrospective cohort analysis of pregnancies (2012-2023) in an integrated healthcare delivery system. We present the association of induced abortion by social and clinical factors; we calculated prevalence ratios (PR) from modified log-Poisson models, adjusted for all other covariates considered. The likelihood of abortion was lower among individuals ≥40 years, individuals with obesity, Spanish speakers, and greater neighborhood deprivation; and higher for public insurance, Black race, and multiparous pregnancies. There are substantial differences in the utilization of abortion services by social and clinical factors.
Portal hypertension is a central driver of morbidity and mortality in advanced chronic liver disease, yet its contribution to death is frequently underestimated owing to underreporting on death certificates. Population-level data on portal hypertension-related mortality trends and disparities in the United States remain limited. We conducted a retrospective, population-based mortality study using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database, identifying deaths with International Statistical Classification of Diseases and Related Health Problems, 10th Revision code K76.6 listed in any cause-of-death field from 1999 to 2023. Crude and age-adjusted mortality rates per 100,000 population were calculated and stratified by sex, U.S. Census region, race/ethnicity, and urban-rural status (the latter restricted to 1999-2020 due to data availability). Temporal trends were assessed using Joinpoint regression, with annual percent change (APC) reported as the primary trend metric and 95% confidence intervals presented for all estimates. A total of 34,551 portal hypertension-related deaths were identified. Overall age-adjusted mortality rates declined sharply from 1999 to 2002 (APC - 12.85%), plateaued for more than a decade, and rose thereafter. Mortality increased significantly in women after 2009 (APC + 6.69%) and in men after 2013 (APC + 6.18%). Among racial and ethnic groups, Hispanic or Latino individuals consistently demonstrated the highest mortality burden throughout the study period, followed by White individuals, whereas Black or African American individuals exhibited comparatively lower but significantly rising rates from 2006 onward. White individuals demonstrated the steepest recent acceleration, with a significant increase after 2014 (APC + 8.51%). Regionally, the South experienced the steepest post-2013 increase, while the Northeast retained the lowest absolute rates despite a significant rise after 2014. Urban populations showed early improvement through 2014 followed by rising mortality, whereas rural populations experienced a later but steeper rise beginning around 2013, with widening urban-rural disparities over time. Portal hypertension-related mortality has risen significantly since the mid-2010s across all demographic and geographic subgroups, with disproportionate burdens among Hispanic individuals, men, rural populations, and residents of the Southern United States. These findings highlight the urgent need for targeted prevention strategies, equitable access to hepatology care, and aggressive management of metabolic and alcohol-related risk factors to reverse this trajectory.
Hemorrhagic fever with renal syndrome (HFRS) is a serious viral disease in mainland China, and Shaanxi Province is one of the most severely affected areas. In order to reduce HFRS incidence, an inactivated bivalent vaccine against Hantaan virus (HTNV) and Seoul virus (SEOV) infections was developed and used in China since the 1990s. Descriptive epidemiological methods were used to analyze the spatial, temporal, and population distribution of HFRS along with changes in age distribution in Shaanxi Province from January 2004 to December 2023. A total of 34,265 HFRS human cases were reported in Shaanxi Province, including 25,737 males and 8,528 females. HFRS cases were geographically concentrated in the Guanzhong Plain. The local incidence of HFRS fluctuated remarkably over the past 20 years. The primary peak was from October to January. The proportion of HFRS cases in the 15-60 years age group showed a decreasing trend. However, the proportion of HFRS cases among the > 60 years age group increased by 150.94%, rising from 11.68% to 29.31%. Data from a 20-year surveillance study shows that the proportion of HFRS cases in individuals over 60 years of age has increased significantly, which may potentially be due to vaccine coverage limitations. The results can be used to adjust the prevention and control measures of HFRS and to consider age-expanded vaccination strategies.
