Frontiers in Medicine最新文献

Background: Pulmonary arterial hypertension (PAH) is a serious complication of chronic obstructive pulmonary disease (COPD) that markedly worsens functional capacity and prognosis. Fasudil, a selective Rho-kinase inhibitor, has shown vasodilatory and vascular-protective effects; however, its therapeutic value in COPD-associated PAH has not been systematically quantified.

Objective: The objective of the study was to evaluate the efficacy of fasudil as an adjunctive therapy for COPD patients with PAH through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: Eight electronic databases were searched from inception to April 2024 for RCTs comparing fasudil plus conventional therapy with conventional therapy alone. Primary outcomes included overall treatment effectiveness and pulmonary artery systolic pressure (PASP). Secondary outcomes were blood oxygen saturation (SaO₂), arterial oxygen tension (PaO₂), and 6-min walk distance (6MWT). Data were pooled using fixed- or random-effects models according to heterogeneity.

Results: A total of 11 RCTs involving 865 participants met the inclusion criteria. Fasudil significantly increased the overall effective rate (risk ratio = 1.18, 95% CI = 1.05-1.31, p = 0.004) and reduced PASP (mean difference = -9.42 mmHg, 95% CI = -10.73 to -8.12, p < 0.001) with negligible heterogeneity. Chronic treatment (≥2 weeks) improved SaO₂ (MD = 3.56, 95% CI 1.73-5.40), whereas single-dose administration had a minimal effect. PaO₂ increased modestly (MD = 2.19 mmHg, 95% CI = 0.84-3.54, p = 0.002). Functional capacity improved substantially, with a 51.96-m gain in 6MWT distance (95% CI = 36.84-67.08, p < 0.001), exceeding the minimal clinically important difference.

Conclusion: Fasudil confers consistent short-term benefits in COPD-related PAH, significantly lowering pulmonary pressures and enhancing oxygenation and exercise tolerance. While the included studies were of moderate methodological quality and limited to Chinese settings, the pooled evidence supports fasudil as a promising adjunct for managing COPD-associated PAH. Larger, multicenter RCTs with longer follow-up are warranted to confirm its long-term efficacy and safety. The short follow-up (maximum 4 weeks) limits insights into sustained benefits or progression; long-term trials are essential.

Background: Acute gastrointestinal bleeding (AGIB) in patients with liver cirrhosis is a frequent and often fatal event. This study aimed to thoroughly characterize the relationship between patients' age and 6-week mortality. We sought to identify specific risk thresholds and key modifying factors to refine clinical risk stratification.

Methods: We conducted a retrospective analysis of 878 patients with liver cirrhosis and AGIB admitted to the Emergency Room at Beijing You'an Hospital. Patients were stratified into age-based tertiles for descriptive analysis. To assess the association between age and 6-week mortality, we built three sequential logistic regression models adjusting for key clinical confounders including the Glasgow-Blatchford Score (GBS), using restricted cubic splines (RCS) to capture non-linear effects and identify risk thresholds. Subgroup analyses and formal tests for interaction were performed to evaluate the consistency of the age-related risk across different clinical scenarios.

Results: The 6-week mortality rate was highest in the oldest age tertile (18.21%). Age emerged as a significant and independent predictor of mortality in all models. The fully adjusted RCS model identified a critical age threshold of approximately 58 years, above which mortality risk increased sharply. The prognostic impact of age was particularly pronounced in male patients and those not receiving endoscopic therapy. Notably, a significant interaction was detected between age and intensive care unit (ICU) admission status (P for interaction < 0.05). The strong association between increasing age and higher mortality observed in non-ICU patients was attenuated and no longer significant in those admitted to the ICU. A significant association between increasing age and 6-week mortality was identified in patients with Child-Pugh grade C (p < 0.001), and in medium-risk and high-risk groups (both p = 0.011) when patients were stratified based on GBS. Additionally, in the etiological subgroups, age was a significant predictor of 6-week mortality only in patients with viral cirrhosis (p = 0.002) and viral/alcoholic cirrhosis (p = 0.01), but not in patients with other etiologies.

