Health systems increasingly screen for health-related social needs (HRSNs), which are modifiable social factors associated with health outcomes. However, screening selection biases and HRSN burdens are poorly characterized. To evaluate patient characteristics associated with HRSN screening completion, positivity, and assistance requests. This retrospective cohort study of adults with screening-eligible outpatient or inpatient encounters in a 22-state, 92-hospital system was performed from January 1, 2020, to November 30, 2024. Data were analyzed from June 7, 2025, to February 4, 2026. Patient sociodemographic characteristics. Unadjusted standardized mean differences and adjusted logistic regression were used to identify characteristics associated with screening completion. Multivariable regression and marginal standardization were used to identify characteristics associated with positivity for any HRSN, total HRSN burden, and assistance requests. Among 1 893 331 eligible adults, 696 925 (36.8%) were 65 years or older (median age, 57 [IQR, 38-71] years), 1 138 792 (60.1%) were female, 8437 (0.4%) were American Indian or Alaska Native, 60 884 (3.2%) were Asian, 257 391 (13.6%) were Black, 4193 (0.2%) were Native Hawaiian or Other Pacific Islander, and 1 561 702 (82.5%) were White; 87 641 (4.6%) were of Hispanic or Latino ethnicity, and 916 449 (48.4%) had Medicare or Medicaid coverage. A total of 1 135 136 participants (60.0%) completed screening and 334 399 (29.5%) reported at least 1 HRSN. Unadjusted differences between screened and unscreened patients were not significant (standardized mean difference, ≤0.20). In adjusted analyses, Black patients (odds ratio [OR], 0.85; 95% CI, 0.79-0.91) and Medicaid beneficiaries (OR, 0.87; 95% CI, 0.80-0.95) had lower odds of being screened, and Hispanic or Latino patients had higher odds (OR, 1.11; 95% CI, 1.01-1.23). Outpatient underscreening was attenuated in inpatient settings for Black patients and Medicaid beneficiaries. The adjusted probabilities of any positive screen were higher among Black (absolute risk difference [ARD], 12.6%; 95% CI, 9.5%-15.7%), American Indian or Alaska Native (ARD, 10.6%; 95% CI, 9.2%-11.9%), and Native Hawaiian or Other Pacific Islander (ARD, 7.2%; 95% CI, 2.1%-12.2%) patients and among Medicare (ARD, 13.1%; 95% CI, 9.7%-16.5%) and Medicaid (ARD, 18.7%; 95% CI, 16.1%-21.2%) beneficiaries compared with White and commercially insured patients. Black patients (ARD, 9.4%; 95% CI, 6.5%-12.3%) and Medicaid beneficiaries (ARD, 16.9%; 95% CI, 16.0%-17.9%) had higher adjusted probabilities of at least 3 positive domains. Among those with at least 3 positive domains, Black patients (ARD, 21.9%; 95% CI, 16.5%-27.2%), Medicare (ARD, 7.0%; 95% CI, 5.1%-8.8%), and Medicaid (ARD, 12.2%; 95% CI, 10.9%-13.6%) beneficiaries had higher assistance requests. In this cohort study across inpatient and outpatient settings, HRSN screening had a substantial reach largely free of selection. Nearly 30% of screened patients demonstrated needs, with higher rates among patients who were members of racial and ethnic minority groups and publicly insured. This study provides support for inpatient HRSN screening workflows, even as policy mandates evolve, to preserve equitable reach for patient groups with disproportionately high social needs.
Knee pain affects 22.9% of individuals aged 40 years and over globally and is associated with body function, activity, environmental, and personal factors described in the International Classification of Functioning, Disability and Health (ICF) model. Most prior studies examined isolated risk factors using conventional regression. This study aimed to examine self-reported knee pain in community-dwelling older adults by combining machine learning and partial-correlation network analysis with smartphone-based physical performance measurement. This cross-sectional study included 852 adults aged 60 years and older. Baseline assessment of 38 variables across 7 ICF-aligned domains was reduced to 21 predictors using prespecified, rule-based criteria (events per variable=14.95). Walking speed, sit-to-stand, gait knee flexion, and gait asymmetry were measured using a validated vision-based smartphone app. Missing data were addressed by multiple imputation (m=5) with Rubin rules. Six algorithms (logistic regression with elastic-net penalty as baseline, k-nearest neighbors, random forest, Extreme Gradient Boosting, Light Gradient Boosting Machine, and support vector machine) were trained using nested 5×5 cross-validation, and the best model was interpreted using Shapley Additive Explanations and partial dependence plots. Partial-correlation network analysis examined the 10 top-ranked features and the knee-pain node, with bootstrap stability assessment and a sensitivity analysis excluding EuroQol 5-Dimension (EQ-5D) Pain/Discomfort. Knee pain prevalence was 36.9% (314/852). Pooled area under the receiver operating characteristic curve values ranged from 0.692 to 0.723, with random forest highest (area under the receiver operating characteristic curve=0.723, 95% CI 0.689-0.757). The top Shapley Additive Explanations features were EQ-5D Pain/Discomfort, EQ-5D Utility, and house estate. In the 11-node network, only EQ-5D Pain/Discomfort (partial correlation=0.260) and house estate (0.158) had direct edges with knee pain. Sit-to-stand showed the highest strength centrality (0.679) without a direct edge, acting as a hub linking body function, body structure, mental health, and activity variables. Shapley Additive Explanations importance and network strength were weakly correlated (ρ=0.018). The sensitivity analysis preserved the pattern (best area under the receiver operating characteristic curve=0.724). Knee pain in older adults was associated with variables spanning 7 ICF domains, with EQ-5D Pain/Discomfort and housing environment (lower-income rental estate residence) as direct correlates and sit-to-stand as a network hub. Combining machine learning and partial-correlation network analysis may inform multidisciplinary biopsychosocial assessment, pending confirmation in prospective and externally validated studies.