The aim of this study was to assess the impact of standardized benzathine penicillin therapy on adverse pregnancy outcomes in high-titer toluidine red unheated serum test (TRUST) positive (≥ 1:16) syphilis cases and refine prevention of mother-to-child transmission (PMTCT) strategies. This retrospective cohort study analyzed 2,229 pregnant women with syphilis from the National PMTCT System of Taizhou City (2013-2023). Standardized treatment was defined as 3 weekly intramuscular benzathine penicillin doses (2.4 MU each). Multivariable logistic regression adjusted for gestational age, maternal age, and comorbidities was used to analyze the outcomes. A total of 1,651 women (74.1%) received standardized therapy and the risk of adverse pregnancy outcomes was significantly lower in this group compared to those with non-standardized treatment: perinatal death (0.55% vs. 2.60%), congenital syphilis (0.24% vs. 2.60%), preterm birth/low birth weight (7.81% vs. 16.78%), and total adverse outcomes (8.60% vs. 38.75%) (all p < 0.001). Adjusted analysis demonstrated 58% risk reduction with standardized treatment (aOR = 0.42, 95% CI: 0.31-0.57, p < 0.001). Early initiation (≤ 20 weeks) enhanced efficacy (aOR = 2.12, 95% CI: 1.45-3.10, p < 0.001), with married (aOR = 2.41) and educated women (aOR = 1.89) showing higher adherence. Standardized penicillin regimens significantly mitigate adverse pregnancy outcomes by 58%, emphasizing early diagnosis, timely treatment, and targeted patient education for PMTCT success. Marital status and education level were independently associated with treatment adherence.
The H9N2 subtype of avian influenza A virus has been endemic in poultry populations across Asia and the Middle East, posing ongoing economic and public health concerns. Since their initial detection in Pakistan in the 1990s, H9N2 viruses have caused repeated outbreaks in commercial poultry, leading to substantial economic losses and raising concerns about zoonotic transmission. To characterize the recent genetic evolution and zoonotic potential of circulating strains, five H9N2 isolates were obtained from poultry in Pakistan between January and March 2023. Phylogenetic analysis of the haemagglutinin gene revealed that all five isolates belong to the G5.3.2, formerly known as B2, sub-lineage of the G1 Eurasian lineage, in accordance with the revised global classification system for H9 viruses. Comparative genomic analysis confirmed that all eight gene segments were closely related to previously reported Pakistani strains, with no evidence of recent reassortment, suggesting localized persistence and ongoing genetic drift. Notably, several mammalian-adaptive mutations were identified in internal gene segments of the isolates, suggesting a potential risk of cross-species transmission. In addition, all five isolates exhibited dual receptor-binding characteristics, recognizing both α2,3-linked (avian-type) and α2,6-linked (human-type) sialic acid glycans, with a stronger affinity for α2,6-linked glycans. These findings underscore the need for continuous surveillance and risk assessment of H9N2 viruses circulating in Pakistan.
Respiratory syncytial virus (RSV) is highly prevalent as a cause of acute respiratory tract infection. Detection of RSV using nucleic acid amplification tests provides rapid results that can help physicians manage patients with acute respiratory symptoms and avoid unnecessary antibiotics. This study aimed to report the positivity rate of RSV among patients with acute respiratory symptoms. Nasopharyngeal swab specimens were obtained from primary healthcare facilities and hospital outpatient clinics from January 2023 to June 2024. The specimens were processed using the multiplex QIAStat-Dx Respiratory SARS-CoV-2 Panel (QIAGEN GmbH, Hilden, Germany). A total of 1339 tests were performed and RSV was positive in 10.3% of tested patients (138/1339). Regarding the monthly positivity rate, the highest rate of RSV positivity was in November 2023, followed by January 2023, and March 2023. This study shows a moderate RSV positivity rate in outpatient settings and suggests a seasonal trend, with higher circulation during the rainy season. These findings highlight the value of RSV surveillance for guiding clinical and public health responses in tropical regions.
