Clomiphene citrate (CC) is the first-line medication for inducing ovulation in women with polycystic ovary syndrome (PCOS). However, approximately 20% of patients with PCOS are resistant to CC. This study aims to identify reliable baseline predictors of CC resistance in infertile women with PCOS. A post-hoc analysis of a large, multicenter randomized controlled trial (PCOSAct trial) conducted in China. The current analysis comprised the 471 participants who were randomized to the active CC arm and completed the requisite follow-up. To identify potential candidate variables, we employed multivariable logistic and LASSO regression analyses. Within the framework of a multivariable logistic regression model, we also estimated the independent associations between the identified candidate variables and resistance to CC. Additionally, we plotted the Receiver Operating Characteristic (ROC) curve and utilized the DeLong method to compare the statistical differences in the area under the curve (AUC). Finally, we constructed a restricted cubic spline (RCS) logistic regression model to illustrate the dose-response relationship between continuous predictor variables and CC resistance. CC resistance was identified in 32 (6.8%) participants. Body Mass Index (BMI), Total Testosterone (TT), and Anti-Müllerian Hormone (AMH) were useful predictors of ovarian response to CC. The "T+BMI" dual-factor model demonstrated high discriminative power (AUC = 0.801) and was statistically comparable to the three-factor model including AMH (AUC = 0.818; P = 0.347). TT was the strongest individual predictor (OR = 2.73 per 1-unit), while BMI was the most significant modifiable risk factor (OR = 2.49 per 1-SD). A simplified "T + BMI" assessment provides comparable prognostic utility without the need for AMH testing. For patients at high risk of CC resistance, we recommend upfront use of aromatase inhibitors or low-dose gonadotropins. This strategy avoids ineffective treatment cycles and enables personalized ovulation induction. The study was registered on ClinicalTrials.gov under the identification number NCT01573858 on July 6, 2012.
This study was conducted to investigate the relationship between sexual health literacy (SHL) and reproductive health and family planning (RHFP) attitudes among university students and to identify the sociodemographic and informational predictors influencing these variables. A descriptive, cross-sectional design was employed with a sample of 867 university students aged 18-35 in Türkiye between May and September 2024. Data were collected using a Sociodemographic Questionnaire, the Sexual Health Literacy Scale (SHLS), and the Reproductive Health and Family Planning Attitude Scale (RHFPAS). Data analysis included Pearson correlation and multiple linear regression models to determine predictors and relationships. The findings revealed a strong positive correlation between SHL and RHFP attitudes (r = 0.880, P < .05). Multiple linear regression analysis showed that total SHLS scores and students' conceptual definitions of sexual health were significant predictors of RHFP attitudes. In particular, the knowledge and attitude subscales of the SHLS were identified as key determinants. Furthermore, residence type, sexual activity status, and information sources were found to significantly influence both SHL levels and RHFP attitudes. SHL is a critical determinant in shaping the RHFP attitudes of young adults. Higher literacy levels directly correlate with more positive attitudes toward reproductive health services, suggesting that targeted educational interventions are necessary to improve health outcomes in this population.
Recurrence of high-grade glioma after primary treatment is inevitable. New contrast-enhancing lesions on follow-up MRI may indicate tumor progression, treatment-associated changes (TAC), or both. A repeated surgical procedure, either biopsy or resection, provides diagnostic clarity and therapeutic benefit, but carries risks. In the patient-specific decision to operate, current literature offers limited guidance on which patients may benefit. This study aimed to describe functional outcomes after repeat surgery of previously irradiated glioma, and to identify predictors of functional deterioration. Single-center retrospective cohort study. Adults with diffuse glioma who underwent first-line radiotherapy and subsequent repeat surgery (biopsy or resection) for suspected high-grade radiological progression were included. Lesions were histologically classified as progression, TAC, or both. The primary endpoint was functional outcome 30 days postoperatively, expressed as decline of Karnofsky Performance Status (KPS). Logistic regression identified predictors of KPS decline. Survival was assessed with Kaplan-Meier and Cox regression. Of 166 patients, 37 (22.3%) experienced a KPS deterioration, 127 (76.5%) remained stable, and 2 (1.2%) improved. Rates of functional deterioration were similar after biopsies and resections. Preoperative steroid usage (odds ratio = 2.73, 95% confidence interval = 1.09-6.79, P = .031) was associated with KPS deterioration. Histological diagnosis was not associated with functional outcome (χ2, P = .361). Patients with deterioration had shorter median survival (4 vs 11 months, P < .001). In this cohort, 22.3% of patients experienced functional decline 30 days after a repeat surgery (biopsy or resection). Preoperative steroid usage predicted deterioration. These findings may provide clinical guidance in identifying which patients will benefit from repeat surgery.
