Medicine最新文献

Dry age-related macular degeneration (dAMD) is the leading cause of blindness among elderly people in developed countries. The main objective of this study is to investigate the causal relationship between gut microbiota (GM), blood metabolites, and dAMD among European participants. Based on the genome-wide association analysis database, double sample Mendelian randomization (MR) analysis was performed on GM, blood metabolites, and dAMD. The inverse-variance weighted method is used to estimate the causal relationship between GM, blood metabolites, and dAMD, while multiple methods are employed to eliminate pleiotropy and heterogeneity. A 2-step MR analysis quantitatively assessed the effect of metabolite-mediated GM on dAMD. In MR analysis, 15 GM were found to be associated with increased or decreased risk of dAMD, and 18 blood metabolites were found to be associated with increased or decreased risk of dAMD. Our research also found that the potential association between GM and dAMD may be mediated by blood metabolite levels, specifically, ADpSGEGDFXAEGGGVR levels accounted for 38.9% of the causal pathway from genus Parasutterella to dAMD. Our research findings indicate that certain GM and blood metabolites can affect the onset of dAMD, and increasing the abundance of genus Parasottella can increase the risk of dAMD through the mediation of ADpSGEGDFXAEGGGVR levels.

To identify second primary malignancies (SPMs) death risk factors in prostate cancer (PCa) survivors and high-risk PCa patients for SPMs. With improved PCa survival, there's a growing need to study second SPMs in PCa survivors. PCa patients from 2004 to 2015 in the surveillance, epidemiology, and end results database were screened for SPM risk. The Fine and Gray competing risk model identified SPM mortality risk factors via univariate and multivariate analyses. A competing risk nomogram predicted 3-, 5-, and 10-year SPM mortality risk, stratifying patients by total scores for risk assessment. Model performance was assessed using the correlation index, receiver operating characteristic curve, calibration curve, and area under the curve. SPM-diagnosed PCa patients (2004-2015) were split into a 7:3 training (n = 31,435) and validation set (n = 13,472). The nomogram included 12 factors: age, chemotherapy, radiation, Gleason score, race, grade, marital status, tumor size, surgical site, surgery/radiation sequence, scope, and stage. C-index values were 0.70 (se: 0.001) and 0.684 (se: 0.002) in training and validation, respectively, indicating high discriminative power. The 3-, 5-, and 10-year area under the curves in training were 0.75 (95% confidence interval (CI): 0.72-0.77), 0.73 (95% CI: 0.72-0.75), and 0.72 (95% CI: 0.7-0.73), and in validation were 0.7 (95% CI: 0.65-0.74), 0.7 (95% CI: 0.67-0.73), and 0.71 (95% CI: 0.69-0.73), respectively, showing good predictive accuracy. The calibration curve confirmed model fit. A competing risk model predicts SPM mortality in PCa survivors, aiding high-risk patient identification and guiding survival-oriented treatment and follow-up strategies.

