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Time-Dependent Fluid Accumulation Index for Phase-Specific Risk Stratification in Septic Shock with Heart Failure 认领 引用
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作者 Qian-fei Liu Liang Ge +3 位作者 Di Yao Xiao-min Huang Guang-cai Li Nian-jin Gong 《Current Medical Science》 SCIE CAS CSCD 2026年第1期161-172,共12页
Objective Fluid management in patients with septic shock and coexisting heart failure is a critical challenge,as it requires balancing resuscitation and the risk of fluid overload.This study investigated the potential... Objective Fluid management in patients with septic shock and coexisting heart failure is a critical challenge,as it requires balancing resuscitation and the risk of fluid overload.This study investigated the potential of the fluid accumulation index(FAI),which is measured serially during the initial 72 h of intensive care unit(ICU)care,to provide dynamic prognostic information to guide fluid management in this high-risk population.Methods Restricted cubic spline(RCS)analysis was used to explore the relationships between FAI levels at different time points within 72 h of ICU admission and ICU mortality.Associations were quantified via multivariate Cox proportional hazards models.Subgroup analyses and Kaplan-Meier survival curves were used to evaluate the consistency of associations and differences in survival between groups.Results A total of 643 patients with septic shock and concurrent heart failure were included,among whom 127 died.The RCS revealed a significant nonlinear relationship between FAI levels at various time points and ICU mortality.The optimal FAI cutoff values decreased over time:the cumulative values were 0.87 at 24 h,0.59 at 48 h,and 0.56 at 72 h.The cutoff values for specific intervals were 0.27 for the 24-48 h period(2-24 h-FAI)and 0.12 for the 48-72 h period(3-24 h-FAI).In the fully adjusted model,FAI values exceeding these time-specific thresholds were significantly associated with increased ICU mortality(24 h-FAI>0.87,HR=1.96,P=0.0251;2-24 h-FAI>0.27,HR=2.07,P=0.0051;48 h-FAI>0.59,HR=2.50,P=0.0005;3-24 h-FAI>0.12,HR=2.05,P=0.0091;72 h-FAI>0.56,HR=2.97,P<0.0001).These associations remained consistent across most predefined subgroups.Conclusion FAI serves as a dynamic and independent prognostic marker for critically ill patients with septic shock and heart failure during the first 72 h of ICU admission.A key finding was the time-dependent decline in the optimal FAI cutoff values(0.87 at 24 h vs.0.12 for the 3-24 h period).This temporal decline supports a shift in fluid management strategy from an initial liberal approach toward a conservative strategy after the first 24 h,which may mitigate mortality risk. 展开更多
关键词 Septic shock Heart failure Fluid accumulation index ICU mortality Fluid management Risk stratification Prognostic marker Critically ill patients
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Development and Validation of a Nomogram Model for Severe Acute Pancreatitis Risk Stratification:A Retrospective Cohort Study 认领 引用
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作者 Ying Chen Jing-ping Liu +2 位作者 Min Wang Huan-yu Ju Jun Zhou 《Current Medical Science》 SCIE CAS CSCD 2026年第2期424-433,共10页
Objective Early prediction of the severity of acute pancreatitis(AP)is crucial for clinical decision-making and for improving patient outcomes.In this study,readily available laboratory data and Least Absolute Shrinka... Objective Early prediction of the severity of acute pancreatitis(AP)is crucial for clinical decision-making and for improving patient outcomes.In this study,readily available laboratory data and Least Absolute Shrinkage and Selection Operator(LASSO)regression were used to select key variables and construct a nomogram for accurate severity prediction in AP patients.Methods We retrospectively analyzed the clinical data of 965 adult AP patients hospitalized at a hospital between January 2017 and December 2019.LASSO regression was used to identify significant predictors of severe acute pancreatitis(SAP),and a nomogram prediction model was constructed.The performance of the nomogram was evaluated using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,the calibration curve,and the decision curve analysis(DCA).Results Among the 965 patients,the incidence of SAP was 15.96%(n=154).Eight independent predictors were identified:C-reactive protein,lactate dehydrogenase,hematocrit,monocyte percentage,prothrombin time,D-dimer,glucose,and total cholesterol.These predictive factors were incorporated into a nomogram model,which demonstrated favorable discriminative ability,with AUC values of 0.809 in the training cohort and 0.768 in the validation cohort.The clinical utility of the model was further supported by satisfactory calibration and positive net benefits of DCA.Conclusion The proposed nomogram was highly discriminative in predicting AP severity,indicating its potential clinical value for risk stratification. 展开更多
关键词 Acute pancreatitis Severe acute pancreatitis LASSO regression Nomogram Risk stratification Early prediction
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Between step-up and upfront intervention:Risk stratification as the missing link in timing endoscopic necrosectomy 认领 引用
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作者 Ana-Maria Singeap Stefan Chiriac +1 位作者 Horia Minea Anca Trifan 《World Journal of Gastrointestinal Endoscopy》 2026年第3期1-5,共5页
