Frontiers in Medicine最新文献

Introduction: Mpox is a viral disease that primarily affects individuals living in endemic regions. The 2022 outbreak notably impacted HIV-positive individuals, who were disproportionately affected. This report describes the first confirmed case of Mpox in Burundi, involving an HIV-positive patient with advanced disease. The case was confirmed by the national laboratory during the early stages of the 2024 outbreak.

Case presentation: A 50-year-old woman presented with pustular and necrotic skin lesions, vulval ulcers, and systemic symptoms. She was diagnosed with HIV upon initial evaluation and, despite an initial misdiagnosis, was ultimately confirmed to have a co-infection of Mpox. Complications included secondary bacterial infection, severe pain, and prolonged healing.

Conclusion: HIV coinfection can exacerbate Mpox, leading to severe clinical presentations. Therefore, early recognition and screening for HIV in Mpox patients are essential.

Background: Postprandial distress syndrome (PDS) is the prominent subtype in patients with functional dyspepsia (FD) and currently lacks a satisfactory treatment. Acupuncture has become a promising alternative and complementary therapy for managing FD. However, high-level clinical evidence supporting the use of acupuncture for FD is limited.

Methods: This study is a multicentre, double-dummy, single-blind, randomized, active-controlled trial. Two hundred and one eligible participants will be randomly assigned into three groups: a verum acupuncture plus placebo group, an itopride plus sham acupuncture group, and a sham acupuncture plus placebo group. This study consists of a 1-week screening period, a 4-week treatment period, and a 12-week follow-up period. During the intervention period, participants will receive 12 sessions of verum or sham acupuncture treatment (one session per day, three sessions per week, for 4 weeks) along with 50 mg itopride tablets or 50 mg itopride placebo tablets 3 times a day for 20 days (5 continual days a week for 4 weeks). The response rate (patients who had adequate relief of gastric symptoms will be considered positive responders) and the elimination rate of cardinal symptoms (postprandial fullness and early satiation) are the primary indicators to evaluate the overall acupuncture effect for PDS. Secondary outcome measures will include the Nepean Dyspepsia Symptom Index (NDSI), the short form-Nepean Dyspepsia Life Quality Index (SF-NDLQI), the Hospital Anxiety and Depression Scale (HADS), and related hormone concentrations. Participants' expectations toward acupuncture treatment will also be assessed, and adverse events will be recorded for safety assessment. All analyses will adhere to an intention-to-treat principle.

Discussion: In conclusion, this trial will determine the efficacy and safety of acupuncture for PDS and provide more high-level evidence to support its application in treating FD.

Trial registration: Identifier [ITMCTR2024000510].

Background: Immunoglobulin A nephropathy (IgAN), a common primary glomerulonephritis worldwide, has been investigated, and complex factors are involved in disease progression. A group of evidence emerged that nutrition status plays a nonsubstitutable role in the management of chronic kidney disease. Meanwhile, a novel marker of nutrition and inflammation, the prognostic nutritional index (PNI), has been studied in various diseases. Whether PNI can predict the renal outcome of patients with IgAN remains unclear. Thus, we aimed to evaluate the relationships between PNI and clinicopathologic features, renal progression and renal prognosis in patients with IgAN.

Methods: A total of 1,377 patients with biopsy-proven IgAN were recruited for this retrospective study. All patients were divided into two groups based on the cutoff value of PNI: the high group (PNI ≥ 47.1, n = 886) and the low group (PNI < 47.1, n = 491). Our study endpoint was end-stage renal disease [estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m² or performance of renal replacement therapy]. A correlation test was conducted to explore the relationship between PNI and other important clinicopathologic parameters. The predictive value was determined by the area under the receiver operating characteristic curve (AUROC). Kaplan-Meier and Cox proportional hazards analyses were performed to assess the value of PNI in predicting renal progression and prognosis.

