Search Results (2,482)

Background: Clostridium difficile colonization (CDC) represents a clinical concern in oncology patients undergoing abdominopelvic surgery, particularly regarding the potential role of prophylactic antibiotics in preventing progression to active infection. Methods: We performed a single-center, retrospective, case-matched observational study of oncology patients with CDC who underwent abdominopelvic surgery between 2018 and 2023. Patients were divided into two cohorts: those who received prophylactic antibiotics and those who did not. Postoperative outcomes were compared using propensity score matching (PSM). Logistic regression and ROC curve analysis were applied to assess the predictive value of antibiotics relative to other comorbidities. Results: Ninety patients were included (62 with antibiotics; 28 without). In the unmatched cohort, patients receiving antibiotics showed a non-significant trend toward higher morbidity (32.2% vs. 21.4%, p = 0.327) and surgical site infection rates (9.6% vs. 0%, p = 0.171). After PSM (26 patients per group), morbidity remained comparable between cohorts (30.7% vs. 23.0%, p = 0.538). Notably, no patient developed active C. difficile infection during follow-up, regardless of antibiotic use. Antibiotic therapy was not an independent predictor of postoperative morbidity (OR 1.746, p = 0.297; AUC 0.549, 95% CI 0.405–0.687). Conclusions: In this study, prophylactic antibiotic use in CDC patients undergoing abdominopelvic oncology surgery was not associated with improved postoperative outcomes. While no progression to active infection was observed, the potential benefits of prophylaxis remain uncertain. Larger, prospective studies are needed to clarify the clinical role of antibiotics in this setting. Full article

Background: Total arterial revascularization (TAR) may improve outcomes in patients with ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF). Methods: We retrospectively screened 574 adults with HFrEF (LVEF < 40%) undergoing isolated CABG across four German centers (2017–2023). After 1:1 propensity score matching, 240 patients were analyzed (120 TAR vs. 120 NTAR). The primary endpoint was in-hospital MACCE (death, MI, stroke). Key secondary endpoints included ICU/hospital length-of-stay, ventilation time, delirium, transfusion requirements, and acute kidney injury. Results: MACCE occurred in 4.1% (TAR) vs. 14.2% (NTAR) (p = 0.007). TAR was associated with shorter ICU stay (median 44.5 h vs. 90 h, p < 0.001), shorter hospital stay (10 d vs. 12 d, p = 0.002), reduced ventilation time (8 h vs. 12 h, p < 0.001), lower delirium (5.0% vs. 14.2%, p = 0.016), and fewer RBC transfusions intra-operatively (0.13 ± 0.45 vs. 0.31 ± 0.58 units, p = 0.028) and during the entire stay (0.70 ± 1.33 vs. 1.77 ± 2.91 units, p < 0.001). Conclusions: In this multicenter propensity-matched cohort, TAR was associated with lower in-hospital MACCE and more favorable perioperative outcomes compared with NTAR. Prospective studies are warranted to confirm causality and long-term benefits. Full article

Background/Objectives: Colorectal cancer (CRC) survivors may face long-term health consequences, yet the relationship between CRC and osteoporosis remains underexplored, particularly in Asia. We conducted a nationwide, retrospective longitudinal cohort study with matched controls using the Korean National Health Insurance Service–National Sample Cohort (2005–2019) to assess whether CRC increases osteoporosis risk or not. Methods: We identified 8733 CRC patients and 34,932 matched controls (1:4 ratio) based on age, sex, income, residence, and index date, excluding individuals with pre-existing osteoporosis. Osteoporosis was defined via ICD-10 codes (M80–M82) plus confirmatory bone imaging claims. Propensity score overlap weighting was applied, and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models, with subgroup analyses based on demographic and clinical factors. Results: With up to 16 years of follow-up, osteoporosis incidence rates were 13.80 and 14.30 per 1000 person-years in CRC and control groups, respectively. Adjusted Cox models revealed no significant association between CRC and osteoporosis (HR = 0.95; 95% CI = 0.87–1.04). Subgroup analysis showed a slightly lower risk among CRC survivors aged ≥65 years (adjusted HR = 0.84; 95% CI = 0.75–0.95), though no associations were observed by sex, income, region, or comorbidities. Conclusions: These findings suggest CRC may not be an independent risk factor for osteoporosis in the Korean population. The unexpected age-specific variation warrants cautious interpretation, possibly reflecting competing mortality risks or detection biases. Full article