The management of walled-off pancreatic necrosis has shifted from surgical debridement to minimally invasive,step-up endoscopic strategies.While lumenapposing metal stents enable effective drainage in many patients,a ... The management of walled-off pancreatic necrosis has shifted from surgical debridement to minimally invasive,step-up endoscopic strategies.While lumenapposing metal stents enable effective drainage in many patients,a substantial proportion still requires direct endoscopic necrosectomy,where the optimal timing of intervention remains debated.Rather than a strict early-vs-delayed paradigm,timing increasingly reflects individualized clinical judgment.The study recently published by Lone et al highlights that clinical,biochemical,and radiologic factors,including necrosis extent,systemic inflammation,nutritional status,and anatomical complexity,can predict failure of passive drainage and the need for direct endoscopic necrosectomy.These findings support a risk-based approach in which patient stratification guides selective upfront or accelerated intervention.Risk stratification thus emerges as the missing link between waiting and acting,enabling more precise and personalized timing of necrosectomy in walled-off pancreatic necrosis management. 展开更多
关键词 Walled-off necrosis Endoscopic necrosectomy Risk stratification Endoscopic step-up approach Passive drainage failure Personalized intervention
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Prognostic Value of Laboratory Biomarkers in Risk Stratification for Short-Term Outcomes in Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis 认领 引用
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作者 Ying Li Xu Xiang 《Current Medical Science》 SCIE CAS CSCD 2026年第1期221-228,共8页
Objectives This study aimed to investigate the association between laboratory biomarkers and short-term poor prognosis in patients with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis(EBV-HLH)and to d... Objectives This study aimed to investigate the association between laboratory biomarkers and short-term poor prognosis in patients with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis(EBV-HLH)and to develop a risk stratification model.Methods A retrospective analysis was conducted on clinical data from 117 EBV-HLH patients admitted to our hospital between June 2016 and December 2024.Patients were classified into poor prognosis(n=48)and good prognosis(n=69)groups based on 28-day outcomes.Potential predictors were screened by univariable logistic regression and receiver operating characteristic(ROC)curve analysis,and a composite laboratory-based risk scoring system was subsequently constructed.Results The poor prognosis group exhibited significantly higher levels of urea(UREA),direct bilirubin(DB),high-sensi-tivity cardiac troponinⅠ(hscTnⅠ),serum ferritin(Ferr),and prothrombin time(PT)than the good prognosis group did(all P<0.05).ROC analysis determined the optimal cutoff values and corresponding odds ratios(ORs)for poor prognosis as follows:UREA(≥5.4 mmol/L,OR=5.911),DB(≥10.0μmol/L,OR=2.524),hscTnⅠ(≥7.4 pg/mL,OR=2.747),Ferr(≥12,422μg/L,OR=2.366),and PT(≥14.1 s,OR=3.221).A 0-5-point risk score model was constructed based on these thresholds.The incidence of poor prognosis increased progressively with the score:23.08%(score 0-1),27.59%(score 2),45.00%(score 3),66.67%(score 4),and 92.30%(score 5).Each 1-point increase in the score was associated with an OR of 1.915 for poor prognosis.Conclusion The composite risk scoring system incorporating UREA,DB,hscTnⅠ,Ferr,and PT showed satisfactory predic-tive performance for short-term outcomes in EBV-HLH patients.A score of≥3 identifies high-risk individuals who may benefit from intensified immunomodulatory therapy,thereby facilitating individualized and stratified clinical management. 展开更多
关键词 EBV-HLH Prognostic biomarkers Hemophagocytic lymphohistiocytosis Risk stratification Ferritin Troponin I Urea Coagulophathy
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Dynamic inflammation-based prognostication in acute-on-chronic liver failure:The COSSH-CAR model as a step forward in personalized risk stratification 认领 引用
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作者 Noura A A Ebrahim Thoraya A Farghaly Soliman M A Soliman 《World Journal of Hepatology》 2026年第2期1-9,共9页
Acute-on-chronic liver failure(ACLF)is a swiftly deteriorating condition characterized by profound systemic inflammation and failure of multiple organ systems,leading to high early mortality.There remains a critical n... Acute-on-chronic liver failure(ACLF)is a swiftly deteriorating condition characterized by profound systemic inflammation and failure of multiple organ systems,leading to high early mortality.There remains a critical need for more effective biomarkers to facilitate timely and accurate risk assessment.Recent findings by Zhu and Yan demonstrated that evaluating temporal changes in the C-reactive protein to albumin ratio(CAR),especially the 7-day variation,offers superior prediction of 28-day mortality compared with single baseline measurements.By integrating the 7-day variation of CAR with the model for end-stage liver disease sodium score and the grade of hepatic encephalopathy,the Chinese Group on Study of Severe Hepatitis B(COSSH)-CAR model was created,which surpassed traditional