Frontiers in Medicine最新文献

Objective: To explore the advantages, applications and shortcomings of virtual reality technology in the prevention of delirium in ICU patients with mechanical ventilation, and to provide references for clinical practice and research in this field.

Methods: This study adopted the narrative review method and systematically retrieved nine databases and related websites including PubMed, Web of Science, Scopus, Embase, Cochrane Library, China Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang, and VIP database. It aims to collect relevant Chinese and English literature published before April 30, 2025. This study reviews the application, effect and evaluation of virtual reality technology in the prevention of delirium in ICU patients with mechanical ventilation.

Results: Virtual reality technology can effectively alleviate patients' negative emotions, enhance the interest and compliance of early activities, and have a positive impact on cognitive functions such as working memory by providing immersive experiences, thereby reducing the risk of delirium from multiple dimensions. Existing evidence indicates that this technology has basic safety and feasibility in such critically ill patients. However, current research generally has limitations such as small sample size, lack of support from high-quality randomized controlled trials, relatively single virtual reality content, insufficient personalization, and insufficient validation of the reliability and validity of related usability evaluation tools in the ICU population.

Conclusion: Virtual reality technology has shown significant potential in preventing delirium in ICU patients with mechanical ventilation. Future research should focus on constructing systematic and individualized virtual reality intervention programs, developing and verifying assessment tools suitable for local ICU patients, and further clarifying its long-term efficacy, optimal implementation model and cost-effectiveness through multi-center large-sample studies, so as to promote the standardized application and clinical transformation of this technology.

Objective: The present study was designed to investigate the effects of exercise training under hypoxic versus normoxic conditions on cardiometabolic health and body composition in older adults.

Method: A systematic search was carried out in five databases, namely PubMed, Web of Science, Embase, Scopus, and the Cochrane Library. Meta-analysis, Cochrane assessment, subgroup analysis, and publication bias assessment were conducted using the Stata 18 and RevMan 5.4 analysis tools.

Results: A total of 12 randomized controlled studies were included, involving 358 participants. Subgroup analysis indicated that hypoxic training (HT) could significantly enhance the cardiorespiratory fitness (CRF) of non-healthy older adults (Hedges' g = 0.57, p < 0.05). The combination of hypoxia and combined training (CT) could significantly improve the CRF of older adults (Hedges' g = 0.88, p < 0.05) and could reduce the systolic blood pressure (SBP) (Hedges' g = -0.51, p < 0.05) and diastolic blood pressure (DBP) (Hedges' g = -0.50, p < 0.05) of older adults. Regarding body composition, no significant differences were observed in body mass (BM), body mass index (BMI), fat-free mass (FFM), and fat mass (FM) for HT.

Conclusion: Compared with exercise in a normoxic environment, CT (aerobic and resistance training) in a hypoxic environment better improves cardiometabolic health in older adults. Moreover, hypoxic training can enhance CRF in older adults with multiple comorbidities or diabetes, playing a role in preventing and improving cardiometabolic health in this population.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251011076.

Goserelin is widely used for prostate cancer, but drug-induced liver injury (DILI) has been rarely reported. We present a patient who developed ALT/AST elevations after each subcutaneous injection, followed by improvement after withdrawal and hepatoprotective therapy, with positive rechallenge upon re-exposure. By the EASL definition, the R-value was ≈6.0, indicating a hepatocellular pattern; Hy's law was not fulfilled. Causality assessed with the updated RUCAM (2016) yielded a total score of 11, corresponding to highly probable. Although the ALT peak did not exceed 5 × ULN, the consistent temporal association and positive rechallenge prompted discontinuation/adjustment of goserelin with close biochemical follow-up, achieving a favorable outcome. This case underscores the need for vigilant monitoring-particularly with higher doses or re-exposure-and highlights the utility of R-value typing, Hy's law, and the updated RUCAM in guiding management. Liver biopsy was not performed, representing a limitation.

Background: The neurosurgical workforce has expanded markedly across Europe, often accompanied by declining operative exposure per surgeon. Austria, with one of the highest physician and hospital bed densities in the OECD, provides an important case study to assess whether workforce expansion has translated into proportional service provision and maintained training opportunities.

Methods: We performed a retrospective, nationwide analysis of official health statistics from Statistik Austria covering 1997-2023. Data included numbers of practicing neurosurgeons, all specialist physicians, population counts, neurosurgical beds, inpatient stays, and cranial procedures. Absolute and per-capita developments were assessed, and services were related to neurosurgeon density. Statistical analyses comprised Kendall's tau-b, Wilcoxon signed-rank, and Friedman tests.