To explore the classification characteristics of positive psychological capital in patients undergoing in vitro fertilization-embryo transfer (IVF-ET), and to analyze the differences in characteristics of different categories of positive psychological capital in women undergoing IVF-ET. A total of 602 patients undergoing IVF-ET were selected using convenience sampling from the outpatient clinic of the Department of Reproductive Endocrinology at a tertiary Grade A obstetrics and gynecology hospital in mainland China between July 2025 and November 2025. On the day of embryo transfer, a general demographic questionnaire, the Kessler Psychological Distress Scale (K10), and the Positive Psychological Capital Questionnaire (PPQ) were administered. Latent profile analysis (LPA) was conducted to explore the potential classes of positive psychological capital in patients undergoing IVF-ET, and univariate analysis and multivariate logistic regression analysis were employed to identify the factors associated with these latent profiles. The positive psychological capital of IVF-ET patients could be categorized into three latent classes: the low psychological capital group (21.6%), the moderate psychological capital group (45.7%), and the high psychological capital group (32.7%). Multivariate logistic regression analysis results showed that age < 35 years (OR = 0.534, 95% CI: [0.316, 0.902], P < 0.05) and psychological distress (OR = 0.942, 95% CI: [0.911, 0.975], P < 0.05) were independent predictors of belonging to Class 2 compared to Class 1. Similarly, for Class 3 vs. Class 1, age < 35 years (OR = 0.361, 95% CI: [0.205, 0.637], P < 0.05) and psychological distress (OR = 0.857, 95% CI: [0.819, 0.897], P < 0.05) were significant predictors. Specifically, younger age (< 35 years) and higher psychological distress positively predicted the likelihood of being in the reference class (Class 1), indicating they are risk factors for lower positive psychological capital. The positive psychological capital of IVF-ET patients can be categorized into three latent profiles. Clinical healthcare professionals should pay particular attention to patients who are younger (< 35 years) and experience higher levels of psychological distress, as they are more likely to exhibit lower levels of positive psychological capital. Tailored psychological screening and supportive strategies are recommended for these specific subgroups to potentially mitigate their psychological burden. Infertility and its treatment, such as IVF-ET, can cause significant emotional stress, which may affect patients’ mental health and willingness to continue treatment. However, little is known about the inner strengths (e.g. hope, self‑efficacy, resilience) that help patients cope with this stress. This study aimed to understand how patients undergoing in vitro fertilization-embryo transfer (IVF-ET) experience positive psychological capital and to identify distinct characteristics among different patient groups. From July to November 2025, 602 IVF-ET patients were recruited from a Chinese obstetrics and gynecology hospital, and researchers used questionnaires to gather information on their personal background, emotional stress, and inner strengths. The data analysis showed that patients’ positive psychological capital could be categorized into low (21.6%), moderate (45.7%), and high (32.7%) groups, and that younger age and higher levels of emotional stress were associated with a higher likelihood of having low inner strengths. Patients in the low inner strengths group tend to have less hope, self‑confidence, and resilience, which may make them more vulnerable to feelings of helplessness, difficulty coping with treatment setbacks, and potentially lower adherence to fertility care. As such, medical staff should consider patients’ personal situations and provide personalized support to those who are younger and experiencing higher emotional stress, in an effort to assist them in strengthening their mental resources and potentially enhancing their well-being.
Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after heart transplantation (HTx). We retrospectively analyzed 830 consecutive HTx performed between 1984 and 2021. After excluding patients <18 years and those with missing data, 667 adult recipients remained. ISHLT PGD criteria were applied and perioperative variables and outcomes were reviewed. PGD occurred in 70 patients (10.5%), including 41 (6.1%) with left ventricular PGD and 29 (4.3%) with right ventricular PGD. Most LV-PGD cases were severe (88%). Patients with PGD were younger and more frequently had pretransplant dialysis, ventricular assist device support, or prior cardiac surgery. No donor-related factors were associated with PGD. Recipient-related factors and longer cardiopulmonary bypass time were associated with increased risk. PGD was associated with prolonged mechanical ventilation and ICU stay, and increased need for mechanical circulatory support, dialysis, reoperation, and treatment for sepsis. Mortality or re-transplantation was significantly higher in PGD patients at 30 days (45% vs. 3%) and 1 year (51% vs. 8%; HR 6.89, 95% CI 4.01-11.83, p < 0.0001).