prognostic tools such as the Child-Pugh,model for end-stage liver disease,and COSSH-ACLF.This comment highlights the importance of using dynamic biomarker trajectories rather than static values for prognostic evaluation.CAR is biologically compelling because it captures both the inflammatory burden and the patient’s nutritional/physiological reserve.While the COSSH-CAR model is promising and based on routinely obtainable laboratory data,its widespread adoption will depend on validation in larger,diverse,and non-hepatitis B virusrelated cohorts.Future work should examine CAR kinetics in prospective and interventional studies and consider how they may support individualized management strategies.Collectively,these observations suggest that the CAR could represent an important addition to current ACLF prognostic frameworks. 展开更多
关键词 Acute-on-chronic liver failure C-reactive protein to albumin ratio(CAR) Chinese Group on Study of Severe Hepatitis B-CAR Dynamic biomarkers Systemic inflammation Hepatic encephalopathy Risk stratification
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Interpretable Cox-Guided Risk Stratification for Specialized Expert Learning in Pan-Cancer Survival Prediction 认领 引用
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作者 Manal Mohammed AL-Tamimi Siti Norul Huda Sheikh Abdullah +3 位作者 Mohammad Khatim Hasan Mohammed Azmi Al-Betar Maw Shin Sim Abdulrahman Mohammed AL-Tamimi 《Computer Modeling in Engineering & Sciences》 SCIE EI 2026年第5期1248-1275,共28页
Pan-cancer survival prediction remains a major challenge in personalized oncology due to profound tumor heterogeneity and the complexity of high-dimensional molecular data.Diverse risk profiles across cancer types and... Pan-cancer survival prediction remains a major challenge in personalized oncology due to profound tumor heterogeneity and the complexity of high-dimensional molecular data.Diverse risk profiles across cancer types and noisy,sparse features hinder deep learning models from capturing robust prognostic patterns.Prior pancancer studies predominantly focus on multimodal integration or unimodal gene expression analysis,leaving other informative modalities such as Copy Number Variation(CNV)and miRNA expression underexplored.We introduce a new formulation of mixture-of-experts(MoE)survival modeling that recasts expert assignment as a clinically interpretable risk-space decomposition problem.The proposed framework,CoxGuided-SE,constructs an ordered prognostic risk axis from a Cox proportional hazards model trained on clinical covariates,then uses quantilebased thresholds to deterministically stratify patients into risk-homogeneous groups and route them to specialized subnetworks.This design replaces black-box neural routing with a transparent,statistically principled alternative,preventing expert collapse without auxiliary regularization.Evaluated on 33 cancer types from TCGA across four modalities independently,namely clinical features,mRNA expression,miRNA expression,and CNV,CoxGuidedSE achieved substantial gains on high-dimensional genomic data,improving both discrimination and calibration.The most pronounced improvement occurred for CNV,widely considered one of the most challenging modalities for survival modeling,with a 24%increase in discrimination over the strongest baseline.The framework offers twolevel interpretability:transparent patient routing based on clinical severity,and expert-specific feature importance within each subgroup.Feature-level analyses further confirm that experts learn complementary and non-redundant representations within each risk stratum.These results provide both a high-performing survival prediction framework and a principled explanation of when and why expert specialization is effective,advancing interpretable and trustworthy clinical AI for pan-cancer prognosis. 展开更多
关键词 Survival prediction mixture-of-experts Cox proportional hazards pan-cancer prognosis deep learning multi-omics risk stratification interpretable AI
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Optimizing branch-duct intraductal papillary mucinous neoplasms surveillance:Data-driven dimensional grouping for risk stratification and cost-effectiveness 认领 引用
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作者 Stefano Kayali Simone Dibitetto +11 位作者 Alberto Busatto Federica Gaiani Andrea Pasta Francesco Calabrese Stefano Fantasia Simone Caprioli Andrea P Luzzi Claudio G De Angelis Edoardo V Savarino Luigi Laghi Edoardo G Giannini Elisa Marabotto 《World Journal of Gastroenterology》 SCIE CAS 2026年第20期25-36,共12页
BACKGROUND The rising detection of branch-duct intraductal papillary mucinous neoplasms(BD-IPMN)has led to updated surveillance guidelines,yet the true malignant transformation rate and the cost-effectiveness of these... BACKGROUND The rising detection of branch-duct intraductal papillary mucinous neoplasms(BD-IPMN)has led to updated surveillance guidelines,yet the true malignant transformation rate and the cost-effectiveness of these strategies remain uncertain.Current protocols are based on expert opinion rather than validated data,leading to conflicting recommendations and significant healthcare costs.This study addresses the need for an evidencebased approach to optimize surveillance by identifying robust risk factors and creating a more efficient protocol.AIM To determine the rate of BD-IPMN malignant progression,identify