Results: The number of practicing neurosurgeons in Austria increased from 97 in 1997 to 301 in 2023 (+ 210.3%), rising from 1.22 to 3.30 per 100,000 inhabitants (+ 170.5%). Growth in neurosurgeon density significantly outpaced both population growth (+ 14.3%) and the overall increase of specialist physicians (+ 77.4%, p = 0.001). Despite this expansion, absolute service provision showed only negligible to moderate increases (beds + 4.7%, inpatient stays + 28.6%, cranial procedures + 0.1%). Adjusted for workforce size, services per neurosurgeon declined sharply: cranial procedures decreased by -67.8%, inpatient stays by -58.6%, and neurosurgical bed capacity per surgeon by -66.3% (all p < 0.001). Regional disparities were pronounced, with Salzburg reaching 6.51 neurosurgeons per 100,000 while Burgenland registered its first only in 2012 and still shows the nationwide lowest density of 1.00 per 100,000.

Conclusion: Austria has experienced rapid workforce growth without a parallel rise in neurosurgical case volume, resulting in declining operative exposure per surgeon. These findings highlight risks for training quality, efficiency, and future competitiveness. Evidence-based workforce planning, structured regulation of training intake, and expansion of outpatient neurosurgical services will be essential to ensure sustainable care and safeguard international standards of neurosurgical education.

Introduction: Coinfection of pulmonary tuberculosis and scrub typhus caused by Orientia tsutsugamushi is exceptionally rare. Overlapping clinical and radiologic features, together with the frequent absence of clear epidemiologic clues, complicate timely diagnosis.

Case presentation: A 57-year-old man residing in a non-endemic region presented with a left-sided cavitary lung lesion on imaging. Computed tomography (CT)-guided percutaneous lung biopsy, acid-fast bacillus staining, and Mycobacterium tuberculosis DNA PCR established the diagnosis of active cavitary pulmonary tuberculosis. Despite initiation of a standard first-line anti-tuberculosis regimen, high-grade fever persisted. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) detected O. tsutsugamushi, which was subsequently confirmed by a positive IgM indirect immunofluorescence assay (IFA). Doxycycline was added, leading to defervescence within 48 h and marked symptomatic improvement. On follow-up, chest CT demonstrated lesion absorption and cavity shrinkage, while new fibrotic changes emerged. The patient was started on maintenance pirfenidone and prescribed home oxygen therapy.

Conclusion: In patients with pulmonary tuberculosis who exhibit persistent fever or suboptimal response despite appropriate therapy-and after excluding drug resistance-scrub typhus should be included in the differential diagnosis, even in non-endemic settings without a typical exposure history. Longitudinal imaging in this case also shows that irreversible structural remodeling may occur despite microbiologic control, underscoring the need to pair prompt pathogen-directed therapy with ongoing monitoring and early strategies to preserve lung function.

Background: Male genital dermatoses encompass a diverse range of infectious, inflammatory, and neoplastic conditions with overlapping clinical presentations, often leading to diagnostic challenges. Misdiagnosis can result in inappropriate management and significant patient distress, particularly given the sensitive nature of the anatomical site. Although histopathology remains the diagnostic gold standard, non-invasive tools such as dermoscopy are becoming increasingly valuable for preliminary evaluation. A thorough understanding of the clinical features associated with male genital dermatoses is essential for achieving accurate diagnoses.

Methods: Our retrospective study analyzed 572 histopathologically confirmed cases of lesions on the male external genitalia at Peking Union Medical College Hospital from 2015 to 2025. Data included demographics, disease duration, lesion distribution, dermoscopy results if exists, and clinical-dermatoscopic-pathological concordance.

Results: The cohort with a mean age of 47.6 years, exhibited distinct age-specific patterns: adolescents (1.2%) had inflammatory/autoimmune conditions; adults (70.6%) showed human papillomavirus-associated (Bowenoid papulosis, genital warts) and inflammatory diseases (lichen sclerosus); and elderly patients (28.1%) had higher malignancy rates (extramammary Paget's disease, squamous cell carcinoma). Overall, inflammatory diseases (33.7%) and tumors (33.4%) were the most common diagnoses. Notably, diagnostic clinical-pathological discordance was observed in 34.6% of cases, particularly for lichen planus (4.9%) and extramammary Paget's disease (2.8%).

