Frontiers in Medicine最新文献

Background: The Sequential Organ Failure Assessment (SOFA) score is widely used to predict prognosis in critically ill patients, but the prognostic value of dynamic SOFA changes (Δ SOFA) and their integration into prediction models remains unclear.

Methods: This retrospective study included 665 ICU patients admitted to the Third Hospital of Hebei Medical University between July 2022 and December 2023. The initial and daily SOFA scores (days 1-3) and demographic data were collected. Patients were stratified by SOFA 1 scores (4-7, 8-11, ≥12). A nomogram combining SOFA1, ΔSOFA 3-1, and age was developed, and its discriminative ability and calibration were evaluated. Additionally, an XGBoost model using the same predictors was constructed to explore the potential value of machine learning. External validation was performed using the MIMIC-IV database.

Results: Overall, the 28-day mortality rate was 18.9%. Mortality increased with higher SOFA 1 and ΔSOFA 3-1 scores. The nomogram showed high discriminative ability (C-index: 0.852 for SOFA 1 = 4-7; 0.845 for SOFA 1 = 8-11) and good calibration. The optimized XGBoost model exhibited excellent discriminative performance in the internal training cohort, with an area under the curve (AUC) of 0.833. The AUC was 0.863 in the independent internal test cohort and 0.671 in the external validation cohort. SHAP analysis identified ΔSOFA 3-1 as the most influential predictor across the datasets.

Conclusion: Dynamic changes in SOFA scores (ΔSOFA 3-1), especially in patients with moderate baseline SOFA 1 scores (4-11), significantly improve prognostic accuracy when combined with age. The nomogram provides an intuitive bedside tool for early risk stratification, whereas the XGBoost model demonstrates the potential value of machine learning. External validation highlights the need for further multicenter studies to enhance model generalizability.

At the start of a Molecular Cell Biology course, 66 students from the biomedical track introduced themselves by identifying with a specific cell component. On the final exam, they were asked once again to name their favorite cell component at that moment-this time providing concrete details based on what they had learned throughout the course. Remarkably, the students named no fewer than 21 distinct components. Popular choices included mitochondria (20 students), the cytoskeleton (7), and the cytoplasm and ribosome (5 each), while more unusual responses featured the flagellum and GPCR receptors. Although the question called for a scientific explanation, only 20 students provided purely scientific answers. A total of 11 students responded with purely associative descriptions, without linking their choice to biological function. The remaining 35 students offered hybrid responses, blending newly acquired cell biology knowledge with personal reflections. The students connected cellular features to broader themes such as personality, personal growth, adaptability, relationship maintenance, organizational skills, hobbies such as physical exercise, and gastronomy. These findings show that cellular features and functions evoke a wide range of associations with aspects that are important in the lives of undergraduate students.

Introduction: There is a critical need for innovative therapies beyond the current standard of care for meningiomas and gliomas. Radioligand therapy (RLT), with its theranostic approach, holds significant promise in this regard. Although several reviews on this topic have been published, none yet have combined the utilization of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology with the Critical Appraisal Skills Programme (CASP) analysis, along with a dedicated subsection specifically addressing ongoing and completed clinical trials. This review aims to fill this gap in the literature by providing a comprehensive assessment of the current evidence on RLT in these tumors.

Materials and methods: Published studies were searched through PubMed, Scopus, and Web of Science up to 30 April 2025. Only original articles and clinical studies were included. Following a structured selection process, data extraction was performed. Study quality was critically appraised using CASP analyses. For clinical trials, an additional search was conducted on ClinicalTrials.gov beginning on 12 May 2025.

