Medicine最新文献

Rationale: Lung cancer exhibits one of the highest incidence and fatality rates globally. With the advancement of next-generation sequencing testing techniques, double or multiple gene driver mutations have been identified in certain patients.

Patient concerns: A 78-year-old female presented with a chest shadow.

Diagnoses: In this case of lung adenocarcinoma, second-generation sequencing revealed a co-occurrence of echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase and MET exon 14 skipping mutation.

Interventions: Crizotinib was administered orally on August 31, 2022, resulting in a partial response and progression-free survival for a duration of 8 months. After 8 months of treatment, the patient's disease progressed, after which the treatment dose of crizotinib was increased; the patient's condition improved again.

Outcomes: Over 4 months of increased-dose oral crizotinib treatment, the patient achieved durable partial response, with significant reduction in tumor burden and without new metastases.

Lessons: This report supports crizotinib can provide potential benefit for anaplastic lymphoma kinase/MET14 co-mutated lung adenocarcinoma patients, but sufficient cases and further research are needed to confirm and explore the possible mechanisms involved.

Ventricular arrhythmias (VAs) are frequently observed in patients awaiting or who have already undergone left ventricular assist device (LVAD) implantation. However, the impact of LVAD implantation on the burden of VAs and the prognostic significance of postoperative VAs remain unclear. Between June 2015 and July 2024, 108 patients who underwent LVAD implantation were retrospectively analyzed. The burden of VAs was defined as the total number of documented VAs or implantable cardioverter-defibrillator therapies, including anti-tachycardia pacing and appropriate shocks. The incidence and burden of VAs before and after LVAD implantation were compared, and factors associated with postoperative VAs were evaluated using multivariable regression analysis. Among the 108 patients who successfully underwent LVAD implantation, the prevalence of VAs decreased after implantation (39.8% [n = 43] vs 25.9% [n = 28], P < .01). However, there was no significant difference in the burden of VAs before and after LVAD implantation (4.30 ± 31.42 vs 2.89 ± 13.11 events/mo, P = .50). The incidence of VAs, anti-tachycardia pacing, and appropriate shocks did not significantly decrease after LVAD implantation (2.34 ± 16.89 vs 2.26 ± 13.04, P = .26; 1.22 ± 7.68 vs 0.91 ± 5.82, P = .58; and 0.88 ± 7.24 vs 0.28 ± 1.29, P = .21, respectively). Multivariable regression analysis showed that only preoperative VAs were associated with postoperative VAs (hazard ratio 15.6 [95% confidence interval, 3.70-64.49]; P < .01). There was no significant difference in survival according to the occurrence of postoperative VAs (P = .94). LVAD implantation does not reduce the burden of VAs. A history of preoperative VAs remains a strong risk factor for postoperative VAs. However, even if VAs occurred after LVAD implantation, the mortality risk did not increase.

To study serum creatinine (Scr) levels and bone mineral density (BMD), we used Mendelian randomization (MR) to investigate the causal relationship between them. The genetic association data of Scr levels and total body BMD across age groups were retrieved from the genome-wide association studies, and the causal relationship between Scr levels and BMD was analyzed using the inverse-variance weighting method, MR-Egger regression method, weighted median estimation method, simple mode, and weighted mode. The results of the inverse-variance weighted method indicated that the creatinine level might be a protective factor for the 45 to 60 age group (P = .005, odds ratio = 1.176, 95% confidence interval = 1.049-1.318). All error lines in the sensitivity analysis graph of the retention method were on the right side of 0, suggesting that the results were highly stable and that the MR results were stable, and no association was found in other age groups. Scr levels exhibited a causal relationship with BMD. As a standard proxy indicator for skeletal muscle mass, Scr levels are correlated with BMD. Reduced Scr levels may indicate sarcopenia, which adversely affects skeletal health. Consequently, monitoring Scr could enable the early identification of individuals at risk of low BMD.

Background: The nevus of Ota is an uncommon pigmentary skin condition that causes bluish-gray pigmentation and is traditionally treated with a Q-switched laser. Emerging evidence suggests that the 755-nanometer picosecond alexandrite laser is a safe and effective therapeutic option. We sought to determine the overall effectiveness and safety profile of the 755-nanometer (nm) picosecond alexandrite laser for managing nevus of Ota.

Methods: We reviewed 6 databases for studies that addressed the safety as well as efficacy profile of the 755-nm picosecond alexandrite laser for nevus of Ota. Ten studies, including 558 individuals with nevus of Ota, were included. The main outcomes were the rate of excellent clinical response and reported side effects encompassing erythema as well as post-inflammatory pigmentary alterations, including both hyperpigmentation and hypopigmentation. Review Manager Version 5.4 and Comprehensive Meta-Analysis v3 software were used for data analysis.

