Frontiers in Medicine最新文献

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss among older adults. Thyroid hormones (THs) are essential endocrine regulators of development and metabolic homeostasis, and increasing evidence suggests that TH signaling is involved in retinal physiology and AMD pathogenesis. Experimental studies have demonstrated that excessive TH signaling exacerbates oxidative stress, mitochondrial dysfunction, and apoptosis in retinal pigment epithelium (RPE) cells and photoreceptors, whereas inhibition of TH signaling confers retinal protection in animal models of dry AMD. Genetic evidence from Mendelian randomization analyses further indicates that genetically predicted higher free thyroxine (FT₄), per one standard deviation increase, is associated with an increased risk of AMD (OR 1.19, 95% CI 1.06-1.33), while no causal association has been established for thyroid-stimulating hormone (TSH). Consistently, large population-based cohort studies, including the Rotterdam Study, have reported a positive association between circulating FT4 levels and the incidence of AMD. In this narrative review, we summarize and critically evaluate recent advances from basic experimental, genetic, and clinical studies on the relationship between thyroid hormones and AMD, discuss potential biological mechanisms underlying this association, and highlight current limitations and future research directions.

Background: Patients with chronic illnesses exhibit elevated healthcare utilization and costs, increased prevalence of depression, and impaired functional capacity. Most healthcare systems rely on primary care physicians (PCPs) to manage the treatment of patients with chronic diseases. Studies have demonstrated that patients who report high-quality care have higher treatment adherence rates, increased self-management skills, and a positive, ongoing relationship with their PCPs. This study aimed to explore the factors influencing satisfaction among patients with chronic diseases receiving primary health care (PHC) in Saudi Arabia.

Methods: A qualitative technique was employed to thoroughly comprehend the intricacies of participant experiences. Online semi-structured interviews were carried out with individuals diagnosed with one or more chronic diseases and who have visited PHC. The thematic analysis framework described by Braun and Clarke was employed to code and thematically assess the data by using NVivo software. The identification of themes and sub-themes resulted in the establishment of an initial coding framework.

Results: Data saturation was attained following the interviews of 46 patients (n = 46). The majority of participants were women, and 66% were over 50. 70% were married, 65% had college degrees, and 17% earned less than 5,000 SAR monthly. Nearly half had three or more chronic illnesses. Our thematic analysis revealed 5 themes relevant to the factors that influence the level of satisfaction among patients with chronic diseases concerning the services provided by their PCP: access to care; respect for patient-centered values, preferences, and expressed needs; coordination and integration of care; information, communication, and education; emotional and mental support; and transition and continuity.

Conclusion: Our study found that dissatisfaction with accessing care remains for particularly vulnerable populations, such as the elderly, residents of remote areas, and individuals with low literacy skills. Insufficient interaction, inadequate privacy, and exclusion from the decision-making process were also significant concerns expressed by our participants, who emphasized the need for a sustained, long-term connection that fosters positive rapport, acknowledges customer competence, ensures effective communication, and addresses consumers' mental health. Thus, it is necessary to implement fundamental modifications at various levels, including medical education, health systems, and tailored regulations, to create a general environment that promotes the establishment of an effective doctor-patient relationship.

Introduction: The integration of artificial intelligence (AI) into radiotherapy planning for pelvic and abdominal malignancies has ushered in a new era of precision oncology, enhancing treatment accuracy and patient outcomes. Central to this advancement is the development of sophisticated image segmentation techniques that accurately delineate tumors and surrounding organs at risk. Traditional segmentation methods, often reliant on manual contouring or basic algorithmic approaches, are time-consuming and susceptible to inter-operator variability, potentially compromising treatment efficacy. Moreover, existing deep learning models, while promising, frequently struggle with challenges such as ambiguous anatomical boundaries, small or disconnected lesion regions, and underrepresented classes within training datasets.

Methods: To address these challenges, research has progressively evolved from rigid anatomical modeling to more flexible, learning-based paradigms capable of adapting to diverse clinical presentations. However, even with the advent of advanced deep neural networks like U-Net and its variants, segmentation models often face difficulties in generalizing across multi-center datasets due to variability in imaging protocols and anatomical diversity. Furthermore, high computational demands and a lack of interpretability continue to hinder seamless clinical integration.

Results and discussion: In this study, we propose an attention-enhanced domain-adaptive segmentation framework tailored for radiotherapy planning in complex anatomical regions. By incorporating a context-aware attention mechanism and a fine-tuned adaptation module, our method aims to achieve high segmentation accuracy while maintaining computational efficiency. This framework not only improves performance on heterogeneous data but also facilitates robust and reproducible contouring of organs and lesions, contributing to more effective and individualized radiation therapy planning.

Background: Severe organ function deterioration is associated with poor prognosis in patients with septic shock combined with ARDS. This study aimed to develop a validated predictive model for early organ function deterioration and to evaluate the factors associated with this deterioration, as well as the prognosis, in patients with septic shock combined with ARDS.

