Frontiers in Medicine最新文献

A supernumerary kidney is an extremely rare congenital renal anomaly that is characterized by the presence of one or more extra kidneys. Unilateral cases occur more commonly on the left side. Reporting such uncommon anomalies is important for several reasons, such as improving diagnosis and treatment, educating clinicians and radiologists about the identification and treatment of supernumerary kidneys, and comparing the case to existing literature to highlight similarities and differences in presentation, management, or outcomes. A 35-year-old male patient presented to our hospital in Addis Ababa, Ethiopia, with left lower flank pain. His blood pressure was elevated during the initial visit; however, the results of the physical examination and laboratory investigations were unremarkable. Abdominopelvic ultrasound and computed tomographic (CT) urography confirmed the diagnosis of a left-sided supernumerary kidney, with no associated abnormalities. In such cases, the diagnosis of a supernumerary kidney is made using an abdominal ultrasound scan, intravenous urography (IVU), CT urography, and magnetic resonance imaging (MRI). Treatment depends on the patient's symptoms. Asymptomatic cases must be followed up regularly. If a supernumerary kidney is nonfunctional or associated with other abnormalities, a nephrectomy is indicated. We treated our patient with adequate analgesia and scheduled a follow-up.

Purpose: This study aim to investigate the clinical findings of subjects characteristics and image quality related factors in Tibetan children by optical coherence tomography (OCT) in epidemiological cohort study.

Methods: Participants were 1,856 first-grade students (mean age = 6.82 ± 0.46 years) from seven selected elementary schools in Lhasa. Following comprehensive systemic and ophthalmic examinations, OCT scans were assessed by specialists with manual segmentation as needed.

Results: A total of 1,698 students completed the examination protocol in this study (91.5%). After manual screening, 1,447 (78%) and 1,289 (70%) images could be analyzed in the macular and optic disc regions, respectively. Common image flaws were blinking or fixation error (70%+), poor focusing, and positioning errors. Among students who have completed OCT, a higher percentage of boys (X ² = 8.48, P = 0.004) and suburban students (X ² = 34.97, P < 0.001) with younger age (t = -2.20, P = 0.03), worse near vision (t = -3.95, P < 0.001), higher IOP (t = 2.38, P = 0.017) and higher heart rate (t = 3.15, P = 0.002) have unsatisfactory image quality in the macular region, almost same as the optic disc region. Students in suburban schools (OR = 1.74, P < 0.001) with lower near VA (OR = 6.64, P < 0.001) or boys (OR = 0.78, P = 0.03) were more likely to have worse image quality on OCT scans when corrected for ethnicity. Manual segmentation was more prevalent in the optic disc region, resulting in increased retinal thickness across most subregions.

Conclusion: This study underscores the imperative for stringent image quality control in pediatric OCT assessments to ensure precise clinical outcomes.

Background: Wire-based index of microcirculatory resistance (IMR) utilizing pressure wires and thermodilution techniques for the assessment of coronary microcirculatory function, presents challenges for clinical routine use due to its complexity, time-consuming, and costly. This study introduces a novel multi-branch and wire-free method for IMR calculation based on coronary angiography. The diagnostic performance of CAG-IMR is validated within a retrospective single-center investigation.

Methods: In a retrospective single-center study, 139 patients with 201 vessels were evaluated using CAG-IMR for coronary microvascular dysfunction (CMD) detection, utilizing wire-based IMR as the reference standard. CMD was determined based on wire-based IMR ≥25U. CAG-IMR was independently calculated from diagnostic coronary angiography in a blinded fashion, employing the same diagnostic threshold of 25U for CMD identification.

Results: CAG-IMR demonstrated significant correlation (r = 0.84, p < 0.001) and good diagnostic performance AUC = 0.97 (95% CI: 0.95-0.99) compared to wire-based IMR. It exhibited the overall diagnostic accuracy at 95.0% (95% CI: 92.0%-98.0%), alongside high sensitivity (92.7%) and specificity (95.6%). The positive predictive value (PPV) stood at 84.4%, and the negative predictive value (NPV) reached 98.1%.

Conclusions: This study introduces CAG-IMR, a novel, multi-branch and wire-free method for IMR calculation. The indicator demonstrates good diagnostic accuracy and correlation with wire-based IMR in a cohort of 139 patients and 201 vessels, with the potential to enhance clinical CMD assessment.

