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Rationale: To investigate the clinical features, management strategies, and prognosis of the rare condition of upper tract urothelial carcinoma (UTUC) with skin metastasis, with emphasis on the efficacy and safety of disitamab vedotin combined with tislelizumab in systemic therapy, we performed a literature search and selection. We searched PubMed, Embase, and Web of Science for English-language publications from January 1, 1990, through December 10, 2024 (last search December 10, 2024). Predefined terms combined "upper tract urothelial carcinoma" or "UTUC" with "skin," "cutaneous," "abdominal wall," or "port-site," and with "metastasis," "implantation," or "seeding." Inclusion criteria were human case reports or small series with histologically confirmed UTUC and cutaneous involvement. We excluded non-UTUC primaries, noncutaneous metastases, pure reviews without primary cases, duplicate reports, and articles lacking extractable case-level clinical or pathologic data. Two reviewers independently screened records and extracted data (patient and tumor features, site and timing of cutaneous involvement, other metastases, postdiagnosis treatment, and outcomes), resolving discrepancies by consensus. Owing to rarity and heterogeneity, we performed a qualitative descriptive synthesis without meta-analysis.

Patient concerns: A patient developed a progressively enlarging cutaneous mass on the abdominal wall at a prior laparoscopic port site following renal cyst surgery.

Diagnoses: Biopsy confirmed metastatic poorly differentiated urothelial carcinoma. On April 27, 2023, the patient underwent robot-assisted radical nephrectomy with abdominal wall tumor resection and latissimus dorsi myocutaneous flap transfer. Postoperative pathology revealed high-grade urothelial carcinoma with human epidermal growth factor receptor 2 (+++) expression.

Interventions: Gemcitabine/cisplatin was administered initially; however, due to intolerance to cisplatin-based chemotherapy, sequential disitamab vedotin (120 mg every 3 weeks) plus tislelizumab (200 mg every 3 weeks) was initiated on November 23, 2023.

Outcomes: At 24-month postoperative follow-up, there was no evidence of local recurrence at the surgical site.

Lessons: Cutaneous metastasis in UTUC is rare and portends a poor prognosis. Radical surgery combined with systemic therapy remains the cornerstone of care. In this case, disitamab vedotin plus tislelizumab, used as a postoperative sequential systemic regimen, demonstrated favorable safety and achieved a 24-month recurrence-free interval after discontinuation of gemcitabine/cisplatin due to intolerance, with manageable adverse effects. This combination may represent a potential treatment option for metastatic UTUC, although its efficacy requires validation in larger cohorts.

This study characterized the dietary patterns of elderly residents in northern China's alpine regions and examined their associations with metabolic risk markers for chronic diseases. A total of 1399 participants aged ≥60 years from Qiqihar City, Heilongjiang Province, China, were enrolled using a multistage cluster sampling method. Factor analysis-derived dietary patterns and binary logistic regression were used to assess the relationship between these patterns and metabolic risk markers for chronic diseases. Five dietary patterns were identified: traditional, high-sodium and high-fat, fruits and vegetables, alcohol and meat, and dairy and egg. Compared to the dairy and egg group, the alcohol and meat group had significantly higher elevated diastolic blood pressure, triglyceride, alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels (all P < .05). The fruits and vegetables group showed higher alanine aminotransferase levels (P < .05) than the dairy and egg group, while the traditional group had lower serum creatinine levels (P < .05). High-sodium and high-fat dietary pattern and alcohol and meat dietary pattern were significantly associated with a higher odds of hyperlipidemia, while traditional and alcohol and meat diets were linked to hypertension. Sex, age, and obesity are also associated with the occurrence of chronic diseases. In China's alpine regions, increased intake of high-quality protein-rich foods was associated with lower risk of hypertension. Moderate energy, alcohol, and meat intake are recommended. Regular monitoring of body weight, blood pressure, and lipid profiles is critical for managing and mitigating chronic diseases.

