Frontiers in Medicine最新文献

Background: Traditional Chinese medicine has been used for Coronavirus disease 2019 (COVID-19) as a therapeutic option. Lianhuaqingwen capsules (LHQW) are well-recognized for their efficacy, while Kegan Liyan oral liquid (KGLY), widely used for influenza treatment, has emerged as a promising candidate for COVID-19 therapy. This trial aims to assess whether KGLY is non-inferior to LHQW in treating mild COVID-19.

Methods: A total of 127 participants (63 in KGLY group and 64 in LHQW group) were randomly allocated to receive either KGLY therapy or LHQW therapy in a 1:1 ratio. The treatment was given for 7 days, and the follow-up period was 3 days.

Outcome measures: The primary outcome was symptom remission at day 10. Secondary outcomes included symptom recovery, time to symptom remission, recovery rates and time to recovery of selected symptoms, change in visual analog scale score for selected symptoms, area under the curve of the visual analog scale score for sore throat, negative conversion of the SARS-CoV-2 infection, having a positive test result after negative conversion, and incidence of pneumonia.

Results: Full analysis set analysis showed that the symptom remission rate at day 10 was 60.7% with KGLY and 58.3% in LHQW (difference + 2.3 p.p., lower limit of 95% confidence interval - 14.8 p.p.), indicating non-inferiority. There were no significant differences between the groups for any secondary outcome. The occurrence of adverse events did not differ between the groups and no severe adverse events were documented in either group.

Conclusion: Based on the study results, this trial proved that KGLY was non-inferior to LHQW for mild COVID-19, providing a promising option for COVID-19 treatment.

Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=166372, Identifier, [ChiCTR2200059105].

Objective: A growing number of research papers have looked at the influence of exercise on pain severity in people with primary dysmenorrhea, but the findings have been inconsistent. The purpose of this research was to thoroughly evaluate the impact of exercise on pain severity in individuals with primary dysmenorrhea and to find the best exercise regimen for these patients.

Methods: All randomized controlled trials (RCTs) of exercise for patients with primary dysmenorrhea were searched in the Embase, PubMed, Cochrane, Web of Science, EBSCO, and CINAHL databases. The search time limit was set from the establishment of each database to 28 January 2025. Control groups included those receiving usual care, only providing health education, or no intervention at all. The outcome measure was pain intensity. The effect size was aggregated using the mean difference (MD) and 95% confidence interval (CI). The methodological quality of the included studies was evaluated using the Cochrane risk-of-bias tool. Stata 15 software was used for meta-analysis, sensitivity analysis, and assessment of potential publication bias. R 4.4.1 software was used for network meta-analysis, area under curve ranking (SUCRA), league plot, and meta-regression.

Results: The analysis included a total of 29 studies that satisfied the criteria. Exercise decreased the visual analog scale (VAS, WMD = -2.62, 95% CI [-3.29, -1.95], p < 0.001) score in individuals with primary dysmenorrhea. Strength training (WMD = -1.76, 95% CI [-2.03, -1.48], p < 0.001), exercise duration of ≥8 weeks (WMD = -1.77, 95% CI [-1.87, -1.66], p < 0.001), frequency of >3 times per week (WMD = -1.60, 95% CI [-1.75, -1.45], p < 0.001), session length of >30 min (WMD = -2.20, 95% CI [-2.38, -2.02], p < 0.001), and a total of ≥90 min per week (WMD = -2.04, 95% CI [-2.19, -1.89], p < 0.001) showed superior efficacy in enhancing VAS (subgroup analyses).

Conclusion: Engaging in physical activity may reduce the intensity of discomfort encountered by individuals afflicted with primary dysmenorrhea, with strength training potentially emerging as the most efficacious alternative. The meta-analysis presents evidence that supports clinicians' advice to patients with primary dysmenorrhea, recommending that they exercise for a minimum of 8 weeks, with sessions occurring more than three times weekly and lasting longer than 30 min each. The goal is to achieve a minimum weekly total of 90 min by increasing the frequency of workouts.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024581879, CRD42024581879.