The respiratory system is continuously exposed to the outside world, making it vulnerable to airborne particles and harmful pathogens like bacteria and viruses that can enter through breathing. Antigen presenting cells (APCs) have a vital function in the innate immune response as they present antigens to T cells and initiate the response of adaptive immune cells. Professional APCs engulf foreign microorganisms and display their peptides to T lymphocytes using MHC molecules. MHC II on their cell surface and potentially present antigen to CD4⁺T cells. Furthermore, various other types of cells have similar function that can also serve as APCs by expressing MHC II, thus impacting the progression of lung diseases, such as alveolar epithelial cells (AECs), endothelial cells (ECs), fibroblasts, innate lymphoid cells (ILCs), eosinophils, interstitial cells, mast cells, etc. express MHC II and present antigen. The non-professional APCs type and the extra signals it provides have a direct impact on CD4⁺T cell programming and downstream effector mechanisms. Here, we summarize the existing research on the expression of MHC II on non-professional APCs in different lung diseases and its influence on CD4⁺T differentiation types and disease outcomes, in order to further clarify the role of MHC II of different non-professional APCs in lung diseases, such as asthma, chronic obstructive pulmonary disease (COPD), etc.

Cutaneous pseudolymphoma is a type of reactive lymphoid hyperplasia that pathologically and/or clinically mimics cutaneous lymphoma. It has a variety of pathogenic factors. However, in many cases, no etiology can be identified. The histopathological findings of cutaneous pseudolymphoma can only be used as the basis for suspected diagnosis. Clinical data, further diagnostic tests and follow-up are needed to confirm the diagnosis. This article reports three cases of cutaneous pseudolymphoma, with different etiology, clinical manifestations and treatment methods. The purpose of this article is to emphasize that the etiology and clinical manifestations of cutaneous pseudolymphoma are diverse, and targeted treatment strategies and long-term follow-up are needed.

Objective: We investigated the association between serum uric acid (SUA) levels and gallstone (GS) prevalence in adult women.

Methods: Participants' information were taken from the United States National Health and Nutrition Examination Survey (2017-2020). Logistic regression analysis and dose-response curve were used to assess the association between SUA levels and the prevalence of GS in adult women. Subgroup analyses were performed to investigate associations between SUA levels and age, ethnicity, body mass index, hypertension, and diabetes.

Results: A total of 600 participants self-reported a history of GS. After adjusting for confounding, the prevalence of GS in adult women increased by 14% for every 1 mg/dL increase in SUA (odds ratio [OR]: 1.14, 95% confidence interval [CI]: 1.06, 1.22). Testing SUA as a categorical variable for sensitivity analyses indicated a 1.6-fold increase in the prevalence of GS in tertile 3 (OR=1.60, 95% CI: 1.25, 2.04) compared to tertile 1. Dose-response curves showed a nonlinear correlation between SUA levels and the prevalence of GS. Subgroup analyses indicated that SUA level was associated with an increased prevalence of GS in most subgroups, although subtle differences existed.

Conclusion: SUA was positively and non-linearly associated with the prevalence of GS in adult females. Despite the inability to clarify the causal relationship between them, our results remain interesting.

Background: Intertrochanteric fractures are one of the most common types of hip fractures, with delayed surgical treatment beyond 48 h associated with increased postoperative complications and mortality, especially in older adults. This study aimed to develop a predictive model for delayed preoperative waiting times in intertrochanteric fracture cases, based on previous research, to offer a valuable reference for clinical decision-making.

Methods: A retrospective analysis was conducted on 1,116 patients with intertrochanteric fractures admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine for internal fixation surgery from January 2017 to January 2024. Patient demographic data and clinical examination results were collected. A logistic regression model was used to construct a predictive model, which was then visualized through a nomogram. The model's performance was subsequently validated.

Results: The predictive model developed from 728 patients in the training cohort, identified key predictors, including age, sex, lower extremity deep vein thrombosis, injury location, and biochemical markers. The model demonstrated strong discriminative ability, with an area under the receiver operating characteristic curve of 0.749 (95% confidence interval: 0.621-0.801) for the training set, and 0.745 in the validation set. Calibration curves indicated that the predicted risk of surgical delay closely aligned with observed outcomes. Furthermore, decision curve analysis verified the model's clinical utility, demonstrating its effectiveness in guiding treatment decisions.

Conclusion: The nomogram model developed in this study provides a reliable tool for predicting delayed surgical intervention in patients with intertrochanteric femur fractures. It offers clinicians a valuable reference to anticipate delays in surgical treatment and aids in the formulation of more timely and appropriate treatment strategies, potentially improving patient outcomes.

Objective: This study analyzed literature on traditional Chinese medicine (TCM) in treating chronic kidney disease (CKD) to identify research trends and provide guidance for future studies and clinical practice.