Citation-based indicators are widely used to assess scientific impact, yet they often overlook the temporal dynamics of knowledge dissemination. Time to first citation has gained relevance as an indicator of early research visibility, particularly in emerging research systems. To analyze time to first citation of Ecuadorian medical publications and identify publication characteristics associated with citation timing using a survival analysis approach. A scientometric study was conducted on Ecuadorian medical publications indexed between 2015 and 2024, with citation follow-up through December 31, 2024. Descriptive statistics summarized publication characteristics and citation counts at 2 and 5 years. Time to first citation was analyzed using Kaplan-Meier estimators and Cox proportional hazards regression models, accounting for right-censored data. A total of 3,968 publications were included. Most articles were published in open access journals (63.0%) and involved international collaboration (69.3%). Publications were predominantly in English (85.1%). Most records were original research articles (2,917; 73.5%), while 597 (15.0%) were review articles; article type information was unavailable for 454 records (11.4%). The median number of cumulative citations was 3 (IQR 1-7) at 2 years and 6 (IQR 3-14) at 5 years. Kaplan-Meier analysis showed that approximately 50% of articles received their first citation within the first year, and most were cited within 4 years. In the multivariable Cox regression analysis, international collaboration (HR = 0.81; 95% CI: 0.67-0.97), non-English language (HR = 0.53; 95% CI: 0.42-0.65), original article type (HR = 1.40; 95% CI: 1.09-1.79), and number of authors (HR = 1.001; 95% CI: 1.001-1.002) were significantly associated with time to first citation, whereas open access status was not independently associated with citation timing after adjustment. Ecuadorian medical publications demonstrated relatively rapid early citation uptake. Publication language, article type, international collaboration, and authorship characteristics were associated with time to first citation. These findings should be interpreted cautiously given the observational design and limitations in metadata completeness. The study highlights structural factors that may influence early research visibility in emerging research systems.
Although immune checkpoint blockade (ICB) has changed treatment strategies for gastric adenocarcinoma (STAD), many patients show primary resistance. Tumor-intrinsic transcriptional heterogeneity may contribute to immune escape, but the malignant-cell programs and candidate biomarkers linked to this process remain incompletely defined. Here, we integrated single-cell transcriptomic profiles of 162,116 cells from 35 STAD samples with multiple bulk transcriptomic cohorts to characterize malignant-cell regulatory programs. Non-negative matrix factorization identified meta-program 2 (MP2), a malignant-cell program closely associated with immune-escape signatures. Through integrated co-expression analysis and machine-learning-based prioritization, RNASE1 was identified as an MP2-related candidate biomarker. High RNASE1 expression was associated with poor survival, higher immune and stromal scores, increased immune-checkpoint expression, and enrichment of ICB-response-related transcriptomic signatures. In vitro RNASE1 knockdown reduced STAD cell proliferation, migration, and invasion, supporting a functional contribution to malignant cellular phenotypes. Together, these findings suggest that RNASE1 is an immune-evasion-associated biomarker with potential value for prognosis and ICB-response stratification in STAD, while prospective clinical and in vivo validation remain necessary.
Despite the availability of various advanced treatments for inflammatory bowel disease (IBD), it has been impossible to predict which therapy would offer the best response to the patient. The aim of this systematic review is to explore current and novel biomarkers for predicting and assessing therapeutic response to advanced therapies presently in clinical use in IBD. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO ID: CRD42024559652). A systematic literature search for all primary research looking at biomarkers in predicting response to advanced therapy in Crohn's disease (CD) or ulcerative colitis (UC) was conducted across MEDLINE, EMBASE and PubMed databases. Abstracts, case studies, commentary papers and review articles were excluded. Fifty-five studies were included in this review investigating baseline predictors of response to anti-tumour necrosis factor, ustekinumab, vedolizumab and ozanimod therapies in both CD and UC. The various biomarkers studied included blood, serum, faecal, histological, nutrient, genetic and pharmacokinetic markers. C-reactive protein and faecal calprotectin were among the most commonly studied biomarkers; however, there were inconsistencies with regard to optimum cutoff values used and hence their roles as baseline predictors of response to advanced therapies are yet unclear. None of the biomarker studies to date has yet transitioned to clinical use. Biomarker identification to predict therapeutic response persists to be an ongoing challenge. Further work through large well-designed prospective cohort studies is needed to further refine the clinical utility of these tools. The protocol was prospectively registered with the PROSPERO database (CRD42024559652). Current and future predictors of response to advanced medical therapy in inflammatory bowel disease Inflammatory Bowel Disease (IBD) is a long term disease that usually requires prolonged medical therapy. Currently, there are multiple classes of drugs available for use, many of which are expensive. However, it has not been possible to predict which patient would benefit from which drug. Biomarkers are tests which would help in this endeavour. Till date, the most commonly used biomarkers are tests such as CRP and stool calprotectin. However, this review goes onto describe the limitations in the evidence to their use. This article goes on to look at other novel tests which would help predict response to various advanced treatment in IBD such as anti-TNF, vedolizumab, ustekinumab or ozanimod. These include tests on blood, serum, stool and others. Some of the larger studies even looked at genetic predictors for this. However, none of these tests have yet been accepted in standard medical practice because of the lack of good quality evidence. Well designed studies would help answer this perennial question.