Results: A total of 30 studies were included in the review: 22 on meningiomas (290 patients) and 8 on gliomas (259 patients). For each study, first author, journal, year of publication, somatostatin receptor imaging, study design, radiopharmaceutical used, main topics, response criteria, toxicity assessment, post-therapy scintigraphy, number of patients, WHO grade, demographics, findings and median follow-up were considered. Among clinical trials, 22 were analyzed, including study site, year of first submission, proposed radiopharmaceutical, study type, primary endpoints and status. Efficacy and toxicity data were the primary focus, and the findings were generally encouraging. Studies on RLT in meningiomas was more robust, while in gliomas remained largely experimental. Nevertheless, the authors' critical appraisal was generally positive. Clinical trials confirmed the more "traditional" nature of research in meningiomas compared to gliomas.

Conclusion: Despite the heterogeneity of the studies, RLT emerges as a promising therapeutic strategy in neuro-oncology. Its theranostic paradigm offers a distinctive advantage, enabling patient selection, treatment personalization, and response monitoring. The development of potentially novel radiopharmaceuticals and the conduct of well-designed multicenter trials with standardized response criteria are needed to further increase the impact and clinical translation of RLT in neuro-oncology.

Purpose: To evaluate the impact of lotilaner ophthalmic solution, 0.25%, compared to vehicle, on disease severity in patients with Demodex blepharitis and meibomian gland disease.

Methods: This post-hoc analysis pooled data from two prospective, randomized, double-masked studies evaluating lotilaner ophthalmic solution, 0.25% (Ersa, N = 39) and vehicle (Rhea, N = 40) in Demodex blepharitis patients with meibomian gland disease. The study utilized a modified International Workshop on Meibomian Gland Dysfunction (IWMGD) severity scale, integrating meibomian gland secretion score (MGSS) and patient-reported visual analog scale for fluctuating vision (VASFLVIS), and categorized meibomian gland disease severity as Grade 1 (subclinical), Grade 2 (mild), Grade 3 (moderate), or Grade 4 (severe). The main outcome was changes in severity grades from baseline.

Results: At baseline, meibomian gland disease severity was comparable between groups. At Day 43, 47% of lotilaner-treated patients achieved Grade ≤2 (mild or better), significantly greater than 21% of vehicle-treated patients (p = 0.02). At Day 85, the difference increased, with 63% in the lotilaner group achieving Grade ≤2 versus 24% in the vehicle group (p = 0.001). For grade improvement, at Day 43, 63% of lotilaner-treated patients versus 38% of vehicle-treated patients achieved ≥1 grade improvement (p = 0.035); and at Day 85, 74% versus 39%, respectively, achieved ≥1 grade improvement (p = 0.004). No serious treatment-related adverse events were observed.

Conclusion: Lotilaner ophthalmic solution, 0.25% significantly improved meibomian gland disease severity in patients with Demodex blepharitis and concomitant meibomian gland disease at 6 and 12 weeks compared to vehicle.

Catheter-related bloodstream infections (CRBSIs) represent a severe clinical complication with high mortality and pose a significant public health challenge due to increasing multidrug-resistant organisms (MDROs). This study aimed to systematically analyze the epidemiology, pathogen distribution, and independent predictors of 28-day mortality in CRBSI to support early risk warning and precise intervention. A retrospective cohort study included 172 patients with confirmed CRBSI, defined per CDC criteria. Data were extracted from electronic health records. Blood cultures used the BACT/ALERT^® 3D system; pathogen identification and antimicrobial susceptibility testing utilized the VITEK^®2 COMPACT platform. Statistical analysis with SPSS 26.0 employed univariate and multivariate logistic regression to identify mortality risk factors, including evaluating a nomogram model for predictive performance. The 28-day mortality rate was 19.77%. Epidemiological surveillance revealed a significant year-by-year decline in CRBSI incidence from 2021 to 2024 (p < 0.01). High-risk wards included Nephrology (34.88%), ICU (22.67%), and Gastroenterology (12.21%), accounting for 69.76% of cases. Gram-positive microorganisms predominated (51.74%, 89/172), with Staphylococcus aureus as the leading pathogen (41.28%, 71/172); Escherichia coli and Klebsiella pneumoniae showed significant increasing trends (p < 0.05). Independent predictors of 28-day mortality were APACHE II score (OR = 1.771, 95% CI: 1.328-2.360) and cardiovascular disease (CVD) (OR = 19.426, 95% CI: 1.248-52.270); among microbiological variables/MDROs, only carbapenem-resistant Acinetobacter baumannii (CR-AB) infection (OR = 3.549) and carbapenem-resistant K. pneumoniae (CR-KP) infection (OR = 5.301) remained independently associated with mortality, while Gram-positive microorganism infection was protective (OR = 0.081). The nomogram demonstrated excellent predictive performance (C-index = 0.979), identifying APACHE II score as the most influential predictor; ROC analysis confirmed disease severity as the core mortality determinant. Findings confirm APACHE II score and CVD are strong mortality predictors, while Gram-positive infections correlate with favorable outcomes. Strengthening infection control effectively reduced incidence, highlighting the need for enhanced surveillance in high-risk departments and continuous monitoring of pathogen distribution and antimicrobial resistance, with particular emphasis on carbapenem-resistant Gram-negative organisms. These results support risk stratification and individualized treatment, though multicenter validation remains necessary.

