SAGE Open Medicine最新文献

Objectives: Invasive fungal sinusitis is associated with substantial morbidity and mortality influenced by multiple factors; however, evidence regarding prognostic determinants of survival remains limited. This study aims to evaluate survival outcomes and identify prognostic factors in patients with invasive fungal sinusitis to support evidence-based treatment planning.

Methods: A retrospective study was conducted on patients with invasive fungal sinusitis treated between February 2000 and June 2018, with follow-up ending on 30 April 2021. Survival curves were analyzed using the Kaplan-Meier method and log-rank test, while Cox proportional hazards models were employed for univariate and multivariate analyses of prognostic factors.

Results: One hundred sixteen patients were diagnosed with invasive fungal sinusitis, and these patients were further classified into an acute sinusitis group (80 patients (69.0%)) and a chronic sinusitis group (36 patients (31.0%)). The overall 1-year survival rate was 49.0% (median survival time of 9.8 months). Among acute invasive fungal sinusitis patients, the 1-year survival rate and median survival time were significantly shorter than those of chronic invasive fungal sinusitis patients. Compared with Aspergillus spp., Mucor spp. appeared to be more aggressive, which resulted in a shorter 1-year survival rate and median survival time in patients with acute invasive fungal sinusitis. Conversely, chronic invasive fungal sinusitis patients with either Aspergillus spp. or Mucor spp. had nearly equivalent survival rates. Furthermore, factors predicting a poor prognosis included chemosis, altered consciousness and leukopenia.

Conclusions: Invasive fungal sinusitis still has a high mortality rate, particularly in patients with chemosis, altered consciousness and leukopenia, necessitating aggressive treatment.

Objectives: The World Health Organization (WHO) advocates for voluntary blood donation by healthy donors to ensure the availability of safe blood. India faces a significant gap between blood demand and supply for various acute and chronic conditions. This study assesses blood donation knowledge, attitudes, and practices, as well as the barriers affecting the willingness to donate blood and predictors of good knowledge and favorable attitudes toward blood donation among the rural adult population in Bihar.

Methods: A community-based cross-sectional study was conducted from January to June 2023 in the Naubatpur block of Patna district, Bihar, involving 500 adults aged 18-59 years via a multistage sampling technique for the enrollment of participants. Data were collected via a pretested semistructured questionnaire. Descriptive and inferential statistics were used, and multivariable logistic regression was used to identify predictors of knowledge and attitude scores.

Results: Approximately 67.4% of the respondents were aware of blood donation, while 39.8% were aware of their blood group. Only 10.8% had donated blood, with 58.5% having donated only once. Nearly 29.08% had good knowledge regarding blood donation. Major barriers included no specific reason, perceived pain, and a fear of needles.

Conclusion: In our study, nearly two out of three participants were aware of blood donation, but hardly one out of three was aware of their blood group. Only slightly more than one-fourth had good knowledge and a favorable attitude toward blood donation, while only one out of 10 had donated blood in the past. Despite good knowledge about blood donation, actual practices were low among the study population. Educational level significantly influences awareness and attitudes. Health education and periodic awareness programs are essential to dispel myths and promote voluntary blood donation in rural areas.

Objective: To investigate the demographic and clinical characteristics of fall-related deaths in Chinese communities and provide clinical insights for fall prevention strategies.

Methods: A retrospective study was conducted on decedents (n = 1455) from a deeply aging urban community (Kaiyuan, Quanzhou, China) between 2020 and 2024. Fall-related deaths were identified by screening death certificates for specific keywords, with confirmation documented in the cause of death. Demographic, clinical, and temporal trend analyses were conducted. Kaplan-Meier and multivariate Cox proportional hazards regression were used to identify factors associated with survival time from fall to death.

Results: Fall-related deaths constituted 5.5% of community deaths, predominantly affecting individuals aged ⩾60 years (93.8%). Significant gender differences were observed in marital status, occupation, and education level (all p < 0.05). Age-standardized mortality rates fluctuated from 9.17 to 16.29 per 100,000 population (2020-2024) with no significant temporal trend (Z = 0.490, p = 0.624). Univariate survival analysis revealed a notably shorter median survival in patients with comorbidities (1.0 vs. 6.0 months, p = 0.116). Multivariate analysis identified age of fall (Hazard ratio (HR) = 1.023, 95% Confidence interval (CI): 1.001-1.046, p = 0.044) and comorbidities (HR = 1.793, 95% CI: 1.022-3.147, p = 0.042) as independent predictors of shorter survival.