This study examines the dynamics of ambient air pollutants and their meteorological determinants in Abeokuta, Nigeria. This study averaged 12 years of hourly data (2012-2023) for PM2.5, PM₁₀, NO2, SO2, CO, and O3, alongside six meteorological variables: temperature, relative humidity, pressure, wind speed, wind direction, and rainfall. Specifically, Particulate matter (PM2.5 and PM10) were the most dominant pollutants, consistently surpassing World Health Organisation (WHO) standards and reaching their highest concentrations during the Harmattan dry season, typically occurring between December and March. Regression analysis demonstrated moderate to strong positive correlations with temperature (R² = 0.48-0.52), while also indicating negative relationships with rainfall and humidity, thereby validating the impacts of thermal stagnation and wet scavenging processes. Furthermore, fluctuations in atmospheric pressure contributed to the buildup of pollutants during periods of stagnant air. Gaseous pollutants showed relatively weaker sensitivity; however, levels of NO2 and CO increased during the hot, arid months, while O3 levels rose in the late dry season. The Aggregate Air Quality Index (AAQI) values fluctuated between 39 and 51, thereby designating the air quality as "moderate." Furthermore, the Health-Risk Adjusted AQI (HAQI) revealed heightened relative risks, especially concerning PM2.5 exposure, with seasonal maxima exceeding 90. These findings highlight the cumulative health impacts of particulate matter, even when gaseous pollutants remain within permissible thresholds. The results highlight the necessity for seasonally adjusted mitigation measures, including dust suppression, emission controls, and cleaner combustion technologies. Furthermore, they advocate for the incorporation of Health-Adjusted Quality Index (HAQI) metrics within air quality management systems.
Urinary tract infections (UTIs) are a leading cause of antibiotic use globally, with rising antimicrobial resistance (AMR) complicating management-particularly in healthcare settings. This cross-sectional study compared community-acquired (CA-UTI) and healthcare-associated UTIs (HA-UTI) at the Habib Thameur Hospital's emergency-intensive care unit in Tunis during 2022-2023. Out of a total of 4,474 urine samples, 446 (10%) were culture-positive. The patients were predominantly elderly (73.3% were ≥ 60 years). More females had CA-UTI (M:F = 0.57) than HA-UTI (M:F = 0.78). Escherichia coli was the main pathogen causing both CA-UTI (57.4%) and HA-UTI (44.6%), while Klebsiella pneumoniae was the more common pathogen in HA-UTI (26.1% vs. 23.3%). Gram-negative bacteria accounted for 90.6% of isolates. Among the K. pneumoniae isolates, resistance to imipenem was significantly higher among HA-UTI isolates (29.2% vs. 5.9%; p = 0.02). Among the E. coli isolates, resistance to nitrofurantoin was significantly higher among HA-UTI isolates (3.7% vs. 12.5%; p = 0.01). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were detected in 8.5% of isolates (mostly E. coli and K. pneumoniae), and carbapenem-resistant Enterobacteriaceae (CRE) in 8.7% (predominantly K. pneumoniae in HA-UTI). CRE showed near-complete β-lactam resistance and high non-β-lactam resistance in HA-UTI. Rising UTI rates and alarming AMR trends, particularly in HA-UTIs, highlight the need for enhanced antibiotic stewardship and tailored empirical therapy. The predominance of multidrug-resistant strains underscores the urgency for infection control measures in Tunisian healthcare settings.
This cross-sectional study uses Medicare data to examine outcomes associated with the New York 2023 Medicaid and Medicare Savings Program eligibility expansion in the number and characteristics of dually enrolled beneficiaries.
This study aimed to develop and internally validate a multivariable prediction model for early postoperative corneal edema following phacoemulsification by integrating patient-related and intraoperative parameters. This retrospective cohort study included 912 consecutive eyes from 912 patients who underwent standard phacoemulsification at a tertiary ophthalmic center in Southwest China between January 2021 and January 2023. Early postoperative corneal edema was defined as either a ≥5% increase in central corneal thickness from baseline on postoperative day 1 or the presence of clinically significant stromal haze on slit-lamp examination. Demographic, systemic, preoperative, and intraoperative variables were evaluated using univariate logistic regression, followed by multivariable logistic regression for model development. Model performance was assessed in terms of discrimination and calibration. Discrimination was quantified using the area under the receiver operating characteristic curve, whereas calibration was evaluated using calibration plots, calibration intercept and slope, and the Hosmer-Lemeshow goodness-of-fit test. A nomogram was constructed based on the final multivariable model to estimate individualized risk. Early postoperative corneal edema occurred in 138 of 912 eyes (15.1%). In the multivariable model, older age, diabetes mellitus, lower preoperative endothelial cell density, and greater cataract and intraoperative complexity, reflected by higher lens nucleus hardness, longer operative duration, higher cumulative dissipated energy, and greater irrigation volume, were associated with early postoperative corneal edema. Intraoperative anterior chamber instability and capsular rupture or vitreous loss were also associated with an increased risk. The final model achieved an area under the receiver operating characteristic curve of 0.892 (95% confidence interval: 0.865-0.919) and demonstrated acceptable calibration in internal validation. Both systemic and intraoperative factors were associated with early postoperative corneal edema after phacoemulsification. The internally validated prediction model demonstrated good discrimination and calibration and may support preliminary perioperative risk estimation in similar clinical settings. However, external validation is required before the nomogram can be recommended for routine clinical implementation.