This study aimed to investigate the synergistic effect of vitamin D deficiency and metabolic disorders on albuminuria in type 2 diabetes mellitus (T2DM) patients with urinary albumin-to-creatinine ratio (ACR) of 0.1~300 mg/g, and to construct a validated risk stratification nomogram for precise clinical assessment. A cross-sectional study was conducted on 507 T2DM patients, divided into normal albumin (ACR < 30 mg/g, n=349) and albuminuria groups (ACR ≥ 30 mg/g, n=158; further subdivided into micro- and moderate albuminuria subgroups). Serum 25-hydroxyvitamin D (25-OH-VD) was detected, with deficiency defined as < 50 nmol/L. Interaction analysis, univariate Logistic regression, LASSO regression and multivariate Logistic regression were used to screen core factors and identify independent predictors of albuminuria. A nomogram was constructed and validated by concordance index (C-index), calibration curves and decision curve analysis (DCA) in the total population and ACR subgroups. The prevalence of vitamin D deficiency was 83.0% in all patients, and was significantly higher in the albuminuria group (91.8%) than the normal group (79.1%, P < 0.001), with the highest rate in moderate albuminuria subgroup (96.8%). ACR levels were significantly negatively correlated with 25-OH-VD levels(ρ=-0.326, P < 0.001). Vitamin D deficiency and elevated HbA1c had a significant positive synergistic effect on albuminuria (multivariate OR = 1.392, 95%CI:1.081~1.789, P = 0.010; univariate OR = 1.426, 95%CI:1.103~1.842, P = 0.007). Age, BMI, HbA1c, 25-OH-VD, LDL-C, eGFR, and the vitamin D deficiency × HbA1c interaction term were identified as independent predictors. The constructed nomogram had excellent discriminative ability (C-index: 0.882 in training set, 0.858 in validation set), with C-indices of 0.845 and 0.861 in micro- and moderate albuminuria subgroups, respectively. Calibration curves showed high consistency between predicted and actual probabilities, and DCA confirmed the nomogram had significantly higher clinical net benefit than traditional and single-index models. Vitamin D deficiency is highly prevalent in T2DM patients with ACR 0.1~300 mg/g and synergizes with elevated HbA1c to drive albuminuria progression. The constructed nomogram integrates key metabolic predictors and the vitamin D-HbA1c interaction term, exhibiting excellent predictive and stratification ability, and may serve as a precise tool for individualized risk assessment and stratified intervention in T2DM patients.
This study aims to evaluate and compare the prognostic performance of shock index (SI) and systolic blood pressure (SBP) for predicting mortality among trauma patients at risk of hemorrhage in South Africa, a high-trauma burden setting with resource constraints. This is a secondary analysis of data from the EpiC study, a prospective, multicenter observational investigation of trauma patients in the Western Cape, South Africa. Adult patients with blunt or penetrating injuries and no significant head injury were included. The predictor variables-SI and SBP at facility arrival-and the outcome (30-day mortality) were analyzed through a sequential analytical framework. Segmented logistic regressions identified inflection points; ROC analyses with Youden's J statistic determined optimal thresholds. Model comparisons employed DeLong's test, calibration plots, Brier scores, and decision curve analysis. Subgroup analyses were conducted by injury mechanism and severity. Among 3609 patients, 6.1% died within 30 days. SI demonstrated an inflection point at 0.69 and SBP at 82 mmHg. ROC analysis yielded similar AUCs of 0.62 (SI) and 0.60 (SBP) (p=0.418). However, SI showed superior calibration (Brier score: 0.054 vs 0.058), a higher positive likelihood ratio (2.70 vs 2.01; p<0.001), and greater net benefit across a broader range of predicted-risk thresholds on decision curve analysis. The optimal SI cutoff of ≥1.21 yielded 85.1% specificity and 40.3% sensitivity. Both SI and SBP demonstrated only modest discrimination for 30-day mortality, reflecting the inherent limitations of single vital-sign predictors in complex trauma populations. Within these constraints, SI showed marginally better calibration and rule-in performance than SBP; however, neither predictor alone is sufficient for definitive mortality risk prediction. An SI threshold of ≥1.21 may serve as a practical screening tool to flag high-risk patients warranting closer monitoring or escalated care, particularly in resource-limited settings where laboratory and imaging resources are constrained.