Conclusion: Fall-related mortality is a major public health issue among older adults in the community. Advanced age of fall and comorbidities are key factors independently associated with shorter post-fall survival. Evidence-based multidimensional prevention and management interventions are essential to alleviate the fatal burden of falls.

Background: Medulloblastoma is a highly malignant primary neuroembryonic tumor characterized by its unique anatomical location, cellular origin, and clinical manifestations, serving as a major contributor to childhood mortality. The disease exhibits biological heterogeneity, with significant variability in cells of origin, genetic mutation profiles, and prognoses across different subgroups, posing challenges for effective treatment. Aberrant DNA methylation has been identified as a promoter of tumorigenesis, influencing the tumor microenvironment and patient prognosis.

Objective: This study aimed to investigate epigenetic changes in different medulloblastoma subtypes by integrating genomics, transcriptomics, epigenetics, and clinicopathological data to identify potential therapeutic targets and drugs that could significantly improve patient outcomes.

Methods: We obtained medulloblastoma transcriptomic and methylation data (GSE85217 and GSE85212) from the NCBI GEO database and performed differential gene expression and methylation analysis using the limma and ChAMP packages. Functional pathway enrichment was assessed via GO and KEGG analysis. A prognostic model was constructed using LASSO regression, while WGCNA and GSEA were employed to analyze key gene modules and signaling pathways. In addition, CIBERSORT and Gene set variation analysis (GSVA) were used to evaluate the immune microenvironment and drug sensitivity.

Results: We identified 1135 differentially expressed genes and 2582 differentially methylated sites, with inhibin beta B and ubiquitin-specific peptidase 2 significantly upregulated in Group 3/Group 4 subtypes. The prognostic model comprised 25 genes, and risk stratification effectively distinguished high- and low-risk patients (AUC 0.76-0.78). Immune analysis revealed decreased plasma cells and monocytes in the high-risk group, alongside increased naïve B cells and M0 macrophages. Drug prediction suggested that atovaquone and embelin may reverse tumor progression.

Conclusion: Inhibin beta B and ubiquitin-specific peptidase 2 are key marker genes for predicting medulloblastoma patient prognosis stratification, with their expression patterns closely linked to molecular subtypes and the immune microenvironment. This study provides novel molecular targets and strategies for precision therapy and prognostic assessment in medulloblastoma.

Background: Intraoperative localization of ureteral strictures and safe placement of double-J stents are pivotal steps during laparoscopic reconstruction, yet practical guidance on these steps is limited.

Objective: To introduce a simple and feasible new method of using ureteroscopy-assisted localization and indwelling double-J tubes in laparoscopic repair of middle and lower ureteral stenosis, and to confirm its safety and effectiveness.

Methods: We conducted a single-center, two-period retrospective comparison of patients undergoing laparoscopic reconstruction for middle or lower ureteral stricture. The control cohort (2010-2017) used conventional laparoscopic localization with trocar-assisted guidewire/stent placement, whereas the experimental cohort (2018-2023) used ureteroscopy-assisted localization with transureteral guidewire/stent placement under simultaneous laparoscopic visualization. Primary outcomes were time to localize the stricture and time to place the double-J stent.

Results: A total of 49 patients were included in the experimental cohort and 56 in the control cohort. Ureteroscopy assistance shortened stricture localization time (138 ± 24 versus 174 ± 12 min; mean difference [MD] -36; 95% CI -43.5 to -28.5; p=0.02) and double-J stent placement time (5.2 ± 0.6 versus 9.8 ± 2.4 min; MD -4.6; 95% CI -5.26 to -3.94; p=0.01). Estimated blood loss, drain duration, time to first flatus, and stent malposition rates were similar between groups.