Suicide is one of the major health problems that imposes a heavy burden on the health system. Currently, there is a notable absence of review and meta-analysis studies capable of exploring a broader spectrum of occupational factors associated with dimensions of suicide. This study was conducted to investigate occupational risk factors related to suicide dimensions by systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-analyses have been used. The databases searched in this study included: PubMed, Web of Science, and Scopus. The defined period included the beginning of the formation of these databases until August 2023, and this search was limited to studies published and available in English. The random effects method was used in a pool of different studies. In this research, the odds ratio with a 95% confidence interval (CI) was used in the report of findings. The relationship between job demands and suicide dimensions was equal to the odds ratio of 1.29 with a CI between 1.11 and 1.50. This relationship was equal to the odds ratio1.15 with a CI between 1.08 and 1.23. Also, other risk factors for suicide were: conflict at work, job strain, job insecurity, workplace bullying, job stress, burnout, and work-family conflict. This study showed how much the work environment and related risk factors can play a role in different aspects of suicide. Therefore, in the policies related to health at work, it is necessary to pay attention to the field of monitoring and screening of mental health in the work environment.
Lower extremity reconstruction is complex and resource-intensive, yet reimbursement continues to decline. The COVID-19 pandemic further strained healthcare delivery, emphasizing the need for innovative strategies to sustain the viability of microsurgical care. While prior literature has focused on strategies to improve operative efficiency in breast microsurgery, the impact in lower extremity reconstruction is less defined. We evaluated the impact of a structured quality improvement (QI) initiative on efficiency and outcomes in lower extremity reconstruction. A single-center QI initiative using a Six Sigma DMAIC framework was implemented in July 2021. Interventions included standardized preoperative planning, parallel operative workflows, process optimization, and increased co-surgeon utilization. After a three-month implementation phase, outcomes from October 2021 to May 2023 were compared with an 18-month pre-intervention cohort. Primary outcome was operative duration; secondary outcomes included limb salvage and operative throughput. Multivariable regression adjusted for case mix and operative characteristics. 103 free flaps were analyzed (53 pre-intervention, 50 post-intervention). Mean operative time decreased from 8.23±2.29 hours to 3.98±1.77 hours (p<0.001). Co-surgeon utilization increased from 22.6% to 79.2% (p<0.001). Limb salvage remained stable (96.0% versus 90.6% pre-intervention, p=0.438). The proportion of operative blocks accommodating additional procedures increased from 28.3% to 86.0% (p<0.001), enabling completion of 52 additional operations in the same block time post‑intervention. A structured QI initiative for lower extremity reconstruction significantly reduced operative time without increasing complications. Engaging stakeholders and optimizing workflows enhances efficiency, resource utilization, and surgical throughput, supporting the sustainability of complex microsurgical care within a strained healthcare environment.
Our study investigated stance markers used in Materials Science research article abstracts by native Chinese-speaking (Chinese L1) and native English-speaking (English L1) researchers, adopting the widely recognized interactional metadiscourse framework. We constructed two comparable corpora, each comprising 501 abstracts from research articles published between 2023 and 2025 in Materials Science journals indexed in the Web of Science Core Collection. Quantitative analysis revealed that there were significant cross-cultural differences between the two corpora: Chinese L1 researchers used hedges more frequently than English L1 researchers (9.67 vs. 7.04 per 1,000 words). Chinese L1 researchers preferred to use the self-mention phrase "this paper", while English L1 researchers employed slightly more boosters and self-mentions generally. Attitude markers were found comparable between the two corpora (4.63 vs. 4.28 per 1,000 words), which can reflect the demands of this academic genre for objectivity. These usage patterns are consistent across all journal quartiles and are generally not influenced by impact levels of the journals. Further analysis of the subcategories shows that Chinese L1 researchers depended more on modal and phrase-based hedges, while English L1 ones used a more diversified range of hedging strategies. In terms of English L1 countries, researchers from the USA, the UK, and Canada shared similar rhetorical conventions. The findings indicate that cultural traditions and disciplinary norms jointly shape the use of stance markers. This study enriches cross-cultural academic discourse studies in hard sciences, and provides practical guidance on the academic English writing instruction for Chinese L1 researchers, especially graduate students.