independent risk factors,and develop a surveillance protocol optimized for both diagnostic accuracy and cost-efficiency.METHODS This is a multicentric retrospective cohort study using prospectively collected data from four Italian tertiary care centers.A total of 333 patients undergoing surveillance for BD-IPMN between January 2017 and August 2023 were included.Multivariate Cox regression and segmentation analysis identified predictors and derived novel size thresholds for malignancy risk stratification.We then compared the diagnostic accuracy and 3-year surveillance costs of a proposed protocol against the Fukuoka 2017 and Kyoto 2024 guidelines.RESULTS Among 333 patients(median follow-up,4 years),malignant transformation occurred in 11(3.3%).Independent risk factors for malignancy included high risk stigmata(HRS)[hazard ratio(HR)=4.4,95%confidence interval(CI):1.1-17.8,P=0.04],the development of≥2 worrisome features(WFs)(HR=5.8,95%CI:1.5-22.4,P=0.01),and cyst size(HR=2.0,95%CI:1.3-3.0,P<0.001).Two new cut-offs(1.5 cm and 3.0 cm)defined dimensional categories with distinct malignant potential(HR=6.6,95%CI:1.7-25.4,P=0.007,HR=9.8,95%CI:1.1-89.7,P=0.04).A proposed surveillance protocol preserved diagnostic accuracy while reducing 3-year costs by 11%vs Fukuoka and 21.4%vs Kyoto(P<0.001).Scenario analysis confirmed cost-effectiveness.CONCLUSION IPMN degeneration is rare.HRS and at least two WFs may independently predict malignancy.Our surveillance protocol based on data-driven size cut-offs(1.5 cm and 3 cm)may enhance cost-effectiveness over current guidelines while maintaining diagnostic precision. 展开更多
关键词 Pancreatic cyst neoplasms Intraductal papillary mucinous neoplasm Risk stratification Surveillance strategy Cost-effectiveness Pancreatic cancer Evidence-based medicine Health care costs
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Modified frailty index and systemic immune-inflammation enable biological risk stratification in geriatric colorectal cancer surgery 认领 引用
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作者 Kai-Zhen Xu Wen-Jian Hu +2 位作者 Yu-Hui Shang Yan-Dong Miao Li-Na Wang 《World Journal of Gastrointestinal Oncology》 SCIE 2026年第7期1-9,共9页
The global demographic shift toward an aging population has significantly increased the incidence of colorectal cancer(CRC)among older adults.However,chronological age alone is an insufficient predictor of surgical ri... The global demographic shift toward an aging population has significantly increased the incidence of colorectal cancer(CRC)among older adults.However,chronological age alone is an insufficient predictor of surgical risk and oncological outcomes.A recent study published by Qi et al in World Journal of Gastrointestinal Oncology identifies the modified frailty index and the systemic immune-inflammation index as critical indices for predicting postoperative complications and recurrence-free survival.This editorial provides an in-depth analysis of how frailty and systemic inflammation intersect to dictate the clinical trajectory of geriatric CRC patients.We discuss the biological mechanisms of immunosenescence,the impact of physiological reserve depletion,and the necessity of incorporating multidimensional indices into routine clinical practice to facilitate personalized prehabilitation and optimized perioperative care. 展开更多
关键词 Colorectal cancer Older adults Modified frailty index Systemic immune-inflammation index Biological risk stratification Postoperative complications Recurrence-free survival
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Complete blood count-derived inflammatory indices:A noninvasive aid for risk stratification in gastric ulcer 认领 引用
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作者 Sevgi Kalkanli Tas Furkan Aydın Duygu Kirkik 《World Journal of Gastroenterology》 SCIE CAS 2026年第5期162-168,共7页
Gastric ulcer(GU)remains a significant global health concern,often leading to severe complications such as bleeding and perforation.While Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use are w... Gastric ulcer(GU)remains a significant global health concern,often leading to severe complications such as bleeding and perforation.While Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use are well-recognized etiological factors,systemic inflammation plays a pivotal but underexplored role in GU pathogenesis.Shen et al provide compelling evidence linking complete blood count-derived inflammatory biomarkers with GU prevalence,identifying the systemic inflammatory response index as the most discriminative marker.Their cross-sectional analysis underscores the potential of routine hematological parameters as cost-effective,accessible tools for early identification of high-risk individuals.Importantly,this study adds to the growing body of literature suggesting that simple indices-neutrophil-to-lymphocyte ratio,monocyte-to-lymphocyte ratio,and systemic inflammatory response index-may serve not only as diagnostic aids but also as windows into disease mechanisms involving im-mune dysregulation and oxidative stress.Future prospective and mechanistic stu-dies are warranted to determine whether these markers can predict ulcer re-currence,guide therapeutic interventions,or integrate into precision gastroente-rology.By leveraging widely available blood tests,we may move closer to a pa-radigm where inexpensive inflammatory indices refine GU risk stratification and management strategies. 展开更多