This study aimed to detect and contrast the adverse drug event (ADE) signals associated with sodium zirconate cyclosilicate (SZC) and Patiromer by leveraging the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS), thereby informing safer clinical decision-making and optimizing therapeutic selection in hyperkalemic patients. We utilized multiple signal detection algorithms, including the reporting odds ratio (ROR), the UK Medicines and Healthcare products Regulatory Agency method, Bayesian confidence propagation neural networks, and the multi-item gamma Poisson shrinker, to extract adverse reaction signals for SZC (from Q2 2018 to Q3 2024) and Patiromer (from Q4 2015 to Q3 2024) from the FAERS database. Our analysis encompassed 8586,052 reports for SZC and 11,937,823 for Patiromer, with 1559 and 12,715 reports, respectively, flagged as primary suspect drugs. The most reports originated from the United States (SZC: 74.21%, Patiromer: 96.02%). The primary reporters were consumers for SZC (34.38%), physicians (31.50%), and consumers for Patiromer (68.16%). Both medications were predominantly prescribed for hyperkalemia management (SZC: 74.93%, Patiromer: 57.84%). We detected 51 significant signals for SZC and 122 for Patiromer. Key signals for SZC involved mortality, increased blood potassium, constipation, hypokalemia, and edema. For Patiromer, prominent signals comprised constipation, death, product leakage issues, and diarrhea. SZC primarily influenced systemic disorders and gastrointestinal complications, whereas Patiromer was associated with gastrointestinal conditions, systemic effects, and reactions at the administration site. Healthcare providers should consider adverse drug events not documented in the prescribing information for SZC (such as hypernatremia, mortality, and congestive heart failure) and Patiromer (such as Individuals undergoing dialysis or using pacemakers might encounter complications like arteriovenous fistula disorders and pacemaker modifications). Positive signals for Patiromer also indicate concerns regarding product solubility, color, taste, and texture, potentially impacting patient compliance. Due to the high frequency of death reports associated with both drugs (SZC: 573, Patiromer: 1656), clinicians should exercise heightened vigilance.

Treatment options for recurrent osteosarcoma remain limited, and prognosis is poor. Pazopanib, a multi-targeted tyrosine kinase inhibitor, has shown activity in various sarcomas. This study evaluated the efficacy and safety of pazopanib combined with doxorubicin and cisplatin (Paz + AP regimen) in patients with recurrent osteosarcoma and analyzed its impact on survival. This single-center retrospective cohort study included recurrent osteosarcoma patients treated between February 2022 and February 2023. Propensity score matching was used to balance baseline characteristics. A total of 100 patients were analyzed: 50 received the Paz + AP regimen, and 50 received conventional chemotherapy (AP regimen). Treatment efficacy was assessed using response evaluation criteria in solid tumors (RECIST 1.1) criteria. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate, disease control rate, safety, and treatment compliance. Baseline characteristics were well balanced between groups (P > .05). The Paz + AP group achieved a higher disease control rate than the control group (62.0% vs 42.0%, P = .046), whereas the difference in objective response rate was not significant (26.0% vs 14.0%, P = .13). Median PFS was significantly longer in the Paz + AP group than in controls (5.1 vs 2.2 months, P = .04). Although the median OS was slightly shorter in the Paz + AP group (8.0 vs 9.6 months), its survival curve declined more slowly after 12 months, showing a significant difference (P = .03). The incidence of adverse events was comparable (92.0% vs 88.0%), though hypertension (28.0% vs 10.0%, P = .03) and hand-foot syndrome (22.0% vs 4.0%, P = .01) were more frequent with pazopanib. No differences were observed in grade ≥3 or serious adverse events. Subgroup analysis indicated greater PFS benefits among patients with lung metastasis, recurrence interval ≥6 months, Eastern Cooperative Oncology Group (ECOG 0-1), and those receiving full-dose pazopanib. The Paz + AP regimen significantly prolonged PFS and improved disease control in recurrent osteosarcoma, with manageable toxicity and good compliance. Although OS improvement was limited, the regimen showed potential clinical value, particularly for patients with favorable performance status and longer recurrence intervals. Prospective studies are warranted to confirm these findings.

Rationale: Diagnosing hypertriglyceridemic acute pancreatitis (HTG-AP) in a parturient is challenging due to pregnancy-related physiological changes, and its treatment is fraught with complexities. This single-patient case report serves as a valuable resource for nursing practice of a parturient with HTG-AP and contributes to the formulation of relevant guidelines for this condition.

Patient concerns: The patient was a 32-year-old woman with a history of 5 pregnancies and 1 live birth, and her last menstrual period was on November 13, 2024. At 29 weeks and 4 days of pregnancy, she was transferred from the obstetrics department to the intensive care unit (ICU) due to HTG-AP for treatment.

Diagnoses: The patient was diagnosed with HTG-AP.

Interventions: With maternal and infant safety as the core, a multidisciplinary team collaborates to balance the timing of cesarean section and the treatment of pancreatitis, simultaneously monitoring fetal distress, uterine contractions, and maternal metabolism, and precisely implementing plasma exchange and insulin therapy. Strengthen perioperative airway management to prevent acute respiratory distress syndrome and atelectasis, and provide full-course psychological support and health guidance.