Pancreatic cancer (PC) represents one of the most formidable challenges in oncology, characterized by its asymptomatic onset, delayed clinical detection, and dismal prognosis. Among pancreatic neoplasms, pancreatic ductal adenocarcinoma (PDAC) accounts for over 90% of cases and remains the most aggressive form, driven by late diagnosis, intrinsic chemoresistance, and a profoundly immunosuppressive tumor microenvironment. Recent advances have reframed the human microbiome not as a passive bystander but as an active architect of pancreatic tumor biology. This review delineates the mechanistic axes through which microbial ecosystems orchestrate PDAC progression across four key anatomical niches-gastrointestinal, oral, urogenital, and intrapancreatic. We elucidate how microbial dysbiosis fosters oncogenesis through immune evasion, metabolic reprogramming, and chronic inflammation, implicating specific taxa such as Fusobacterium nucleatum, Malassezia spp., and Porphyromonas gingivalis in immune suppression and chemoresistance. Microbial enzymatic inactivation of gemcitabine and modulation of cytokine networks further underscore the microbiome's pivotal role in therapeutic failure. Conversely, commensal and probiotic species may potentiate immunosurveillance and enhance treatment efficacy. This review also explores microbiota-derived biomarkers for early detection and the translational promise of microbiome-targeted interventions, including fecal microbiota transplantation, probiotics, and selective antibiotics. By decoding the microbial blueprint of PC, we propose a paradigm in which the microbiome emerges as both a biomarker and a therapeutic axis, offering novel avenues for precision oncology. Furthermore, this integrative synthesis emphasizes the multi-omic, immunometabolic, and therapeutic dimensions of the pancreatic cancer-microbiome interface, where metagenomic, transcriptomic, metabolomic, and immunomic layers converge to shape tumor evolution and therapeutic response, advancing the vision of microbiome-informed precision oncology.

This case report describes the successful integration of veno-venous extracorporeal membrane oxygenation (VV-ECMO) with physiologically optimized fracture fixation in a critically ill polytrauma patient who presented with life-threatening acute respiratory distress syndrome (ARDS). A 23-year-old male with bilateral femoral fractures, Gustilo IIIB open tibiofibular injury, left radius-ulna fractures, and refractory hypoxemia (PaO2/FiO2 40.5 mm Hg) underwent VV-ECMO initiation 1 h postinjury (total ECMO duration 144 h). Physiological optimization guided delayed surgical intervention on day 5, incorporating heparin-based anticoagulation and dynamic ECMO parameter modulation, resolving lactic acidosis (peak lactate 5.0 mmol/L on day 1 to 1.8 mmol/L preoperatively). The patient achieved successful decannulation by day 6 with satisfactory recovery at the 2-month follow-up [Short Musculoskeletal Function Assessment (SMFA) score 28.1, gait speed 1.2 m/s]. This case demonstrates the feasibility of a multidisciplinary protocol challenging traditional contraindications to surgery in severe ARDS patients and providing a replicable protocol for managing competing priorities of oxygenation and hemorrhage control.