Transfusion thresholds in upper gastrointestinal bleeding are debated; hemoglobin cutoffs of 70-80 g/L are widely cited yet inconsistently applied. Common risk scores offer limited individualized guidance and rarely provide calibrated, interpretable predictions for transfusion decisions. This study aimed to develop and validate a two-stage, clinically constrained gradient-boosting framework (Medically Constrained Gradient Boosting [MCGB]) that predicts transfusion need and estimates transfusion dose with quantified uncertainty and to implement a prototype recommendation system for clinical use. We analyzed a retrospective multicenter cohort of 849 adults with endoscopically confirmed upper gastrointestinal bleeding admitted to 3 hospitals in Chongqing, China (January 2019 to August 2025). Predictors available before the transfusion decision included demographics, first recorded vital signs, initial laboratory indices, and clinician-adjudicated etiology. Stage 1 used a calibrated classifier with prespecified monotonic constraints and stability-screened, clinically justified interactions. Stage 2 modeled transfusion dose via quantile predictions with conformal adjustment to generate 95% prediction intervals. Performance was assessed using a cross-site hold-out design. Overall, 2 hospitals were used as the development cohort, within which stratified 5-fold cross-validation was performed for model development, hyperparameter tuning, interaction screening, and calibration. The remaining hospital was held out as an independent test cohort for final evaluation. Hospital-wise alternating external testing was further conducted as a supplementary robustness analysis to assess performance stability across institutions. Classification performance was evaluated using discrimination metrics (area under the receiver operating characteristic curve and area under the precision-recall curve), calibration metrics, and decision-curve analysis; regression performance was evaluated using R², mean absolute error, and prediction-interval coverage. A graphical user interface was implemented to enable clinicians to input patient data and obtain calibrated predictions of transfusion probability and corresponding dose recommendations. MCGB achieved strong discrimination and good calibration across subgroups (area under the receiver operating characteristic curve=0.97 and area under the precision-recall curve=0.91). At a reference probability threshold of .50, sensitivity, specificity, and F1-scores were 0.99, 0.87, and 0.85, respectively, providing a representative operating point for comparison. For dose prediction among transfused patients, MCGB achieved R² of 0.95 and mean absolute error 0.04; 95% prediction-interval coverage was 0.94, indicating accurate point estimates with reliable uncertainty quantification. The software prototype further demonstrated feasibility of real-time decision support at the bedside. MCGB provides calibrated, interpretable predictions of transfusion need and individualized dose in upper gastrointestinal bleeding and may support bedside decision-making and blood-bank planning, with a prototype interface demonstrating potential for clinical deployment. External validation in additional settings is warranted to confirm generalizability.
The Lampyrinae tribe Cratomorphini includes some of the largest and most widespread New World fireflies. Their overlapping genus-level diagnoses are based on a few traits related to sexual signaling known to be fast-evolving and labile within-genus in other Lampyrinae taxa. To clarify the taxonomy and investigate the morphological evolution in Cratomorphini, Lamprocerini, and closely related taxa, we inferred the phylogenetic relationships of 50 species using 97 adult morphological characters contrasting the results of Maximum Parsimony Analysis and Bayesian Inference. Using a statistical framework, we demonstrate that terminalia and genitalic traits are less homoplastic than signaling or other somatic traits. Cratomorphini was recovered as polyphyletic, with four distinct clades, as follows: (i) Cratomorphus (partim: the type species, C. splendidus, and associated species) + Erythrolychnia bipartita; (ii) Cratomorphus (partim; transferred here to Nyctocera gen. nov. [Lamprocerini]); (iii) Cratomorphus (partim; transferred here to Bituca gen. nov. [Lampyrinae incertae sedis]) and (iv) (Micronaspis ((Aspisomoides, Pyractomena) Aspisoma)). Based on these results, we redefine Cratomorphini and Lamprocerini and present updated diagnoses for both tribes. We propose a new tribe, Aspisomini trib. nov. and establish two new genera: Nyctocera gen. nov. (within Lamprocerini sensu nov.) and Bituca gen. nov. (incertae sedis). Four species formerly assigned to Cratomorphus sensu nov. are transferred - three to Nyctocera gen. nov., and one to Bituca gen. nov. - and all are redescribed based on type and additional material. We illustrate all diagnostic features, and provide updated keys to the genera of Cratomorphini sensu nov., Aspisomini trib. nov., and Lamprocerini sensu nov. Additionally, we identify and discuss synapomorphies for clades previously recovered only in DNA-based phylogenies. Our work stresses the need for thorough investigations of morphological data, especially of the terminalia and genitalia, to elucidate the phylogeny of fireflies.
Postoperative sleep disturbance (PSD) is a complication that often follows surgery. The condition is closely associated with impaired recovery, heightened pain sensitivity, and increased risk of chronic postsurgical pain. While pharmacological interventions like dexmedetomidine and esketamine have been reported to improve perioperative sleep quality, their comparative efficacy-particularly in the realm of analgesia-remains uncertain. This review aimed to evaluate the efficacy of dexmedetomidine and esketamine in treating PSDs and providing analgesia. We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs) that compared the effects of dexmedetomidine, esketamine, and control interventions on adult surgical patients. Comprehensive literature searches were performed in 4 electronic databases from their inception to August 1st, 2025. The protocol was previously registered in the PROSPERO database under the registration number CRD420251126227. The primary outcomes were postoperative pain scores assessed using the Visual Analog Scale (VAS) at 24 and 48 hours. Secondary outcomes included the incidence of PSD, Athens Insomnia Scale (AIS) scores, and sleep quality measured on the Numerical Rating Scale (NRS). Subjective sleep outcomes were synthesized using a Bayesian network meta-analysis. Additionally, a supplementary traditional meta-analysis was performed on studies that used polysomnography (PSG) to evaluate objective sleep architecture. Ten RCTs involving 645 patients were included in the study. Esketamine demonstrated significantly superior analgesic efficacy, substantially reducing VAS pain scores both at rest and during movement at 24 and 48 hours postoperatively. Compared to the control, both esketamine and dexmedetomidine showed a tendency to reduce the incidence of PSD on the first postoperative day (esketamine: risk ratio [RR] = 0.655, 95% credible interval [CrI]: 0.517-0.798; dexmedetomidine: RR = 0.773, 95% CrI: 0.434-1.23) and improved AIS and NRS scores. A supplementary meta-analysis of 4 PSG studies (n = 182 patients) indicated that dexmedetomidine increased the percentage of stage N2 sleep (mean difference [MD] = 13.0%, 95% confidence interval [CI]: -5.2 to 31.2) and the odds of experiencing stage N3 sleep, although the latter finding was not statistically significant (odds ratio [OR] = 2.99, 95% CI: 0.61 to 14.66). The primary limitation on this study is that the trials included were all conducted in China. Both dexmedetomidine and esketamine improve postoperative sleep quality effectively. Esketamine demonstrates superior analgesic efficacy and has the higher probability being the optimal treatment for reducing early PSD incidence. In contrast, dexmedetomidine appears to objectively improve sleep architecture by promoting N2 sleep. The superior analgesic profile of esketamine likely underpins its enhanced subjective sleep benefits.