Primary glomerular diseases (PGDs) are not uncommon in elderly patients, where age-related histological changes, frailty, and multimorbidity overlap with disease-specific drivers of damage. Evidence on the impact of older age at onset on PGD presentation and outcomes remains heterogeneous. This retrospective multicenter study assessed the impact of older age at diagnosis on the clinical-histological presentation, treatment and outcome of PGDs. Adults with biopsy-proven minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy/vasculitis with nephritis enrolled in CureGN between 2014 and 2023 with available kidney function data were stratified by age at diagnosis into three age groups: young adults (18-39 years), middle-aged adults (40-64 years), and elderly patients (≥65 years). Clinical-histological features and treatment patterns were compared across age groups, with a focus on elderly patients. Evaluated outcomes included all-cause mortality and a composite kidney outcome (>40% eGFR decline or Kidney Failure). Cox regression and Fine-Gray models were fitted to evaluate the impact of age on the composite kidney outcome. Among 1562 adults, 211 were aged ≥65 years at diagnosis. Elderly patients exhibited a higher comorbidity burden and lower eGFR at enrollment (55 [34-75] versus 84 [50-115] in young adults and 65 [43-91] ml/min in middle-aged adults, P<0.001). In 704 biopsies with an available Cure Glomerulopathy Pathology Classification, nephrosclerosis features-particularly arteriosclerosis-increased with advancing age, whereas disease-specific features were similar across age groups. Elderly patients more often received conservative or steroid-sparing regimens. A 5-year excess mortality of 7-14% compared with young adults was observed in the elderly. In adjusted models, older age was independently protective for the composite kidney outcome (subdistribution HR 0.65 - 0.79). Aging adds comorbidity and histological chronicity without altering PGDs phenotype; excess mortality and, possibly, underlying biological differences shape outcomes in elderly-onset PGDs.
Data on lupus nephritis (LN) prognosis in the diverse Asian races outside of East Asia is scarce. We aimed to evaluate the cardiometabolic comorbidity burden and outcomes of LN in a multi-racial Southeast Asian population. Single-center, retrospective cohort study of 340 patients with biopsy-proven LN between 2011 and 2023. The outcome was kidney failure and/or death. Among Chinese (252 patients), Malay (57 patients), Indian (11 patients) and other races (20 patients), the median age was 42.3 years (interquartile range 31.4-52.8). Chinese were older at diagnosis than other races (p = 0.002). Malays were less likely to be older than Chinese (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.18-0.61). Diabetes mellitus was more frequent in Malays (OR 3.05, 95% CI 1.04-8.97) and Indians (OR 5.65, 95% CI 1.06-30.06) than Chinese. Compared to Chinese and Malays, other races were less likely to have hypertension and renin-angiotensin system blocker (OR 0.27, 95% CI 0.08-0.96 and OR 0.20, 95% CI 0.06-0.69, respectively). There were no differences in hyperlipidemia, ischemic heart disease, kidney histology, and induction immunosuppressant type. During the median follow-up of 50 (38, 74) months, 49 patients (14.4%) developed kidney failure and/or died. Adjusting for cardiometabolic risk factors (age > 40 years, male sex, eGFR < 60 ml/min/1.73 m2, diabetes mellitus, hypertension, hyperlipidemia and ischemic heart disease), race was not significantly associated with patient and kidney survival, but reduced kidney function (adjusted OR 5.77, 95% CI 2.77-12.01) was. Future studies should include under represented ethnic groups to better understand race-specific cardiometabolic risk profiles and their effects on LN outcomes.