关键词 Gastric ulcer Systemic inflammation Complete blood count Inflammatory biomarkers Systemic inflammatory response index Risk stratification
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Age and red cell distribution width in pancreatic cystic neoplasms:A simple tool for preoperative malignancy risk stratification 认领 引用
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作者 Shu-Qi Ren Yuan-Huan Han Chuang Cai 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第1期458-461,共4页
The study conducted by Martli et al,on the preoperative risk stratification of malignant potential in pancreatic cystic neoplasms(PCNs),identifies age and red cell distribution width(RDW)as independent predictors.This... The study conducted by Martli et al,on the preoperative risk stratification of malignant potential in pancreatic cystic neoplasms(PCNs),identifies age and red cell distribution width(RDW)as independent predictors.This study offers a simple and cost-effective clinical tool for preoperative assessments.The significance lies in its integration of routine laboratory parameters with clinical features,effectively addressing the limitations associated with the accessibility and operator dependency of imaging and invasive diagnostic methods.However,factors such as the retrospective design,single-center setting,small sample size,and selection bias because of the inclusion of only surgical cases limit the generalizability of the findings.Future studies should emphasize multi-center prospective validation to further clarify the biological role of RDW in the malignant transformation of PCNs and to explore integrated models that combine RDW with imaging characteristics and molecular biomarkers,ultimately enhancing precision in individualized clinical decision-making. 展开更多
关键词 Pncreatic cystic neoplasms Red cell distribution width Age Preoperative assessment Malignancy risk stratification
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Letter to the Editor:Magnetic resonance imaging-based deep learning radiomics for preoperative risk stratification in pediatric hepatoblastoma 认领 引用
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作者 Ujjayita Chowdhury Atharva A Mahajan +3 位作者 Muthu Subash Kavitha Ramya Lakshmi Rajendran Prakash Gangadaran Byeong-Cheol Ahn 《World Journal of Radiology》 2026年第4期62-67,共6页
This letter to the editor discusses a recent multi-institutional study that developed a noninvasive deep learning-based radiomics score derived from preoperative magnetic resonance imaging(MRI)to predict event-free su... This letter to the editor discusses a recent multi-institutional study that developed a noninvasive deep learning-based radiomics score derived from preoperative magnetic resonance imaging(MRI)to predict event-free survival in pediatric hepatoblastoma.The original study by Yang and Li published in World Journal of Radiology,leveraged convolutional neural networks to extract high-dimensional features from T1 and T2 sequences,the researchers developed an integrated nomogram that combines these imaging signatures with traditional markers like alpha-fetoprotein and the pretreatment extension of disease stage.This model significantly outperforms standard clinical predictors,offering preliminary evidence for an MRI-based approach to preoperative risk stratification that warrants further large-scale validation. 展开更多
关键词 Pediatric hepatoblastoma Magnetic resonance imaging radiomics Deep learning Event-free survival Preoperative risk stratification Alpha-fetoprotein Pretreatment extension of disease stage Nomogram
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Role of claudin-6 in high-grade endometrial carcinoma: Implications for risk stratification and personalized treatment strategies 认领 引用
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作者 Chuang Cai Jin-Man Chen +1 位作者 Zu-Xun Qiu Shu-Qi Ren 《World Journal of Clinical Oncology》 2026年第2期1-5,共5页
This commentary discusses the groundbreaking study by Ebrahim et al on the role of claudin-6(CLDN6)in high-grade endometrial carcinoma,addressing a significant gap in current knowledge.Their research reveals that over... This commentary discusses the groundbreaking study by Ebrahim et al on the role of claudin-6(CLDN6)in high-grade endometrial carcinoma,addressing a significant gap in current knowledge.Their research reveals that overexpression of CLDN6 is linked to unfavorable pathological features.Moreover,multivariate analysis establishes CLDN6 as an independent predictor of disease-free survival,with a hazard ratio of 68.98.These results highlight the promise of CLDN6 in improving risk stratification and as a potential therapeutic target,especially with the development of CLDN6-directed antibody-drug conjugates.To advance CLDN6 towards clinical application,further validation in prospective patient cohorts and studies exploring its interactions with other molecular pathways are essential. 展开更多
关键词 Claudin-6 High-grade endometrial carcinoma Risk stratification Therapeutic target Prognosis
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Letter to the Editor:Transcatheter aortic valve implantation beyond 85 years:Age is no longer the limiting factor,but risk stratification still matters 认领 引用
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作者 Nikolaos Ktenopoulos Nikias Milaras +3 位作者 Anastasios Apostolos Constantinos Tsioufis Konstantinos Toutouzas Skevos Sideris 《World Journal of Cardiology》 2026年第7期115-118,共4页