Conclusion: Age is a critical independent predictor of 6-week mortality in cirrhotic patients with AGIB, but its prognostic effect varies with the level of care. Specifically, It strongly predicts mortality in non-ICU settings, but not in the ICU. This challenges the uniform view of age as a risk factor and suggests that early transfer to higher-level care such as ICU admission may reduce age-related risk in this vulnerable population.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary small arteriolar disease caused by mutations in the NOTCH3 gene. Acute vision loss is not commonly associated with the classical phenotype of CADASIL. We report a rare CADASIL case with the simultaneous onset of visual dysfunction and cerebral infarction in a young male. The patient was confirmed to have cerebral infarction on magnetic resonance imaging. Symptoms of acute vision loss occurred simultaneously due to optic nerve and retinal ischemia. Consequently, this case provides novel perspectives on the relationship between ocular hemodynamics and inherited cerebral small vessel disease. It is crucial to heighten awareness that presentation of non-arteritic anterior ischemic optic neuropathy (NAION) and retinal hypoperfusion in a young patient without any other risk factors necessitates consideration of secondary causes. These manifestations could represent a potential presentation of CADASIL.

Objectives: The aim of the following study is to determine the association between lymphocyte subsets (total lymphocytes, CD3, CD4, CD8, B cells, NK cells) and clinical outcomes (need for non-invasive ventilatory support, ICU admission and in-hospital death) in patients hospitalized with SARS-CoV-2 infection.

Methods: We conducted a single-center, pre-vaccination, retrospective cohort study including adults hospitalized between March 2020 and April 2021. Peripheral blood samples were collected within the first 24 h of admission for immune phenotyping. Additional clinical data were obtained from electronic health records. Statistical analyses included chi-square tests and multivariable logistic regression, adjusted for clinical characteristics and inflammatory biomarkers. Optimal cutoff points for immune and inflammatory markers were determined using the Youden index.

Results: Among 959 patients, 29.4% required ventilatory support, 11.3% required ICU admission, and 10.7% died. In multivariable analysis adjusted by clinical and laboratory confounders, CD3+ cells (cutoff point: 666 cells/mm³) were independently associated with ventilatory support (aOR: 2.3, 95%CI: 1.5-3.4, p = 0.013) and in-hospital death (aOR: 2.4, 95%CI: 1.3-4.3, p = 0.048); and CD4+ cells (cutoff point: 359 cells/mm³) were independently associated with in-hospital death (aOR: 2.8, 95%CI: 1.4-5.5, p = 0.045).

Conclusion: Adaptive immunity, especially T CD3+ and T CD4+ cells, is relevant in the prognosis of COVID-19, and T-cell counts can help identify hospitalized COVID-19 patients at risk for severe outcomes: ventilatory support and in-hospital death.

Background: Melanotrichoblastoma (MTB) is an exceptionally rare benign adnexal tumor with follicular differentiation. Its clinical and dermoscopic resemblance to pigmented basal cell carcinoma (BCC) often leads to misdiagnosis.

Case presentation: A 51-year-old male presented with a slow-growing, blue-black nodule on the right canthus that had been present for five decades, with recent central ulceration. Dermoscopy revealed homogeneous pigmentation with atypical blue-white areas and dilated vessels, suggestive of BCC. Histopathological examination showed well-demarcated dermal nests of basaloid cells with peripheral palisading and stromal pigment deposition. Importantly, retraction clefts were absent, a key feature distinguishing MTB from BCC. The lesion was completely excised, with no recurrence after two years.

Conclusion: This case highlights the diagnostic challenge of MTB. Histopathology remains the gold standard for differentiation, wherein the absence of retraction clefts serves as a pivotal diagnostic clue. Increased awareness of MTB is essential to avoid misdiagnosis and ensure appropriate, conservative management.

Purpose: Vulvar Paget's disease with secondary invasive adenocarcinoma can be challenging to manage, particularly in inoperable or recurrent situations. We report this rare case to raise clinical awareness, accumulate diagnostic and treatment experience, and offer guidance for managing similar cases in the future.