Deep vein thrombosis (DVT) of the legs is a rare but clinically important complication of Chlamydia psittaci pneumonia. We report a case of a 51-year-old man who was admitted to the hospital with fever, cough, and dyspnea. Next-generation sequencing confirmed the diagnosis of Chlamydia psittaci pneumonia. His D-dimer level was elevated on admission, and ultrasound confirmed DVT in the legs. The patient was treated with intravenous doxycycline for the infection and rivaroxaban as an anticoagulant. His condition gradually improved and he was discharged after making a full recovery. In this paper, we explore the potential association between Chlamydia psittaci infection and venous thrombosis, as well as clinical management strategies.

VV116 is an oral antiviral drug against SARS-CoV-2, known for its favorable efficacy and safety profile. But its application in patients with severe liver dysfunction has not been evaluated. Here, we report a case in which a patient with aplastic anemia and liver impairment (recovery phase of acute liver failure) was infected with SARS-CoV-2. Based on clinical trials and pharmacokinetic analysis about VV116, we initiated a reduced dose of 300 mg every 12 h on day 1, 200 mg every 12 h on days 2-5 for antiviral therapy. Finally, the patient's viral load rapidly dropped to an undetected level, and no drug-related adverse effects were observed.

Background: Esophageal stricture is one of the major complications after endoscopic submucosal dissection (ESD) of the esophagus. However, even with steroid prophylaxis, stenosis still occurs in up to 45% of patients. Accordingly, the aim of this study was to evaluate the efficacy and safety of steroid therapy in preventing esophageal strictures after ESD, as well as to assess the predictors of esophageal strictures after the application of steroids.

Methods: Between February 2018 and March 2023, 207 patients who underwent esophageal ESD at Southeast University Affiliated Zhongda Hospital were retrospectively enrolled. We evaluated stenosis rate, number of endoscopic dilations after ESD, the interval between the first endoscopic dilatation after ESD and explored risk factors for strictures after steroid prophylaxis.

Results: In the control group, the oral steroids group, and the combined group, the stenosis rates were 83/87 (95.4%), 44/53 (83.0%), and 56/67 (83.6%), respectively; the number of endoscopic dilations were 3.43 (±2.22), 2.34 (±2.17), and 1.52 (±1.25), respectively; the time intervals between first endoscopic dilation and ESD procedure were 38.36 (±6.87), 68.18 (±9.49), and 96.82 (±8.41) days, respectively; all these indicators were significantly better in the oral and combined groups than in the control group (p < 0.05). Multivariate analysis identified lesion circumference ≥ 5/6th and submucosal injection of solution were two independent factors on esophageal stricture formation (p < 0.05).

Conclusion: Steroid prophylaxis is effective and safe in preventing esophageal stenosis. Moreover, lesion circumference and submucosal injection of sodium hyaluronate were two independent factors on esophageal stricture formation even with steroids administration.

Introduction: Specialty nursing certifications reflect nurse's knowledge and competence in certain areas. Obtaining certification allows them to advance their careers and enhance patient care standards as their role and scope of responsibility expands. This study aimed to understand how nurses view specialty certification and related challenges in three university hospitals in Riyadh, Saudi Arabia.

Methods: A cross-sectional, correlational design was used. A survey questionnaire (Perceived Value of Certification-12 Tool) was sent through email, and it had one question for each barrier.

Results: The majority of participants valued certification to verify specialist knowledge (93.9%), enhance achievement (82.8%), and increase competence (79.1%). Certification was associated extrinsically with hiring preference (54.7%), recognition from colleagues (52.3%), and professional autonomy (51.7%). The primary barriers were lack of institutional reward (72.7%) and examination cost (64.8%), with not passing earlier being the least mentioned barrier (2%). The biggest obstacles faced by clinical nurses in obtaining certification include limited institutional rewards because their organization did offer incentives, such as promotions or salary bumps. Age and hospital significantly predicted clinical nurses' intrinsic value of certification, while age, gender, nationality, and hospital significantly predicted their extrinsic value. Age and gender significantly influenced their overall perceived value of certification.