Methods: This is a retrospective study including 67 patients with septic shock combined with ARDS. Patients were categorized into two groups based on the change in their Sequential Organ Failure Assessment (SOFA) score over 24 h: the organ function deterioration group (SOFA_{24h - 0h} score ≥ 1) and the non-deterioration group (SOFA_{24h - 0h} score <1). The sublingual microvasculature of patients was assessed using microcirculatory microimaging to obtain metrics such as proportion of perfusion vessel change rate (ΔPPV), which were then analyzed to characterize the patients with early organ function deterioration.

Results: There were a total of 34 patients with early organ function deterioration. ΔPPV and LCR were independently associated with early organ function deterioration, and ΔPPV and lactate clearance rate (LCR) were associated with ΔSOFA. The AUC for ΔPPV was 0.813 (95% CI: 0.707-0.919), and when combined with the LCR, the AUC was 0.871 (95% CI: 0.785-0.957).

Conclusions: Deterioration of organ function is common in patients with septic shock combined with ARDS and early detection is crucial. Microcirculation is an important factor in safeguarding organ function. We developed a predictive model to predict the risk of early organ function deterioration, and the combination of ΔPPV and LCR may merit further investigation.

Aim: Research on pediatric ocular trauma remains limited, and clinical management is often extrapolated from adult data. This study aimed to analyze the risk factors, visual prognosis, and microbiological characteristics of infectious endophthalmitis following pediatric ocular trauma, thereby providing evidence for clinical decision-making.

Methods: A retrospective cohort study was conducted on 108 hospitalized children with ocular trauma treated at Hebei Eye Hospital between January 2019 and June 2025. Three parallel analyses were performed within the same population: (1) 54 children (54 eyes) with post-traumatic infectious endophthalmitis (endophthalmitis group) were matched to 54 children (54 eyes) without endophthalmitis (control group). Clinical features and inflammatory markers were compared, and risk factors were identified using receiver operating characteristic (ROC) curves and logistic regression; (2) patients were categorized into good-vision (55 cases) and poor-vision (33 cases) groups. Baseline data and inflammatory indices were compared to classify independent risk factors for poor visual outcome; and (3) pathogen culture and antibiotic susceptibility results were summarized.

Results: A total of 108 children were included, of whom 83 (76.85%) were male and 98 (90.74%) were rural residents. Risk factors for post-traumatic infectious endophthalmitis included delayed presentation, elevated white blood cell count (WBC), neutrophils (NEUT), monocytes (MON), monocyte-to-lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) (OR = 0.979, 1.413, 1.29, 51.404, 166.58, 2.019, and 1.001, respectively). WBC (OR = 1.404) was identified as an independent risk factor. WBC presented good diagnostic performance with an AUC of 0.722; combined predictors improved the AUC to 0.745. Risk factors for poor visual prognosis included endophthalmitis, lens injury, elevated WBC, and elevated NEUT (OR = 4.667, 6.176, 1.152, and 1.15, respectively), with a combined AUC of 0.732. Among culture-positive cases in the endophthalmitis group, bacterial infection predominated (81.48%, 22/27). Gram-positive cocci were most common, primarily Staphylococcus and Streptococcus species, with broad susceptibility to cephalosporins, penicillin, vancomycin, aminoglycosides, and fluoroquinolones.

Conclusion: Pediatric traumatic infectious endophthalmitis predominantly occurs in male children from rural areas. WBC is a valuable diagnostic biomarker, and the combination of multiple inflammatory indices further improves diagnostic accuracy. Delayed medical consultation is a critical risk factor. Patients with less severe lens damage and lower inflammatory marker levels are more likely to achieve favorable visual outcomes. Bacterial infections, especially Gram-positive cocci, are the predominant pathogens.

Background: Antimicrobial resistance (AMR) is a growing global threat with disproportionate impact in resource-limited settings. We characterized clinically significant bacteria in Goma, Democratic Republic of the Congo (DRC), and their susceptibility using the WHO AWaRe framework.

Methods: We conducted a cross-sectional study (September 2019-March 2022) of routine clinical specimens (blood cultures, urine, vaginal, perineal swabs and pus). Specimens were cultured on standard nonselective (chocolate agar with polyvitamin supplement, fresh blood agar, tryptican broth) and selective media (MacConkey and Chapman agar); isolates were identified locally and referred to the Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) for confirmation and antimicrobial susceptibility testing (AST).

Results: Overall, 341 isolates underwent AST. Escherichia coli was most prevalent (~27%), followed by Klebsiella pneumoniae and Enterococcus faecalis. Enterobacterales exhibited high non-susceptibility to first- and second-line AWaRe Access agents. In E. coli, resistance exceeded 60% to ampicillin, amoxicillin/clavulanate, and ciprofloxacin. K. pneumoniae showed uniform resistance to ampicillin and high resistance to cefuroxime, cefotaxime, gentamicin, and colistin. These patterns constrain the effectiveness of commonly used empiric regimens.

Conclusion: AMR is a major public-health problem in Goma. Strengthening laboratory capacity and establishing continuous surveillance are urgent priorities. Recommended actions include participation in WHONET/GLASS program and antibiotic stewardship. In the interim, empiric strategies should favor nitrofurantoin for uncomplicated cystitis, judicious aminoglycoside use where appropriate, early culture, and prompt de-escalation, reserving carbapenems for severe ESBL-risk presentations.