Methods: We present a 79-year-old woman with large invasive vulvar Paget's disease (HER2 3+).

Results: As surgery was not feasible, she received trastuzumab plus capecitabine, achieving marked tumor shrinkage. Nine months later, local recurrence with bone metastasis was treated with the same regimen followed by sequential radiotherapy (60 Gy), resulting in partial remission. With trastuzumab maintenance, disease control has been sustained for 17 months.

Conclusion: HER2-targeted therapy combined with chemotherapy and radiotherapy is a promising treatment strategy for HER2-positive, inoperable or recurrent VPD.

Background: Psittacosis is a zoonotic disease caused by Chlamydia psittaci (C. psittaci). Its clinical symptoms are nonspecific, ranging from influenza-like symptoms to severe pneumonia. Thus, it is often ignored and underreported. To date, the report of C. psittaci infections detected by targeted next generation sequencing (tNGS) is still limited.

Methods: tNGS was performed on the platform of Vision Medicals in patients with fever or respiratory infections from August 2024 to August 2025 in our hospital. The specimens included blood and bronchoalveolar lavage fluid (BALF). C. psittaci infection was confirmed by real-time PCR. Detailed clinical data of the included patients were collected and analyzed from electronic medical records.

Results: Eight psittacosis patients were detected by tNGS and confirmed by real-time PCR. The median age of 8 patients was 69 years (range: 46-86 years). Five patients (62.5%) had a history of exposure to birds. Clinical symptoms included fever, cough, fatigue, headache and dyspnea. Patients exhibited normal or elevated white blood cell (WBC) counts with decreased lymphocyte counts. C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels were significantly elevated. The majority of patients (87.5%, 7/8) developed hepatic dysfunction. Pulmonary lesions were multi-lobar, presenting as consolidation, ground glass opacities and air bronchogram signs, with pleural effusion occurred in some cases. Following confirmation of C. psittaci infection, targeted antimicrobial therapies with tetracyclines (tigecycline or omacycline) were administered. All patients demonstrated significant reductions in inflammatory markers after treatments, with clinical symptoms improving until resolution. Follow-up chest computed tomography (CT) scans showed resolution of infection foci. All patients ultimately recovered and were discharged.

Conclusion: tNGS is a promising tool for rapidly detecting C. psittaci infections. Early diagnosis of psittacosis with subsequently targeted therapies improved patients' outcome.

Objective: To explore the effects of sequential enteral nutrition support in elderly patients with severe ischemic stroke after thrombectomy.

Methods: From January 2022 to January 2024, 115 elderly patients with severe ischemic stroke who underwent thrombectomy were selected and divided into a control group (n = 57) and an intervention group (n = 58). The control group received routine enteral nutrition support, while the intervention group received sequential enteral nutrition support. The nutritional status, immune function, degree of neurological impairment, prognosis, daily living ability, gastrointestinal dysfunction, and incidence of complications were compared between the two groups.

Results: Compared with the control group, the intervention group had higher levels of albumin (ALB), total protein (TP), prealbumin (PA), and hemoglobin (Hb) on the 14th day after intervention (p < 0.05), higher levels of immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) on the 14th day after intervention (p < 0.05), lower NIHSS score after 14 days of intervention, higher Glasgow Coma Scale (GCS) score, higher Barthel Index (BI) at discharge (p < 0.01), lower gastrointestinal dysfunction score on the 14th day after intervention (p < 0.05), and lower complication rate (p < 0.05).

Conclusion: Sequential enteral nutrition support can attenuate the deterioration of intestinal adaptability under pathological conditions, promote the absorption of nutrients, and slow the decline of nutritional status in elderly patients with severe ischemic stroke after thrombectomy in the short term. It also shows early functional benefits, such as mitigating the worsening of the GCS and NIHSS scores at 14 days and the BI at discharge, and reducing the occurrence of short-term complications. Additionally, it appears to decelerate the decline of cellular and humoral immune parameters. These short-term physiological and early functional modifications create favorable conditions for the initial treatment and early rehabilitation of the diseases.

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.