This study examines whether China’s high-tech enterprise identification policy promotes corporate sustainable innovation. Using panel data from Chinese listed firms on the Shanghai and Shenzhen stock exchanges between 2008 and 2022, we adopt a time-varying difference-in-differences (DID) model to evaluate the policy’s effectiveness and explore its underlying mechanisms. The results reveal that this certification policy significantly facilitates green innovation, and the findings remain robust across various checks, including alternative measurements, placebo tests, propensity score matching DID (PSM-DID), and the exclusion of digital transformation trend and confounding macro-level policies. Mechanism analysis shows that the policy influences green innovation by alleviating financing constraints, increasing access to government subsidies, facilitating the agglomeration of scientific and technological talent, and encouraging greater R&D investment. Heterogeneity analysis further indicates that the policy effect is more pronounced among non-state-owned enterprises, small-scale firms, capital-intensive businesses, those located in high-institutional-quality regions, and firms in China’s eastern provinces. Moreover, the positive impact is strongest for growth-stage firms. The policy has also been found to improve green innovation efficiency. These findings offer empirical insights for optimizing selective industrial policies to enhance sustainable innovation and support China’s dual-carbon goals. Full article

Spherical Adsorptive Carbon (SAC), a type of oral sorbent, is prescribed to chronic kidney disease (CKD) patients to remove uremic toxins. However, evidence regarding its effectiveness in delaying chronic kidney disease (CKD) progression remains insufficient. We aimed to evaluate the impact of SAC on CKD progression in patients with CKD stage 3 or higher using nationwide data. In this retrospective cohort study, we included patients diagnosed with CKD stage ≥3 from the Korea National Health Insurance System database between January 2020 and December 2022. Outcomes were compared between SAC users (N = 1289) and non-users (N = 1289) after 1:1 propensity score matching (PSM). After PSM, the time from index date to end-stage kidney disease (ESKD) was significantly longer in the SAC user group compared to the non-user group (246.8 days vs. 118.6 days, p < 0.001). In Cox regression analysis, the risk of ESKD was significantly lower in the SAC group (HR = 0.37, 95% CI: 0.29–0.48). However, the risk of dialysis initiation did not show a significant difference between the two groups (HR = 0.83, 95% CI: 0.27–2.59). This nationwide cohort study suggests that SAC treatment may delay progression from CKD stage 3 to ESKD, although it did not significantly reduce the risk of dialysis initiation. Full article

Background: Proton beam therapy (PBT) provides excellent tumor control with minimal hepatic toxicity in patients with unresectable hepatocellular carcinoma (HCC), by minimizing radiation exposure to non-cancerous liver tissue. Progressive skeletal muscle loss, often seen in cirrhosis and HCC, can negatively impact treatment outcomes and survival. This study compared the efficacy and safety of PBT with transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in patients with unresectable HCC. Methods: A total of 91 patients (PBT/TACE+RFA, n = 41/50) ineligible for surgery or RFA alone were retrospectively analyzed, with propensity score matching applied to adjust for differences in baseline characteristics, resulting in matched groups of 33 patients each. The cross-sectional area of the psoas muscle at the third lumbar vertebra was assessed using computed tomography. Results: PBT resulted in longer overall survival (OS) and fewer hepatic and systemic adverse events compared to TACE+RFA, with no grade 3 or higher toxicities observed in the PBT group. Importantly, psoas muscle size remained stable after PBT, even in patients with tumors ≥ 3 cm, whereas TACE+RFA led to significant muscle loss regardless of tumor size, which was associated with poorer prognosis. These findings suggest that, for patients with unresectable HCC not adequately controlled by RFA alone, PBT may improve OS and help preserve muscle mass, while offering lower toxicity and more favorable clinical outcomes than TACE+RFA. Conclusions: Overall, PBT may represent an effective strategy for managing unresectable HCC. Full article

