Frontiers in Medicine最新文献

Background: Primary dysmenorrhea is a common gynecological disease. Compared with traditional Chinese medicine treatment, moxibustion has advantages as a main treatment method. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of simple moxibustion therapy for primary dysmenorrhea.

Methods: Randomized controlled trials were searched from PubMed, Web of Science, Embase, The Cochrane Library, China National Knowledge Infrastructure, Wan-fang database and VIP database. In the literature included in these databases, clinical reporters evaluated the efficacy of moxibustion as the treatment for primary dysmenorrhea. All included literature was assessed for risk bias by using Risk of Bias assessment tool 2.0, and meta-analysis was conducted using Rev. Man 5.4.

Results: The findings demonstrated that the moxibustion group exhibited a statistically significant response in comparison to the control group. The improvement observed in the Cox Menstrual Symptom Scale and the visual analogue scale score between the two groups exhibited heterogeneity, with a statistically significant difference noted. In terms of Traditional Chinese Medicine symptom scores, the experimental group demonstrated superiority over the control group. Furthermore, the progesterone levels in the moxibustion treatment were found to be higher than in the control group, while the estrogen levels in the experimental group were lower than in the control group, with a statistically significant difference observed (p < 0.05). Conversely, the levels of β-EP and PGE2 in the observation group were higher than those in the control group.

Conclusion: Moxibustion therapy shows significantly better efficacy in treating primary dysmenorrhea. However, a large sample, multi-center, high-quality RCT is still needed to evaluate its safety and efficacy.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, Identifier CRD42024580466.

Background: In standard cardiopulmonary resuscitation (CPR), rescuers switch between ventilation and chest compressions. We examined the effect of this task-switching requirement on chest-compression quality to gain insights into the cognitive mechanisms underlying performance in standard CPR. Understanding these mechanisms can help in the development of evidence-based practical implications and cognitive aids for CPR.

Methods: A total of 300 first-year medical and dentistry students (212 females, 20.2 ± 4.4 years) participated in this randomized controlled trial. They received either a CPR training comprising both chest compressions and ventilation (standard CPR) or a CPR training comprising chest compressions only (chest-compression-only CPR). Chest-compression quality (compression depth and rate) was measured via a resuscitation manikin and analyzed using linear mixed models and linear trend analyses.

Results: Overall, chest-compression quality did not differ across standard CPR and chest-compression-only CPR. However, in standard CPR, compression quality was better after ventilation than before ventilation. Importantly, ventilation impaired the quality of the compressions executed immediately after ventilation, but the quality increased with each compression after ventilation, resulting in a better chest-compression quality after ventilation than before it.

Conclusions: This study suggests that ventilation acts as a break, improving physical capability, which in turn enhances compressions after ventilation. However, at the same time, ventilation causes a task switch which increases cognitive demands and impairs chest-compression quality immediately after ventilation. Considering the negative effect of the task-switching demand on chest-compression quality, it is useful to develop cognitive aids for professional medical care. Such cognitive aids can signal an upcoming switch to ventilation, thereby reducing the multitasking load in terms of reduced monitoring demands with respect to the number of chest compressions that have already been executed.

Background: Currently, the baseline estimated glomerular filtration rate (eGFR), the urine albumin level and renal fibrosis are the common risk and prognostic factors for chronic kidney disease (CKD). Intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) is a proven noninvasive tool for assessing renal fibrosis. The aim of this study was to evaluate whether IVIM-DWI could be used to identify high-risk patients with CKD during long-term follow-up.

Methods: In this exploratory study, 62 CKD patients who were followed for 5 years and who underwent renal biopsy and IVIM-DWI magnetic resonance imaging (MRI) at the National Clinical Research Center of Kidney Disease in China were enrolled. We recorded baseline data, including clinical, pathology and MRI parameters, and evaluated the associations between baseline parameters and renal outcomes. The value of DWI parameters in predicting end-stage kidney disease (ESKD) was compared with that of clinical and pathological data.

Results: The mean baseline eGFR was 78.1 ± 28.05 ml/min/1.73 m², and the median eGFR slope was -0.07 (-0.43-0.06) ml/min/1.73 m²/yr. Sixteen patients eventually developed ESKD. The values of perfusion fraction (f) were positively correlated with the eGFR slope (r_s = 0.54, p = 0.028). The results of the receiver operating characteristic (ROC) analysis demonstrated that the areas under the curve (AUCs) of total apparent diffusion coefficient (ADC_T), true diffusion coefficient (D) and f in distinguishing ESKD were 0.778 (95% confidence interval [95% CI] 0.65-0.906; p = 0.001), 0.893 (95% CI 0.816-0.97; p <0.001), and 0.823 (95% CI 0.706-0.939; p < 0.001), respectively. For the combination of baseline eGFR with both D and f, the AUC was significantly greater than that for the combination of baseline eGFR and interstitial extracellular matrix volume [AUC 0.955 (95% CI, 0.909 to 1.000) vs. AUC 0.886 (95% CI, 0.803 to 0.969), p = 0.049]. Cox proportional hazard regression revealed that f was a risk and prognostic factor for ESKD after adjustment for baseline variables (p = 0.006).