Chronic pelvic pain is a common and multifactorial clinical syndrome that markedly impairs quality of life in both men and women. Superior hypogastric plexus block (SHGPB) is an effective minimally invasive treatment. The sacral notch approach, a modification of the transdiscal technique, offers a more direct and technically simple puncture pathway. However, sex-related pelvic anatomical differences may affect puncture parameters, and imaging-based evidence remains limited. This study aims to evaluate sex-related differences in key anatomical and technical parameters of SHGPB via the sacral notch approach based on computed tomography imaging and explore the potential clinical value of puncture angle, puncture distance, and the SHGPB index for preoperative assessment and individualized approach selection. This retrospective study analyzed abdominal computed tomography images of 200 patients (100 males and 100 females). Measured parameters included: the angle between the simulated needle trajectory and the sagittal plane; the distance from the skin entry point to the target point; and the SHGPB index, defined as the ratio of the inter-posterior superior iliac spine distance to the transverse diameter of the L5 vertebral body. Parameters were compared between sexes using appropriate statistical tests. The angle between the puncture trajectory and the sagittal plane was 25.33 ± 7.26° (range, 10.70-44.40°) in males and 27.18 ± 8.44° (range, 11.90-52.00°) in females, with no significant difference (P > .05). The puncture distance was 13.43 ± 1.53 cm (range, 10.20-17.60 cm) in males and 13.29 ± 2.39 cm (range, 9.90-32.70 cm) in females, also without significant difference (P > .05). However, the SHGPB index was significantly lower in males (1.75 ± 0.23; range, 1.24-2.33) than in females (1.96 ± 0.24; range, 1.53-2.63; P < .05). The sacral notch approach is characterized by a relatively small puncture angle and a straightforward puncture pathway. Puncture angle and distance remain stable across sexes, whereas the SHGPB index shows significant sex-related differences. The SHGPB index may serve as an important imaging marker for preoperative evaluation of pelvic anatomy and individualized selection of the puncture approach, with potential clinical value in the interventional management of chronic pelvic pain.

This study aims to investigate the toxicity of di(2-ethylhexyl) phthalate (DEHP) and the potential molecular mechanisms of DEHP-induced bladder cancer (BLCA) using network toxicology and molecular docking strategies. The toxicity of DEHP was assessed using Prox-II software, and potential targets for DEHP-induced BLCA were identified by integrating data from ChEMBL database, Search Tool for Interactions of Chemicals, SwissTargetPrediction, GeneCards, Therapeutic Target Database, Online Mendelian Inheritance in Man, and The Cancer Genome Atlas. STRING database and Cytoscape were employed to construct target networks and determine core targets. The expression levels of core targets were analyzed using R. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed on potential and core targets. Molecular docking was carried out using CB-Dock 2 to verify the interactions between DEHP and core targets. A total of 105 potential targets related to DEHP-induced BLCA were identified, from which 7 core targets were selected: cyclin-dependent kinase 1, interleukin 6, cyclin-dependent kinase 2, cyclin B1, Erb-B2 receptor tyrosine kinase 2, cyclin B2, and B-cell lymphoma 2. IL-6 and B-cell lymphoma 2 showed downregulated expression in tumor tissues, while cyclin-dependent kinase 1, cyclin-dependent kinase 2, cyclin B1, Erb-B2 receptor tyrosine kinase 2, and cyclin B2 were upregulated. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses indicated that these targets were enriched in cell signaling and cancer-related pathways. Molecular docking confirmed that DEHP interacts with these core targets. DEHP may promote the development of BLCA by interacting with key proteins and signaling pathways. This study provides a theoretical basis for understanding the molecular mechanisms of DEHP-induced BLCA and offers references for future prevention and treatment strategies.

This study aims to evaluate appropriate treatment measures after endoscopic closure of perforation. A retrospective analysis of patients undergoing endoscopic closure of gastric perforation was conducted to analyze whether stomach tube, fasting time, tumor site, antibiotics, operation time, and endoscopic method are related to body temperature and abdominal pain. Whether stomach tube, fasting time, antibiotics, tumor site, operation time, endoscopic method, body temperature, and abdominal pain are related to length of stay. Body temperature was correlated with fasting time and antibiotics, with statistical significance (P < .05), but not with gastric tube, lesion location, treatment method, and resection time; the incidence of abdominal pain was correlated with gastric tube, fasting time, and antibiotics, with statistical significance (P < .05), but not with lesion location, treatment method, and resection time. The length of stay was correlated with fasting time, body temperature, and abdominal pain, with statistical significance (P < .05), but not with gastric tube, lesion location, treatment method, antibiotics, and resection time. After perforation repair, it is feasible to use antibiotics according to the abdominal pain and body temperature of the patient. Gastric tube may cause abdominal pain and discomfort of the patient. Early oral feeding can shorten length of stay.

