Search Results (479)

Background: The number of elderly patients with hepatocellular carcinoma (HCC) has been increasing worldwide. This study aimed to evaluate the clinical outcomes of stereotactic body radiation therapy (SBRT) for patients aged ≥80 years with solitary HCC. Methods: This retrospective study included 117 patients with solitary HCC treated with SBRT between January 2019 and June 2025 at eight institutions in Japan. Patients were categorized into the very elderly group (≥80 years, n = 41) and the control group (<80 years, n = 76). Overall survival (OS), local tumor progression (LTP), and treatment-related toxicities were evaluated. Propensity score matching (PSM) was performed to minimize baseline imbalances between the two groups. Results: The median age was 84 years in the very elderly group and 74 years in the control group. The 3-year OS rates were 79.0% in the very elderly group and 62.8% in the control group, with no statistically significant difference observed (crude cohort: 95% CI, 0.18–1.08, p = 0.072; PSM cohort: 95% CI, 0.12–1.26, p = 0.114). The 3-year LTP rates were 18.9% in the very elderly group and 15.6% in the control group, without significant intergroup differences. Acute toxicities were numerically more frequent in the very elderly group; however, no grade ≥3 toxicities or treatment-related deaths were observed. Changes in ALBI score did not differ significantly between groups (p = 0.785). Conclusions: SBRT may represent a feasible treatment option with an acceptable safety profile in carefully selected very elderly patients with solitary HCC. It may be a reasonable option for this growing patient population. Full article

Background: Eczema, atopic dermatitis, and urticaria are common pediatric inflammatory skin diseases, but serum vitamin profiles across these diseases remain poorly characterized. Objectives: To compare demographic characteristics, serum vitamin levels, and vitamin insufficiency rates among children with these diseases, and to identify independent factors associated with disease presence. Methods: This retrospective study included 504 children: 43 with eczema, 43 with atopic dermatitis, 40 with urticaria, and 378 healthy controls. Serum levels of nine vitamins were measured by electrochemical assays. Univariable and multivariable logistic regression analyses were used to identify associated factors with false discovery rate correction. Propensity score matching based on age and sex was additionally performed for each disease-control comparison, followed by matched regression analyses. An exploratory nomogram was developed and evaluated. Results: The mean age of the cohort was 6.26 years, and 50.2% were male. Vitamin B9 insufficiency was the most prominent abnormality, occurring more frequently in the overall disease group than in controls (17.5% vs. 0.3%, p < 0.001). Vitamin D insufficiency appeared more frequently in the urticaria group than in controls (42.5% vs. 28.3%, p = 0.062). In multivariable analyses after PSM, vitamin B9 insufficiency and lower vitamin B6 levels remained independently associated with all three diseases. Conclusions: Pediatric inflammatory skin diseases exhibited distinct vitamin profiles relative to healthy controls, with vitamin B9 insufficiency emerging as a common feature across eczema, atopic dermatitis, and urticaria. Full article

Background: The ERAS (Enhanced Recovery After Surgery) protocol is a multidisciplinary perioperative care pathway aimed at improving postoperative recovery. Few studies have investigated their effectiveness in thyroid surgery. The aim of this study was to evaluate the potential clinical benefits of a structured ERAS protocol applied to thyroid surgery in a tertiary referral center. Methods: We conducted a single-center retrospective study on consecutive series of patients undergoing thyroid surgery for benign or malignant disease before (January 2018–December 2022) and after (May 2024–July 2024) the introduction of the ERAS protocol. A propensity score matching (PSM) analysis was used, matching the groups for age, gender, BMI and type of surgery. Results: After PSM, 64 matched patient pairs were analyzed. ERAS patients showed a significant reduction in length of hospital stay (p < 0.001), postoperative nausea and vomiting (3.1% vs. 12.5%, p = 0.04), and pain with an NRS > 5 12 h after surgery (9.4% vs. 26.6%, p = 0.01). Patients in the ERAS group showed significantly higher calcium levels at 6 h (9.09 vs. 8.7 mg/dL, p < 0.001) and 24 h (8.8 vs. 8.6 mg/dL, p = 0.008) postoperatively, with a reduction in the need for intravenous calcium therapy (0% vs. 12.5%, p = 0.003). Conclusions: This study showed significant clinical benefits and reduced length of stay were achieved in thyroid surgery patients after the implementation of a structured ERAS protocol with potential implications for healthcare cost reduction. Full article

