Frontiers in Medicine最新文献

This review provides a detailed overview of how digital health can be utilized in the management of Interstitial Lung Disease (ILD), and Chronic Obstructive Pulmonary Disease (COPD). ILD encompasses a diverse range of lung disorders characterized by inflammation and scarring of lung tissue, leading to restrictive lung physiology and impaired gas exchange, with symptoms including progressive dyspnoea, cough, and hypoxia. COPD which ranks as the third leading cause of death globally, is characterized by chronic lung inflammation causing irreversible airflow obstruction, recurrent exacerbations. While recent advances in digital health have shown promise, predicting disease progression in patients with ILD and exacerbation in patients with COPD remains challenging. This review explores the role of digital health in managing ILD and COPD, particularly focusing on telehealth and digital health technologies. Telehealth, defined broadly as the use of electronic information and telecommunications technologies in healthcare, has become increasingly relevant, especially during the COVID-19 pandemic. This review examines the role of digital health technologies in the management of ILD and COPD, with particular focus on telemedicine, and digital health tools. Remote monitoring technologies, including home spirometry and wearable devices, have demonstrated feasibility in managing respiratory diseases. However, challenges such as evidence, data reliability, varying adherence, education, and the high costs of data collection and lack of qualified clinicians present barriers for many national health systems.

Background: To evaluate refractive, visual, and patient-reported outcomes three months after bilateral implantation of a novel bi-aspheric, non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) using PhaseRing technology to achieve good vision across distances with reduced dysphotopsia.

Methods: Twenty-two patients received bilateral Asqelio EDOF IOLs (AST VisionCare Inc.) and were evaluated 3 months post-surgery. The main outcomes assessed were refractive error, monocular and binocular visual acuities at distance, intermediate (67 cm) and near (40 cm), low contrast visual acuity, defocus curves, contrast sensitivity, and patient questionnaires.

Results: The average postoperative spherical equivalent was -0.31 ± 0.30 D. Astigmatism of ≤ 1.00 D was present in all eyes (100%, n = 44), with 75% (n = 33) showing astigmatism of ≤ 0.50 D. Every patient attained a corrected distance visual acuity (CDVA) of 20/25 or better and a distance-corrected intermediate visual acuity (DCIVA) of 20/32 or better. Contrast sensitivity met or exceeded normal levels under both photopic and mesopic conditions, with and without glare, except at 12 cycles per degree under mesopic conditions with glare. Light distortion index was comparable to published reports on monofocal IOLs and other non-diffractive EDOF IOLs, and lower than diffractive multifocal IOLs. Post-surgery, 90.9% (n = 20) of patients reported being satisfied with their vision. No significant visual symptoms were reported.

Conclusion: Asqelio™ EDOF IOL offers an efficient design, providing good clinical outcomes for distance and intermediate vision, while some patients reach functional levels of near vision. Its non-diffractive design minimizes dysphotopsia and reduces light distortion compared to other presbyopia-correcting IOLs.

Background: Little information is available regarding whether active physical activity lowers mortality risk in individuals with bronchiectasis.

Methods: We used the Korean National Health Insurance Service database from 2010 to 2016 to evaluate the association between changes in physical activity and mortality risk in individuals with bronchiectasis. Of 552,510 individuals with newly diagnosed bronchiectasis, we enrolled 165,842 individuals who had two consecutive health examinations before and after bronchiectasis diagnosis, within two years, as the study aimed to measure changes in exercise habits between the two time points. Active physical activity was defined as engaging in moderate- or vigorous-intensity physical activity at least once a week, either before or after bronchiectasis diagnosis. The outcome measure was all-cause mortality.

