Open Medicine最新文献

{"title":"Earthquake preparedness and earthquake-related anxiety among emergency department patients: a cross-sectional study.","authors":"Burak Demirci, Burak Akın, Enes Ferhatlar, Selman Gündoğan, Ömer Kilim, Abuzer Coskun","doi":"10.1515/med-2026-1537","DOIUrl":"10.1515/med-2026-1537","url":null,"abstract":"<p><strong>Objectives: </strong>To describe earthquake-preparedness behaviors and earthquake-related anxiety responses in emergency department patients and examine associated factors and the relationship between the two composites.</p><p><strong>Methods: </strong>This cross-sectional study included 3,964 adults presenting to an emergency department in an earthquake-prone region between July and December 2025. A structured questionnaire assessed sociodemographic and housing characteristics, 15 binary preparedness behaviors, and five earthquake-related anxiety items. Preparedness was summarized as a behavioral composite (0-15) and anxiety as an exploratory composite (5-25). Nonparametric tests, effect sizes, false discovery rate adjustment, exploratory internal-structure analyses, and multivariable regression were used.</p><p><strong>Results: </strong>Median preparedness was 9 (IQR, 7-12) and median anxiety was 13 (IQR, 7-18). Knowledge-based behaviors were common, whereas practical measures were less frequent. Most group differences had small effect sizes. Preparedness showed a multidimensional structure, whereas anxiety showed a single-dimension exploratory structure. The inverse correlation was very weak (Spearman's ρ=-0.107; 95 % CI, -0.140 to -0.070). After adjustment, higher anxiety was associated with lower preparedness (B=-0.074; 95 % CI, -0.090 to -0.059), and higher preparedness with lower anxiety (B=-0.241; 95 % CI, -0.289 to -0.193).</p><p><strong>Conclusions: </strong>Practical preparedness remained incomplete. Preparedness and anxiety were weakly associated; findings are exploratory and should not be interpreted causally or diagnostically.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261537"},"PeriodicalIF":1.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucocorticoids combined with rituximab treatment for IgG4-related tubulointerstitial nephritis with diabetic nephropathy: a case report.","authors":"Tianshu Wang, Jingjing Zhang, Yaguang Xu","doi":"10.1515/med-2026-1528","DOIUrl":"10.1515/med-2026-1528","url":null,"abstract":"<p><strong>Objectives: </strong>IgG4-related disease is a chronic immune-mediated disorder featuring elevated serum IgG4 levels and the tissue infiltration of IgG4-positive plasma cells. Kidney involvement in IgG4-related disease, known as IgG4-related kidney disease, most commonly manifests as tubulointerstitial nephritis.</p><p><strong>Case presentation: </strong>A 55-year-old male presented with acute kidney injury (creatinine=816 μmol/L), severe anemia, lymphadenopathy, and high IgG4 levels (13.89 g/L). Renal MRI and Chest CT showed diffuse renal abnormalities and mediastinal lymphadenopathy. Renal biopsy confirmed IgG4-related tubulointerstitial nephritis, complicated by IgA nephropathy and diabetic nephropathy. Initial glucocorticoid treatment was prescribed followed by 1.8 g rituximab consolidation therapy. Over 32 months follow-up, the patient's renal function significantly improved (creatinine 215 μmol/L) and his serum IgG4 levels normalized (0.89 g/L).</p><p><strong>Conclusions: </strong>This success of this case suggests that combination therapy may be a reasonable option in selected cases, and underscores the importance of an early diagnosis, pathological confirmation, and standardized immunosuppressive therapy for improving the outcomes in IgG4-related kidney disease.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261528"},"PeriodicalIF":1.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secretory IgA and butyrate depletion in Southeast Chinese infants with cow's milk allergy: pathogenic link and diagnostic biomarker.","authors":"XiaoYan Chen, XiongFeng Xie, XiaoYun Shi, XueJie Gao, Hong Ye, Rui Zhang, YouTao Chen","doi":"10.1515/med-2026-1483","DOIUrl":"10.1515/med-2026-1483","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the clinical significance of fecal butyrate and SIgA as non-invasive biomarkers for CMPA diagnosis.