Current literature is limited regarding the impact of diabetes mellitus (DM) on short- and long-term postoperative complications following distal femur (DF) fracture surgery in geriatric patients. Although DM is a known risk factor for adverse outcomes following hip fracture and lower-extremity arthroplasty, large-scale data specific to DF fractures, which pose distinct fixation, weight-bearing, and healing challenges, remain limited. This study evaluates short- and long-term postoperative complication rates among geriatric patients undergoing operative treatment for DF fractures, comparing those with and without DM. Using a nationally representative multi-institutional database, we conducted a retrospective analysis of patients aged ≥ 65 years who underwent DF fracture surgery between January 2012 and January 2022. Patients were categorized as having DM or not, and propensity score matching controlled for demographic and comorbidity differences. A subgroup analysis stratified diabetic patients into complicated and uncomplicated DM to assess whether disease severity modified risk. Follow-up periods were 6 months, 1 year, and 3 years. A total of 9390 patients were matched into each cohort. Patients with DM had significantly higher risks of myocardial infarction, transfusion, acute kidney failure, glomerular disease, pneumonia, mortality, cardiac arrest, and wound dehiscence across all follow-up intervals. Surgical site infection was more frequent in the DM cohort at 6-month and 1-year follow-up but did not reach statistical significance at 3 years. No significant differences were observed in deep vein thrombosis, pulmonary embolism, hematoma, DF nonunion, or DF malunion. In the subgroup analysis, patients with complicated DM showed higher rates of major complications, including acute kidney failure and myocardial infarction, compared with matched patients with uncomplicated DM. Geriatric patients with DM were observed to have significantly higher rates of medical and infectious complications following distal femur fracture surgery compared with matched non-diabetic patients. These findings identify DM, and particularly complicated DM, as an important risk marker and may warrant consideration of enhanced perioperative co-management. Because this is a retrospective observational study, findings represent associations rather than causal relationships; prospective and interventional studies are needed to clarify modifiable factors in geriatric patients with DM undergoing DF fracture surgery.
To analyze the risk factors for postoperative complications in elderly patients with fragile hip fractures and their impact on postoperative mobility, and to construct a risk prediction model. A retrospective analysis was performed on the postoperative clinical data of 278 elderly patients diagnosed with fragility hip fractures, who received treatment between January 2019 and December 2024. Of these patients, 120 were male and 158 were female, aged from 63 to 82 with a mean age of (74.91±4.87) years old and an average bone mineral density (BMD) T uale was raging from -3.63 to -2.15 with an aberage of (-2.89±0.74) g·cm-2. The patients were categorized into two groups based on the presence or absence of postoperative complications:the complication group(78 patients) and the non-complication group (200 patients). Furthermore, according to the postoperative functional mobility status of elderly patients with fragile hip fractures, those in the complication group were further classified into a good activity ability group(37 patients) and a limited activity ability group (41patients). Clinical data were collected from patients, including gender, Charlson comorbidity index (CCI), mini-mental state examination(MMSE) scores, age, type of surgical procedure, and time to ambulation. The study further analyzed potential risk factors for postoperative complications and their impact on patients' postoperative functional mobility. There were statistically significant differences between the complication group and the non-complication group with respect to age, MMSE score, CCI score, type of surgery, operation time, intraoperative blood loss, anesthesia method, and preoperative nutritional status(P<0.05). Logistic regression analysis demonstrated that age[OR=1.167, 95% CI(1.103, 1.234), P=0.001], MMSE score [OR=0.847, 95% CI(0.775, 0.927), P=0.001], CCI score[OR=1.374, 95% CI(1.099, 1.718), P=0.005], type of surgery [OR=2.976, 95% CI(1.700, 5.208), P=0.001], operation time [OR=2.065, 95% CI(1.209, 3.528), P=0.008], intraoperative blood loss[OR=1.024, 95% CI(1.004, 1.044), P=0.020], anesthesia method [OR=2.165, 95% CI(1.267, 3.698), P=0.005], and preoperative nutritional status[OR=0.500, 95% CI(0.348, 0.719), P=0.001], were significant independent risk factors associated with the development of postoperative complications in elderly patients with brittle hip fractures. There were statistically significant differences in activity levels among patients with different types of complications (P<0.05). Additionally, statistically significant differences were observed in the incidence of complications including pulmonary infection, deep vein thrombosis, pressure ulcers, surgical site infection, and cardiovascular and cerebrovascular diseases between the group with good activity ability and the group with limited activity ability (P<0.05). The receiver operating characteristic(ROC) curve of the nomogram prediction model, constructed based on independent risk factors, demonstrates that the mean area under the curve (AUC)>0.800 for each influencing factor. The risk prediction model developed through multifactorial analysis facilitates the early identification of postoperative complications and functional limitations in elderly patients with fragility hip fractures, thereby supporting the clinical formulation of individualized intervention strategies and improving patient outcomes.