Introduction: This meta-analysis aimed to determine the clinical efficacy of acupuncture combined with biofeedback electrical stimulation for stress urinary incontinence in women.

Methods: Databases including CNKI, WanFang, VIP, PubMed, Cochrane Library, Embase, and Web of Science were searched to collect randomized controlled trials (RCTs) on acupuncture combined with biofeedback electrical stimulation for female stress urinary incontinence from database inception to June 1, 2025, and performed a meta-analysis using Stata 15 software.

Results: A total of 33 studies involving 2,860 patients were included in the analysis. Meta-analysis revealed that compared with the biofeedback electrical stimulation group, the acupuncture plus biofeedback electrical stimulation group significantly reduced the number of leakage episodes [SMD = -2.26, 95% CI (-3.42, -1.11)] and urine leakage volume [SMD = -1.79, 95% CI (-2.22, -1.37)], and ICIQ-SF scores [MD = -2.00, 95% CI (-2.61, -1.39)]. Additionally, the acupuncture plus biofeedback electrical stimulation group demonstrated significantly greater increases in pelvic floor muscle strength scores [SMD = 0.99, 95% CI (0.32, 1.65)]. The clinical efficacy of the acupuncture plus biofeedback electrical stimulation group was significantly higher than that of the biofeedback electrical stimulation control group [RR = 1.20, 95% CI (1.16, 1.25)].

Conclusion: Acupuncture combined with biofeedback electrical stimulation therapy may offer certain advantages in treating female stress urinary incontinence. It may reduce the frequency and volume of urinary leakage, lower ICIQ-SF scores, increase pelvic floor muscle strength scores, and improve quality of life in women.

This report details the first documented instance of successful hepatic resection performed in a patient presenting with focal nodular hyperplasia (FNH) concomitant with constitutional indocyanine green (ICG) excretory defect - an exceptionally rare hepatic transport disorder initially characterized in 1974. A male patient in his early 20s was diagnosed with FNH necessitating surgical evaluation. Preoperative assessment revealed a profoundly elevated ICG retention rate at 15 min (ICG-R15) of 66.7%, indicating severely impaired clearance based on conventional interpretation. Crucially, however, comprehensive evaluation demonstrated discordantly normal standard liver function biochemical parameters (including bilirubin, transaminases, albumin, coagulation profile) and entirely unremarkable histopathological findings obtained via percutaneous biopsy of radiologically normal liver parenchyma. This definitive constellation of findings confirmed the diagnosis of constitutional ICG excretory defect, effectively excluding intrinsic hepatic parenchymal dysfunction or significant functional impairment. Consequently, proceeding with hepatic mass resection was deemed justified. The surgical intervention and immediate postoperative course were entirely uneventful, characterized by hemodynamic stability, absence of biochemical liver failure, and no complications during the critical recovery phase, with histopathology confirming FNH. This case constitutes a seminal demonstration that ICG clearance kinetics are inherently unreliable and potentially misleading as a sole indicator of functional hepatic reserve in patients harboring this specific excretory defect who are candidates for hepatectomy. Our findings establish the critical principle that the imperative for a multifaceted preoperative evaluation strategy that transcends reliance on ICG kinetics alone to safely guide surgical intervention in this unique patient population.

Objective: This study aimed to evaluate remimazolam's anesthetic efficacy and impact on postoperative cognitive function in breast cancer patients undergoing radical mastectomy.

Methods: A total of 80 patients were randomized into two groups: Group R (remimazolam, n = 40) and Group EP (etomidate-propofol mixture, n = 40). Mean arterial pressure (MAP) and heart rate (HR) were recorded at T₀ (pre-induction), T₁ (post-intubation), T₂ (1 h intraoperation), and T₃ (post-extubation). Pain, measured using the visual analog scale (VAS), was assessed upon awakening and at PACU discharge. Cognitive function, measured using the Mini-Mental State Examination/Montreal Cognitive Assessment (MMSE/MoCA), was evaluated on postoperative days 1 and 3. Recovery times and adverse events were also compared between groups.

Results: Baseline characteristics were comparable between groups (p > 0.05). At T₁, HR was lower in Group R than in Group EP (p < 0.05). At T₂, MAP was higher in Group R (p < 0.05). VAS scores showed no intergroup differences postoperatively (p > 0.05). MMSE and MoCA scores were significantly higher in Group R at postoperative days 1 and 3 (p < 0.05). Following flumazenil antagonism, eye-opening and extubation times were shorter in Group R than in Group EP (p < 0.05). The overall adverse event rate was significantly lower in Group R (12.5% vs. 32.5%, p < 0.05).

Conclusion: Remimazolam provides effective anesthesia for elderly female patients undergoing radical mastectomy, offering superior hemodynamic stability at key time points, faster recovery, fewer adverse events, and significantly better preservation of early postoperative cognitive function compared with an etomidate-propofol mixture.

Clinical trial registration number: identifier ChiCTR2500106237.