The association between the anterior column realignment (ACR) technique and acute proximal junctional failure (APJF) in adult spinal deformity (ASD) has not been thoroughly evaluated, and risk factors for revision surgery following APJF remain unclear. Therefore, this study was performed to determine the incidence of and the risk factors for revision surgery in APJF following ACR for ASD. Patients eligible for the study were those with severe degenerative sagittal imbalance who underwent deformity correction using ACR at 1 or more levels between 2020 and 2023. APJF was defined as proximal junctional failure occurring within 6 months postoperatively. Cases requiring revision surgery were classified as bony or soft tissue failures. Patient characteristics, surgical factors, and radiographic features were compared to identify risk factors for revision surgery. Univariate and multivariate logistic regression analyses were used to determine independent risk factors. The study included 114 patients (mean age 70.7 ± 5.3 years) with a mean fusion length of 7.2 ± 1.9 levels. APJF occurred in 36 patients (31.6%), with 24 cases of bony failure and 12 cases of soft tissue failure. Revision surgery was performed in 14 patients (38.9% of APJF cases, 12.3% of the study cohort) at a mean of 156.6 ± 76.2 days postoperatively. Among those revisions, 12 cases were due to bony failure and 2 to soft tissue failure. Univariate analysis identified a cranial screw angle at the upper instrumented vertebra (UIV), preoperative thoracic kyphosis (TK), postoperative TK, and proximal junctional angle (PJA) as significant risk factors for revision. Multivariate analysis revealed several independent risk factors for revision surgery: cranial screw angle at UIV (HR 21.578, p < 0.001), preoperative TK (HR 1.049, p = 0.034), and postoperative PJA (HR 1.125, p = 0.046). The incidence of revision surgery due to APJF following ACR for ASD was 12.3% overall. Key risk factors included a cranial UIV screw angle, greater preoperative TK, and increased postoperative PJA.
Combining immune checkpoint inhibitors (ICIs) with chemotherapy has become a major clinical research focus. Patients with extensive-stage small-cell lung cancer (ES-SCLC) have been treated with different first-line ICI combinations in randomized controlled trials (RCTs), but the optimal combination strategy has not yet been determined. Our aim was to evaluate this strategy through a systematic review and meta-analysis. Articles published from inception to October 20, 2024 were systematically searched in PubMed, Cochrane CENTRAL, Embase, and MEDLINE. Candidates were RCTs using ICI treatments as first-line treatment for ES-SCLC. According to PRISMA guidelines, 3 independent investigators extracted data. Hazard/odds ratios (HRs/ORs) with their 95% confidence intervals (CIs) and adverse event (AEs) were extracted. ICI combinations were compared for overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and AEs. A random-effects model and Bayesian network meta-analysis were used. PROSPERO: CRD42023388838. The meta-analysis included 8 RCTs with 3910 patients. Overall, ICI-chemotherapy provided superior OS (HR, 0.78; 95% CI, 0.72 to 0.86), PFS (HR, 0.73; 95% CI, 0.64 to 0.82), ORR (OR, 1.20; 95% CI, 1.01 to 1.42) and DCR (OR, 2.64; 95% CI, 1.32 to 5.24) compared with chemotherapy alone. A higher risk of any grade irAEs (OR, 3.88; 95% CI, 2.09 to 7.18) and grade ≥ 3 irAEs (OR, 5.54; 95% CI, 2.38 to 12.88) was associated with ICI addition. ICI-chemotherapy combinations did not differ significantly in OS, PFS, ORR, DCR, or safety. In the Bayesian ranking analysis, the PD-1 inhibitor-based regimens Serplu-EP and Nivo-EP achieved the highest efficacy rankings; Serplu-EP ranked first for both OS and PFS, followed by Nivo-EP. Efficacy and safety were effectively balanced in Serplu-EP and Adebre-EP. Similar results were shown in subgroup analyses. First-line ICI-chemotherapy combinations improved survival outcomes but increased the risk of irAEs, with no significant differences in efficacy or safety among ICI-chemotherapy combinations. Among the evaluated regimens, the PD-1 inhibitor-based Serplu-EP and Nivo-EP achieved the highest efficacy rankings, whereas Serplu-EP and Adebre-EP appeared to provide the most favorable efficacy-safety balance. Further head-to-head trials are warranted to confirm the optimal first-line ICI strategy for ES-SCLC.