The triglyceride-glucose(TyG) index, a surrogate marker of insulin resistance, has been linked to cardiac dysfunction; however, its underlying associated pathways in patients with type 2 diabetes mellitus(T2DM) remain unclear. This study used cardiac magnetic resonance(CMR) to explore the association of TyG index with subclinical left ventricular(LV) myocardial dysfunction and whether imaging indicators statistically mediate this relationship. In this retrospective cross-sectional study, a total of 235 T2DM patients who underwent CMR examination were included and assigned to three groups based on the tertiles of their TyG indexes as follows: low(< 8.73, n = 78), moderate(8.73-9.36, n = 79), and high TyG index(≥ 9.36, n = 78) groups. LV geometry, function, myocardial energetic efficiency index (MEEi), resting first-pass perfusion, and global peak strain in radial(GRPS), circumferential(GCPS), and longitudinal(GLPS) directions were measured. Univariate and multivariate linear regression models and exploratory mediation analysis were used to analyze the associations of TyG index on LV global strain. Compared with the low and moderate TyG index groups, the high TyG index group had significantly higher LV remodeling index, lower LV global function index, lower MEEi, impaired resting myocardial perfusion, and reduced LV global peak strain (all p ≤ 0.002). Multivariate analysis showed that TyG index remained independently associated with reduced LV strain after adjusting for confounders (GRPS β = -0.261; GCPS β = 0.271; GLPS β = 0.381; all p < 0.001). And MEEi and upslope were also independently associated with reduced LV GRPS and GLPS (all p < 0.05). Further mediation analysis revealed the statistically mediated proportions of the association between the TyG index and LV global strain were 8.2-8.6% for MEEi and 4.3% to 12.5% for upslope. In model comparison analyses, the TyG index demonstrated substantially better model fit than either component alone across all strain directions (all Akaike Information Criterion difference > 150). In patients with T2DM, a higher TyG index is independently associated with decreased LV global strain, and this relationship is statistically mediated by reduced MEEi and impaired resting perfusion upslope. These findings generate hypotheses regarding myocardial energetics and resting perfusion as potential pathways associated with diabetic myocardial dysfunction that warrant prospective investigation.
To summarize the clinicopathological characteristics and survival outcomes of pediatric non-Hodgkin lymphoma (NHL) in Fujian Province. Clinical data of 294 newly diagnosed pediatric NHL patients treated at multiple centers in Fujian Province from January 2011 to December 2023 were collected. The characteristics of different pathological subtypes were summarized, Kaplan-Meier survival analysis were performed and Cox proportional hazards regression model was used for prognostic analysis. A total of 294 pediatric NHL patients were included in this study, with a male-to-female ratio of 3.03∶1 and a median age of 7 years (range, 0.9-14 years). The most common subtype was mature B-cell lymphoma, accounting for 59.2% of cases. The majority of patients were diagnosed at stage III/IV (86.2%), with 32 cases (10.9%) involving central nervous system (CNS) infiltration and 89 cases (30.3%) showing bone marrow involvement. The rate of voluntary abandonment significantly decreased after 2018 (abandonment rates before and after 2018: 6/110 (5.45%) vs. 1/184 (0.54%), P =0.012). Furthermore, excluding cases of voluntary abandonment, the 5-year EFS and OS of newly diagnosed pediatric NHL patients from 2018 to 2023 were still significantly higher than those diagnosed from 2011 to 2017 (EFS: 79.3%±3.7% vs. 70.2%±4.5%, P =0.032; OS: 87.7%±2.6% vs. 70.2%±4.5%, P < 0.001). OS improvements after 2018 were significant in patients with BL and LBL (BL: 89.3%±3.6% vs. 73.5%±7.6%, P =0.033; LBL: 89.3%±5.3% vs. 56.5%±10.3%, P =0.001). However, there were no statistically significant differences in EFS or OS for patients with ALCL or DLBCL (all P >0.05). Multivariate survival analysis identified concurrent hemophagocytic lymphohistiocytosis syndrome was an independent risk factors for both EFS and OS in pediatric NHL patients. Over the past six years, OS and EFS in children with NHL in Fujian Province have improved markedly, with more pronounced gains in BL and LBL. This trend may be related to the combined effects of reduced voluntary treatment abandonment, more standardized diagnostic and therapeutic pathways, treatment optimization, and updated protocols. HLH at initial diagnosis is an independent risk factor for poor prognosis in pediatric NHL, while remission after two chemotherapy cycles suggests a favorable outcome. 福建省儿童非霍奇金淋巴瘤的临床特征及生存分析. 总结福建省儿童非霍奇金淋巴瘤（NHL）的临床病理特征及生存情况。. 收集2011年1月-2023年12月期间福建省多中心诊治的294例初发NHL患儿临床资料，总结不同病理亚型患儿的临床特征，采用Kaplan-Meier进行生存分析，采用Cox比例风险回归模型进行预后分析。. 共纳入294例NHL患儿，男女比例为3.03 ∶1，中位年龄为7（0.9-14）岁，以成熟B细胞淋巴瘤最常见（59.2%）。绝大多数在诊断时处于Ⅲ/Ⅳ期（86.2%），32例（10.9%）合并有中枢神经系统浸润，89例（30.3%）伴有骨髓浸润。总体5年无事件生存（EFS）率和总生存（OS）率分别为74.0%±2.7% 和79.1%±2.5%。2018年后主动放弃率显著降低［2018年前后放弃率分别为6/110（5.45%）、1/184（0.54%）, P =0.012］，而且剔除主动放弃病例后，2018-2023年期间初诊NHL患儿5年EFS、OS仍均显著高于2011-2017年初诊患儿（EFS：79.3%±3.7% 对 70.2%±4.5%，P =0.032；OS：87.7%±2.6% 对 70.2%±4.5%， P < 0.001），其中以伯基特淋巴瘤（BL）和淋巴母细胞淋巴瘤（LBL）最为显著（BL：89.3%±3.6% 对 73.5%±7.6%，P =0.033；LBL：89.3%±5.3% 对 56.5%±10.3%，P =0.001），而ALCL及DLBCL患儿的EFS及OS差异无统计学意义（均P >0.05）。多因素生存分析结果显示，合并噬血细胞综合征是NHL患儿EFS和OS的独立危险因素，化疗2疗程后达到缓解则是EFS和OS预后良好因素。. 近6年来，福建省儿童NHL的OS及EFS明显改善，尤以BL和LBL更为突出。这一趋势可能与主动放弃率下降、诊疗流程规范化、治疗优化以及方案更新等多因素共同作用相关。初诊合并HLH是儿童NHL不良预后的独立危险因素，而2疗程后达到缓解则提示预后良好。.
