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.

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.

Although polyunsaturated fatty acids (PUFAs) are recognized for their beneficial impact on human health, evidence regarding their association with high-frequency hearing loss (HFHL) remains limited. This study aimed to examine the association between the dietary intake of n - 3 and n - 6 PUFAs, dietary n - 6/n - 3 PUFA ratio, and HFHL. In this cross-sectional study, data were obtained from 2 cycles of the National Health and Nutrition Examination Survey 2011 to 2012 and 2015 to 2016. Multivariable logistic regression models were used to assess the associations of dietary n - 3 and n - 6 PUFA intake and the dietary n - 6/n - 3 PUFA ratio with HFHL. Restricted cubic spline (RCS) analyses were performed to evaluate potential dose-response relationships. Stratification and sensitivity analyses were conducted to evaluate the robustness of the findings. A total of 6454 adults aged 30 to 69 years were included (mean [standard deviation age, 49.2 [11.4] years; 50.9% women), among whom 44.7% had HFHL. After full adjustment, higher dietary intake of both n - 3 and n - 6 PUFAs was associated with lower odds of HFHL (adjusted odds ratio, 0.93; 95% confidence interval [CI], 0.87-0.99 for n - 3 PUFAs; and 0.90; 95% CI, 0.81-0.99 for n - 6 PUFAs). RCS analyses demonstrated a linear inverse dose-response relationship (all P for nonlinearity > 0.05). Subgroup and sensitivity analyses generally supported the robustness of these associations; no significant interactions were observed for n - 3 PUFAs. For n - 6 PUFAs, a significant interaction was detected in the race/ethnicity subgroup (interaction P < .001), whereas interactions were not significant in other subgroups. Dietary n - 3 and n - 6 PUFA intake and HFHL among adults in the United States aged 30-69 years were negatively associated. This finding could have significant implications for further research on modifying dietary patterns to address HFHL.

gastric cancer (GC) is a common malignancy in the elderly, and postoperative delirium (POD) is one of its significant complications, severely affecting postoperative recovery and quality of life. This study aims to explore the association of preoperative Modified Frailty Index (mFI)-assessed frailty and Prognostic Nutritional Index (PNI) with POD in elderly GC patients. A total of 164 elderly GC surgery patients were included in this study. Frailty was assessed using mFI, and PNI was calculated based on serum albumin levels and peripheral blood lymphocyte count. Multivariable logistic regression analysis was used to evaluate the association of frailty and PNI with POD, and the accuracy of both in predicting POD was analyzed using receiver operating characteristic curves. Additionally, the nonlinear relationship between PNI and POD was assessed using restricted cubic splines. Compared with the non-POD group, the POD group had older age, higher proportions of frailty (mFI ≥3), alcohol consumption history, intraoperative blood loss (≥200 mL), and longer surgical duration (≥3 hours). Furthermore, the levels of albumin, hemoglobin, lymphocytes, and PNI were lower in the POD group. In multivariable logistic regression analysis, frail patients had a 4.660 times higher risk of POD (P = .003), and for every 1 standard deviation increase in PNI, the risk of POD decreased by 36.2% (P <.001). The relationship between PNI and POD exhibited a significant nonlinear association (P = .004). The area under the curve of PNI was 0.884, which was superior to that of frailty (0.694, P <.001). Frailty and PNI are important predictive factors for POD in elderly GC patients.

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.

Pneumonia is a significant cause of mortality in the United States. In the same way, obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder that can disrupt the normal respiratory function through intermittent hypoxia, systemic inflammation, and impaired airway clearance. Data suggest that OSA may increase the chances of having pneumonia and can make the outcomes worse. To describe temporal trends and demographic patterns in mortality among US adults with pneumonia and coexisting OSA from 1999 to 2020. We performed a retrospective analysis by population using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research multiple-cause-of-death database from 1999 to 2020. Pneumonia deaths were identified by International Classification of Diseases, Tenth Revision codes J09-J18, and OSA by International Classification of Diseases, Tenth Revision code G47.3. We have calculated age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint Regression Software was used to estimate annual percent change and average annual percent change with confidence intervals of 95%. This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A total of 13,496 deaths from pneumonia and OSA in US adults aged ≥ 25 were identified during this study period-males exhibited higher mortality than females (AAMR: 0.38 vs 0.21). The total deaths in males were 8046, consisting 59.63% of the overall total deaths, while total deaths in females were 5450, consisting 40.38% of the overall total deaths. The AAMR rose from 0.09 in 1999 to 0.86 in 2020 (average annual percent change: 7.3307%, 95% confidence interval: 3.93-10.84). Between 1999 and 2020, mortality related to pneumonia among the patients with OSA increased significantly in the US, with significant demographic and geographic variations. There was a significant increase in death in male population 2018 onwards. These findings emphasize the need for better screening and management of OSA in populations that are at risk for pneumonia.

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.