Results: During a mean follow-up of 6.2 ± 2.1 years, 10,535 (6.4%) individuals with bronchiectasis died. Individuals with bronchiectasis who were physically active exhibited a lower mortality rate than those who were physically inactive. Mortality reduction was particularly evident in the exercise maintainers group (aHR [adjusted hazard ratio] = 0.69, 95% confidence interval [CI] = 0.64-0.74) and individuals with physical activity ≥1,000 metabolic equivalent of task-min per week (aHR = 0.73, 95% CI = 0.70-0.77) compared to those who were physically inactive.

Conclusion: Engaging in active physical activity is associated with a decreased risk of mortality in individuals with bronchiectasis.

Objective: This study aims to assess the mesenchymal-epithelial transition factor's (c-MET) prognostic value in oesophageal carcinoma (ESCA) through a meta-analysis and bioinformatics.

Methods: We analysed c-MET expression in ESCA tissues using data from The Cancer Genome Atlas (TCGA) and conducted a meta-analysis to evaluate its association with clinicopathological factors and survival outcomes. The meta-analysis included studies reporting hazard ratios (HRs) and odds ratios (ORs) for survival and metastatic outcomes.

Results: The Cancer Genome Atlas analysis revealed elevated c-MET expression in ESCA, which was significantly correlated with lymph node metastasis, tumour grade and stage, though not with overall survival (OS). In the meta-analysis, 278 publications were identified, and 89 duplicates were removed. After screening, 176 articles were excluded, leaving 13 for full-text review. Of these, 5 studies lacked sufficient survival data, resulting in 8 eligible studies with a total of 1,488 patients. Meta-analysis findings indicated that high c-MET expression was associated with worse OS (HR = 1.54, 95% confidence interval [CI]: 1.17-2.01; p = 0.002), distant metastasis (OR = 1.97, 95% CI: 1.14-3.40; p = 0.02) and advanced stage (OR = 2.23, 95% CI: 1.41-3.53; p = 0.0006).

Conclusion: High c-MET expression is associated with poor prognosis and advanced disease in ESCA, highlighting its potential as a biomarker for risk stratification. Further studies are needed to confirm its prognostic value and explore therapeutic implications.

Exposure to cross-cultural medical education is essential for professionals aiming to work in global health or serve diverse communities. However, traditional in-person exchange programs can be complex, costly, and restricted, particularly during times when travel is limited, such as during the COVID-19 pandemic. These challenges prompted us to explore novel approaches to support cross-cultural exchange programs. We designed, piloted, and evaluated a cross-cultural virtual exchange experience using case-based learning (CBL). Our study involved 14 bilingual medical students from the United States and Colombia who participated in four virtual CBL sessions. Following each session, participants engaged in guided discussions to reflect on their attitudes toward the experience, and content analysis was framed by sociocultural learning theory (SCLT). This study provides justification and operational guidance for implementing and improving upon cross-cultural virtual exchange experiences among medical trainees, with potential applicability to other contexts.

Objective: This study aimed to examine the clinical characteristics of choroidal metastases (CMs) and assess the efficacy of various treatment strategies for CMs in a specific patient cohort.

Methods: This retrospective case series study included 32 patients (38 eyes) diagnosed with CM at the Department of Ophthalmology, Peking University People's Hospital, between 2009 and 2022. The cohort included 10 male patients (10 eyes) and 22 female patients (28 eyes), with a mean age of 52.53 ± 10.81 years. Detailed medical histories and multiple ophthalmic examinations were performed for all patients, with diagnoses confirmed by two senior ophthalmologists. Clinical characteristics, treatment responses, and follow-up outcomes were analyzed.

Results: Lung cancer was the most common primary tumor (53.1%), with six patients initially presenting with ocular symptoms. Initial ultrasound imaging revealed a mean tumor height of 3.02 mm and a mean basal diameter of 11.09 mm. Optical coherence tomography (OCT) revealed irregular, highly reflective foci with undulating anterior surfaces, and fluorescein angiography (FFA) revealed early choroidal tumor masking and late-phase mottled hyperfluorescence with occasional leakage. Indocyanine green angiography (ICGA) revealed hypofluorescence in early and late phases, with slightly mottled hyperfluorescence in the late phase. The follow-up period ranged from 3 months to 4 years (median 4 months), during which systemic and local treatments effectively controlled or delayed tumor progression in most patients.