Neonates, defined as infants within the first 28 days of life, are especially vulnerable in conflict-affected settings. Globally, about 2.3 million neonatal deaths occur annually, with nearly 98% occurring in low- and middle-income countries. Despite several studies in this area, context-specific evidence remains limited, and knowledge and data gaps continue to hinder efforts to address health inequalities in resource-limited settings. This study, therefore, aims to evaluate neonatal mortality and identify its key predictors. This study aimed to assess neonatal mortality and identify its associated risk factors. A hospital-based retrospective cohort study was conducted among 329 neonates admitted between 2021 and 2023. Data were extracted from medical charts, registers, and maternal and neonatal history sheets. Kaplan-Meier survival curves and Cox regression models were used for analysis. Log-rank test and proportional hazards assumption were evaluated. Predictors of neonatal mortality were identified using Cox proportional hazards regression model, with statistical significance set at p < 0.05. The overall neonatal mortality rate was 216 per 1,000 live births (95% CI: 190.5-241.5), with a median survival time of 52 days. Multivariable Cox regression identified respiratory distress syndrome (RDS) and delayed initiation of breastfeeding as significant predictors of neonatal mortality. RDS was associated with an increased risk of death [AHR = 2.00, 95% CI: 1.16-3.46]. Compared with breastfeeding initiated within one hour of birth, delayed initiation of breastfeeding was associated with a higher risk of mortality [AHR = 6.23, 95% CI: 3.03-12.82], whereas formula feeding showed a similar trend that did not reach statistical significance [AHR = 2.602, 95% CI: 0.835-8.10]. Neonatal mortality in this study was substantially high. Delayed initiation of breastfeeding and respiratory distress syndrome were identified as significant predictors of neonatal death. Public health interventions should focus on addressing modifiable risk factors for neonatal mortality. Strengthening postnatal maternal health education, promoting early initiation of breastfeeding, and increasing community awareness are essential. In addition, prioritizing respiratory distress syndrome management through effective infection prevention and control measures, quality neonatal care, and timely access to oxygen and surfactant therapy could enhance neonatal survival.
To investigate the correlation between the neutrophil-to-lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), and transfusion-related adverse reactions. Patients who received transfusion therapy (including plasma, red blood cells, platelets, and cryoprecipitate) at our hospital from May 2020 to December 2024 were enrolled. Among them, 55 patients who experienced transfusion-related adverse reactions were included in the observation group. According to a 1∶2 matching ratio, 110 patients from the same (or nearby) departments during the same period who received the same blood products but did not experience transfusion-related adverse reactions were selected as the control group. General clinical data, complete blood count parameters, and hs-CRP levels were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for transfusion-related adverse reactions and construct a logistic regression prediction model. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of individual and combined risk factors. The differences in white blood cell (WBC), neutrophil (Neu), monocyte (Mon), neutrophil-to-lymphocyte ratio (NLR), neutrophil-monocyte ratio (NMR), high-sensitivty C-reactive protein (hs-CRP), lymphocyte-monocyte ratio (LMR) between the observation group and the control group were statistically significant (P<0.05), while no statistically significant differences were observed among the other indicators (P>0.05). Logistic regression analysis showed that NLR(OR=1.220, 95%CI:1.064-1.398) and hs-CRP(OR=1.056, 95%CI:1.035-1.076） were independent risk factors for transfusion-related adverse reactions. ROC curve analysis demonstrated that the AUC for predicting transfusion-related adverse reactions using NLR, hs-CRP, and their combination were 0.827, 0.891, and 0.924, respectively. The corresponding sensitivities were 78.0%, 80.0%, and 81.8%, and the specificities were 75.5%, 85.5%, and 89.1%, respectively. Elevated NLR and hs-CRP levels are associated with a higher risk of transfusion-related adverse reactions, and their combination shows superior predictive value. 外周血中性粒细胞-淋巴细胞比值、超敏C反应蛋白与输血不良反应的相关性. 分析外周血中性粒细胞-淋巴细胞比值（NLR）、超敏C反应蛋白（hs-CRP）与输血不良反应的相关性. 以2020年5月至2024年12月在本院接受输血（血浆、红细胞、血小板及冷沉淀）治疗的患者为研究对象，将其中发生输血不良反应的55例纳入观察组。按照1∶2的比例匹配同期、相同（临近）科室接受同类血制品输注且未发生输血不良反应的患者共110例作为对照组。比较两组的一般资料、全血细胞计数参数、hs-CRP检测结果。通过单因素、多因素二元Logistic回归分析筛选出引起输血不良反应的危险因素，构建Logistic回归预测模型。绘制受试者工作特征（ROC）曲线，计算ROC曲线下面积（AUC），评估危险因素单独及二者联合对输血不良反应的预测效能. 观察组和对照组的白细胞计数（ＷＢＣ）、中性粒细胞计数（Ｎｅｕ）、单核细胞计数（Ｍｏｎ）、中性粒细胞-淋巴细胞比值（NLR）、中性粒细胞-单核细胞比值（ＮＭＲ）、超敏Ｃ反应蛋白（ｈｓ-ＣＲＰ）、淋巴细胞－单核细胞比值（ＬＭＲ）差异有统计学意义（P<0.05），其余指标组间比较无统计学差异（P>0.05）。Logistic回归分析发现，NLR（OR=1.220,95%CI:1.064-1.398）和hs-CRP（OR=1.056,95%CI:1.035-1.076）是输血不良反应的独立危险因素。ROC曲线分析显示，NLR、hs-CRP及二者联合预测输血不良反应的AUC分别为0.827、0.891、0.924，灵敏度分别是78.2%、80.0%、81.8%，特异性分别是75.5%、85.5%、89.1. NLR、hs-CRP与输血不良反应发生风险的增加存在显著关联，联合检测具有更高预测价值.