Background/Objectives: Adolescence is a critical life stage characterized by rapid growth, increased nutrient requirements, and the establishment of long-term healthy behaviors. Growing evidence suggests that nutritional inadequacies may persist even when conventional indicators such as body mass index (BMI) appear normal, reflecting hidden malnutrition, a condition characterized by micronutrient inadequacy despite adequate energy intake. This issue may be particularly relevant in structurally constrained environments. This study aimed to compare dietary intake and nutrient adequacy between adolescents residing in residential care institutions (RCIs) and those in the general population in Taiwan. Methods: A total of 248 adolescents were included in the analysis. Institutional data were collected in 2018 and compared with nationally representative data from the Nutrition and Health Survey in Taiwan (NAHSIT 2010–2012). To improve comparability, 1:1 propensity score matching (PSM) was applied based on age, sex, and geographic region. Nutrient intakes were evaluated according to the Taiwan Dietary Reference Intakes (DRIs). Results: Adolescents in RCIs demonstrated significantly lower energy and protein adequacy than their counterparts in the general population. Among boys aged 13–15 years, the proportion meeting protein adequacy was substantially lower in RCIs than in the general population (34.0% vs. 84.0%). Similarly, among girls aged 13–15 years, energy adequacy was markedly lower in RCIs (25.0% vs. 63.9%). In addition, inadequate intake of multiple micronutrients, particularly B vitamins and essential minerals, was observed. Despite these differences, BMI remained largely comparable between groups, indicating a mismatch between anthropometric status and underlying nutritional quality. Conclusions: These findings suggest that hidden nutritional vulnerability may persist even within structured institutional environments designed to ensure stable food provision. The results highlight the limitations of relying solely on anthropometric indicators to assess nutritional status and underscore the need for targeted nutritional strategies to improve dietary quality and reduce health inequalities in residential care settings. Full article

Background/Objectives: This retrospective cohort study compared hospitalization and follow-up rates in patients with newly diagnosed proliferative diabetic retinopathy (PDR) versus those without prior diabetic retinopathy (DR) screening. Methods: Using TriNetX, a global electronic health record database, 57,964 patients aged ≥ 40 years with type 2 diabetes and newly diagnosed PDR without diabetic macular edema (DME) requiring panretinal photocoagulation or intravitreal injection were included. Patients were stratified based on the presence or absence of prior DR screening in the last 5 years and balanced using propensity score matching (PSM). Primary outcomes included 30-, 60-, and 90-day hospitalization rates and repeat ophthalmic follow-up as estimated using repeat PDR diagnosis codes and repeat retinal imaging codes, including OCT, fundus photography, and fluorescein angiography. Results: Of 57,964 patients, 25,003 had no prior DR screening and 32,961 had prior DR screening. After matching, 19,316 patients were included per cohort. Patients without known DR screening had significantly higher hospitalization rates at 30 days (RR = 1.78, 95% CI 1.67–1.89), 60 days (RR = 1.59, 95% CI 1.51–1.67), and 90 days (RR = 1.51, 95% CI 1.44–1.58), and lower repeat ophthalmic visits by PDR codes at 30 days (RR = 0.458, 95% CI 0.440–0.476), 60 days (RR = 0.450, 95% CI 0.437–0.463) and 90 days (RR = 0.420, 95% CI 0.408–0.432) or by repeat retinal imaging codes at 30 days (RR = 0.450, 95% CI 0.423–0.478), 60 days (RR = 0.394, 95% CI 0.377–0.411), and 90 days (RR = 0.381, 95% CI 0.366–0.396) (all p < 0.0001). Conclusions: Absence of known prior DR screening in PDR patients is associated with higher hospitalization risk and reduced ophthalmic follow-up, suggesting that a lack of screening indicates broader gaps in healthcare engagement and disease control. Tailored strategies are needed to prevent vision loss as well as systemic complications. Full article