Conclusion: The combination of baseline eGFR and IVIM-DWI outperforms pathological factors alone in the diagnosis of long-term kidney dysfunction. This study indicated that IVIM-DWI could be a promising tool for identifying patients at high risk of CKD progression.

Introduction: The aim of this study was to evaluate the changes in macular structure and visual function of patients with diabetic macular edema (DME) after intravitreal aflibercept injection.

Methods: Twenty-five patients (43 eyes) diagnosed with DME were included in this study. All patients underwent aflibercept monthly for 3 months. The study's endpoints included the best corrected visual acuity (BCVA), central retinal thickness (CRT), fovea avascular zone (FAZ) area, vessel density of superficial retinal capillary plexus (SVD), vessel density of deep retinal capillary plexus (DVD), mean light sensitivity (MLS), 2° fixation rate (P1) and 4° fixation rate (P2).

Results: Before treatment and after the third treatment, the LogMAR BCVA was 0.69 ± 0.27 and 0.40 ± 0.18, the CRT was 471.10 ± 159.93 μm and 319.84 ± 113.51 μm, the MLS was 18.14 ± 3.97 dB and 21.68 ± 3.55 dB, P1 was 69 (47, 87)% and 88 (72, 92)%, and P2 was 90 (83, 97)% and 97 (93, 99)%, respectively. After treatment, CRT decreased, BVCA, MLS, and fixation stability improved (all p < 0.001). Post-treatment, FAZ area, SVD, and DVD showed no significant changes (all P > 0.05). MLS was negatively correlated with LogMAR BCVA and CRT, and positively correlated with P1 and P2.

Conclusion: In short term, aflibercept was effective in reducing CRT and improving BCVA, MLS, and fixation stability in DME patients.

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that significantly affects populations in both developing and developed countries. Due to both intrinsic pathology and extrinsic risk factors, the incidence of GERD has risen substantially in recent decades. This disorder results from an imbalance between the esophagus's defensive mechanisms and the harmful effects of the refluxate. The pepsin, an enzyme secreted exclusively by the stomach, plays a critical role in the pathogenesis of GERD due to its invasiveness effects in acidic environments. By thoroughly understanding the pathogenesis of pepsin-induced GERD, we could better address its diagnostic and therapeutic potential in clinical practice. Although current diagnostic tools are widely used, they have several limitations. As a result, researchers have increasingly focused on the salivary pepsin test, a novel diagnostic method that utilizes the specific pathological mechanisms of pepsin. To overcome the drawbacks of the currently used salivary pepsin test, fluorescence response detection has been integrated with other technologies. Beyond its diagnostic significance, pepsin in saliva may also serve as a target for GERD management in innovative clinical trials. In this review, we summarize the latest advancements in the diagnosis and management of GERD to improve patient outcomes.

[This corrects the article DOI: 10.3389/fmed.2023.1293640.].

The prevalence of Alzheimer's disease (AD) poses a significant public health challenge. Distinguishing AD stages remains a complex process due to ambiguous variability within and across AD stages. Manual classification of such multifaceted and massive data of brain volumes is operationally inefficient and vulnerable to human errors. Here, we propose a precise and systematic framework for AD stages classification. The core of this framework discovers and analyzes functional connectivity among regions of interest (ROIs) of a human brain. Multivariate Pattern Analysis (MVPA) is applied to extract features that reveal complex functional connectivity patterns in the brain. These features are then used as inputs for an Extreme Learning Machine (ELM) model to classify AD stages. The model's performance is assessed through comprehensive evaluation metrics to ensure robustness and reliability. Applying this framework on datasets which contain meticulously validated fMRI scans such as the OASIS and AD Neuroimaging Initiative datasets, we validate the merit of this proposed work. The framework's results show improvement in the collective performance of two-class and multi-class classification. Feeding ELM with MVPA features yield decent outcomes given a generalizable and computationally-efficient model. This study underscores the effectiveness of the proposed approach in accurately distinguishing AD stages, offering potential improvements in AD and AD stages detection.

Background: Skin trauma and the subsequent wound healing process present significant challenges for healthcare systems and patients globally. Allergic contact dermatitis (ACD) was a delayed-type hypersensitivity reaction that can disrupt the normal wound repair process due to prolonged inflammation and immune dysregulation. However, the specific impact of ACD on the inflammatory response and repair in wound healing remains incompletely understood. This study aimed to investigate the influence of ACD on the inflammatory response and repair during the wound healing process.