The aim of this study was to examine temporal trends in metabolic syndrome-associated osteoarthritis (MetS-OA) among patients undergoing revision total knee arthroplasty (RTKA) and to identify patient- and clinical-level factors associated with this condition and related outcomes. A retrospective cohort analysis was conducted using data from the Nationwide Inpatient Sample from 2010 through 2019. Patient demographics, hospital characteristics, length of stay, total hospitalization charges, in-hospital mortality, comorbid conditions, and perioperative complications were assessed. All analyses incorporated NIS discharge weights, and multivariable logistic regression models were used to assess associations between MetS-OA and clinical outcomes among patients undergoing RTKA. Among 1,361,454 RTKA hospitalizations identified, 1,330,099 RTKA hospitalizations were included in the analysis. The overall prevalence of MetS-OA was 16.1%, demonstrating a progressive increase from 2011 through 2019. Factors independently associated with MetS-OA included advanced age, male sex, non-White racial background, and the presence of comorbid conditions such as chronic pulmonary disease, depression, and hypothyroidism. Patients with MetS-OA experienced slightly longer hospital stays and incurred higher median total hospitalization charges, exceeding those without MetS-OA by $1,445.50. In-hospital mortality did not differ significantly between groups. MetS-OA was also associated with a higher likelihood of postoperative complications, including acute myocardial infarction, severe malnutrition, acute cerebrovascular disease, postoperative delirium, acute respiratory distress syndrome, prolonged mechanical ventilation, urinary tract infections, acute renal failure, and lower limb nerve injury. The prevalence of MetS-OA among patients undergoing RTKA has increased over time and is associated with a higher burden of postoperative complications and healthcare utilization. Patient- and hospital-level factors play a substantial role in shaping these outcomes. Targeted preoperative optimization and standardized perioperative management strategies for patients with MetS-OA may mitigate adverse events, enhance postoperative recovery, and reduce overall hospitalization charges.
Leukemia is a group of diverse and biologically distinct blood cancers. While progress has been made in combating infectious diseases, chronic diseases like leukemia are increasingly prevalent. Current data on leukemia's prevalence in Africa are inconsistent, necessitating a comprehensive systematic review. This study aims to determine the pooled prevalence and associated risk factors of leukemia across Africa through a systematic review and meta-analysis. This systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, and Science Direct, supplemented by searches using the Google Scholar and manual searches to identify eligible studies. Statistical analysis was performed using STATA version 11, with a random-effects model employed to compute pooled estimates. Higgen's I2 test statistics and meta-regression was conducted to explore potential sources of heterogeneity. Publication bias was assessed visually by Funnel plots and statistically using Egger's weighted regression test, a p-value of less than 0.05 indicates the presence of significant publication bias. A total of 17,546 articles were retrieved, of which fifteen studies, which recruited 42,884 individuals, were included in the meta-analysis. The pooled prevalence of leukemia was 5.09% (95% CI: 4.02, 6.17) with I2 of 97.1%. Due to the heterogeneity, subgroup analyses by country showed that the highest prevalence was 10.58% in Nigeria, and the lowest was 0.58% in Zambia. Subgroup analysis based on publication year revealed 4.16% among studies conducted before 2015 and 6.67% among studies conducted after 2016. Additionally subgroup by sample size showed: smaller sample sizes (<384 participants) yielded a higher pooled estimate of 7.99%, conversely, studies with larger sample sizes (≥385 participants) showed 3.61%. Whereas subgroup analysis by population showed that 3.38% in children and 7.15% in the general population. Among the factors identified, rural residency (OR: 56.98, 95% CI: 9.97-326.70) and older age (OR: 3.90, 95% CI: 1.39-10.98) were significant predictors of leukemia in Africa. This review reveals a pooled prevalence of 5.09%, with rural residency and older age identified as significant predictors of leukemia in Africa, underscoring a public health concern.