Septic shock remains a major cause of death in the ICU with high 28-day mortality, and concomitant left ventricular systolic dysfunction (LVSD) further worsens patient outcomes, while existing prediction models lack adequate specificity. This study aimed to establish and perform internal-external validation of a 28-day mortality prediction model specifically for septic shock patients with LVSD as a key risk factor. This retrospective multicenter cohort study enrolled 226 septic shock patients from September 2021 to October 2024 as the training cohort and 132 patients from November 2024 to December 2025 as the validation cohort, from ICUs of General Hospital and Cardiovascular Hospital of Ningxia Medical University. Baseline LVEF was measured at admission, with LVSD defined as LVEF < 50% or > 70%. Baseline data, clinical variables, myocardial biomarkers, and 28-day mortality were collected. Univariate and multivariate logistic regression identified independent predictors. A predictive nomogram was constructed and assessed using ROC, calibration curves, and DCA. Internal validation was performed via 1,000 bootstrap resamples, followed by external validation in the validation cohort. Independent predictors of 28-day mortality in patients with septic shock were: left ventricular systolic dysfunction, decreased pH, atrial arrhythmia, dopamine use, and reduced PaO2/FiO2. Based on these predictors, a predictive model for 28-day mortality in patients with septic shock was constructed, and a nomogram was developed. The area under the ROC curve (AUC) of the model in the training cohort was 0.767 (95% CI: 0.703-0.831). After internal validation via Bootstrap sampling, the mean AUC was 0.779 (95% CI: 0.713-0.841). The calibration curve approached the ideal line (Hosmer-Lemeshow test P = 0.476), and the DCA indicated clinically net benefit within the 0.05-0.85 probability threshold range. External validation confirmed the reliability of the predictive model. Further comparison revealed that the predictive performance of this model was significantly superior to that of the APACHE II score for predicting mortality (0.767 vs. 0.652, P = 0.006). This nomogram has been converted into a web-based dynamic nomogram calculator available for free public use (https://linjia.shinyapps.io/dynnomapp/). The 28-day mortality prediction model demonstrated excellent discriminative power, stability, and clinical applicability.
Ramadan fasting influences daily routines, dietary patterns, and oral hygiene behaviors among Muslims. Understanding how these changes affect oral health is essential for developing culturally appropriate health promotion strategies. This study examined oral health knowledge, attitudes, behaviors, and sugar consumption among adults living in Qatar during Ramadan. A cross-sectional survey was conducted among 199 adults. Data were collected using a structured self-administered questionnaire covering oral hygiene practices, dietary habits, attitudes toward oral health, and perceptions of dental care during fasting. Descriptive statistics, chi-square tests, Kruskal-Wallis tests, McNemar tests, and logistic regression analyses were applied to assess associations and predictors of oral health behaviors. Participants demonstrated generally high oral hygiene awareness, with most maintaining regular brushing before and during Ramadan. However, misconceptions persisted, as 23% believed that toothpaste use invalidates fasting. Education level was the strongest predictor of oral health knowledge, and positive attitudes significantly influenced brushing frequency. Younger and less-educated individuals reported higher sugar consumption, often linked to cultural Ramadan traditions. The findings partially supported the Knowledge-Attitude-Behavior model. Culturally grounded and faith-aligned oral health promotion strategies are needed to address misconceptions and reduce sugar consumption during Ramadan. Integrating community-based and digital educational approaches may help sustain healthy oral hygiene behaviors throughout and beyond the fasting month.
Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are complex multisystemic conditions frequently associated with chronic pain. Central Sensitization (CS)-a state of neural amplification and hyperexcitability-is hypothesized to be a unifying mechanism underlying the heterogeneous symptoms in chronic pain patients. Our aim was to investigate the association between central sensitization and multisystemic symptom burden in patients with hEDS/HSD while identifying independent clinical predictors of CS. We prospectively enrolled 150 adults diagnosed with hEDS/HSD at a specialized joint hypermobility clinic. Participants were evaluated using the Central Sensitization Inventory (CSI) and the SPIDER questionnaire. Clinical CS was defined as a CSI score > 40. Statistical analyses included univariate correlations and multivariable logistic regression. Centrally sensitized patients (n = 76) were significantly younger and predominantly female compared to the non-CS group. While CSI scores correlated strongly with all eight SPIDER domains (p < 0.001), a multivariable logistic regression model (AUC 0.98) identified only three independent predictors of CS: fatigue (OR 1.089), pain (OR 1.067), and cardiac dysautonomia (OR 1.057). Central sensitization in hEDS/HSD is independently associated with a triad of fatigue, pain, and cardiac dysautonomia. Clinical management should shift toward multidisciplinary strategies to effectively address the sensitized state in this population.
This study aimed to assess the level of health literacy among older adults in Taiwan and to examine the predictive roles of media use, perceived healthcare experiences, and social support. A cross-sectional survey was conducted with 335 adults aged 65 years and older between July 2016 and December 2016. Data were collected through structured face-to-face interviews using the validated instruments. Health literacy was assessed using the Mandarin Multidimensional Health Literacy Questionnaire; media use was measured by the frequency of traditional (e.g., TV and newspapers) and digital (e.g., Internet and social media) health information access; healthcare experiences were evaluated based on perceptions of organizational health literacy; and health-related social support was measured via perceived support from family and friends. Data were analyzed using descriptive statistics and hierarchical multiple regression analysis. Overall, 69.3% of participants exhibited limited health literacy, with the appraisal domain being the weakest (66.3% limited). Significant differences in health literacy were observed by gender, educational attainment, traditional and digital media use, and perceived healthcare experience (all P < 0.001). Hierarchical regression analysis identified traditional media use (β = 0.333), digital media use (β = 0.215), and perceived healthcare experience (β = 0.165) as significant predictors, increasing the explained variance from 12.1% to 35.3%. Social support was not a significant predictor. Media use and favorable healthcare experiences were positively associated with health literacy in older adults. Future interventions should improve access to traditional and digital media and foster health-literate environments to mitigate disparities in aging populations.
This study aimed to evaluate the prognostic impact of lymphovascular space invasion (LVSI) on treatment outcomes and survival in patients with endometrial cancer (EC). We conducted a multicenter, retrospective study of 298 EC patients who underwent hysterectomy-based surgery between January 2011 and June 2021. Clinical and pathological data, including LVSI status, were collected. Cox regression and multivariate analyses were performed to assess recurrence, progression-free survival (PFS), and overall survival (OS), with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) reported. LVSI-positive patients (n = 99) were more likely to present with advanced Federation of Gynecology and Obstetrics stage, lymph node involvement, and to receive adjuvant radiotherapy (RT) and chemotherapy (all P < 0.0001). LVSI was an independent predictor of recurrence (aHR: 7.76, P = 0.0064), but its association with PFS and OS was not significant in multivariate analysis, likely due to the effects of adjuvant treatment. The absence of RT or chemotherapy substantially increased the risk of recurrence and mortality in LVSI-positive patients. High-grade tumors (grade 3) were associated with poorer OS (aHR: 3.87, P = 0.0092), and older age was also linked to worse survival (aHR: 1.05, 95% CI: 1.01-1.10). Histological type 2 tumors were associated with increased recurrence. LVSI is an independent predictor of recurrence in EC but may not significantly affect PFS or OS after adjusting for treatment. These findings highlight the need for tailored adjuvant therapy in LVSI-positive patients and further research to clarify its prognostic value.