Results: The correlation test revealed that PNI was positively associated with eGFR (r = 0.16, p < 0.001) and negatively related to 24-h proteinuria (r = -0.387, p < 0.001). Multivariate Cox regression analysis indicated that low PNI was an independent risk factor for IgAN patients even after adjusting for important clinical and pathological parameters (HR, 0.664; 95% CI, 0.443-0.994; p = 0.047). Kaplan-Meier analysis showed that low PNI was significantly correlated with severe renal outcome in patients with IgAN (p < 0.001). Moreover, the subgroup analyses of Kaplan-Meier survival demonstrated that low PNI predicted severe renal prognosis in different types of IgAN patients when considering the level of glomerular filtration rate, 24 h proteinuria and hemoglobin.

Conclusion: PNI is associated with renal function and pathologic lesions in IgAN patients and could be a novel marker for the evaluation of renal progression and prognosis.

Background: Cipepofol is a highly selective gamma-aminobutyric acid A receptor potentiator. As a new sedative drug, detailed studies on its respiratory effects are further needed. The present study aims to investigate the effects of cipepofol on breathing patterns, respiratory drive, and inspiratory effort in mechanically ventilated patients.

Methods: In this one-arm physiological study, cipepofol was initiated at 0.3 mg/kg/h and increased by 0.1 mg/kg/h every 30 min until reaching 0.8 mg/kg/h. Discontinuation criteria were Richmond Agitation and Sedation Scale (RASS) score ≤ -4 or respiratory rate (RR) < 8 breaths/min or pulse oxygen saturation (SpO₂) < 90%. The primary outcomes were changes from baseline in respiratory variables [RR, tidal volume (VT), minute ventilation (V_min), airway occlusion pressure at 100 msec (P_0.1), pressure muscle index (PMI), expiratory occlusion pressure (P_occ)] at 30 min after 0.3 mg/kg/h cipepofol infusion. The secondary outcomes included changes in respiratory variables, cardiorespiratory variables, and RASS scores at rates of cipepofol from 0.3 to 0.8 mg/kg/h.

Results: 20 patients were enrolled and all of them completed the cipepofol infusion rate at 0.3 mg/kg/h, achieving RASS score of -2 to +1. For the primary outcomes, there was a significant reduction in VT (390.9, [356.6-511.0] vs. 451.6 [393.5-565.9], p = 0.002), while changes in RR (16.7 ± 2.7 vs. 16.2 ± 3.4, p = 0.465) and V_min (7.2 ± 1.8 vs. 7.5 ± 1.9, p = 0.154) were not significant. The reductions in P_0.1 (p = 0.020), PMI (p = 0.019), and P_occ (p = 0.007) were significant. For secondary outcomes, as the infusion rate of cipepofol increased from 0.3 to 0.8 mg/kg/h, there was a further decrease in VT (p = 0.002) and an increase in RR (p < 0.001), while the change in V_min (p = 0.430) was not significant. RASS score (p < 0.001) was further decreased.

Conclusion: Cipepofol demonstrates the capability to achieve RASS score -2 to +1 in mechanically ventilated adult patients. The effect of cipepofol on breathing patterns was a decrease in VT, while changes in RR and V_min were insignificant. The effect on respiratory drive and inspiratory effort significantly reduced P_0.1, PMI, and P_occ.

Clinical trial registration: ClinicalTrials.gov, identifier NCT06287138. https://clinicaltrials.gov/study/NCT06287138.

Introduction: This investigation assesses the impact of healthy lifestyle behaviors on depressive symptoms among older adults in China, utilizing data from the 2020 China Health and Retirement Longitudinal Study (CHARLS).

Methods: The analysis included 9,020 valid samples from individuals aged 60 and above. Sleep duration, social participation, and physical exercise were examined as independent variables. Depressive symptoms were measured using the CESD-10 scale, with relationships analyzed through an ordered logistic regression model.