Rural industrial integration is widely recognized as a pivotal strategy for rural revitalization and sustainable development. However, despite its potential to foster economic growth, its actual impact on the livelihood resilience of individual farm households remains a complex issue that requires empirical validation. Drawing upon the Sustainable Livelihood Analysis (SLA) framework and micro-level data from the China Land Economic Survey (CLES) (2020–2022), this study employs propensity score matching (PSM) and the conditional mixed process (CMP) method to systematically examine the impact of rural industrial integration on household livelihood resilience, its transmission mechanisms, and its heterogeneous effects. The empirical results demonstrate that rural industrial integration significantly enhances farmers’ livelihood resilience, with an estimated net impact of 17.1%. Specifically, the positive influence on learning capacity is found to be more pronounced than that on buffering and self-organizing capacities. Mechanism analysis suggests that livelihood resilience is bolstered through the dual pathways of “external push” and “endogenous pull.” Furthermore, heterogeneity analysis reveals that models involving vertical industrial chain extension and technology diffusion models yield more substantial impacts among various integration forms. Notably, compared to leading enterprises, participation in cooperatives is found to exert a more significant influence on farmers’ resilience. Consequently, to promote sustainable livelihoods, policy interventions should prioritize the integrated development of rural industries by balancing external resource mobilization with the activation of internal drivers, while remaining vigilant against potential development imbalances arising from different organizational structures. Full article

Background: The prognostic significance of histological transformation (HT) in treatment-naive diffuse large B-cell lymphoma (DLBCL) remains controversial. This study aimed to evaluate the clinical outcomes and failure patterns of treatment-naive transformed DLBCL (trDLBCL) compared with de novo DLBCL using a large-scale cohort. Methods: We retrospectively analyzed 1735 consecutively enrolled treatment-naive DLBCL patients (118 trDLBCL and 1617 de novo). Propensity score matching (PSM) was performed to balance baseline characteristics. Survival outcomes were assessed using Kaplan–Meier and Cox proportional hazards models. Subgroups were defined by pathology (t-FL vs. t-MZL) and pattern: concurrent (synchronous indolent lymphoma and DLBCL components at diagnosis) vs. pure transformation (DLBCL occurring as the sole histology in patients with a prior history of untreated indolent lymphoma). Results: In the overall cohort, trDLBCL was associated with significantly inferior progression-free survival (PFS) compared with de novo disease and remained an independent adverse prognostic factor in multivariable analysis (HR 1.754, p < 0.001). These findings were confirmed in a 1:1 propensity score-matched cohort (108 pairs), where trDLBCL continued to show worse PFS (p < 0.01), while overall survival (OS) was comparable (p = 0.99). Within trDLBCL patients, the underlying indolent subtype (t-FL vs. t-MZL) did not significantly affect survival (PFS p = 0.17, OS p = 0.35), whereas “pure transformation” was associated with markedly inferior PFS (p = 0.005) and OS (HR 2.56, p = 0.02) compared with concurrent transformation. Failure pattern analysis revealed a higher risk of early progression in trDLBCL (POD24: 30.56% vs. 18.52%; OR 1.94, 95% CI: 1.05–3.56), whereas central nervous system (CNS) involvement was low and comparable between groups (2.78% vs. 0.93%, p = 0.62). Conclusions: Treatment-naive trDLBCL is associated with inferior PFS driven by early progression, whereas OS is comparable due to effective salvage therapies. Pure transformation appeared to define a higher-risk subgroup with inferior disease control, supporting the need for future prospective studies to evaluate risk-adapted frontline, consolidation, or maintenance strategies. Full article