Introduction Neonatal infections continue to pose major challenges in intensive care settings. This study aimed to evaluate the prevalence, maternal risk factors, neonatal characteristics, and clinical outcomes associated with early-onset neonatal septicemia in neonates admitted to the neonatal intensive care unit. Materials and methods This retrospective observational cohort study was conducted in the neonatal intensive care unit at Government Medical College, Hingoli, India, using medical records of neonates admitted between January 2019 and December 2024. A total of 128 neonates aged 0-28 days were included in the study. Maternal variables, such as preterm delivery, prolonged membrane rupture, intrapartum fever, chorioamnionitis, and maternal urinary tract infection, were assessed. Neonatal variables, including birth weight, Apgar score, resuscitation at birth, and clinical outcomes, were evaluated. Early-onset neonatal septicemia was defined as clinical signs of sepsis occurring within the first 72 hours of life, with a positive blood culture and/or positive sepsis screening parameters. Statistical analysis was performed, and statistical significance was set at p < 0.05. Results The prevalence of early-onset neonatal septicemia was found in 21 neonates (16.4%), including proven sepsis in 13 neonates (10.2%) and probable sepsis in eight neonates (6.2%). Preterm delivery, prolonged membrane rupture, intrapartum fever, and chorioamnionitis were significantly associated with early-onset neonatal septicemia (p < 0.05). Low birth weight was observed in 17 neonates (81.0%) with sepsis compared with 41 neonates (38.3%) without sepsis (p < 0.001). Mechanical ventilation was required in 11 neonates (52.4%), while in-hospital mortality was observed in four neonates (19.0%) with early-onset neonatal septicemia. Multivariate logistic regression analysis identified prolonged rupture of membranes (aOR: 4.67), intrapartum fever (aOR: 3.89), preterm delivery (aOR: 3.21), low birth weight (aOR: 2.98), and a five-minute Apgar score <7 (aOR: 2.42) as independent predictors of early-onset neonatal septicemia. Conclusion Early-onset neonatal septicemia remains a significant cause of neonatal morbidity and mortality in neonatal intensive care units. Prolonged rupture of membranes, intrapartum fever, preterm delivery, low birth weight, and a low five-minute Apgar score were identified as independent predictors of early-onset neonatal septicemia. Early identification of high-risk neonates and timely management strategies may improve neonatal outcomes.
Chronic obstructive pulmonary disease (COPD) frequently coexists with coronary heart disease (CHD), markedly worsening prognosis in middle-aged and older patients. Early identification of CHD comorbidity in this population remains clinically imperative. This single-center, cross-sectional study included COPD patients aged 45 years or older admitted between 2020 and 2025. Missing data were imputed using random forest, and least absolute shrinkage and selection operator regression was applied for feature selection. Nine machine learning models were constructed and evaluated by the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. SHapley Additive exPlanations and restricted cubic splines (RCS) were employed for model interpretation and dose-response exploration. Of 17,862 eligible patients, 7,211 (40.37%) had coexisting CHD. Sixteen predictors were identified. The XGBoost model demonstrated moderate predictive performance (training AUC 0.871, 95% CI: 0.864-0.877; validation AUC 0.743, 95% CI: 0.730-0.756), significantly outperforming all other models in the training set and showing comparable performance to GBDT in the validation set. Age, hypertension, total cholesterol (TC), chronic gastritis, and uric acid (UA) were the top five predictors. RCS identified various dose-response patterns, including nonlinear associations for pulse rate, diastolic blood pressure, TC, and platelet count, and linear positive associations for prothrombin time and UA. The XGBoost model showed moderate discriminative ability for predicting CHD comorbidity in middle-aged and older COPD patients. However, further external validation is required before clinical application, and the findings should be interpreted with caution given the single-center, cross-sectional design.
Postoperative healing quality critically determines functional recovery following Achilles tendon rupture (ATR) repair. Poor healing often leads to postoperative re-rupture. While mechanical factors influencing healing are well-studied, the role of metabolic disease remains unclear. Emerging evidence suggests metabolic disorders may impair tendon repair, yet their impact on early postoperative outcomes is underexplored. This study hypothesized that metabolic disease (such as hyperuricemia and dyslipidemia) negatively affect early tendon healing after ATR repair. We aimed to identify key metabolic predictors of delayed healing to guide optimal management of perioperative metabolic parameters. Sixty patients with acute ATR undergoing surgical repair were included. Preoperative serum levels of uric acid (UA), triglycerides (TG), total cholesterol (TC), high-/low-density lipoprotein (HDL-C, LDL-C), and total bilirubin (TBIL) were measured. Postoperative signal-to-noise quotient (SNQ) values were calculated from T2-weighted MRI at 3 months. In preliminary analyses, Spearman's rank correlation and multivariate linear regression were conducted to assess associations between six metabolic biomarkers and SNQ, identifying significant metabolic markers. Subgroup analyses subsequently stratified patients into cohorts based on these determinants, with Mann-Whitney U test comparing intergroup SNQ differences. Serum UA showed a significant positive correlation with SNQ (ρ = 0.400, p = 0.002). Multivariate linear regression confirmed UA as an independent predictor of elevated SNQ (β = 0.394, p = 0.006). Lipid markers (TC, TG, HDL-C, LDL-C) and TBIL demonstrated no significant associations. Subgroup analyses compared SNQ levels between hyperuricemic patients and normouricemic controls. Hyperuricemia patients exhibited markedly higher median SNQ values than controls (14.57 vs. 7.27, p < 0.001), indicating delayed healing. Hyperuricemia is a significant metabolic factor impairing early ATR healing, highlighting the clinical utility of preoperative UA screening for personalized rehabilitation. Perioperative uric acid control is recommended for hyperuricemic patients to optimize Achilles tendon healing outcomes.