Results: The pooled excellent clinical response rate for the 755-nm picosecond alexandrite laser was found to be 36.8% (95% confidence interval [24.4-51.2%], P = .642). Post-inflammatory hyperpigmentation and hypopigmentation were each observed in 20.6% and 12.2% of the cases (P-value < .001), respectively. Post-inflammatory erythema, assessed in 2 studies (n = 23), demonstrated a pooled prevalence of 45.2% (95% confidence interval: 12.9-82.2%).

Conclusion: The 755-nm picosecond alexandrite laser demonstrated moderate effectiveness and a favorable safety profile in the treatment of nevus of Ota. Pigmentary complications occurred at relatively low rates across the included studies. Further high-quality prospective and randomized controlled trials are required to confirm long-term effectiveness and safety.

Pulmonary hypertension (PH) is an important reason for morbidity and mortality in patients with left heart disease (LHD). LHD is one the most common cause of PH in the elderly. Few studies have reported risk factors in patients with PH accompanied with LHD. To identify associated risk factors with PH in patients with LHD in elderly. A total of 411 aged male patients (>60 years) with LHDs were enrolled in this trail. Pulmonary artery systolic pressure (PASP), heart chamber diameters, and left ventricular functions were evaluated by transthoracic echocardiography. Patients were classified as PH group (n = 211) and non-PH group (n = 200) according to their PASP. Clinical history was collected from medical recordings. Independent associated factors for PH were identified by Logistic regression analysis. Compared with non-PHs, PH patients were more likely to have atrial fibrillation (AF; 21% vs 9.4%, P < .01), left atrial enlargement (39.25 ± 4.96 mm vs 36.94 ± 3.16 mm, P < .01), and reduced left ventricular ejection fraction (LVEF; 58.97 ± 6.51% vs 61.15 ± 4.72%, P < .01). Multivariate logistic regression analysis showed that AF, larger left atrial diameter, lower LVEF was independently associated with the presence of PH in patients with LHDs. In patients with PH, the PASP and left atrial diameter were all related to the number of co-morbidities (P < .05). AF, left atrial enlargement, and decreased LVEF are associated with the presence of PH in patients with LHDs. Well control of comorbidities and underlying heart diseases, prevention or treatment of AF may play key roles in the management of PH in patients with LHDs.

Pediatric adenotonsillectomy frequently requires Boyle-Davis mouth gag placement, which may transiently increase intracranial pressure (ICP). Ultrasonographic optic nerve sheath diameter (ONSD) is a validated noninvasive marker of ICP. This study aims to investigate the impact of endotracheal intubation and Boyle-Davis mouth gag placement on ONSD, eyeball transverse diameter (ETD), and ratio of optic nerve sheath diameter to eyeball transverse diameter (ONSD/ETD) ratio in children. In this prospective observational study of 120 children (American Society of Anesthesiologists I-II, 2-18 years), bilateral ONSD and ETD were measured at post‑induction (T0), post‑intubation (T1), post‑gag placement (T2), and post‑gag removal (T3). Unadjusted profiles used repeated-measures ANOVA. Adjusted analyses used linear mixed-effects models with time and random intercept for subject; end-tidal carbon dioxide (EtCO2) and mean arterial pressure (MAP) were entered as time-varying covariates. Means (±standard deviation) for ONSD were 5.74 ± 0.46 (T0), 5.79 ± 0.46 (T1), 5.86 ± 0.44 (T2), 5.77 ± 0.48 (T3); for ONSD/ETD: 0.251 ± 0.021, 0.252 ± 0.020, 0.255 ± 0.020, 0.249 ± 0.021. The overall time effect was significant for both outcomes (P < .01). In adjusted models, T2 versus T0 remained higher for ONSD (+0.108 mm; 95% confidence interval (CI): 0.046-0.170; P < .001) and ONSD/ETD (+0.0033; 95% CI: 0.0003-0.0063; P = .03), whereas MAP was not significant and EtCO2 showed a modest positive association with both outcomes (ONSD: +0.007 mm/mm Hg; 95% CI: 0.002-0.012; P < .01). Heart rate and MAP varied over time (both P < .001), EtCO2 rose early and declined by T3 (P < .001). No neurologic events occurred. Mouth-gag suspension produces a small, transient rise in ONSD and ONSD/ETD that peaks at T2 and recedes after removal. Effects persisted after adjustment for EtCO2 and MAP, primarily suggesting contributions from positioning and suspension rather than hypercapnia. Findings support prudent positioning and monitoring in at‑risk children.

We aimed to determine the predictive value of the anterior segment and lens structures for intraocular pressure (IOP) reduction after uncomplicated phacoemulsification surgery. This prospective observational study included 133 nonglaucomatous open-angle eyes with uncomplicated cataracts. The preoperative anterior segment and lens structure measurements were performed. The predictive values of preoperative IOP, anterior chamber depth (ACD), axial length, lens thickness (LT), lens vault (LV), anterior chamber volume, iridocorneal angle, anterior chamber angle 500/750, and angle opening distance 500/750 for IOP reduction were analyzed. IOP reduction was significantly correlated with LV, ACD, LT, and preoperative IOP (R = 0.292, P = .003; r = -0.218, P = .030; R = 0.205, P = .043; and R = 0.660, P < .001, respectively). LV (F [1, 97] = 9.051, P = .003), ACD (F [1, 97] = 4.841, P = .030), LT (F [1, 97] = 3.829, P = .043), and preoperative IOP (F [1, 97] = 74.791, P < .001) were significant predictors of IOP reduction. Preoperative IOP, LV, LT, and ACD were significant predictors of IOP reduction in nonglaucomatous open-angle eyes after uncomplicated phacoemulsification surgery.