Conclusions: Ureteroscopy-assisted localization and transureteral stent placement may streamline laparoscopic reconstruction for middle and lower ureteral strictures by reducing operative time without compromising safety. Prospective studies with longer follow-up are warranted. Ureteroscopy-assisted double-J stent.

Objective: To identify the independent risk factors for postpartum stress urinary incontinence by combining pelvic floor ultrasound parameters with clinical information.

Methods: Pelvic floor examination and clinical data were collected from 152 postpartum women who underwent pelvic floor ultrasound at Yancheng Third People's Hospital between December 2023 and September 2024. Independent risk factors for postpartum stress urinary incontinence were identified using multivariate logistic regression analysis. A nomogram model was constructed using R 4.3.1 software and the rms package to evaluate the correlation between the identified factors and the disease.

Results: Maximal Valsalva state posterior urethrovesical angle (RVA), bladder neck descent, and Young's modulus of the resting posterior lip of the urethral sphincter were identified as independent risk factors for postpartum stress urinary incontinence (p < 0.05). The areas under the receiver operating characteristic curve for RVA, bladder neck descent, and posterior lip of the urethral sphincter were 0.840, 0.867, and 0.914, respectively, indicating high diagnostic efficiency. The nomogram model demonstrated that the risk of developing stress urinary incontinence increased with higher RVA and bladder neck descent values and lower posterior lip of the urethral sphincter values, with posterior lip of the urethral sphincter showing the strongest correlation with the disease.

Conclusion: RVA (Valsalva), bladder neck descent, and posterior lip of the urethral sphincter are independent risk factors for postpartum stress urinary incontinence. The nomogram model based on these factors demonstrated high diagnostic performance (area under the curve = 0.984), suggesting potential utility for clinical application. However, this model is preliminary and requires validation in larger, multicenter cohorts before widespread use.

Objective: Predictors of mortality in severe traumatic brain injuries (TBI) in pediatric patients are not well explored. We investigate traditional and novel prognostic predictors in pediatric patients with severe TBI. The primary outcome was in-hospital mortality.

Methods: A retrospective study of children ⩽18 years old with a Glasgow Coma Scale ⩽8 was conducted at a level I pediatric trauma center. Predictors of mortality included interventions within 72 h, Pediatric Risk of Mortality (PRISM) III at 24 h, and the pediatric Sequential Organ Failure Assessment (pSOFA) score over 3 days. Novel prognostic models included a combined PRISM III and pSOFA score, a model that combined the two prognostic scores with medical interventions, and a combined medical and surgical intervention model. Categorical and continuous variables were analyzed using Fisher's exact test and the Mann-Whitney U test, respectively. Receiver operating characteristic curves and area under the curve (AUC) were used to assess the predictive performance of prognostic scores.

Results: There were 97 patients with severe TBI included in this study. The combined PRISM-pSOFA day 2 model was the strongest predictor of mortality (AUC = 0.973), but did not provide a statistically significant benefit over PRISM III, which served as the referent model. While the PRISM III (AUC = 0.968) had a higher predictive ability than the pSOFA-day 2 (AUC = 0.940), the difference was not statistically significant.

Conclusion: Predicting outcomes is essential for guiding care decisions and standardizing research. The pSOFA-day 2 score offers a comparable mortality prediction to PRISM III and serves as a practical, easy alternative that can be especially helpful when the PRISM III score is unavailable or difficult to calculate due to resource limitations.

Sepsis-induced cardiomyopathy (SCM), a frequent complication of septic shock with mortality exceeding 40%, arises from catecholamine-driven cardiotoxicity, sympathetic hyperactivity, and inflammation-mediated biventricular dysfunction. Short-acting β₁-blockers (esmolol, landiolol) offer a targeted therapeutic approach by reducing heart rate (target: 80-95 bpm), myocardial oxygen demand, and proinflammatory cytokines while improving diastolic perfusion-leveraging ultra-short half-lives (t₁/₂ = 4-9 min) for rapid reversibility during instability. Clinical evidence remains divergent: a landmark single-center RCT demonstrated significant 28-day mortality reduction (49.4% vs 80.5%; p < 0.001), improved hemodynamics, and reduced vasopressor requirements in hemodynamically stabilized patients, whereas premature termination of a multicenter trial revealed harm (increased vasopressor needs, mortality trend) when initiated during persistent hypoperfusion (lactate > 2 mmol/L). Current limitations include heterogeneous trial designs, small samples, and undefined benefiting phenotypes. Thus, cautious short-acting β-blockade is supported only for selected SCM patients with hemodynamic stability (MAP ⩾65 mmHg, normalized lactate, LVEF >35%), necessitating future precision trials with AI phenotyping to guide mechanism-targeted application.