Leadership research increasingly emphasizes the role of health-oriented leadership (HoL) for employee well-being and motivation, yet the motivational relevance of leaders' own self-care remains insufficiently understood. Addressing this gap, the present study integrates the HoL framework with self-determination theory (SDT) to examine how leader self-care relates to employees' basic psychological need satisfaction and intrinsic motivation. Building on SDT, self-care is conceptualized as a form of health-related self-regulation that supports the satisfaction of the basic psychological needs for autonomy, competence, and relatedness. The study proposes a theoretically ordered model in which leader self-care is associated with staff-care, employee self-care, need satisfaction, and intrinsic motivation, thereby extending prior research that has primarily focused on leaders' health-supportive behavior toward employees. Data were collected from 122 employees in Germany using a cross-sectional online survey. Regression analyses showed that leader self-care was a strong and significant predictor of staff-care (b = 1.01, p < 0.001) and employee self-care (b = 0.37, p < 0.001). Within the mediation model, staff-care was positively but not significantly associated with basic psychological need satisfaction (b = 0.12, p = 0.055), and the indirect effect of leader self-care on need satisfaction via staff-care was not statistically significant (b = 0.12, 95% CI [0.00, 0.25]). In contrast, employee self-care was a significant predictor of need satisfaction (b = 0.41, p < 0.001), which in turn strongly predicted intrinsic motivation (b = 1.06, p < 0.001). These findings suggest that HoL may influence motivation less through direct supportive behavior and more through enabling employees' self-regulatory engagement. By identifying employee self-care as a proximal correlate of need satisfaction, the study contributes to a more differentiated understanding of how leadership-related health resources translate into motivational outcomes. The study is limited by its cross-sectional design, reliance on self-report data, and geographically restricted sample. Future research should employ longitudinal and multi-source designs to examine causal mechanisms and contextual boundary conditions.
This study used clinical data from patients with type 2 diabetes mellitus (T2DM) and applied least absolute shrinkage and selection operator (LASSO) regression to identify risk factors for diabetic kidney disease (DKD). We then constructed a nomogram prediction model to support early clinical screening of high-risk populations. Clinical data from patients with T2DM were collected from January 2020 to December 2025. Data from January 1, 2020, to December 31, 2023, were used as the training set for LASSO-based variable selection, model development, and internal validation. Data from January 1, 2024, to December 31, 2025, were used as a temporal internal validation set. Variables selected by LASSO regression were entered into a multivariable logistic regression model, and a nomogram was constructed from the regression results. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Calibration was evaluated using calibration curves, and clinical net benefit was assessed using decision curve analysis (DCA). Internal validation was performed with 1,000 bootstrap replicates. The retrospective study included 23,152 patients with T2DM, of whom 5,019 (21.68%) had DKD and 18,133 (78.32%) did not. LASSO regression identified nine candidate predictors: hypertension, diabetes duration, HbA1c, estimated glomerular filtration rate, urine protein, serum creatinine, uric acid, total cholesterol, and homocysteine. The nomogram showed moderate discrimination, with an AUC of 0.773 (95% CI: 0.764-0.782). In the temporal internal validation set, the AUC was 0.758 (95% CI: 0.743-0.774), indicating similar performance over time within the same hospital system. The calibration curves for both validation procedures were close to the diagonal, indicating agreement between predicted and observed probabilities. Based on real-world clinical data, this study used LASSO regression to identify risk factors associated with DKD in patients with T2DM. We developed a nomogram that integrates multidimensional predictors to estimate individualized DKD risk. Internal validation and temporal internal validation showed acceptable discrimination, calibration, and clinical net benefit. The model may serve as an auxiliary decision-support tool for early screening of patients at high risk of DKD in clinical practice. Because the AUC values indicate moderate rather than strong discrimination, multicenter external validation is still needed before broad implementation. The model is intuitive, practical, and cost-effective, and it may help clinicians identify high-risk patients who warrant closer monitoring or intensive intervention.