Methods: This study was a retrospective cohort study. A total of 120 patients with skin trauma treated at Henan Provincial People's Hospital from January 2023 to December 2023 were included. There were 69 cases of control and 51 cases of ACD. Inclusion and exclusion criteria were defined, and various indicators, including patient data, inflammatory factors, cell detection, and wound healing assessment, were measured and analyzed using appropriate statistical methods.

Results: The study revealed significant differences between the control and ACD groups. ACD was associated with higher levels of TNF-α, IL-6, IL-1β, C-reactive protein, and IL-8 compared to control (p < 0.05). Additionally, ACD group exhibited increased counts of macrophages, neutrophils, T lymphocytes, B lymphocytes, and mast cells compared to the control group (p < 0.05). Moreover, ACD was linked to delayed wound closure time and differences in the distribution of healing degrees (p < 0.05). Correlation analysis indicated significant associations among ACD, inflammatory markers, cellular responses, wound closure time, and healing degree (p < 0.05).

Conclusion: The study demonstrates that ACD exerts a substantial impact on the inflammatory response, cellular components, and wound healing parameters in the context of skin trauma. The heightened levels of inflammatory markers, altered cellular responses, and delayed wound closure observed in ACD patients underscore the need for targeted interventions tailored to optimize wound repair in this population.

Objective: To analyses real-world safety data of mRNA COVID-19 vaccines within the European Economic Area (EEA), using Individual Case Safety Reports (ICSR), and to evaluate the variability in safety profiles between different vaccine versions.

Methods: We utilized EudraVigilance data from 1 January 2020, to 31 December 2023, focusing on Moderna (Spikevax) and Pfizer/BioNTech (Comirnaty) vaccines against COVID-19. We performed descriptive statistics, co-occurrence analysis, and correspondence analysis to identify patterns and clusters of adverse events following immunization (AEFI).

Results: We retrieved 993,199 ICSR (Moderna: 394,484; Pfizer: 605,794), with most reports related to women patients (69%) and non-healthcare professionals (65%). A total of 10,804 distinct AEFI terms were described across the retrieved ICSR, with a cumulative occurrence frequency of 3,558,219 (Moderna: 1,555,638; Pfizer: 2,031,828). The most prominent serious clusters included headache, fatigue, pyrexia, myalgia, arthralgia, malaise, nausea, and chills, which frequently co-occurred with vaccination failure. Specific AEFI like fever, chills, malaise, arthralgia, injection site pain, inflammation, and warmth were more often linked to Moderna, while Pfizer was more commonly associated with vaccination failure, menstrual disorders (heavy menstrual bleeding and dysmenorrhea), and hypoesthesia. In older adults, serious clusters included confusional states, cerebrovascular accidents, and myocardial infarctions, while myocarditis and pericarditis were noted in younger males. Although rare, serious systemic AEFI, like anaphylactic reactions, were identified but require further causality evaluation.

Conclusion: The overall safety of mRNA COVID-19 vaccines for mass vaccination is supported, but continuous pharmacovigilance remains essential. Identified clusters of AEFI, particularly serious and systemic ones, although rare and potentially influenced by other underlying causes, underscore the need for continuous monitoring and further epidemiological investigations to explore potential causal relationships.

Objective: To evaluate the effects of Enhanced Recovery After Surgery (ERAS) on postoperative rehabilitation, complications, and long-term prognosis in patients undergoing radical laryngectomy using a single-center propensity score matching (PSM) study.

Methods: A retrospective cohort study included patients newly diagnosed with laryngeal cancer between January 1, 2019, and January 1, 2021, scheduled for partial laryngectomy. The control group (CG) comprised patients treated with standard interventions in 2019, while the research group (RG) included patients undergoing ERAS in 2020. After exclusions, 233 individuals remained: 94 in the RG and 204 in the CG. Following PSM in a 2:1 ratio, there were 180 in the CG and 90 in the RG. Relevant indices were analyzed.

Results: No significant differences were found in baseline characteristics (p > 0.05). The RG showed significantly lower hospital stay, nasogastric tube and tracheal cannula duration, early enteral nutrition, hospitalization expenses, and readmission rates compared to the CG (p < 0.05). The RG had higher albumin and prealbumin levels on postoperative days 3 and 7 (p < 0.05) but not on day 1 (p > 0.05). No significant differences were found in 1-year or 2-year overall survival rates, nor in recurrence-free survival rates between the groups (p > 0.05), though the RG showed marginally better survival.

Conclusion: ERAS treatment for postoperative laryngeal cancer patients reduces hospitalization duration, nasogastric tube and tracheal cannula use, costs, readmission rates, and complications, while accelerating recovery and facilitating early discharge. ERAS enhances patient comfort and clinical outcomes, supporting broader clinical adoption.