This cross-sectional evaluation aimed to evaluate the quality of patient education materials provided by ChatGPT regarding otologic balance disorders. A total of 126 patient-oriented questions covering 9 common vestibular conditions - including benign paroxysmal positional vertigo, vestibular neuritis, labyrinthitis, Meniere disease, superior semicircular canal dehiscence, persistent postural perceptual dizziness, perilymph fistula, presbyvestibulopathy, and acoustic neuroma - were submitted to ChatGPT version 4o. The responses were independently evaluated by 2 otolaryngologists using the DISCERN tool to assess information quality and the PEMAT-P tool to evaluate understandability and actionability. The mean DISCERN score was 48.06 (range: 44.0-53.0), indicating moderate quality. PEMAT scores averaged 80% for understandability (range: 75%-88%) and 43% for actionability (range: 40%-60%). While the outputs were generally easy to understand, many lacked actionable guidance. In terms of information quality, the responses were generally acceptable for patient education purposes, though they occasionally included inaccuracies or omissions. ChatGPT may serve as a supportive tool for patient education on vestibular disorders but should be used with professional oversight to ensure safe and accurate communication.

Background: To investigate the effects of different antibiotic regimens used in the treatment of preterm premature rupture of membranes (PPROM) on maternal and fetal outcomes after 34 weeks of gestation.

Methods: A total of 40 pregnant women diagnosed with PPROM between 34 and 37 weeks of gestation were enrolled in this randomized controlled trial and allocated equally into 2 groups. Group 1 received sulbactam-ampicillin, azithromycin, and amoxicillin, whereas Group-2 received ceftriaxone, clarithromycin, and amoxicillin. The primary outcome was neonatal intensive care unit (NICU) length of stay. Recorded variables included maternal age, gestational age, obstetric history, time of delivery, latency period, infection markers (white blood cell count and C-reactive protein), neonatal birth weight, Apgar scores, NICU admission, mode of delivery, and maternal complications. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 27.0 (Armonk).

Results: No statistically significant differences were observed between the groups in terms of age, obstetric age, obstetric history, time of delivery, infection markers (white blood cell, C-reactive protein), and type of delivery (P > .05). The difference between the groups in terms of NICU requirement and stay duration was not statistically significant; Group 1: mean 8.3 ± 6.7 days and Group 2: 4.3 ± 1.9 days (P = .356). The incidence of maternal complications showed no statistically significant difference; chorioamnionitis was observed in 4 patients (20.0%) in Group 1 and in a patient (5.0%) in Group 2 (P = .141). No difference was observed type of delivery and history of PPROM.

Conclusion: The 2 different antibiotic regimens administered to pregnant women diagnosed with PPROM after the 34th week of gestation demonstrated similar clinical effects in terms of maternal and neonatal outcomes. Although the differences in NICU stay duration and the number of chorioamnionitis cases were not statistically significant, we believe that these findings could reach significance in studies with larger sample sizes.

Postoperative headache and cerebrospinal fluid (CSF) leakage are common complications after meningioma resection, which may prolong hospitalization, increase infection risk, and negatively affect patient recovery. Although maintaining a 30° head-of-bed (HOB) elevation is standard postoperative nursing care to reduce intracranial pressure, the optimal elevation angle remains uncertain. This study aimed to evaluate the efficacy of an improved HOB elevation of 30° to 35° in reducing postoperative headache severity and CSF leakage in patients undergoing meningioma resection. This retrospective cohort study included 128 patients who underwent meningioma resection between January 2021 and December 2023 at our hospital. Patients were allocated to the control group (n = 64, HOB = 30°) or the improved group (n = 64, HOB = 30°-35°). Postoperative headache severity, CSF leakage incidence, wound healing, and patient satisfaction were compared between groups. Statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk), and a P value <0.05 was considered statistically significant. An early postoperative HOB elevation of 30° to 35° after meningioma resection significantly reduces postoperative headache severity, reduces CSF leakage, and improves patient satisfaction compared with the conventional 30° position. These findings suggest that slightly increasing the HOB angle could be considered as part of optimized postoperative nursing protocols. Compared with the control group, the improved group exhibited significantly lower headache scores on postoperative day 3 (3.12 ± 1.21 vs 4.58 ± 1.44, t = 5.487, P < .001) and day 7 (2.11 ± 0.93 vs 3.72 ± 1.26, t = 7.023, P < .001). The incidence of CSF leakage was markedly reduced in the improved group (3.13% vs 14.06%, χ2 = 4.398, P = .036), while patient satisfaction was significantly higher (93.75% vs 79.69%, χ2 = 5.184, P = .023).