Digital supply chain management (DSCM) has emerged as a critical driver of enterprise performance in the modern economy, yet empirical evidence on its causal impact on productivity remains limited. This study examines how DSCM adoption affects total factor productivity (TFP) by leveraging China’s supply chain innovation pilot program as a quasi-natural experiment. Using a difference-in-differences approach with propensity score matching, the analysis employs a comprehensive dataset of 2843 Chinese A-share listed companies from 2013 to 2022; the analysis reveals that DSCM adoption leads to an average TFP increase of 14.1%. This positive effect strengthens over time, demonstrating a clear dynamic of organizational learning. Mediation analysis indicates that this productivity enhancement operates through two primary channels: innovation capability enhancement (accounting for approximately 35% of the total effect) and cost efficiency improvement (21%). Crucially, heterogeneity analysis reveals that the positive effects of DSCM are significantly more pronounced in supply-chain-intensive industries, such as manufacturing, and for firms with higher R&D intensity. The findings provide robust causal evidence on the productivity effects of DSCM, offering valuable insights into its underlying mechanisms and key boundary conditions for both enterprise strategy and digital transformation policy. Full article

Objectives: Overall survival (OS) of patients with stage 0 adenocarcinoma in situ (AIS) of the lung is not well characterized in the U.S. Specifically, there are a lack of data regarding the OS of patients with stage 0 AIS who do not receive treatment. We compared OS among stage 0 AIS patients who received surgery and those who received no treatment. Methods: OS of patients with stage 0 (TIS, N0, M0) AIS of the lung who received surgery versus no treatment from 2010 to 2018 in the National Cancer Data Base was evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Predictors of surgery were evaluated using multivariable logistic regression. Survival outcomes based on surgical approach were evaluated in a propensity score-matched subgroup analysis. Results: Of the 897 patients who were diagnosed with stage 0 AIS, 716 (79.8%) underwent surgical resection. A propensity score-matched analysis of 134 patients who received no treatment and 134 patients who underwent surgery showed that the surgical group had a significantly improved OS at five-years 85.8% (95% CI: 74.2–92.4%) compared to the group who received no treatment 62.8% (95% CI: 50.1–72.7%) (log-rank, p < 0.0001). Subgroup propensity score-matched analysis showed no significant differences in OS at five-years in the surgical group consisting of 201 patients who underwent a wedge resection 90.8% (95% CI: 83.8–94.8) compared to 201 patients who underwent a lobectomy 94.9% (95% CI: 89.9–97.4%) (log-rank, p = 0.19). Conclusions: In this national analysis, stage 0 AIS patients who underwent surgery had significantly better OS when compared to patients who did not receive treatment. Full article

Background: Robotic partial nephrectomy (RPN) for posterior renal tumors can be performed via the transperitoneal approach (TA); however, it may provide suboptimal visualization of posterior lesions compared to the retroperitoneal approach (RA). The camera port swapping (CPS) technique was developed to enhance intraoperative visualization and robotic arm maneuverability during TA-RPN. Methods: We conducted a retrospective review of patients who underwent RPN for posterior renal tumors between 2018 and 2024 using either TA with the CPS technique (n = 35) or RA (n = 29). All procedures used the da Vinci Xi surgical system, and the CPS technique involved repositioning the camera port intraoperatively when standard visualization proved inadequate during TA. Propensity score matching (1:1) was performed based on tumor size and body mass index to compare outcomes (n = 21 in each group). Results: Propensity score-matching analysis revealed that body mass index, tumor size, and RENAL nephrometry score were comparable between the two groups. The positive surgical margin was zero in all patients. The warm ischemia time was 22 min (0–44 min) in the TA-CPS group and 18 min (7–45 min) in the RA group (p = 0.504). No complications of Clavien–Dindo classification grade > 3 occurred in the TA-CPS group, while one occurred in the RA group (p = 1.000). Renal function decline was 4.8% in the TA-CPS group and 19% in the RA group (p = 0.343). Trifecta achievement rates were also comparable: 95.2% in the TA-CPS group and 81.0% in the RA group (p = 0.343). Conclusions: Camera port swapping during TA-RPN provided adequate visualization and perioperative outcomes comparable to those achieved with RA-RPN. This may be a practical alternative, particularly for anatomically complex posterior tumors. Full article