The rapid expansion of transcatheter aortic valve implantation(TAVI)has fundamentally reshaped the management of severe aortic stenosis in elderly and highrisk populations.However,evidence specifically addressing outc... The rapid expansion of transcatheter aortic valve implantation(TAVI)has fundamentally reshaped the management of severe aortic stenosis in elderly and highrisk populations.However,evidence specifically addressing outcomes in the very elderly,particularly patients aged 85 years and older,needs further exploration.In this context,the retrospective cohort study by Algethami et al provides interesting and clinically relevant insights into mid-term survival following TAVI in this advanced-age group.The authors report favorable survival rates at 1 year and 3 years,reinforcing the concept that chronological age alone should not constitute a contraindication to TAVI.Importantly,their findings highlight obesity as a significant predictor of early mortality,underscoring the need for refined risk stratification beyond conventional age-based decision-making.This article discusses the implications of these results within the evolving landscape of structural heart disease management,emphasizing the shift from age-centered to biologyand comorbidity-driven patient selection.Furthermore,it explores how factors such as frailty,metabolic burden and non-cardiac comorbidities should increasingly inform multidisciplinary heart team decisions.As TAVI continues to expand into older populations,studies such as this one help define realistic expectations,guide individualized care and support evidence-based expansion of indications in the very elderly. 展开更多
关键词 Transcatheter aortic valve implantation Aortic stenosis Elderly patients Transcatheter aortic valve implantation Risk stratification Frailty Survival outcomes
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Risk Stratification and Influencing Factors of Postoperative Pain in Primary Endodontic Treatment for Apical Periodontitis Patients in Primary Hospitals 认领 引用
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作者 WEI Lingyan 《外文科技期刊数据库（文摘版）医药卫生》 2026年第3期006-009,共4页
Objective: To explore the pain risk stratification and pain factors in patients with periapical periodontitis in primary hospitals after a single root canal treatment. Method: Sixty patients with periapical periodonti... Objective: To explore the pain risk stratification and pain factors in patients with periapical periodontitis in primary hospitals after a single root canal treatment. Method: Sixty patients with periapical periodontitis who underwent a single root canal treatment in the dental department of primary hospitals from September 2024 to September 2025 were selected. The numerical scoring system (NRS) was used to evaluate pain at 6h, 24h, 48h, and 72h after treatment;Pain risk stratification is based on NRS scores within 48 hours after treatment, with low-risk scores ranging from 0-3, medium risk scores ranging from 4-6, and high-risk scores ranging from 7-10. Use univariate and multivariate logistic regression analysis to identify factors associated with postoperative moderate to high-risk pain. Out of 60 patients, 36 were at low risk (60.00%), 16 were at medium risk (26.67%), and 8 were at high risk (13.33%). Postoperative pain decreases over time and becomes more pronounced 6-24 hours after treatment. Univariate analysis showed that tooth grinding, preoperative spontaneous pain, significant percussion pain, apical transmission shadow diameter ≥ 5 mm, treatment time ≥ 45 min, and filling material apical overflow were associated with postoperative moderate to high-risk pain (P<0.05). Multivariate logistic regression analysis showed that molars, preoperative spontaneous pain, apical transmission shadow diameter ≥ 5 mm, and filling material apical overflow were independent risk factors for postoperative moderate to high-risk pain (P<0.05). Conclusion: The pain of patients with periapical periodontitis in primary hospitals after a single root canal treatment is mainly concentrated in the early postoperative period, with low risk as the main factor. Teeth grinding, preoperative spontaneous pain, large apical translucency, and apical overflow of filling materials increase the risk of postoperative pain, which should be identified and intervened clinically. 展开更多
关键词 Apical periodontitis One-visit root canal treatment Postoperative pain risk stratification
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Novel approach to risk stratification:Integrating waist-hip ratio for predicting advanced colorectal neoplasia 认领 引用 被引量：1
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作者 Arvind Mukundan Devansh Gupta +1 位作者 Riya Karmakar Hsiang-Chen Wang 《World Journal of Clinical Oncology》 2025年第10期9-13,共5页