Background and Objectives: FLOT is a highly effective first-line treatment for metastatic gastric cancer and offers a favorable safety profile. Clinical studies investigating the FLOT regimen have reported varying outcomes depending on the infusion duration and have highlighted possible differences in complication rates and the efficacy of neoadjuvant therapy. The choice between 24 h or 48 h infusion durations for fluorouracil can be influenced by several factors, such as the patient’s overall health status, their tolerance to treatment, and the specific treatment protocol determined by the medical team. In this study, we aimed to evaluate the effects of different infusion durations (24 and 48 h) on clinical response, toxicity, and survival in patients with gastric and gastroesophageal junction (GEJ) adenocarcinoma. Materials and Methods: This retrospective multicenter study included 113 patients with gastric or gastroesophageal junction adenocarcinoma who received neoadjuvant FLOT chemotherapy (24 h infusion: n = 28; 48 h infusion: n = 85). Propensity score matching (PSM) was performed to balance baseline characteristics, yielding a matched cohort of 90 patients. The primary endpoints were the pathologic complete response (pCR) and toxicity. Secondary endpoints included disease-free survival (DFS) and overall survival (OS). Results: Significant baseline imbalances existed (cT stage p < 0.001). After PSM, the balance improved (cT stage p = 0.009). In the matched cohort, pCR 11.1% (24 h) vs. 12.1% (48 h), p > 0.99. The median DFS was 27.4 mo (24 h) vs. NR (48 h), p = 0.847. The median OS was 32.8 mo in both, p = 0.797. Multivariate analysis (baseline variables) indicates that infusion duration is not prognostic (DFS HR = 0.77, p = 0.453; OS HR = 0.72, p = 0.328). Power was ~10% for a 1% pCR difference. Conclusions: The 24 h infusion protocol was associated with similar outcomes to the 48 h protocol after PSM adjustment. However, residual confounding persists (cT stage p = 0.009 despite PSM), and the combination of this study’s retrospective design and severe underpowering (~10%) precludes definitive conclusions. As a result, the findings are hypothesis-generating. Full article

This study examines how internal board governance influences carbon emission disclosure (CED), conceptualized as both a key dimension of ESG transparency and a mechanism for managing disclosure-related risks. Using panel data from 175 listed firms across six ASEAN countries during 2014–2021, we develop a composite Board Effectiveness Score (BES) that integrates five governance attributes: gender diversity, board size, board independence, meeting frequency, and the presence of an environmental committee. Unlike prior single-attribute studies, the BES captures governance complementarities and the interactive effects of board structures. Applying a multi-method empirical framework—including fixed-effects estimation, quantile regression, two-step system GMM, Heckman selection correction, Propensity Score Matching (PSM), and Two-Stage Least Squares (2SLS)—we find that gender-diverse boards, environmental committees, and higher BES values significantly enhance carbon emission disclosure. The results remain robust across alternative disclosure measures and additional econometric specifications, with the strongest effects observed among low- and mid-level disclosing firms. These findings highlight the role of internal board governance as a potential substitute for weak institutional oversight in emerging markets. The study offers practical implications for regulators and investors seeking to strengthen climate transparency, ESG accountability, and governance-based risk management in ASEAN economies. Full article

Market-based environmental regulations are increasingly vital for driving green transitions. As a major construction economy and the world’s leading carbon emitter, China launched its Carbon Emission Trading System (CETS) to advance dual-carbon goals and pilot decarbonization in high-emission sectors. Using 2009–2021 data on A-share listed construction enterprises, this study employs a propensity score matching difference-in-differences (PSM-DID) approach to assess CETS’ impact on corporate Environmental, Social, and Governance (ESG) performance. Results show that CETS significantly improves construction enterprises’ ESG performance. Mechanism analysis identifies green technology innovation as a key transmission channel, with government subsidies positively moderating this effect. Heterogeneity analyses reveal stronger policy effects among state-owned enterprises and firms in eastern regions. These findings remain robust under alternative specifications, matching methods, and higher-order fixed effects. This study offers micro-level evidence on how market-based carbon regulations shape corporate sustainability through ESG, informing China’s carbon market refinement and global market-driven decarbonization efforts. Full article