To retrospectively analyze the early death of patients with newly diagnosed multiple myeloma (NDMM) treated with daratumumab, build a risk warning model and verify its clinical decision-making benefits. The clinical data of 112 NDMM patients treated with daratumumab combination therapy in Tangshan Gongren Hospital from June 2018 to June 2022 were retrospectively collected as the training set, and the clinical data of 78 NDMM patients who received daratumumab combination therapy in the same period were collected as the validation set. According to whether early death occurred during regular follow-up (OS <24 months), the patients were divided into early death group (26 cases) and non-early death group (86 cases). The differences of clinical data between the two groups were analyzed, and Kaplan-Meier survival curves were used to analyze the survival difference of patients with different efficacy. Univariate and multivariate Cox regression analysis were used to analyze the independent risk factors affecting early death of NDMM patients treated with daratumumab. A warning nomogram model for the risk of early death was established, and the predictive performance was analyzed by receiver operating characteristic (ROC) curve and verified internally. According to whether the efficacy of daratumumab treatment achieved partial response (PR), the patients were divided into <PR group (32 cases) and ≥PR group (80 cases). Kaplan-Meier analysis found that the median OS of both groups were not reached, while the OS of patients with efficacy ≥PR was significantly longer than that of patients with efficacy <PR (log-rank χ2=14.225, P <0.001). Multivariate Cox regression analysis showed that older age, R-ISS stage Ⅲ, elevated hs-CRP, and efficacy <PR were independent risk factors for early death in NDMM patients (all P <0.05), and a nomogram model for early death risk in NDMM patients was constructed. ROC analysis and DeLong test showed that the AUC of the nomogram model was 0.894(95%CI : 0.828-0.959), which was higher than that of each individual model, and the differences were statistically significant (all P <0.05). Internal and external validation showed that the nomogram model was stable and had a positive net benefit. The OS of NDMM patients who did not reach PR after daratumumab treatment can be affected. Daratumumab treatment early death risk warning model for NDMM has good efficacy, and can be targeted at high-risk population for intensive treatment to improve prognosis. 达雷妥尤单抗治疗新诊断多发性骨髓瘤患者早期死亡风险预警多模型研究及临床决策分析. 分析达雷妥尤单抗治疗新诊断多发性骨髓瘤（NDMM）患者早期死亡情况，构建发生风险预警模型并验证其临床决策效益。. 回顾性收集2018年6月至2022年6月于唐山市工人医院接受含达雷妥尤单抗联合方案治疗的112例NDMM患者临床资料，设为训练集；收集同期接受含达雷妥尤单抗联合方案治疗的78例NDMM患者临床资料，作为验证集。依据定期随访中是否发生早期死亡（总生存期OS <24个月），将患者划分为发生早期死亡组（26例）与未发生早期死亡组（86例）。对两组患者临床相关资料行差异性分析，Kaplan-Meier生存曲线分析不同疗效患者生存期差异。单因素和多因素Cox回归分析NDMM达雷妥尤单抗治疗早期死亡的独立危险因素。建立早期死亡发生风险预警列线图模型，通过ROC曲线分析预测效能并进行内部验证。. 根据治疗疗效是否达到部分缓解（PR），将所有患者分为<PR组（32例）与≥PR组（80例）。Kaplan-Meier分析结果显示，两组患者的中位OS均未达到，而≥PR患者OS明显长于<PR患者（log-rank χ2=14.225，P <0.001）。多因素Cox回归分析结果显示，年龄越大、R-ISS分期Ⅲ期、hs-CRP升高、疗效未达到PR为NDMM早期死亡的独立危险因素（均P <0.05），并构建NDMM患者早期死亡风险预警列线图模型。ROC分析和DeLong法检验结果显示，列线图模型的AUC值为0.894(95%CI :0.828-0.959)，高于各单个变量的AUC，比较差异有统计学意义（均P <0.05）。内部及外部验证结果显示，该列线图模型较为稳定，且有正向净收益率。. 达雷妥尤单抗治疗未达PR的NDMM可影响患者OS。NDMM达雷妥尤单抗治疗早期死亡风险预警模型效能良好，可针对高风险人群进行强化治疗以改善预后。.
This study aimed to assess the prevalence of high myopia and its associated demographic and ocular factors among residents aged 50 and older in Fujian Province, Southeast China. A population-based cross-sectional eye study was conducted from May 2018 to October 2019, enrolling residents aged 50 and older. Participants completed a questionnaire covering education, income, medical history, and lifestyle habits (including smoking, drinking, and tea consumption). They also underwent physical and ophthalmological examinations measuring height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), refraction, intraocular pressure (IOP), and visual acuity (distance and best-corrected). Statistical analysis was performed using Stata software, and a multivariate logistic regression model was employed to identify factors associated with high myopia. A total of 8,024 residents were included in the study. The overall prevalence of high myopia was 3.85% [95% CI: 3.43%-4.27%]. Multiple logistic regression showed that high myopia was significantly associated with inland residency (OR=0.672, p = 0.037), higher IOP (OR=1.069, p = 0.001) and higher education level (OR=1.645, p < 0.001). High myopia is prevalent among Chinese adults, affecting 3.85% of the study population. The findings highlight the need for greater investment in accessible eye care services and policies aimed at inland elderly residents, particularly those with higher IOP and higher education level.
To compare clinical outcomes between urinary and non-urinary tract sepsis in nonagenarians and centenarians admitted to intensive care units (ICUs). Retrospective propensity score-matched multicentre cohort study. Adult ICUs participating in the Australian and New Zealand Intensive Care Society Adult Patient Database across Australia and New Zealand (2010-2023). We included all ICU admissions for sepsis in patients aged 90 years or older, classified as urinary or non-urinary tract sepsis using Acute Physiology and Chronic Health Evaluation III-J diagnostic codes. After 1:1 nearest neighbour propensity score matching, 1130 patients (565 per group) were included. The primary outcome was all-cause mortality within 180 days and beyond 180 days. Secondary outcomes included ICU mortality, hospital mortality, ICU length of stay and hospital length of stay. Of 1669 patients, 573 had urinary tract sepsis and 1096 had non-urinary tract sepsis. After matching, 1130 patients were included (565 per group). In the matched cohort, non-urinary tract sepsis was associated with higher mortality within 180 days than urinary tract sepsis (HR 1.67, 95% CI 1.33 to 2.09, p<0.001), whereas mortality beyond 180 days did not differ (HR 1.03, 95% CI 0.80 to 1.34, p=0.816). ICU and hospital length of stay were similar between groups. Among nonagenarian and centenarian ICU patients with sepsis, infection source was an important determinant of early but not late mortality, with non-urinary tract sepsis conferring a higher risk than urinary tract sepsis. Incorporating infection source and simple physiological markers alongside illness severity scores may improve prognostication and support shared decision-making in this very old population.