The urgent necessity for enhanced risk stratification to improve the efficiency of colonoscopy screening is underscored by the fact that colorectal cancer(CRC)continues to be a primary cause of global cancer mortality... The urgent necessity for enhanced risk stratification to improve the efficiency of colonoscopy screening is underscored by the fact that colorectal cancer(CRC)continues to be a primary cause of global cancer mortality.Conventional models mostly rely on generalized obesity markers including body mass index(BMI),which does not effectively represent oncogenic risk linked with abdominal obesity.Liu et al undertook a large-scale case-control study comprising 6484 firsttime colonoscopy patients at a prominent Chinese hospital between 2020 and 2023 to overcome this restriction.Age,male sex,smoking status,and raised waist-hip ratio(WHR)were found by multivariate logistic regression as independent predictors of advanced colorectal neoplasia(ACN).In a validation cohort of 1891 individuals,a new 7-point risk scoring model was created and stratified into low-(5.0%)ACN prevalence,moderate-(10.3%)and high-risk(17.6%).With C-statistic=0.66 the model showed better discriminating ability than the Asia-Pacific Colorectal Screening(APCS)score(C-statistic=0.63)and the BMI-modified APCS model.These results fit newly published data showing central obesity as a major carcinogenic driver via pro-inflammatory visceral adipokine channels.With the use of WHR,patient risk classification is greatly improved,providing a practical tool to make the most of screening resources in the face of rising CRC incidence rates.Finally,multi-ethnic validation is necessary for the WHR-based scoring model to be considered for integration into global CRC preventive frameworks,since it improves the accuracy of ACN risk prediction. 展开更多
关键词 Colorectal cancer Advanced colorectal neoplasia Risk prediction model Waist-hip ratio Central obesity Colonoscopy screening Cancer risk stratification Visceral adiposity Predictive analytics Precision oncology
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Recent advances in risk stratification and treatment of acute pulmonary embolism 认领 引用
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作者 George Latsios Emmanouil Mantzouranis +5 位作者 Ioannis Kachrimanidis Panagiotis Theofilis Sotirios Dardas Evaggelia Stroumpouli Constantina Aggeli Costas Tsioufis 《World Journal of Cardiology》 2025年第5期29-41,共13页
Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis... Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes. 展开更多
关键词 Acute pulmonary embolism Interventional treatment Catheter-directed treatments Thrombolysis Risk stratification Pulmonary embolism response team
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Risk stratification for future cardiac arrest after COVID-19 vaccination 认领 引用
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作者 Peter A McCullough Nicolas Hulscher 《World Journal of Cardiology》 2025年第2期22-28,共7页
Unheralded cardiac arrest among previously healthy young people without antecedent illness,months or years after coronavirus disease 2019(COVID-19)vaccination,highlights the urgent need for risk stratification.The mos... Unheralded cardiac arrest among previously healthy young people without antecedent illness,months or years after coronavirus disease 2019(COVID-19)vaccination,highlights the urgent need for risk stratification.The most likely underlying pathophysiology is subclinical myopericarditis and reentrant ventri-cular tachycardia or spontaneous ventricular fibrillation that is commonly preci-pitated after a surge in catecholamines during exercise or the waking hours of terminal sleep.Small patches of inflammation and/or edema can be missed on cardiac imaging and autopsy,and the heart can appear grossly normal.This paper reviews evidence linking COVID-19 vaccines to cardiac arrest where unfortu-nately the majority of victims have had no antecedent clinical evaluation.We propose a comprehensive strategy for evaluating cardiovascular risk post-vaccination,incorporating detailed patient history,antibody testing,and cardiac diagnostics in the best attempt to detect abnormalities before sudden cardiac death.This approach aims to identify individuals at higher risk of cardiac events after COVID-19 vaccination and guide appropriate clinical management.It is prudent for each primary care physician to have a pre-established plan when addressing this issue in their practice. 展开更多
关键词 COVID-19 mRNA vaccines Myocarditis Cardiac arrest Risk stratification Cardiovascular safety
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From fatty liver indices to the Zhejiang University index:Re-shaping risk stratification of metabolic liver disease in diabetes 认领 引用
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作者 Mostafa M Gouda 《World Journal of Diabetes》 SCIE 2025年第12期1-7,共7页
This editorial comments on the study by Tao et al,emphasizing the scalable diagnostic tool for metabolic dysfunction-associated steatotic liver disease(MASLD)in type 2 diabetes mellitus(T2DM).Classical indices such as... This editorial comments on the study by Tao et al,emphasizing the scalable diagnostic tool for metabolic dysfunction-associated steatotic liver disease(MASLD)in type 2 diabetes mellitus(T2DM).Classical indices such as the fatty liver index(FLI),hepatic steatosis index(HSI),and non-alcoholic fatty liver disease-liver fat score have provided valuable insights.Still,their predictive accuracy often varies across populations and clinical settings.In Western cohorts,FLI and HSI are widely applied,yet they depend heavily on anthropometric or categorical variables,which limits their sensitivity in Asian populations.The Zhejiang University index(ZJU index),developed in China,integrates fasting glucose,triglycerides,hepatic enzyme ratios,and body mass index into a composite score of insulin resistance.Recent studies show that the ZJU index outperforms FLI and HSI in predicting MASLD among Chinese patients,particularly those with T2DM,where it demonstrates a nonlinear association with disease risk and identifies a critical threshold of 38.87.The ZJU index links to conditions like sarcopenia,sleep apnea,and gallstones,showing its versatility in metabolic health.This editorial compares its performance with other indices and emphasizes the ZJU index as a nextgeneration tool for MASLD risk stratification globally. 展开更多