Background: Minimally invasive surgery is the standard approach in colorectal cancer (CRC), yet the clinical value of robotic-assisted surgery (RAS) compared with laparoscopy remains under debate. This study aimed to compare surgical quality using textbook outcome (TO) and textbook oncological outcome (TOO) in patients undergoing minimally invasive resection for locally advanced CRC. Methods: A retrospective analysis of patients with locally advanced CRC (cT2-4N0-2M0) treated in a high-volume centre was performed. Patients undergoing laparoscopic or robotic surgery were included. Propensity score matching (PSM) was applied to balance baseline characteristics. TO was defined as an optimal perioperative course without complications, conversion, reintervention, prolonged length of stay, or mortality. TOO extended TO by including oncological parameters such as R0 resection and adequate lymph node yield. Results: A total of 123 patients were included (80 laparoscopic, 43 robotic), with 80 patients analyzed after PSM (40 per group). RAS was associated with significantly higher rates of intracorporeal (97% vs. 18.9%) and mechanical anastomoses (96.9% vs. 48.6%). No differences were observed in postoperative complications, reintervention rates, length of stay, or mortality. Although the comprehensive complication index was lower in the robotic group, this did not translate into improved TO or TOO rates. After matching, TO was achieved in 72.5% of RAS and 85.0% of laparoscopic cases (p = 0.1745), while TOO rates were also comparable between groups. No independent predictors of TO or TOO were identified in multivariable analysis. Conclusions: Robotic surgery for locally advanced CRC provides comparable perioperative safety and oncological quality to laparoscopy. The implementation of RAS in a high-volume centre does not compromise short-term outcomes, supporting its safe integration into clinical practice. Full article

The research on the effectiveness and mechanism of environmental policy is the focus of ecological policy research. This paper constructs panel data and studies the Eco-efficiency (EE) and influence mechanism of Central Environmental Supervision (CES). The Super Slacks-Based Measure (Super-SBM) model is adopted to measure EE. Difference-in-Differences (DID) methods were used for regression analysis. (1) Research shows that CES can significantly improve EE by 5.11%. A parallel trend test shows that DID is valid. (2) Endogeneity test does not find reverse causality, and Propensity Score Matching and Difference-in-Differences (PSM-DID) test does not find sample selection bias. Variable substitution test shows that the conclusions remain robust. The time bandwidth test finds that the longer CES is implemented, the better the effect. (3) CES can promote EE through industrial upgrading, technological innovation, and promoting green consumption, with relative contributions of 17.52%, 13.78%, and 14.57% respectively. (4) Heterogeneity analysis shows that CES has a significant impact on the EE of the eastern, central, and western cities, with insignificant differences, and the impact is stronger in the core cities. CES only has a significant impact on large- and medium-sized cities with a population of 3 to 10 million. Full article

Enhancing the willingness of rural–urban migrant workers (RUMs) to pursue the withdrawal of rural homesteads is a key measure to deepen the reform of the rural land system and advance new-type urbanization. This study aims to examine the impact of trade union participation on RUMs’ willingness to withdraw from rural homesteads (WFRH). It further offers implications for improving trade union services and refining relevant institutional arrangements for homestead withdrawal. Based on valid questionnaire data from 1949 RUMs in Hefei, Anhui Province, China, analytical methods, including the ordered Probit model, Propensity Score Matching (PSM), and KHB model, are adopted for empirical analysis. The main conclusions are as follows: trade union participation significantly enhances RUMs’ willingness to WFRH. This conclusion remains robust after the replacement of explained variables, adjustment of econometric models, and use of the PSM method to correct for selection bias. Heterogeneity analysis based on an ordered probit model reveals that the impact of trade union participation on homestead withdrawal willingness is more pronounced among females, individuals under 45 years old, and those with a college degree or above. Mediation effect test based on the KHB model finds that urban identity and sense of social fairness play mediating roles between trade union participation and RUMs’ homestead withdrawal willingness. Trade union participation improves their withdrawal willingness by strengthening their urban identity and sense of social equity. Efforts should be made to enhance the willingness of RUMs to withdraw from homesteads by improving the service function system of “capacity cultivation + rights protection + emotional connection” of trade unions, expanding the effective coverage of trade union organizations, promoting the collaborative linkage between “trade unions and governments”, and strengthening the full process service support for homestead withdrawal. The study conclusions help optimize the allocation of rural land resources and advance the integration of urban and rural development. Full article