</p><p><strong>Methods: </strong>45 OFC-confirmed CMPA infants (0-24 months) and 45 healthy controls were enrolled. Fecal SIgA (ELISA/BCA) and butyrate (HPLC) were quantified. Analyses included: univariate and multivariable logistic regression (adjusting for age/weight/length), symptom correlation (Cow's Milk-related Symptom Score, CoMiSS), and ROC-based diagnostic validation.</p><p><strong>Results: </strong>CMPA infants showed lower SIgA (6.39 ± 2.79 vs. 11.31 ± 3.32 μg/mg; p<0.001) and butyrate (298.81 vs. 810.07 μg/g; p=0.009). Both were associated with CMPA risk and inversely correlated with symptom severity. SIgA combined with CoMiSS achieved superior diagnostic accuracy (AUC=0.909) vs. CoMiSS alone (ΔAUC=0.103, p=0.010). Butyrate with CoMiSS showed no significant improvement (ΔAUC=0.002, p=0.767).</p><p><strong>Conclusions: </strong>This study indicates that low fecal SIgA and butyrate are associated with CMPA, suggesting they may play a role in the disease. The SIgA-CoMiSS integrated workflow allows non-invasive diagnosis with improved accuracy, addressing some limitations of current OFC-based protocols.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261483"},"PeriodicalIF":1.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant anthracycline-containing vs. anthracycline-free chemotherapy with dual HER2 blockade in HER2-Positive breast cancer: a Systematic Review and meta-analysis.","authors":"Wenwen Bai, Qingyu Wang, Zhiguo Zhou, Xiaoyan Lv, Yajing Wu, Yuzhi Song, Ruohui Zhang, Rui Zhang, Yunjie Cheng, Xinyi Li, Jun Wang","doi":"10.1515/med-2026-1525","DOIUrl":"10.1515/med-2026-1525","url":null,"abstract":"<p><strong>Objectives: </strong>Neoadjuvant chemotherapy with dual HER2 blockade is the standard of care for early-stage HER2-positive breast cancer. However, the role of anthracyclines remains controversial. This meta-analysis aimed to evaluate the efficacy and safety of neoadjuvant dual HER2 blockade combined with anthracycline-containing vs. anthracycline-free chemotherapy.</p><p><strong>Methods: </strong>A literature search was conducted across PubMed, EMBASE, and the Cochrane Library. Eligible studies included patients with resectable stage I-III HER2-positive breast cancer receiving neoadjuvant dual HER2 blockade with either an anthracycline-containing (A-based) or anthracycline-free (non-A) chemotherapy regimen. Standard meta-analytic methods using a random-effects or fixed-effect model were applied according to heterogeneity (I²).</p><p><strong>Results: </strong>Seven articles met the inclusion criteria. The addition of anthracyclines to dual HER2 blockade therapy (DHBT) did not significantly improve the pCR rate (OR, 1.07; 95 % CI, 0.81-1.43; p=0.62), composite DFS/EFS/PFS (HR, 0.50; 95 % CI, 0.18-1.38; p=0.18), or overall survival (OS) (HR, 0.77; 95 % CI, 0.39-1.51; p=0.45). The incidence of cardiac adverse events did not differ significantly between the A-based and non-A groups (OR, 0.96; 95 % CI, 0.31-2.91; p=0.94). No significant difference was observed in the incidence of LVEF decline ≥10 % from baseline to <50 % between the A-based and non-A groups (OR, 1.47; 95 % CI, 0.79-2.77; p=0.23). Notably, the non-A group had a significantly higher incidence of grade ≥3 diarrhea (OR, 0.60, favoring the A-based group; 95 % CI, 0.38-0.95; p=0.03).</p><p><strong>Conclusions: </strong>In resectable HER2-positive breast cancer, neoadjuvant DHBT without anthracyclines achieves pCR rates non-inferior to A-based regimens, with no early survival detriment observed. While short-term cardiotoxicity is unremarkable, grade ≥3 diarrhea occurs more frequently with non-A approaches.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261525"},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coordinated Hippo, IFN and NF-κB pathway activation in kidney rejection.","authors":"Eda Balkan, Murat Kızılkaya, Mahmut Aktürk, Elif Demirci, Necip Altundaş","doi":"10.1515/med-2026-1516","DOIUrl":"10.1515/med-2026-1516","url":null,"abstract":"<p><strong>Objectives: </strong>Renal allograft rejection diagnosis requires invasive biopsy. We assessed whether peripheral blood mRNA of 14 Hippo, interferon (IFN) and NF-κB pathway genes and 11 serum biomarkers could distinguish acute rejection from stable graft function.