Medicine最新文献

Gastrointestinal (GI) polyps are common benign lesions that may progress to malignancy if untreated. Optimizing perioperative nutritional management is crucial to enhance recovery after polypectomy. This study aimed to evaluate the effects of targeted nutritional nursing versus routine dietary care on postoperative nutritional status, inflammatory response, and recovery outcomes in patients undergoing GI polypectomy. A retrospective controlled study was conducted among 126 patients who underwent endoscopic polypectomy between January 2023 and December 2024. Patients were divided into a control group (routine dietary care) and an experimental group (targeted nutritional nursing). The targeted intervention included individualized nutrition screening (Nutritional Risk Screening 2002), personalized prescriptions (25-30 kcal/kg/d energy, 1.2-1.5 g/kg/d protein), and daily monitoring of tolerance and GI recovery. Primary outcomes included serum albumin, prealbumin, and hemoglobin. Secondary outcomes included inflammatory markers (C-reactive protein and interleukin-6), postoperative recovery parameters, and complication rates. Baseline characteristics were comparable between groups. Postoperatively, the experimental group had significantly higher albumin (40.41 ± 3.58 vs 37.23 ± 3.50 g/L, P < .001), prealbumin (208.89 ± 30.94 vs 192.87 ± 30.64 mg/L, P = .004), and hemoglobin (124.91 ± 10.74 vs 119.0 ± 10.76 g/L, P = .003). Inflammatory markers were significantly lower (C-reactive protein 9.32 ± 3.9 vs 13.66 ± 4.42 mg/L; interleukin-6 12.88 ± 5.67 vs 19.97 ± 7.63 pg/mL; both P < .001). The experimental group recovered faster with shorter anal exhaust time (1.74 ± 0.60 vs 2.18 ± 0.63 days, P < .001) and hospital stay (6.01 ± 1.11 vs 7.22 ± 1.81 days, P < .001). The total complication rate was markedly lower (12.7% vs 28.6%, P = .01). Targeted nutritional nursing effectively enhances postoperative nutritional and inflammatory status, accelerates GI function recovery, and reduces complication incidence in patients undergoing GI polypectomy. Incorporating individualized nutritional nursing into perioperative management is recommended to optimize surgical outcomes and recovery efficiency.

The Triglyceride-Glucose (TyG) index is a recognized predictor for incident cardiometabolic diseases (CMDs) and cardiometabolic multimorbidity (CMM) in general populations. However, its utility for predicting progression from single CMD to CMM among patients with existing CMD remains unverified. This study combined retrospective cohort analyses (cross-sectional cohorts: China Health and Retirement Longitudinal Study [CHARLS]-1, n = 5415; First Affiliated Hospital of Shantou University Medical Center, n = 544; longitudinal cohort: CHARLS-2, n = 1866) with Mendelian randomization to evaluate this relationship. Cross-sectional analyses initially indicated positive associations between elevated TyG index and CMM progression (per-standard deviation increase: CHARLS-1 adjusted odds ratio [OR] = 1.43, 95% confidence interval [CI]: 1.30-1.57; First Affiliated Hospital of Shantou University Medical Center adjusted OR = 1.75, 95% CI: 1.33-2.31). However, longitudinal analysis showed no significant association after multivariable adjustment (hazard ratio = 0.87, 95% CI: 0.73-1.02). Crucially, Mendelian randomization analysis with sequential exclusion of confounder-associated single nucleotide polymorphisms (glucose, triglycerides, and body mass index) revealed no causal relationship (Model 3 inverse-variance weighted OR = 0.647, 95% CI: 0.412-1.014). These findings demonstrate that the apparent association between TyG index and CMM progression in patients with baseline CMD is likely a false-positive result attributable to residual confounding, with no causal link supported by rigorous longitudinal or genetic evidence. Thus, while TyG is valuable for predicting initial CMD onset, it lacks clinical utility for forecasting progression to multimorbidity in established patients, necessitating exploration of alternative biomarkers for this critical transition.