 The global burden of uterine fibroids (UFs) has increased from 4.5% to 68.6%, but insufficient data in sub-Saharan Africa limit the development of effective prevention and treatment strategies. The study aimed to determine the prevalence and associated risk factors of symptomatic UFs in Eswatini.  An analytical cross-sectional study used purposive sampling to enrol 645 women aged 25-64 years old with UFs or symptoms. Data were collected via face-to-face interviews with a standardised questionnaire and analysed with descriptive statistics and logistic regression.  The overall prevalence of UFs was 67.8% (437/645). A higher prevalence was evident in the age group 50 years and older (81.4%) compared to prevalence (33.3%) in the age group 25-29 years. Notably, high prevalence was among people with diabetes (88.5%), widows (80%), those with a primary level of education (79.1%), the obese (76.3%), Depo-Provera (75.6%) and Hhohho (76.3%) participants. The univariate analysis significant association show that: for (1) ages 30-34 years (OR: 2.33; 95% CI: 1.26-4.35, p  0.007), 35-39 years (OR: 5.08; 95% CI: 2.82-9.36, p  0.001), 40-44 years (OR: 7.77, 95% CI: 4.19-14.9, p  0.001), 45-49 years (OR: 5.50; 95% CI: 2.96-10.5, p  0.001) and 50+ years (OR: 8.80, 95% CI: 4.58-17.6, p  0.001); (2) primary education (OR: 2.43; 95% CI: 1.27-4.84, p = 0.009), and secondary education (OR: 1.88; 95% CI: 1.12-3.18, p = 0.017); (3) been pregnant (OR: 1.53; 95% CI: 1.04-2.23, p = 0.029); (4) obesity (OR: 3.39, 95% CI:2.02-5.70, p  0.001); and (5) overweight (OR: 1.71; 95% CI: 1.02-2.89, p = 0.044). After adjustments, age remained significantly associated.  Uterine fibroids are highly prevalent and significantly associated with age, underscoring the need for targeted awareness and future research.Contribution: The study provided insights to inform policy and enhance preventive strategies within the sexual reproductive health programs.
Type 2 diabetes mellitus (T2DM) poses a significant health burden globally, with India accounting for a large proportion of cases. Beyond physical complications, diabetes distress (DD)-the emotional and psychological strain associated with diabetes management-is increasingly recognized as a critical factor affecting patient outcomes. However, data on the prevalence and determinants of DD in Western India remain limited. A cross-sectional study was conducted among 158 adult T2DM patients attending an outpatient clinic in Vadodara, Gujarat. DD was assessed using the validated Diabetes Distress Scale-17 (DDS-17). Demographic, clinical, and psychosocial variables were collected and analyzed using descriptive statistics, Chi-squared tests, t-tests, and logistic regression to identify factors associated with DD. The prevalence of DD was 70.2%, with 31.6% experiencing moderate distress and 38.6% experiencing high distress. Emotional burden was the most prevalent distress domain, followed by regimen-related, interpersonal, and physician-related distress. Factors significantly associated with lower DD included higher education, good family support, regular physical activity, and diabetes duration over 10 years. Conversely, poor glycemic control, insulin therapy, hypoglycemic episodes, and the presence of diabetic complications were linked to higher DD. DD is highly prevalent among T2DM patients in Western India and is influenced by both clinical and psychosocial factors. Incorporating routine psychosocial screening and patient-centered interventions into diabetes care is essential to address this underrecognized burden and improve overall disease management.
This systematic review and network meta-analysis (NMA) evaluated the efficacy of autologous blood-derived products compared with open flap debridement (OFD) over time in patients with intrabony periodontal defects. Randomized clinical trials were included, and clinical attachment level (CAL) gain, probing depth (PD) reduction, and bone regeneration (BR) were assessed at 6, 9, and 12 months. Study selection followed the PRISMA-NMA guidelines, and the protocol was registered in PROSPERO (CRD420250651074). Risk of bias was assessed using RoB 2.0, and the certainty of evidence was evaluated with CINeMA. NMA was conducted using a random-effects model integrating direct and indirect comparisons, with treatment ranking based on Surface Under the Cumulative Ranking (SUCRA) probabilities. PRF-based protocols, alone or combined with adjunctive agents, were associated with favorable trends in CAL, PD, and BR outcomes, particularly at the 9-month follow-up. Combinations of PRF with alendronate or rosuvastatin achieved high ranking probabilities and may offer additional regenerative benefits; however, these findings should be interpreted cautiously given the variability in certainty across comparisons. Although statistically significant differences were not consistently observed at 12 months, some interventions maintained favorable point estimates and ranking probabilities over time. Although sustained statistical superiority was not consistently demonstrated, some interventions showed potentially favorable clinical outcomes that may contribute to periodontal stability. Overall, PRF-based therapies showed promising results, particularly at intermediate follow-up periods; however, the magnitude and durability of these effects remain uncertain. Further well-designed long-term clinical trials are required to clarify their role as adjunctive regenerative therapies.
In the context of stalled progress in reducing malaria burden and ongoing efforts to develop novel vector control methods, there is ongoing debate about the impact of livestock on malaria transmission. Zooprophylaxis refers to the use of livestock as an alternate source of blood that diverts mosquito vectors away from humans, potentially reducing malaria transmission. However, conflicting evidence highlights the concept of zoopotentiation, where livestock may instead increase vector populations and enhance malaria transmission. Prior studies that explore these concepts have examined livestock as a household asset, which does not account for the geospatial effect of animals owned by neighbours around the home. We implemented a novel spatial approach to explore the impact of cattle on the risk of malarial infection in coastal Kenya. Using data with high granularity from a recent randomised controlled trial, we measured the presence of animals at increasing concentric areas around the household. We fit binomial regression models with generalised estimating equations to explore how cattle density and cattle-to-human-ratio measures were related to malaria prevalence in children 5-15 years old, accounting for relevant environmental and socio-economic variables. Our findings show that cattle density measured at 400, 500, and 600 m around the household (ORs: 1.63, 95% CI 1.20 to 2.21; 1.84, 95% CI 1.21 to 2.80 and 2.04, 95% CI 1.13 to 3.67, respectively) and cattle-to-human ratio at 500 and 600 m (ORs: 2.73, 95% CI 1.45 to 5.41 and 2.32, 95% CI 1.11 to 4.86, respectively) are significantly related to higher odds of testing positive for malaria. We did not find a significant association at closer distances (<400 m) or when cattle were evaluated only as a household asset. To better understand the impact of livestock on malaria transmission and potentially develop vector control strategies that account for these impacts, future research should consider animals as an environmental exposure and not only as a household asset.