</p><p><strong>Methods: </strong>Three groups: biopsy-confirmed acute rejection (n=20), stable graft (n=25), healthy controls (n=30). PBMC mRNA was quantified by qRT-PCR; serum biomarkers by ELISA and spectrophotometry. Statistical analyses used Mann-Whitney <i>U</i> with Benjamini-Hochberg correction; ROC analyses used bootstrap 95 % CIs and 5-fold cross-validation. GEO datasets GSE51675 and GSE145408 provided directional cross-validation.</p><p><strong>Results: </strong>Thirteen of 14 genes were upregulated in rejection vs. controls (pFDR<0.01); <i>TEAD1</i> (log₂FC=+2.44) and <i>TRAF6</i> (+2.40) led. <i>ISG15</i> was downregulated in both transplant groups, consistent with calcineurin inhibitor-mediated suppression, while serum free ISG15 protein was unchanged in stable graft but markedly lower in rejection than in both controls and stable graft (pFDR<0.001 and 0.002), discriminating rejection from stable graft in a way the mRNA signal did not. Only <i>TEAD1</i> (Cohen's <i>d</i>=1.40) and <i>YAP1</i> (<i>d</i>=1.17) discriminated rejection from stable graft with adequate power. <i>TEAD1</i> mRNA (AUC=0.849) and serum leptin (AUC=0.922) were the strongest single markers; their combination yielded cross-validated AUC=0.990.</p><p><strong>Conclusions: </strong>PBMC <i>YAP1/TEAD1</i> with serum leptin are promising non-invasive biomarkers for acute renal rejection. <i>ISG15</i> downregulation is more consistent with calcineurin inhibitor-mediated suppression than with generalized immune impairment, although this interpretation requires direct mechanistic confirmation; notably, serum free ISG15 protein discriminated rejection from stable graft even though PBMC ISG15 mRNA did not, suggesting the protein-level measurement warrants further evaluation as a candidate marker. Prospective multicentre validation is required.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261516"},"PeriodicalIF":1.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenolic and fatty acid profile and antioxidant activity of <i>Fumaria agraria</i>.","authors":"Ferdaous Albouchi, Gianluigi Maria Lo Dico, Luay Rashan, Vittorio Calabrese, Manef Abderrabba","doi":"10.1515/med-2026-1517","DOIUrl":"10.1515/med-2026-1517","url":null,"abstract":"<p><strong>Objectives: </strong><i>Fumaria agraria</i> is still poorly characterized, although the interest in plant-derived bioactive compounds is growing. This study aimed to investigate its phytochemical composition and its antioxidant potential.</p><p><strong>Methods: </strong>Sequential solvent extraction yielded <i>n</i>-hexane, ethyl acetate and methanol fractions. Fatty acids were determined by gas chromatography with flame ionization detection (GC-FID) and phenolic compounds in the polar fractions by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Antioxidant activity was assessed via DPPH, ABTS, and FRAP assays, alongside total phenolic (TPC) and flavonoid (TFC) content.</p><p><strong>Results: </strong>GC-FID analysis identified five fatty acids dominated by unsaturated forms (76.51 %), with linoleic acid as the principal individual component (40.29 %). LC-MS/MS analysis revealed 11 phenolic compounds, with luteolin being the most abundant phenolic compound, accounting for 67 % of the total identified polyphenols. The polar extracts exhibited the highest TPC, TFC, and antioxidant activity in all assays.</p><p><strong>Conclusions: </strong><i>F. agraria</i> is a valuable source of unsaturated fatty acids and flavonoids, particularly luteolin, which likely contribute to the antioxidant activity of its polar extracts. These findings support its traditional medicinal use and highlight its potential as a source of natural antioxidant compounds, although further <i>in vivo</i> studies are required to confirm these results.