Objectives: This retrospective single-center cohort study aims to evaluate the impact of dual-trigger therapy (recombinant hCG [rhCG] combined with GnRH agonist) compared to rhCG alone on ART outcomes in women undergoing GnRH antagonist protocols. Methods: Data from 1291 IVF cycles performed between 2016 and 2022 were analyzed. After propensity score matching (PSM) to adjust for confounders, 395 cycles in each group were compared. Primary outcomes included the total number of oocytes retrieved, while secondary outcomes assessed mature oocytes, fertilization rates, and embryo numbers. Results: Dual-trigger therapy yielded significantly more total oocytes (7.50 ± 5.23 vs. 6.12 ± 4.23, p < 0.001) and mature oocytes (5.67 ± 3.87 vs. 5.01 ± 3.13, p = 0.047) compared to rhCG alone. Cycles with no oocytes were fewer in the dual-trigger group (1.3% vs. 3.8%, p = 0.015). Total embryos were also higher with dual trigger therapy (2.43 ± 1.90 vs. 2.00 ± 1.93, p = 0.001). In intracytoplasmic sperm injection (ICSI) cycles, the fertilization rate significantly improved with dual trigger (64.93 ± 33.50% vs. 52.22 ± 34.12%, p = 0.003). No significant differences were noted in fertilization rates for standard IVF (55.14 ± 30.72% vs. 52.29 ± 32.11%, p = 0.18) or maturation rates (72.52 ± 26.91% vs. 71.53 ± 24.75%, p = 0.37). Conclusions: These findings demonstrate that dual-trigger therapy improves ART outcomes by increasing oocyte and embryo yields. Full article

Background: Hepatocellular carcinoma (HCC) is a major global health burden and a leading cause of cancer-related deaths. While aspirin has shown potential chemopreventive effects in chronic liver disease, its impact on clinical outcomes among patients hospitalized with HCC remains under-investigated. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2022, we conducted a retrospective cohort study to evaluate the association between aspirin use and clinical outcomes in adult HCC hospitalizations. Patients were stratified based on documented aspirin use, and propensity score matching with inverse probability of treatment weighting (IPTW) was applied to minimize confounding. The primary outcome was in-hospital mortality; secondary outcomes included morbidity-related complications, hospital length of stay, and total charges. Results: Among 337,730 hospitalizations with HCC, 8.37% involved aspirin use. Aspirin users demonstrated significantly lower in-hospital mortality (5.2% vs. 10.09%), with an adjusted odds ratio (OR) of 0.58 (95% CI: 0.50–0.68; p < 0.001). Aspirin use was also associated with shorter hospital stays (5.42 vs. 6.39 days), lower total charges ($80,310 vs. $95,098), and reduced incidence of complications, including acute liver failure, hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, sepsis, ICU admission, and acute kidney injury. Importantly, no statistically significant increase in gastrointestinal or variceal bleeding was observed among aspirin users. Conclusions: These findings suggest that aspirin use may reduce mortality, morbidity, and healthcare burden in patients hospitalized with HCC. Full article

Background: Colovesical fistulas are abnormal communications between the colon and urinary bladder, most commonly caused by diverticular disease. Although colovesical fistulas are rare, they should be suspected in patients presenting with recurrent urinary tract infections, pneumaturia, or fecaluria. We integrated two case reports with a retrospective national cohort analysis to assess the surgical treatment of colovesical fistulas. Methods: We report two cases of colovesical fistulas, both secondary to sigmoid diverticulitis, treated surgically via minimally invasive approaches. A retrospective analysis using the National Inpatient Sample database from 2016 to 2022 was conducted to compare outcomes of open surgery with those of minimally invasive surgery. Propensity score matching and multivariable regression analyses were used to evaluate clinical outcomes. Results: The first patient underwent hand-assisted laparoscopic sigmoidectomy with fistula takedown and has remained asymptomatic at 8 months, while the second patient underwent robotic-assisted sigmoidectomy with staged ileostomy reversal and has remained asymptomatic at 1 month. National data analysis showed no significant difference in mortality (<1% versus <1%, p = 0.931), wound complications (1.4% versus 1.0%; p = 0.554), or postoperative sepsis or shock (7.1% versus 5.6%; p = 0.114) between open and minimally invasive surgical approaches. However, the minimally invasive surgery group had significantly shorter length of stay than the open surgery group (6.9 versus 7.3 days, p < 0.001). Conclusions: Minimally invasive repair of colovesical fistulas was associated with shorter hospital stays than open surgery, with no significant differences in major complications. Early identification and timely surgical management are critical for achieving favorable outcomes. Full article