Studying prevalence and predictors of computer vision syndrome (CVS) and ocular surface disease symptoms among females can aid in identifying risk factors and developing effective preventive measures. This study aims to explore the prevalence and predictors of CVS and ocular surface disease symptoms among female adults in Jordan. This was an online cross-sectional survey study that was conducted in Jordan between July 8th, 2025 and October 01st, 2025 utilizing Qualtrics survey software. Female adults from the general public in Jordan formed the study population. Logistic regression analysis was used to identify predictors of the outcomes. The presence of CVS was determined based on participants' responses to the CVS-questionnaire (CVS-Q), with total scores of ≥6 indicative of CVS. This investigation demonstrated a significant correlation between CVS and ocular surface disease index (OSDI) severity. This association may be due to overlaps between CVS and ocular surface-related behaviors and factors, specifically long screen times, wearing contact lenses, and the presence of chronic diseases, which increase both CVS and OSDI in the current study. Thus, preventive interventions, ongoing monitoring, and targeted interventions are necessary, particularly in high-risk groups. A total of 741 females were included. A significant association was found between CVS and OSDI severity (χ2 = 177.5, P < .001). Among participants with high OSDI scores, 56.7% had CVS, compared to only 10.1% among those with low OSDI scores. Participants with chronic diseases showed significantly increased odds of both CVS (adjusted odds ratio (AOR): 2.6, 95% confidence interval [CI]: 1.6-4.3; P < .001) and OSDI (AOR: 1.9, 95% CI: 1.2-3.2; P = .008). Spending more than 6 hours daily on electronic devices for study or work was also strongly associated with both outcomes (CVS: AOR = 2.6, P < .001; OSDI: AOR = 2.5, P < .001). The use of corrective lenses significantly increased the odds of CVS (AOR = 2.6, 95% CI: 1.7-4.0, P < .001), OSDI (AOR = 2.9, 95% CI: 1.9-4.5, P < .001). Taking regular breaks was slightly protective against CVS (AOR = 0.7, 95% CI: 0.5-1.0, P = .04). Night mode or blue light filter use was associated with higher odds of CVS (AOR = 1.6, 95% CI: 1.1-2.2, P < .009).

Staple-line leakage remains one of the most serious complications of sleeve gastrectomy (SG). Although routine postoperative fluoroscopy is commonly performed to detect leaks, its true diagnostic and clinical value remains controversial. This study aimed to assess the diagnostic accuracy, clinical outcomes, and cost implications of routine fluoroscopy compared to selective symptom-driven imaging after SG. This retrospective cohort study was conducted in the Department of General Surgery, Mersin City Training and Research Hospital and included 301 patients who underwent primary SG between January 2019 and December 2024. Patients were divided into 2 cohorts: those who underwent routine postoperative fluoroscopy (Group I, n = 268) and those managed with selective imaging based on clinical findings (Group II, n = 33). Computed tomography was used as the reference standard to confirm the leaks. Statistical analyses were performed using Statistical Package for the Social Sciences v25. Diagnostic indices, including sensitivity, specificity, predictive values, and receiver operating characteristic area under the curve, were calculated, and cost differences were analyzed. Baseline demographic and clinical characteristics were comparable between the groups. The leak rate was 0.7% in Group I and 3.0% in Group II (P = .751). Fluoroscopy demonstrated low sensitivity (37.5%), but high specificity (96.2%), and negative predictive value (98.3%), with a moderate receiver operating characteristic area under the curve of 0.67. Despite similar clinical outcomes, the fluoroscopy group incurred higher costs ($4100 ± 650 vs $3500 ± 540, P < .05). Our findings indicate that routine postoperative fluoroscopy after sleeve gastrectomy contributes minimally to diagnostic or clinical decision-making. While its specificity and negative predictive accuracy remain excellent, its limited sensitivity and additional cost reduce its overall value. Adopting a selective, symptom-oriented imaging strategy, supported by clinical evaluation and computed tomography, appears to be safer and more cost-effective. Future multicenter studies that combine clinical evaluation, imaging, and biomarkers may further improve early leak detection and help standardize postoperative care in bariatric surgery.

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.

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.

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.