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261517"},"PeriodicalIF":1.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel prognostic model based on Golgi apparatus-related genes predicts patient survival in glioblastoma.","authors":"Hongliu Wang, Zhigang Liao, Lihua Jin, Youkun Dong, Hanjiang Cui, Xihong Xing, Feng Lu, Kedong Jiang, Xiaoli Hu, Xiaofen Bo, Li Ni","doi":"10.1515/med-2026-1479","DOIUrl":"10.1515/med-2026-1479","url":null,"abstract":"<p><strong>Objectives: </strong>Glioblastoma (GBM) is a highly aggressive brain cancer. Golgi dysfunction plays a role in tumorigenesis.</p><p><strong>Methods: </strong>This study analyzed the role of Golgi apparatus-related genes (GARGs) in GBM using bioinformatics. Prognostic genes were identified using differential expression, Cox, and Lasso analyses. A prognostic model and nomogram were constructed based on gene expression and clinical characteristics. Immune infiltration and drug sensitivity analyses were performed in different risk groups. Reverse transcription quantitative PCR (RT-qPCR) was employed to explore the expression of prognostic genes.</p><p><strong>Results: </strong>A total of 5 prognostic genes (CD14, FMOD, LGR6, SLC16A13, and KDELR2) of GBM were identified, and on the basis of the prognostic genes, a prognostic model was built. There was a significant survival difference between patients in the high and low risk groups for GBM. Receiver operating characteristic (ROC) curve indicated that the predictive effect of the prognostic model in the training set was moderate, with an AUC value of around 0.7. The nomogram showed that risk score had a better predictive effect than age. Drug sensitivity analysis demonstrated that sorafenib was more sensitive in the low-risk group of GBM. RT-qPCR results revealed that compared with the control group, the expression levels of CD14 and SLC16A13 were significantly downregulated in GBM cell lines, while FMOD and LGR6 were markedly upregulated. The expression of KDELR2 exhibited obvious cell line-dependent variation.</p><p><strong>Conclusions: </strong>In summary, this study establishes a Golgi apparatus-related gene signature that not only offers prognostic insights but may also informs tailored therapeutic strategies for GBM patients.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261479"},"PeriodicalIF":1.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Admission blood gas, platelet, and inflammatory parameters associated with intraventricular hemorrhage in preterm infants: a retrospective case-control study.","authors":"Zeynep Alara Saltık, Hakan Aylanc","doi":"10.1515/med-2026-1521","DOIUrl":"10.1515/med-2026-1521","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the association between admission blood gas, platelet, and inflammatory parameters and the presence of IVH.</p><p><strong>Methods: </strong>This retrospective case-control study included 356 preterm infants admitted to a tertiary neonatal intensive care unit between 2016 and 2025, including 165 infants with IVH and 191 without IVH. Initial blood gas and complete blood count parameters were analyzed. Multivariable logistic regression was used to identify independent factors associated with IVH.</p><p><strong>Results: </strong>Lower gestational age was significantly associated with IVH presence and severity (p<0.001). Lactate levels were higher in the IVH group (3.10 vs. 2.60 mmol/L; p=0.013). In the exploratory integrated model including gestational age, lactate, platelet count, MPV, and the N/L ratio, lactate showed a borderline association with IVH (OR=1.099, 95 % CI: 0.995-1.214; p=0.063), whereas lower platelet count, lower MPV, and higher N/L ratio remained independently associated with IVH.</p><p><strong>Conclusions: </strong>Lower platelet counts, lower MPV values, and higher N/L ratios were independently associated with IVH in the exploratory integrated model, while admission lactate showed a borderline association after adjustment for gestational age and hematological parameters. These findings should be interpreted as early associations rather than validated predictive biomarkers, and prospective studies with standardized cranial ultrasonography and external validation are needed.