Conclusion: Lung and breast cancers are the leading sources of CMs, with bilateral or multifocal lesions more frequently linked to breast cancer. Treatment for CMs should be meticulously individualized and should take into account the patient's overall condition, tumor burden, and precise tumor location. Local treatment is essential for patients with significant ocular symptoms. A combination of local and systemic treatments has been shown to lead to a more significant reduction in tumor burden.

Hemorrhoids are a prevalent and benign anal disorder for which minimally invasive treatments are increasingly preferred. The UK National Institute for Health and Care Excellence clinical guideline (2010) recommends hemorrhoidal artery ligation as a treatment option for hemorrhoidal disease. Superior rectal artery embolization (SRAE) leverages this principle by using digital subtraction angiography to precisely identify and superselectively embolize the arteries supplying the hemorrhoidal region. This procedure has demonstrated favorable clinical outcomes. SRAE is minimally invasive, painless, preserves the anal sphincter and normal anal anatomy, and offers a quick recovery, establishing it as an effective minimally invasive surgical option. As a result, this technique has gained increasing clinical recognition and adoption. This article examines the efficacy and safety of superselective SRAE for hemorrhoidal disease.

The treatment landscape for chronic lymphocytic leukemia (CLL) has expanded dramatically over the last decade, with a wide range of effective treatments now available. Clinical management of CLL varies widely depending on patient profile, meaning the optimal treatment in Arab patients, who tend to be young and often present with comorbidities, including diabetes and obesity, requires specific considerations. In the absence of regional guidelines, a group of experts from across the Gulf region and one international expert from Germany convened to discuss and agree upon a position statement for venetoclax-based fixed-duration treatment strategies for Arab patients with CLL. Our position is that ibrutinib-venetoclax should be the first choice as first-line therapy for all fit CLL patients in the region, regardless of age. The advantages of an all-oral, fixed-duration treatment are discussed in the context of a young Arab patient population, including excellent patient and physician convenience, limited accumulative risk of toxicities, uncomplicated logistics, and low burden of healthcare administration costs. Finally, we discuss the management of key safety considerations in Arab populations including ethnic neutropenia, risk of cardiotoxic events, considerations during intermittent fasting, and avoiding adverse drug-drug interactions, e.g., with anti-tuberculosis or anti-obesity medications.

The role of gut microbiota (GM) in the pathogenesis of Symptomatic Uncomplicated Diverticular Disease (SUDD) remains controversial. Here, we assessed the efficacy of a butyrate formulation in modulating GM and abdominal pain in patients with SUDD. A retrospective study was conducted in patients with SUDD who were treated with a delayed- and colonic-release formulation of butyrate (two capsules bid, for a total dose of 400 mg butyrate) for 3 months. GM was profiled before (T0) and after 90 days of treatment (T2) using 16S rRNA amplicon sequencing. The primary endpoint was change in GM at T2; secondary endpoints were reduction in abdominal pain severity according to VAS (Visual Analog Scale, 0: absence; 10: maximum severity) at T1 (45 days) and T2, stool characteristics according to the Bristol stool form scale at T0, T1 and T2, and safety of treatment. Fifty-nine patients with SUDD (59.3% male; median age 65.5 years, interquartile range 55-71 years) completed treatment. The butyrate formulation increased GM diversity and resulted in several compositional changes that were closely related to baseline abdominal pain severity. Regarding secondary endpoints, abdominal pain decreased significantly over time, while the Bristol stool form scale did not. Mild adverse events were recorded in 3 (5.08%) patients. This study showed that a microencapsulated and colonic-release formulation of butyrate favorably modulates GM and reduces abdominal pain in patients with SUDD.