Results: The study reveals significant correlations between healthy lifestyle behaviors - specifically adequate sleep, regular physical exercise, and active social participation - and reduced prevalence of depressive symptoms in the elderly (p < 0.05).

Discussion: These findings underscore the potential of healthy lifestyle interventions as key strategies in alleviating the mental health burden among China's aging population. Integration of these results into public health policies is recommended to enhance the mental well-being of older adults.

Objectives: Cancer has been reported as a potential trigger for IgA vasculitis (IgAV) in adults; however, data on this topic are scarce. The aim of our study was to examine the frequency and location of cancer in adults with IgAV.

Methods: We included 295 IgAV patients diagnosed between January 2010 and June 2021 and followed at our secondary/tertiary rheumatology centre. Cancer episodes were recorded and classified into three groups according to their temporal relation to IgAV: (1) cancer diagnosed prior to IgAV; (2) cancer diagnosed concurrently with IgAV; and (3) cancer diagnosed during IgAV follow-up. The term IgAV associated with cancer (IgAV-CA) was used for IgAV cases presenting while cancer was active or diagnosed within a three-year period before or after the IgAV diagnosis.

Results: Forty-seven IgAV patients (15.9%) developed a total of 56 different cancers. Of these, 43 cancers (76.8%) preceded the IgAV diagnosis, 3 cancers (5.3%) were diagnosed concurrently with IgAV, and 10 cancers (17.9%) were diagnosed during the IgAV follow-up. Twenty-two IgAV patients (7.5%) who developed a total of 24 cancers (42.9%) could be classified as IgAV-CA cases. The three most frequently diagnosed cancers in the IgAV-CA group were prostatic, renal and bladder cancer, together accounting for 50% of cancers. Age and smoking were associated with concurrent cancers, and arthritis represented a risk factor for cancer development during IgAV follow-up.

Conclusion: IgAV cases associated with cancer represent 7% of adult IgAV cases. In elderly patients, careful examination of the urogenital tract is warranted when cancer is suspected.

Background and aims: Lymph node metastasis plays a crucial role in determining the appropriate treatment approach for patients with gastric cancer (GC), particularly those in the T1-T2 stage. Currently available diagnostic strategies for GC with lymph nodes have limited accuracy. The present research aimed to create and validate diagnostic and prognostic nomograms specifically tailored for the T1-T2 stage GC patients with LNM.

Methods: We derived clinicopathological characteristics of patients diagnosed with GC from the Surveillance, Epidemiology, and End Results (SEER) database. We utilized univariate and multivariate logistic analyses to examine the risk factors linked with the occurrence of lymph node metastasis (LNM) in GC patients within the T1-T2 stage. Furthermore, the prognostic factors related to the T1-T2 stage GC patients with LNM were explored by univariate and multivariate cox analyses. Two nomograms were built by the risk factors screened above.

Results: Ultimately, our study included 5,350 patients with T1-T2 stage GC. After identifying age, T stage, tumor size, primary site, grade, and histological type as risk factors for the LNM occurrence, we successfully developed a diagnostic nomogram utilizing these variables. Age, T stage, M stage, tumor size, primary site, grade, radiation, surgery, and chemotherapy were all independent prognostic factors that related to the T1 - T2 GC patients with LNM. The results of the AUC, calibration curve and decision curve analysis (DCA) showed excellent calibration performance and clinical applicability of the two nomograms. The Kaplan-Meier (K-M) curves clearly demonstrated a notable distinction in overall survival between low-risk and high-risk groups, highlighting the prognostic significance of the nomogram.

Conclusion: The establishment and validation of the two nomograms for T1-T2 GC patients with LNM were successful, serving as valuable tools for clinical decision-making and the formulation of personalized treatment approaches.

Introduction: The study aimed to assess the relationship between plasma pentraxin 3 (PTX-3) levels and the potential diagnosis of fibrosis in metabolic dysfunction-associated steatohepatitis (MASH) in older adults. This was assessed using the Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), and Hepamet fibrosis score (HFS).