关键词 Metabolic dysfunction-associated Type 2 diabetes mellitus Zhejiang University index Fatty liver index Hepatic steatosis index Non-invasive diagnostics Risk stratification
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Novel cardiac biomarkers and multiple-marker approach in the early detection,prognosis,and risk stratification of cardiac diseases 认领 引用 被引量：2
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作者 Syed Faqeer Hussain Bokhari Muhammad Umais +8 位作者 Syed Muhammad Faizan Sattar Umair Mehboob Asma Iqbal Maaz Amir Danyal Bakht Khawar Ali Abdul Haseeb Hasan Muhammad Arsham Javed Wahidullah Dost 《World Journal of Cardiology》 2025年第7期11-52,共42页
Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponi... Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponin,and natriuretic peptides play crucial roles in CVD management,yet they are often limited by sensitivity and specificity constraints.This narrative review critically examines the emerging landscape of cardiac biomarkers and advocates for a multiple-marker approach to enhance early detection,prognosis,and risk stratification of CVD.In recent years,several novel biomarkers have shown promise in revolutionizing CVD diagnostics.Gamma-glutamyltransferase,microRNAs,endothelial microparticles,placental growth factor,trimethylamine N-oxide,retinol-binding protein 4,copeptin,heart-type fatty acid-binding protein,galectin-3,growth differentiation factor-15,soluble suppression of tumorigenicity 2,fibroblast growth factor 23,and adrenomedullin have emerged as significant indicators of CV health.These biomarkers provide insights into various pathophysiological processes,such as oxidative stress,endothelial dysfunction,inflammation,metabolic disturbances,and myocardial injury.The integration of these novel biomarkers with traditional ones offers a more comprehensive understanding of CVD mechanisms.This multiple-marker approach can improve diagnostic accuracy,allowing for better risk stratification and more personalized treatment strategies.This review underscores the need for continued research to validate the clinical utility of these biomarkers and their potential incorporation into routine clinical practice.By leveraging the strengths of both traditional and novel biomarkers,precise therapeutic plans can be developed,thereby improving the management and prognosis of patients with CVDs.The ongoing exploration and validation of these biomarkers are crucial for advancing CV care and addressing the limitations of current diagnostic tools. 展开更多
关键词 Cardiac biomarkers Multiple-marker approach Cardiovascular disease diagnosis Risk stratification Prognostic indicators
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Personalized translational medicine:Investigating YKL-40 as early biomarker for clinical risk stratification in hepatocellular carcinoma recurrence post-liver transplantation 认领 引用 被引量：1
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作者 Ileana Lulic Dinka Lulic +2 位作者 Jadranka Pavicic Saric Iva Bacak Kocman Dunja Rogic 《World Journal of Transplantation》 2025年第2期1-7,共7页
Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamm... Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamma-carboxy prothrombin(DCP),lack specificity,limiting their utility in risk strati-fication.YKL-40,a glycoprotein involved in extracellular matrix remodeling,hepatic stellate cell activation,and immune modulation,has emerged as a promising biomarker for post-LT surveillance.Elevated serum levels of YKL-40 are associated with advanced liver disease,tumor progression,and poorer post-LT outcomes,highlighting its potential to address gaps in early detection and personalized management of HCC recurrence.This manuscript synthesizes clinical and mechanistic evidence to evaluate YKL-40’s predictive utility in post-LT care.While preliminary findings demonstrate its specificity for liver-related pathologies,challenges remain,including assay standardization,lack of pro-spective validation,and the need to distinguish between malignant and non-malignant causes of elevated levels.Integrating YKL-40 into multi-biomarker panels with AFP and DCP could enhance predictive accuracy and enable tailored therapeutic strategies.Future research should focus on multicenter studies to validate YKL-40’s clinical utility,address confounding factors like graft rejection and systemic inflammation,and explore its role in predictive models driven by emerging technologies such as artificial intelligence.YKL-40 holds transformative potential in reshaping post-LT care through precision medicine,providing a pathway for better outcomes and improved management of high-risk LT recipients. 展开更多
关键词 Hepatocellular carcinoma recurrence Liver transplantation Personalized translational medicine Biomarkers YKL-40 Risk stratification
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