Outcomes: After 5 days of treatment in the ICU, the patient was transferred to the operating room for a cesarean section. The operation was successful and a baby girl was delivered. The newborn was transferred to the pediatric department for further treatment. The mother was then returned to the ICU for continued treatment after the operation. On the fourth day after delivery, the patient's vital signs were stable and she was transferred back to the obstetrics department for further treatment.

Lessons: Multidisciplinary joint care plays a crucial role in the treatment of pregnancy complicated with HTG-AP. In the future, it is necessary to further explore the standardized nursing pathway for HTG-AP during pregnancy and strategies for improving long-term maternal and infant outcomes.

To develop and validate a machine learning (ML) model integrating multidimensional clinical, pathomic, and ultrasound radiomic parameters for precise identification of endometrial malignancy and precancerous lesions, with a focus on addressing the diagnostic needs of younger patients pursuing fertility preservation. This retrospective study enrolled patients with suspected endometrial lesions from a single institution. Clinical baseline data (e.g., age, body mass index, menopausal status), pathomic features (e.g., cellular atypia, gland density), and ultrasound radiomic parameters (e.g., endometrial thickness, resistance index) were collected. Key predictors were selected using Pearson correlation, SHapley Additive exPlanations analysis, and least absolute shrinkage and selection operator regression. Seven ML models were constructed and optimized via 5-fold cross-validation. Model performance was evaluated using metrics such as ROC-AUC, sensitivity, specificity, and precision-recall performance in training (70%) and testing (30%) sets. A total of 1221 patients (854 in training, 367 in testing) were included. Seven variables including age, body mass index, menopausal status, cellular atypia, gland density, endometrial thickness, and resistance index emerged as robust predictors. Among the 7 ML models, the random forest model showed superior performance, with receiver operating characteristic area under curve of 0.98 in the training set and 0.96 in the testing set (95% confidence interval [CI]: 0.93-0.98). It had balanced sensitivity (0.89, 95% CI: 0.75-0.96) and specificity (0.86, 95% CI: 0.82-0.90) in the testing set. It maintained stability across varying risk thresholds and cost-benefit ratios, outperforming other models in precision-recall balance. Integration of multidimensional data via ML, particularly the random forest model, enhances the precision of endometrial malignancy detection. This approach enables personalized risk stratification, supporting targeted management for younger patients and advancing patient-centered care.

Rationale: Iron-deficiency anemia is commonly treated with intravenous (IV) iron supplementation; however, excessive use can lead to iron overload and subsequent organ damage. Iron isomaltoside, a newer IV iron formulation, may also contribute to iron overload, necessitating vigilant monitoring by clinicians. This report presents a case of iatrogenic iron overload induced by iron isomaltoside therapy. To the best of our knowledge, this is the first documented case of iron overload associated with iron isomaltoside.

Patient concerns: A 65-year-old female patient with systemic lupus erythematosus developed iron overload after receiving 7500 mg of iron isomaltoside over 5 weeks. Laboratory results showed significantly elevated serum ferritin levels (4336.47 ng/mL), and magnetic resonance imaging confirmed iron deposition in both the liver and spleen.

Diagnoses: Laboratory tests and magnetic resonance imaging confirmed iron overload.

Interventions: The patient was treated with deferasirox for iron chelation.

Outcomes: After 8 months of iron removal treatment, the patient's serum ferritin level gradually decreased to 1236.2 ng/mL, accompanied by improvements in hyperpigmentation and fatigue. No severe adverse events or gastrointestinal symptoms were observed during deferasirox administration, and kidney function remained stable throughout.

Lessons: This case highlights the risk of iron overload associated with unmonitored IV iron supplementation. Monitoring iron levels is crucial to prevent complications, particularly in high-risk patients. Iatrogenic iron overload can arise from excessive IV iron isomaltoside administration, emphasizing the importance of vigilant monitoring of iron metabolism to prevent adverse outcomes.

Rationale: Limb-girdle muscular dystrophy type 2B (LGMD2B) is a degenerative muscle disorder induced by mutations in the dysferlin gene. Dysferlin is involved in membrane repair and vesicle fusion through its 7 C2 calcium-binding domains, which mediate these calcium-dependent processes. It is currently considered an untreatable neuromuscular condition with a poor prognosis. The estimated incidence of this disease is 1 to 6.5 per 100,000 individuals. The primary clinical features of LGMD2B include proximal muscle weakness and elevated serum creatine kinase (CK) levels; occasionally, patients may present with elevated transaminase and hematuria. It is often misdiagnosed as polymyositis or liver disease. Herein, we report a case of LGMD2B initially presenting with elevated transaminase levels and hematuria.