This study aimed to analyze the quality, reliability, and content of YouTube videos related to the use technique of metered dose inhalers (MDIs). Considering the increasing use of digital platforms for health education, it is important to evaluate the accuracy and educational value of such online resources. This descriptive and cross-sectional study evaluated 377 YouTube videos retrieved through a systematic search. The video selection process was monitored using the PRISMA flow diagram according to predefined inclusion and exclusion criteria. The videos' content, quality, and reliability were assessed using the Modified DISCERN tool, Global Quality Scale, Patient Education Materials Assessment Tool, and a checklist containing MDI use steps. Statistical analyses were conducted to determine associations between evaluation scores and video characteristics. A total of 12 YouTube videos on MDI use were analyzed. Of these, 33.3% were uploaded in 2022, and 66.7% were produced by associations or unions in the health sector. The mean interaction index was 0.53 ± 0.32, and the Video Power Index was 0.08 ± 0.15. The mean reliability level of the videos was 2.91 ± 0.75, quality level 4.16 ± 0.76, understandability level 80.83 ± 18.75, actionability level 81.66 ± 18.16, information level 77.00 ± 15.06, and information accuracy level 76.25 ± 15.80. YouTube videos on MDI use were largely adequate in terms of content but demonstrated some deficiencies in reliability. It is recommended that digital health information be produced under professional supervision and in collaboration with health authorities to ensure accuracy and trustworthiness.

Epidemiological observations suggest a potential causal relationship between rheumatoid arthritis (RA) and interstitial lung disease (ILD), and vice versa. Alternatively, this association could be due to simple co-occurrence of RA and ILD resulting from shared population genetic or environmental risk factors. However, the causal nature of this relationship remains uncertain. This study aims to investigate the genetic causality between RA and ILD. Two-sample bidirectional Mendelian randomization (MR) was employed to test the causal effects of RA on ILD and ILD on RA, utilizing genome-wide association studies for ILD and RA. Data statistics were collected from public data sets. Relevant single nucleotide polymorphisms were selected through quality control steps in the meta-analysis results of genome-wide association studies. Two-sample bidirectional MR analysis was conducted to assess the causal relationship between the 2 conditions. The main MR analyses utilized methods such as inverse variance weighting, weighted median, and MR-Egger regression. Sensitivity analyses, including MR-Egger, leave-one-out, MR pleiotropy tests, and heterogeneity tests, were performed to evaluate heterogeneity and pleiotropy. In the European population, the risk of ILD was found to be increased by RA (odds ratio = 1.272, 95% confidence interval: 1.186-1.363, P < .001). Conversely, ILD was associated with an increased risk of RA (odds ratio = 1.111, 95% confidence interval: 1.008-1.223, P = .033). These findings highlight a potential genetic link between rheumatoid arthritis and interstitial lung disease and may inform future research regarding potential screening strategies in genetically susceptible individuals.

To evaluate the therapeutic efficacy of myofascial trigger point acupuncture combined with gabapentinoids compared with gabapentinoid therapy alone in patients with postherpetic neuralgia, and to identify clinical factors influencing treatment response. A total of 494 patients with postherpetic neuralgia were randomly assigned to receive either gabapentinoids alone (control group, n = 247) or combined myofascial trigger point acupuncture and gabapentinoids (experimental group, n = 247). Pain intensity was assessed using the Numerical Rating Scale (NRS) at baseline, week 3, and week 6, and changes from baseline (ΔNRS) were calculated to reflect short-term pain improvement. Regression analyses were performed to identify prognostic factors associated with the magnitude of pain reduction rather than to estimate causal treatment effects. Both groups improved significantly, but the experimental group showed greater pain reduction at week 3 and week 6 (P < .001). Multivariate analysis revealed that older age and higher body mass index were independently associated with poorer treatment response at both time points, while pain location was associated with variability in pain reduction at week 6 (patients with thoracic [chest/back] pain showed the greatest improvement). Myofascial trigger point acupuncture combined with gabapentinoids may provide additional short-term pain relief compared with pharmacological therapy alone, with thoracic pain showing the most favorable response; however, baseline imbalance and the absence of sham control limit causal inference. Age and body mass index were associated with poorer efficacy, highlighting the need for individualized strategies. Longer-term randomized trials, including an acupuncture-only arm and multidimensional pain assessments, are warranted to confirm and extend these findings.