Background/Objectives: Coronary CT angiography (CCTA) is a cornerstone in evaluating stable coronary artery disease (CAD), but conventional energy-integrating detector CT (EID-CT) has limitations, including calcium blooming and limited spatial resolution. Photon-counting detector CT (PCD-CT) may overcome these drawbacks through enhanced spatial resolution and improved tissue characterization. Methods: In this retrospective, propensity score–matched study, we compared CCTA findings from 820 patients (410 per group) who underwent either EID-CT or PCD-CT for suspected stable CAD. Primary outcomes included stenosis severity, high-risk plaque features, and downstream invasive coronary angiography (ICA) referral and yield. Results: The matched cohorts were balanced in demographics and cardiovascular risk factors (mean age 67 years, 63% male). PCD-CT showed a favorable shift in stenosis severity distribution (p = 0.03). High-risk plaques were detected less frequently with PCD-CT (22.7% vs. 30.5%, p = 0.01). Median coronary calcium scores did not differ (p = 0.60). Among patients referred for ICA, those initially evaluated with PCD-CT were more likely to undergo revascularization (62.5% vs. 44.1%), and fewer underwent potentially unnecessary ICA without revascularization (3.7% vs. 8.0%, p = 0.001). The specificity in diagnosing significant stenosis requiring revascularization was 0.74 with EID-CT and 0.81 with PCD-CT (p = 0.04). Conclusions: PCD-CT improved diagnostic specificity for CAD, reducing unnecessary ICA referrals while maintaining detection of clinically significant disease. This advanced CT technology holds promise for more accurate, efficient, and patient-centered CAD evaluation. Full article

This paper focuses on students receiving vertically integrated vocational education and evaluates the impacts of long-duration vocational education (LDVE) on individuals’ vocational identity, self-efficacy, and job satisfaction. Based on 1878 survey data, a logit model was used to analyze the influencing factors of students’ participation in the vertically integrated vocational education (VIVE) program, and the propensity score matching (PSM) method was used to measure the effects. Moreover, the comparison was made in different VIVE models to find the heterogeneity of effects. The results showed that family background and major significantly negatively affected the odds of an individual receiving VIVE. Merely extending the duration of vocational education does not significantly improve vocational identity, self-efficacy, and job satisfaction. Furthermore, the results of the between-group difference analysis indicated that neither the secondary-to-higher VIVE model nor the higher-to-undergraduate VIVE model had a significant impact on individuals’ vocational identity, self-efficacy, and job satisfaction. This research finding expands on the research achievements regarding the effects of LDVE. It can provide data references for the government and relevant institutions to pay attention to the quality and potential influence factors of LDVE. Full article

Background: The incidence of early-onset gastric cancer (EOGC) has been steadily increasing in recent years. However, the efficacy of adjuvant chemotherapy (AC) in this population remains unclear. This study aimed to investigate the clinicopathological characteristics, survival outcomes, and efficacy of AC between EOGC and average-onset gastric cancer (AOGC) patients. Methods: Patients with stage II–III gastric adenocarcinomas who underwent curative D2 gastrectomy at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2021 were enrolled and classified into two groups: EOGC (≤45 years) and AOGC (>45 years) groups. Clinicopathological characteristics, overall survival (OS), and efficacy of AC were compared between the two groups. Western and East Asian cohorts were included as external validation sets to compare the efficacy of AC between different age groups. Results: Compared to AOGC, EOGC patients exhibited a higher proportion of females, poor differentiation, diffuse Lauren type, middle-third GC, perineural invasion (PNI), and receipt of AC. Univariate and multivariate analyses identified that T stage, N stage, PNI, and AC were independent prognostic factors for OS. After balancing the baseline characteristics between patients who received AC and those who did not, the Kaplan–Meier survival curves indicated that AC significantly improved OS across all patients. Further subgroup analysis revealed a survival benefit of AC in AOGC patients, whereas no significant survival difference was observed in the EOGC subgroup. Consistently, external validation in both Western and East Asian cohorts confirmed that AC did not confer a survival advantage in EOGC patients. Conclusions: EOGC exhibits aggressive pathological characteristics, and chemotherapy does not consistently improve survival in EOGC patients. Full article