Conclusion: This study highlights the diverse etiologies of male genital dermatoses and underscores the necessity of age-stratified evaluations. The use of dermoscopy improves diagnostic accuracy and minimizes the need for unnecessary biopsies. Conditions such as extramammary Paget's disease, bowenoid papulosis, and lichen sclerosus require heightened awareness due to their potential for malignancy or diagnostic complexity. Integrating clinical, dermoscopic, and histopathological data is critical for effective management.

Bloodstream infections caused by anaerobic bacteria present a serious threat to patients. Rapid and accurate diagnosis is crucial for treatment and patient prognosis. Herein, we report a rare case of Clostridium paraputrificum bacteremia in an 82-year-old woman who developed an infection after undergoing necrotic small bowel resection. The patient was treated with 5-day anti-infective therapy with meropenem and linezolid, successfully controlling the disease. We also constructed a phylogenetic tree with other similar bacteria using gene sequencing and showed the virulence and antimicrobial resistance of C. paraputrificum. Additionally, the clinical features and antibiotic treatment of this case were reviewed and discussed in the existing literature. This case and review illustrate the insidious nature of C. paraputrificum infections, emphasizing the need for greater clinician awareness and improved diagnostic and treatment strategies.

Background: Evidence-based nursing curriculum is a key course to develop nursing students' evidence-based practice competencies. How to plan and design an evidence-based nursing curriculum to improve students' competencies has been an issue explored by nursing educators. Case-based learning (CBL) has been widely used in teaching practices that promote the development of nursing students' practice competencies. However, an effective framework for implementing CBL in evidence-based nursing curricula to facilitate the development of these competencies remains unclear. Additionally, most current evaluations of the effectiveness of CBL implementation focus on endpoint indicators, while neglecting the impact on learners' learning processes. This focus is not conducive to analyzing the mechanisms behind CBL's effectiveness in student development and hinders the continuous optimization of instructional design.

Objective: This study explored the effectiveness of an instructional model that integrates CBL with the Conceive-Design-Implement-Operate (CDIO) model and analyzed the students' learning processes based on the control-value theory (CVT).

Design: A longitudinal pre- and post-test study.

Methods: The study was conducted in a master's nursing program at a university in China, involving 64 students. Participants completed the questionnaires before and after the implementation of the instructional model. The data were analyzed using SPSS 27 software.

Results: Excellent results were achieved in this instructional model. Students' knowledge and skills increased significantly. Our results also demonstrated that students' competencies (attitudes, skills, and knowledge) were influenced by control appraisals, emotions, and learning strategies.

Conclusion: Future research should vigorously develop such models to advance evidence-based nursing. Furthermore, educators should focus on key factors that influence student learning to foster a more conducive teaching environment.

Background: This study investigated the safety and efficacy of hysteroscopic sutureless fixation of the levonorgestrel-releasing intrauterine system (LNG-IUS) for treating heavy menstrual bleeding (HMB), providing a viable therapeutic option for patients at high risk of LNG-IUS expulsion.

Methods: Ninety patients were enrolled and equally divided into three groups: conventional implantation of LNG-IUS group (control group), hysteroscopic suture fixation of LNG-IUS group (suture fixation group) and hysteroscopic sutureless fixation of LNG-IUS group (sutureless fixation group). The rates of LNG-IUS expulsion and displacement, complication rates, pre- and postoperative menstrual flow, pain scores, and life satisfaction scores were recorded for each of the three groups.

Results: The LNG-IUS expulsion rate in the sutureless fixation group was 3.3% and the displacement rate was 10%. There was no significant difference compared to the suture fixation group (3.3% LNG-IUS expulsion rate and 16.7% displacement rate in the suture fixation group, p > 0.05). There was a significant difference compared to the control group (13.3% expulsion rate and 23.3% displacement rate in the control group, p < 0.05). There was no significant difference in the rate of postoperative complications among the three groups (p > 0.05). Postoperative menstrual flow was significantly reduced in all three groups (p < 0.05), pain scores were significantly reduced (p < 0.05), and quality of life scores were significantly improved (p < 0.05).

Conclusion: Our findings indicate that hysteroscopic sutureless fixation of the LNG-IUS is a safe, effective, and minimally invasive surgical procedure to prevent the LNG-IUS expulsion. This procedure leads to a significant reduction in menstrual flow, relieves the symptoms of dysmenorrhea, and improves patient quality of life.