Methods: The study used data from Web of Science from 2000 to 2024 to analyze English-language literature on CKD and TCM. Bibliometric analysis was done using R software and the bibliometric package, with scientific mapping and visualization analysis conducted using tools like Citespace, VOSviewer, and ScimagoGraphica to explore research trends and connections.

Results: This study revealed that a total of 1,153 relevant documents were retrieved, and the number of published articles showed an increasing trend, reaching a peak in 2022. In terms of article publication, China ranked first with 760 articles, closely followed by the United States with 132 articles. Guangzhou University of Traditional Chinese Medicine published 60 papers, the most among academic institutions, followed by Shanghai University of Traditional Chinese Medicine with 54 papers. In terms of individual authors, Liu Xinhui holds the record for the highest number of published articles, totaling 17, followed by Li Ping and Li Shunmin. The prevalent keywords include "chronic kidney disease," "TCM," and "oxidative stress." Currently, the prominent areas of research interest include network pharmacology, gut microbiota, oxidative stress, and related topics. The current research trend in this field is towards the adoption of novel methodologies such as network pharmacology and the emphasis on exploring the relationship between gut microbiota and CKD.

Conclusion: Global research on TCM in the treatment of CKD is showing a positive development trend, but further research on safety, efficacy evaluation, and international cooperation is still needed. The development trend is to adopt new scientific research methods and focus on exploring the mechanism of TCM in treating CKD.

Introduction: The healthcare sector is globally experiencing increasing demands and workplace interventions on an organisational level is sought to create healthy workplaces. The aim of this study was to provide an overview of Nordic research on the work environment and health of healthcare professionals, with a focus on identifying organisational-level risk and health-promoting factors.

Methods: This systematic search and review was based on an analysis of studies published in peer-reviewed journals between 1 January 2016 and 3 January 2023. The selected studies investigate the relationships between organisational-level risk and health-promoting factors and measures of health and well-being among healthcare professionals during ordinary operations. To increase applicability, this systematic search and review was limited to the Nordic countries as they share the same context with a publicly-funded widely accessible healthcare system. A total of 2,677 articles were initially identified, with 95 original studies meeting the criteria for relevance and quality.

Results: Identified organisational risk and health-promoting factors were categorised into five categories: work schedule distribution, operations design and work methods, ergonomic conditions, working conditions and personnel policies, and the organisation's ethical environment. In addition, two themes across the categories emerged, providing further insight into the implications for practice. The first theme emphasises risk and health-promoting factors in the actions that employers take to fulfil the organisation's goals. The second theme emphasises risk and health-promoting factors in connection with the ability of employees to do their jobs at a level of quality they deem acceptable.

Conclusion: Several organisational-level risk and health-promoting factors were identified, and the results indicate that the actions that employers take to fulfil the health-care organisation's goals and promote the ability of employees to provide high-quality care are important for the health and wellbeing of healthcare employees.

Purpose: Systemic sclerosis (SSc) affects blood vessels, internal organs, and skin. In ophthalmology, SSc impacts the choroid. The choroidal vascularity index (CVI) measures the vascular component of the choroid and may serve as a biomarker for the disease staging and prognosis. Studies have reported reduced choroidal thickness and altered CVI in SSc, which supports the theory of vascular damage. This study aimed to examine interocular symmetry in choroidal parameters among SSc patients. It has provided the insight into the disease symmetry and assessed the representativeness of examining one eye.

Methods: This prospective single-center cross-sectional study included 33 patients with SSc and 40 healthy controls. The patients underwent ophthalmological examination (including refraction, visual acuity, IOP, biometry, slit-lamp biomicroscopy, dilated fundus examination, and spectral-domain optical coherence tomography) and rheumatological evaluation. Various parameters of the choroid in the macular and peripapillary regions were analyzed, including choroidal thickness, choroidal volume, and CVI. The interocular asymmetry in the choroidal parameters was quantified using signed and absolute differences. The correlation analysis between the left and right eyes was based on the intraclass correlation coefficient (ICC), Spearman's correlation coefficient, and paired Wilcoxon test.

Results: There were no significant differences in the macular and peripapillary choroidal parameters between fellow eyes in both SSc patients and controls (p > 0.05). The parameter that showed the lowest correlation among those examined was CVI-in both groups, as well as in both examined areas. The interocular correlation of choroidal parameters was stronger in the peripapillary area than in the macular area in both groups. In general, the results were confirmed in subgroup analyses stratified according to sex, SSc subtype, Scl70 antibody positivity and previous and/or active digital ulcers.

Conclusion: There is interocular symmetry of the choroidal parameters in patients with SSc and controls included in our study. The parameters from one eye are representative of the fellow eye of a given patient. This conclusion may contribute to the design and interpretation of future studies. It also broadens our knowledge of SSc pathophysiology.