Introduction: Osteoarthritis (OA) is a common degenerative joint disease resulting from the breakdown of multiple joint tissues, remains a leading cause of disability with limited therapeutic options. Synovitis is one of the reasons of OA progression, while communication between blood and synovium during disease process is still unclear.

Methods: We used transcriptomic datasets from blood and synovium of healthy controls and OA patients to investigate potential molecular crosstalk between blood and synovium in OA pathogenesis through ligand-receptor pairs.

Results: Ligand-receptor pair analysis revealed 129 ligands and 137 receptors differentially expressed in blood, and 108 ligands and 86 receptors in synovium. Gene ontology enrichment analysis of differentially expressed ligands indicated receptor ligand activity in both tissues, with blood enriched in leukocyte migration, cell chemotaxis, and leukocyte chemotaxis, and synovium in negative regulation of response to external stimulus, epithelial cell proliferation, and cell chemotaxis. Further protein-protein interaction (PPI) network analysis showed that blood ligands were mainly associated with inflammation and immunity (IL6, IL1B, IL23A, IFNA1, and TNF), while several synovium ligands were linked to angiogenesis (TGFB1, FGF7, and PDGFA). Based on ligand-receptor interactions and PPI network of differentially expressed ligands, we predicted and constructed molecular communication map between blood and synovium. Immunofluorescence staining of synovium showed more blood micro-vessels in OA patients and elevated IL6 and IL1B expression levels, suggesting that synovial inflammation might partly originate from pro-inflammatory cytokines in blood.

Discussion: These findings offered new understanding of the molecular mechanisms underlying blood and synovium communication in OA, and provided potential therapeutic drug targets for OA treatment to simultaneously modulate systemic inflammation and local angiogenesis.

Introduction: Elderly migrants face significant mental health risks and social isolation within the context of global aging and mobility. As their daily activities are highly community-centric, the residential environment is a critical determinant of their well-being; however, a systematic assessment framework tailored to this population is lacking. This study aims to address this gap by identifying key community environmental factors influencing their mental health and employing the DANP-V model to construct a systemic methodology that elucidates complex inter-factor causalities and establishes prioritized improvement strategies.

Methods: We established a framework of community environmental factors based on the daily behaviors of elderly migrants. The Fuzzy Delphi Method (FDM) was used to screen and finalize 16 key indicators across six dimensions. The DANP-V model, a hybrid multi-criteria decision-making (MCDM) technique integrating DEMATEL, ANP, and VIKOR methods, was then applied to analyze the interrelationships and weights of these factors. The model was empirically tested through a case study in Qianshan Community, Zhuhai, China, using survey data from both domain experts (n=10) and elderly migrants (n=140).

Results: The DANP-V analysis revealed a total performance gap of 0.495 for the case community, indicating substantial room for improvement. "Environmental Exposure" (D6, gap = 0.629) and "Self-Actualization" (D4, gap = 0.617) were the most deficient dimensions. Key criteria with the largest gaps included "Pet-Friendly Facilities" (C54, gap = 0.779), "Ambient Temperature" (C63, gap = 0.726), and "Ancestral Worship Sites" (C51, gap = 0.713). The Influential Network Relation Map (INRM) illustrated that factors like "Transportation & Mobility" (C53) and "Living Convenience Facilities" (C52) were influential predecessors, affecting other criteria.

Discussion: The DANP-V model provides a systemic approach to assess and improve community environments for elderly migrants' mental health, moving beyond isolated factors to address root causes within an interconnected system. The case study demonstrates that critical gaps often lie in culturally-specific (e.g., ancestral worship) and emotion-supporting (e.g., pet-friendly) elements, which are frequently overlooked. The study offers a robust framework for policymakers and designers to develop targeted, effective community improvement strategies.