Objectives: Blood-derived immune-inflammatory markers have been identified as promising tools in many conditions. This study aims to determine the perioperative factors and hematologic indices associated with the occurrence of delayed recover after pancreatic and biliary surgeries (PBS).

Methods: Included in this study were 106 patients with PBS who were divided into prolonged hospitalization group (≤5 days; n = 48) and short hospitalization group (>5 days; n = 58) between January 2020 and April 2023 in a tertiary hospital in Saudi Arabia. The clinico-demographic characteristics, laboratory parameters and blood-derived immune-inflammatory markers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), aggregate index of systemic inflammation, and systemic inflammatory response index) of the patients with and without prolonged hospitalization were compared by independent sample t-test, Mann-Whitney U-test, chi-square test, and Fisher's exact test as appropriate. Receiver operating characteristic (ROC) analysis was used to establish a cut-off level of postoperative PLR and SII values to predict prolonged hospitalization. Perioperative factors associated with prolonged hospitalization were evaluated by univariable and stepwise multivariable logistic regression analyses.

Results: Of the 106 patients undergoing PBS, 48 patients (45.28%) had prolonged hospitalization. Both postoperative PLR and SII in patients with prolonged hospitalization were significantly higher than those in patients without. The ROC curve showed that the optimal cut-off value of postoperative SII to predict prolonged hospitalization was 1073.17, with 0.792 sensitivity and 0.483 specificity. In addition, the optimal cut-off value of postoperative PLR to predict prolonged hospitalization was 227.55, with 0.604 sensitivity and 0.638 specificity. Stepwise multivariate analysis showed that postoperative SII (>1073.17) was an independent predictor for prolonged hospitalization (odds ratio = 3.527, 95% confidence interval: 1.491-8.434, p = 0.004), together with intraoperative blood transfusion requirement and preoperative prothrombin time.

Conclusions: Our findings demonstrated an association between the higher level of postoperative SII and delayed recovery, suggesting that it may be a useful parameter for identifying patients at risk of delayed recovery after PBS.

Background: Dysmenorrhea is a common menstrual health problem among adolescents, often managed through pharmacological and non-pharmacological strategies. However, the factors that predict adolescents' choice between these management approaches remain poorly understood, particularly in settings where traditional and modern practices coexist. This study examined the predictors of pharmacological and non-pharmacological management practices among school-going female adolescents in Ghana.

Methods: A cross-sectional survey was conducted among 490 female students aged 13-24 years in 2 senior high schools within the Effutu and Agona West Municipalities. Participants were recruited using simple random sampling. For minors (aged 13-17 years), written informed consent was obtained from Legally Authorized Representatives and written assent from participants; adult participants (aged 18-24 years) provided written informed consent directly. Exclusion criteria included diagnosed gynecological disorders, inability to provide informed assent or parental/guardian consent, and cognitive impairments. Data were collected using a structured questionnaire and analyzed with chi-square tests and logistic regression.

Results: The prevalence of dysmenorrhea was 82.4%. Pharmacological management was significantly associated with dysmenorrhea experience (χ² = 11.51, p = 0.003). Pain intensity emerged as a strong predictor, with adolescents reporting moderate (Exp(B) = 1.7, p = 0.03) and severe pain (Exp(B) = 2.42, p < 0.01) more likely to use medications. Non-pharmacological practices were significantly associated with program of study (χ² = 28.75, p = 0.001), while demographic factors showed no significant associations.

Conclusion: Pain severity drives pharmacological management, whereas educational exposure influences non-pharmacological choices. Comprehensive menstrual health education is needed across academic programs to promote effective, evidence-based management of dysmenorrhea among adolescents in Ghana.