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261521"},"PeriodicalIF":1.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated segmentation of lymph node metastases in colorectal cancer based on convolutional KAN.","authors":"Peng Wang, Zixiong Fan, Haoyu Wu, Kaijiao Wang, Jinyi Lu, Yang Zhou, Yang Liu, Baoshun Zhang","doi":"10.1515/med-2026-1469","DOIUrl":"10.1515/med-2026-1469","url":null,"abstract":"<p><p>Accurate preoperative segmentation of colorectal cancer lymph node metastasis holds significant clinical value for formulating individualized surgical strategies. However, accurate segmentation remains a formidable challenge due to the complex backgrounds, small sizes, irregular shapes, and indistinct boundaries typically exhibited by colorectal cancer lymph nodes. Consequently, this paper proposes the U-Convolutional KANs Attention Net (UCKAN). First, in complex environment, we replace the convolutional layers with the convolutional KAN module, leveraging the learnable non-linear fitting advantage of KAN to enhance the ability to accurately extract the features of small targets. Second, we invented the Global Spatial Multi-scale Attention (GSMA) module, which integrates global context and multi-scale features to improve the model's sensitivity to small-volume lymph nodes, achieving precise spatial focusing on lesions. Evaluations on practical medical imaging tasks show that the UCKAN model has superior performance., with Dice and IoU scores reaching 91.52 and 83.29 %, respectively, comprehensively outperforming eight advanced medical image segmentation models. The innovative mechanisms proposed in this study effectively address the segmentation challenges associated with low-contrast and multi-scale lesions, providing a reliable quantitative basis for formulating individualized preoperative surgical strategies and demonstrating significant potential for clinical translation.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261469"},"PeriodicalIF":1.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of surgical site infection/fracture related infection after open tibial fracture.","authors":"Yabin Liu, Guoqi Ji, Chengkuo Cai, Hengsheng Shu","doi":"10.1515/med-2026-1493","DOIUrl":"10.1515/med-2026-1493","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and internally validate leakage-robust landmark models to estimate 12-month fracture-related infection (FRI) risk after open tibial fracture at admission and postoperative day 3 (POD3).</p><p><strong>Methods: </strong>In this single-center retrospective cohort, adults with open tibial fractures treated with limb salvage between January 2023 and June 2024 were included. Definite 12-month FRI was adjudicated using the international FRI consensus definition. Two landmark models were prespecified: admission and postoperative day 3 (POD3). Predictors included injury severity, contamination, host and physiologic factors, antibiotic timing, and, at POD3, early clinical course, routine laboratory results, debridement timing, and soft-tissue coverage status. Elastic net-penalized logistic regression with restricted cubic splines was used. Missing data were addressed with multiple imputation nested within 1,000-bootstrap internal validation. Performance was assessed by AUC, Brier score, calibration, and decision curve analysis.</p><p><strong>Results: </strong>Among 913 patients, 125 (13.7 %) developed FRI. The admission model achieved an AUC of 0.77 and Brier score of 0.097. The POD3 model improved performance (AUC 0.82; Brier 0.089) and showed slightly greater net benefit across 5-25 % thresholds.</p><p><strong>Conclusions: </strong>Landmark models provided internally validated 12-month FRI risk estimates at admission and POD3, with modest improvement after POD3 updating. External validation and recalibration are required to evaluate its potential clinical deployment.</p>","PeriodicalId":19715,"journal":{"name":"Open Medicine","volume":"21 1","pages":"20261493"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}