Materials and methods: The subanalysis included 2,397 older adults (aged 60 years and older) from the population-based PolSenior2 study, all of whom had risk factors for metabolic dysfunction-associated steatotic liver disease (MASLD) and underwent PTX-3 assessment. The participants were divided into two subgroups according to the FIB-4 values (≤2.67 and > 2.67), three subgroups according to the NFS values (< -1.455, -1.455, and 0.675, and > 0.675), and three subgroups according to the HFS values (< 0.12, 0.12 and 0.47 and > 0.47).

Results: The empirical cutoff points for PTX-3 levels as a potential marker of liver fibrosis were assessed separately for women and men. In women, the cutoff points for PTX-3 levels based on ROC curve analyses ranged from 1.96 to 2.30 ng/mL (an AUC ranging from 0.596 to 0.643, sensitivity between 39.1 and 61.7%, and specificity between 56.1 and 79.6%). In men, a significant cutoff point was established for FIB-4 (an AUC of 0.549, sensitivity of 39.4%, and specificity of 69.6%). Overall, the accuracy was poor.

Conclusion: Our study suggests that plasma PTX-3 levels are not sensitive enough to be used as a non-specific marker of liver fibrosis in older adults.

Meigs' syndrome is a rare gynecological condition characterized by a benign ovarian tumor, ascites, and pleural effusion, all of which resolve spontaneously after tumor removal. While mildly elevated serum CA-125 levels are frequently observed, levels exceeding 1,000 IU/mL are extremely rare, and concurrent elevation of other tumor markers, such as HE-4, may further complicate its diagnosis. We report a case of Meigs' syndrome in a 41-year-old premenopausal woman. Initial presenting symptoms included severe dyspnea, abdominal distention, anorexia, and weight loss. Subsequent imaging studies revealed a large right ovarian tumor accompanied by massive ascites and pleural effusion. Serum CA-125 and HE-4 levels were markedly elevated (1,200 IU/mL and 82.1 pmol/L, respectively), with a Risk of Ovarian Malignancy Algorithm (ROMA) score of 25.63%, suggesting advanced ovarian malignancy. Neoadjuvant chemotherapy was initiated, but the tumor continued to grow, necessitating internal debulking surgery. Postoperative histopathology revealed a benign ovarian fibroma, confirming the diagnosis of Meigs' syndrome. Spontaneous resolution of ascites and pleural effusion occurred by the second postoperative day, and the tumor markers normalized within the next six months. The patient remained disease-free at 2-year follow-up. This case underscores the importance of considering Meigs' syndrome in patients with markedly elevated tumor markers, an ovarian tumor unresponsive to chemotherapy, and concomitant ascites and pleural effusion. Early recognition and surgical intervention are critical for accurate diagnosis and optimal management of this rare condition.

Rheumatoid arthritis (RA) is a systemic autoimmune disease that affects millions of people worldwide and is characterized by persistent inflammation, pain, and joint destruction. In RA, the dysregulation of the immune system is well documented. However, the genetic basis of the disease is not fully understood, especially when extra-articular organs are involved. Interstitial lung disease (ILD) is a major cause of morbidity and mortality in patients with RA. Notably, RA-ILD shares several risk factors with idiopathic pulmonary fibrosis (IPF), namely male gender, smoking history, usual interstitial pneumonia (UIP) pattern of fibrosis, and association with the MUC5B rs35705950 polymorphism. In addition, other genetic susceptibilities are reported in RA-ILD for some HLA alleles and other less studied polymorphisms. However, the pathobiology of RA-ILD, particularly whether and to what extent genetic and environmental factors interact to determine the disease, remains elusive. In this review, we summarize and critically discuss the most recent literature on the genetics and pathogenesis of RA-ILD. The main clinical aspects of RA-ILD are also discussed.