Background: Short telomere length (TL) has been associated with chronic diseases and reduced lifespan. Vitamin D may help preserve telomeres through its anti-inflammatory effects; however, the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and TL remains inconclusive. This meta-analysis was conducted to evaluate the association between circulating 25(OH)D and leukocyte TL (LTL).

Methods: A comprehensive literature search was performed across PubMed, Scopus, Google Scholar, ClinicalTrials.gov, and Cochrane Library to identify relevant studies published up to February 2025. Standardized β coefficients with 95% confidence intervals were applied as the effect size metric to evaluate the associations using a random effect model.

Results: A total of 21 studies comprising 185,191 participants were analyzed. The overall results demonstrated a positive association between serum 25(OH)D levels and LTL (β = 0.04, 95% CI = 0.02-0.06), with remarkable heterogeneity across studies (I²= 89.1%, P ≤.001). This association was supported in adults (β = 0.04, 95% CI = 0.03-0.06), women (β = 0.05, 95% CI = 0.01-0.08), individuals with vitamin D deficiency (β = 0.22, 95% CI = 0.01-0.43), and studies that adjusted for covariates (β = 0.05, 95% CI = 0.01-0.08). No significant associations were found in men, participants with serum 25(OH)D levels ≥ 30 ng/mL, children, or studies without covariate adjustments. The relationships were not influenced by the method of TL assessment, body mass index, smoking status, and sample size.

Conclusion: Serum 25(OH)D levels showed a positive correlation with LTL in women, adults, and individuals with vitamin D deficiency.

Human blood metabolites have been closely linked to ankylosing spondylitis (AS) in observational studies, yet direct causal evidence remains limited. This study aims to use Mendelian randomization (MR) to pinpoint causal metabolites associated with AS and to predict potential side effects of metabolite interventions. Genetic instruments for exposure were sourced from a genome-wide association study of 1400 blood metabolites, while genome-wide association study data for AS outcomes were derived from the FinnGen cohort. The primary MR analysis was conducted using the inverse variance weighted method. Supplemental analyses were conducted using weighted median, MR-Egger, simple mode, and weighted mode methods, while sensitivity analyses were performed to evaluate heterogeneity and pleiotropy. A replication analysis using an additional the UK Biobank cohort was also performed to determine metabolites associated with AS. The Steiger test and linkage disequilibrium score regression were used to further strengthen causal inference. Lastly, a phenome-wide Mendelian randomization analysis was performed to investigate the potential on-target side effects of metabolite interventions. After comprehensive analyses, 3 metabolites (the 2'-deoxyuridine levels, the hate to mannose ratio, and the Uridine to 2'-deoxyuridine ratio) were identified as being genetically associated with AS. The phenome-wide Mendelian randomization analysis revealed that the hate to mannose ratio might have deleterious effects on 4 other diseases, while no significant associations were found for the 2'-deoxyuridine levels or the uridine to 2'-deoxyuridine ratio with other diseases. This systematic MR analysis unveiled the potential role of the 2'-deoxyuridine levels, hate to mannose ratio and uridine to 2'-deoxyuridine ratio as the causal mediator in the development of AS. Considering the advantages and disadvantages, 2'-deoxyuridine appears as the most promising prospective therapeutic target for the prevention of AS.