Patient concerns: A 30-year-old woman was found to have elevated transaminases and subsequent hematuria.

Diagnoses: The patient was ultimately diagnosed with LGMD2B after muscle biopsy and genetic testing were performed.

Interventions: In the patient's first hospitalization, she was found to have elevated transaminase levels and untested CK levels, and no pathogenic findings were identified after a liver biopsy. Four years later, the patient was admitted to the Nephrology Department with gross hematuria. After hospitalization, serum CK levels were elevated. She was misdiagnosed with polymyositis and treated with oral prednisone; however, her condition did not improve, muscle strength declined, and hematuria persisted. Muscle biopsy and genetic testing were performed, and the patient was ultimately diagnosed with LGMD2B. Supportive therapy with coenzyme Q10, idebenone, and creatine monohydrate was initiated, and she was advised to avoid strenuous physical activity.

Outcomes: Currently, the patient exhibits generalized muscle weakness, unstable walking gait, and urine positive (+++) for occult blood. Her muscle strength has gradually declined over the past 13 years.

Lessons: LGMD2B initially presents with atypical clinical manifestations. In some cases, elevated transaminase levels can be the first manifestation of the disease; therefore, any unexplained elevated transaminase levels should prompt evaluation of underlying muscle diseases. A 13-year follow-up of a female patient demonstrated progressive muscle atrophy, emphasizing the importance of considering muscle diseases in patients with unexplained elevated serum transaminase levels. Subsequent dark brown urine and hematuria were likely caused by increased myoglobin levels and dysferlin deficiency in podocytes, which may be associated with minimal change nephropathy.

Background: Every year, millions of people bleed from conflicts, traffic accidents, natural disasters and surgical procedures, and with the development of space technology and the increasing number of manned space missions, astronauts will also face this risk, and uncontrolled post-traumatic bleeding is a major cause of death. Research on rapid wound hemostasis is essential to enhance emergency medical response and care for combat casualties. This study aims to explore the development trend of rapid wound hemostasis, grasp the discipline structure and dynamics, and provide data support for scientific research decision-making.

Methods: This study conducts a bibliometric analysis of the literature on rapid wound hemostasis to identify changes in research themes and directions, highlighting key areas and predicting future trends. We employed CiteSpace, VOSviewer and Origin software packages for bibliometric analysis of publications on rapid wound hemostasis from the Web of Science Core Collection, covering the period from 2004 to 2024. The analysis included data related to countries, institutions, authors, journals, and keywords.

Results: The analysis indicates a growing trend in wound hemostasis research, led predominantly by China. The Chinese Academy of Sciences ranks highest in publication volume, with Baolin Guo as the most prolific author. The International Journal of Biological Macromolecules is the leading journal in this field. Future research is likely to focus on developing innovative hemostatic materials that are diverse, multifunctional, and suited for rapid management of various wound types.

Conclusion: As scientific progress continues, there is an escalating demand for advanced hemostatic products. The ideal hemostatic agents of the future should integrate immediate coagulation effectiveness with antibacterial, hydrating, and tissue regenerative capabilities to cater to diverse injury scenarios.

Rationale: In patients with atrial fibrillation (AF) complicated by severe aortic stenosis (AS), atrioventricular node ablation (AVNA) combined with permanent pacemaker implantation is an effective treatment strategy, especially when conventional rhythm control methods fail.

Patient concerns: An 88-year-old female with a 40-year history of paroxysmal palpitations and chest tightness, with significant worsening of symptoms over the past 20 days. Despite undergoing AF ablation 5 years ago, her symptoms and arrhythmia burden persisted.

Diagnosis: Long-standing (24 years) AF, severe AS, and a history of failed radiofrequency catheter ablation for AF.

Interventions: The patient underwent left bundle branch pacing followed by AVNA.

Outcomes: During the 9-month follow-up period, her palpitations completely resolved, with no recorded atrial arrhythmias. The AF's impact on quality of life score significantly improved, and her performance on the 6-minute walk test markedly increased, indicating significant functional enhancement.

Lessons: This case demonstrates that left bundle branch pacing combined with AVNA is clinically effective and technically feasible for AF patients in the elderly population with severe AS, particularly when conventional rhythm control methods fail. This approach offers an effective option for symptom relief and functional improvement in this challenging patient population.