Background and Objectives: Whether hyperglycaemia causes hypertension, hypertension worsens glycaemic control, or both conditions arise from shared metabolic drivers remains clinically consequential yet unresolved. This study applies a triangulated causal inference framework to large-scale population data to quantify the direction, magnitude, and robustness of the glucose–blood pressure relationship. The primary objective is to test for bidirectional causal effects between glycaemic status and blood pressure; secondary objectives include quantifying effect magnitudes by multiple complementary methods and assessing robustness to unmeasured confounding. Materials and Methods: We analysed 55,386 adults from the National Health and Nutrition Examination Survey (NHANES, 1999–2023). Multiple causal inference techniques were integrated: directed acyclic graph (DAG) testing, structural equation modelling (SEM) with latent constructs, propensity score matching (PSM), inverse probability weighting (IPW), doubly robust augmented IPW (AIPW), and E-value/Rosenbaum Γ sensitivity analyses, with external replication in the Framingham Heart Study data (n = 4240). Results: All of the methods used confirmed the bidirectional effects. PSM showed that hyperglycaemia increased systolic BP by 1.76 mmHg (95% CI: 0.58–2.96, p = 0.005), and hypertension increased fasting glucose by 6.55 mg/dL (95% CI: 4.61–8.58, p < 0.001), revealing a marked asymmetry favouring the BP → glucose direction. AIPW confirmed both effects (3.51 mmHg and 6.15 mg/dL, both p < 0.001). SEM identified significant bidirectional structural paths between latent glycaemic and blood-pressure constructs, with the Glycaemic → BPState path showing a negative coefficient (β = −0.15, p = 0.043), a sign reversal attributable to conditioning on the shared latent metabolic-syndrome factor. Sensitivity analyses indicated that an unmeasured confounder would need associations of RR ≥ 1.40–1.64 with both exposure and outcome to nullify these estimates, representing moderate robustness. Conclusions: The BP → glucose pathway is the dominant causal direction, suggesting that prioritisation of hypertension control may yield underappreciated benefits for glycaemic regulation. These findings support integrated cardiometabolic management strategies. Full article

Background/Objectives: Emerging evidence suggests that alterations in lipid metabolism may play a contributing role in the pathogenesis of age-related macular degeneration (AMD). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a novel class of lipid-lowering agents, offer anti-inflammatory and antioxidant benefits, which may provide protective effects against AMD. We aimed to evaluate the risk of developing AMD among patients with atherosclerotic cardiovascular disease (ASCVD) who were newly treated with PCSK9 inhibitors compared with those receiving statins. Methods: This retrospective cohort study utilized data from the Global Collaborative Network within the TriNetX Research Network. Patients with ASCVD who were newly initiated on PCSK9 inhibitors or statins were identified and matched for age, sex, race, laboratory data, comorbidities, and concomitant medications. The primary outcomes were the hazard ratios (HRs) for developing AMD, dry AMD, and wet AMD. Propensity score matching (PSM) was used to adjust for baseline demographics and comorbidities. Results: After PSM, 50,102 patients were included in each group (PCSK9 inhibitor users vs. statin users). Compared to statin users, PCSK9 inhibitor users had significantly lower risks of AMD (HR, 0.81; 95% confidence interval [CI], 0.72–0.92) and dry AMD (HR, 0.78; 95% CI, 0.65–0.94), but not wet AMD (HR, 0.90; 95% CI, 0.70–1.16). Stratified and subgroup analyses showed reduced AMD risk among patients aged ≥65 years, White patients, female patients, and evolocumab users. Conclusions: In patients with ASCVD, compared with use of statins, use of PCSK9 inhibitors is associated with reduced risks of AMD and dry AMD, suggesting a potential novel strategy for managing a condition with limited therapeutic options. Full article