Discussion: Overall, nurses in Riyadh recognize the value of certification. However, focused interventions must be implemented to overcome identified challenges and amplify the professional benefits of certification. Recommended measures include implementing tailored support initiatives and financial aid programs to address these barriers. A collaborative approach should be developed to provide support and actively promote the pursuit of nursing certification. Future studies should adopt longitudinal and qualitative designs to evaluate the impact of focused strategies.

Whole slide images (WSIs) play a vital role in cancer diagnosis and prognosis. However, their gigapixel resolution, lack of pixel-level annotations, and reliance on unimodal visual data present challenges for accurate and efficient computational analysis. Existing methods typically divide WSIs into thousands of patches, which increases computational demands and makes it challenging to effectively focus on diagnostically relevant regions. Furthermore, these methods frequently rely on feature extractors pretrained on natural images, which are not optimized for pathology tasks, and overlook multimodal data sources such as cellular and textual information that can provide critical insights. To address these limitations, we propose the Abnormality-Aware MultiModal (AAMM) learning framework, which integrates abnormality detection and multimodal feature learning for WSI classification. AAMM incorporates a Gaussian Mixture Variational Autoencoder (GMVAE) to identify and select the most informative patches, reducing computational complexity while retaining critical diagnostic information. It further integrates multimodal features from pathology-specific foundation models, combining patch-level, cell-level, and text-level representations through cross-attention mechanisms. This approach enhances the ability to comprehensively analyze WSIs for cancer diagnosis and subtyping. Extensive experiments on normal-tumor classification and cancer subtyping demonstrate that AAMM achieves superior performance compared to state-of-the-art methods. By combining abnormal detection with multimodal feature integration, our framework offers an efficient and scalable solution for advancing computational pathology.

Background: Research on patients with persistent symptoms despite prior treatment for Lyme disease can be challenging to interpret given the diversity of criteria selected to characterize Lyme disease and to define the syndrome of those with persistent symptoms. Because most research studies only include patients with well-documented prior Lyme disease, the generalizability of the study results is limited, excluding the larger group of patients often seen in community practice who do not meet these stringent enrollment criteria. Researchers at the Lyme and other Tick-borne Diseases Clinical Trials Network (LTD-CTN) recognized early on that a research classification system was needed to facilitate the design of studies that are more inclusive. This paper presents a proposed research classification system.

Methods: Criteria used in published clinical research on previously treated Lyme disease were reviewed. Clinical expertise was provided by principal investigators in the LTD-CTN. Further input was obtained from a diverse panel of stakeholders in the field, including clinicians, academic researchers, and patient advocates. This classification system was developed based on feedback collected from all these sources.

Results: The new research classification system proposes criteria for Lyme disease at different levels of diagnostic certainty: well-defined, probable, possible, and uncertain. Criteria for ascertainment for each classification level and additional factors to be considered in patient selection for research are described.

Conclusion: The proposed research classification system should improve the quality and generalizability of clinical research by providing clear case definitions for enrollment of a more diverse group of patients with sequelae from Lyme disease.

Introduction: Health profession enrichment programs for underrepresented minority students are crucial to supporting students' interest in healthcare careers and improving preparedness for important academic and professional milestones. Doctor for a Day, an enrichment program at the University of Washington School of Medicine, hosts monthly events where underrepresented kindergarten-12th grade students are exposed to careers in medicine by healthcare professionals from diverse backgrounds.

Methods: This study investigates to what extent participation in Doctor for a Day programming improves self-efficacy using a survey study of 958 students who attended at least one Doctor for a Day event between 2017 and 2023.

Results: Using an evaluation tool composed of six questions, our results demonstrate that participation in Doctor for a Day programming increases self-efficacy and interest in medicine as a career. Analysis of these results found significant differences in responses based on grade level, with students in high school demonstrating the largest improvement in self-efficacy.

Discussion: These findings underscore the value of such enrichment programs and offer insights for the development of similar initiatives.