Medicine最新文献

This study aimed to validate the preoperative gastric cancer immune prognostic score (GCIPS) as a prognostic biomarker in resectable gastric cancer (GC). We retrospectively analyzed 226 GC patients undergoing radical resection. The optimal cutoff value of the GCIPS was determined by receiver operating characteristic curve analysis, and patients were stratified accordingly to assess its prognostic value for recurrence-free survival and overall survival. The GCIPS was calculated using preoperative blood parameters. Using receiver operating characteristic-derived cutoff (2.840), patients were stratified into high- and low-GCIPS groups. The high-GCIPS group showed significantly poorer tumor differentiation (P < .001). Kaplan-Meier analysis revealed that high GCIPS was associated with worse 5-year recurrence-free survival (hazard ratio = 2.856, P < .001) and overall survival (hazard ratio = 3.222, P < .001). Multivariate analysis confirmed GCIPS as an independent predictor for both outcomes after adjusting for tumor-node-metastasis stage and differentiation. The GCIPS is a robust, independent prognostic biomarker derived from routine blood tests, offering a practical tool for risk stratification and guiding individualized management in GC after radical resection.

Rationale: This case report describes an unusual presentation of recurrent Wernicke encephalopathy (WE) in a patient undergoing hemodialysis, with distinctive neuroimaging findings that provide new insights into the disease.

Patient concerns: The patient presented with progressive gait ataxia, dysarthria, and mild memory impairment, with recurrent neurological symptoms following thiamin discontinuation.

Diagnoses: WE was diagnosed based on characteristic MRI findings including the rare lentiform fork sign and other atypical brain lesions, supported by symptom recurrence after thiamin cessation and radiological reversibility with treatment.

Interventions: The patient received immediate thiamin supplementation therapy, close neurological monitoring, and regular hemodialysis.

Outcomes: Neurological symptoms significantly improved with treatment, and MRI showed reversal of the lentiform fork sign and other atypical lesions, demonstrating the importance of sustained thiamin management during follow-up.

Lessons: This case highlights the lentiform fork sign as a valuable neuroimaging marker for WE, suggests that blood-brain barrier dysfunction may be pathogenic, and emphasizes the need for continuous thiamin management in high-risk patients to prevent recurrence.

An increasing number of studies have sought to identify ischemia by developing radiomics (Rad) models. Prior studies have demonstrated that computed tomography-based Rad features of peri-coronary adipose tissue (PCAT) exhibits satisfactory efficacy in identifying abnormal fractional flow reserve derived from coronary computed tomography (FFRCT). However, its specific role in modeling remains unclear. This study aims to ascertain the impact of PCAT on the FFRCT, with a particular focus on the mediation analysis of the underlying mechanisms. In this cross-sectional study, vessels were divided into 2 groups: FFRCT ≤ 0.75 and FFRCT > 0.75. PCAT was semiautomatic outlined by 3 dimensions slicer and the Rad features were extracted. The dataset was divided into the train set (70%) and the test set (30%), and feature selection yielded the formula for Radiomics Score (Rad-Score). The role of Rad-Score in structural equation modeling was also determined by mediation analysis. Finally, Rad-Score models and Rad-Score + stenosis degree models were constructed using random forest (RF) methods. A total of 253 vessels from 174 patients were included. The mediation analysis demonstrated that the Rad-Score plays a significant role in mediating the impact of stenosis on ischemia, with a partial mediation effect (11.43% in left anterior descending artery, 6.38% in right coronary artery). The efficacy of Rad-Score combined stenosis to construct a RF model to identify FFRCT ≤ 0.75 was high, with an area under the curve of 0.879, sensitivity of 0.8, and specificity of 0.929 in the subgroup of left anterior descending artery; and an area under the curve of 0.840, sensitivity of 0.889, and specificity of 0.778 in the subgroup of right coronary artery. The proximal PCAT partially mediates the relationship between stenosis and coronary ischemia. The findings of the study indicate that RF models exhibit a high degree of identifying efficacy.

There are three types of diabetes-related stigma (DRS): perceived, experienced, and internalized, all of which negatively impact individuals with diabetes. Over the past 2 decades, research in Japan has grown, highlighting the significant clinical effects of DRS. In this study, we focused on the least-studied form, experienced stigma investigating its prevalence, clinical correlates, and the awareness of DRS and advocacy activities among Japanese people with diabetes. We conducted a single-center, cross-sectional study from April 3 to 28, 2023, at the Ohta Nishinouchi Hospital Diabetes Center in Japan, involving 114 adults with type 1 or type 2 diabetes. Participants with severe mental or physical conditions were excluded. Each participant completed a questionnaire assessing experienced stigma, the impact of diabetes on their social life, and their familiarity with the terms "diabetes stigma" and "advocacy activities." Associations between reported stigma and demographic or clinical factors were analyzed statistically. Our findings showed that only 19.3% of participants reported a significant impact of DRS on their social life, with younger individuals and those on multiple diabetes medications more likely to report experiencing stigma. Additionally, awareness of "diabetes stigma" and "advocacy activities" was notably low among participants. In conclusion, compared to international studies, the prevalence of experienced stigma among Japanese individuals with diabetes appears lower, based on this single-center face-to-face study of outpatients. However, age and polypharmacy were identified as significant factors associated with increased reports of stigma. Despite the limitations of a single-center design, small sample size, and use of non-validated survey tools, the observed low awareness of "diabetes stigma" and "advocacy activities" underscored the need for enhanced educational initiatives by healthcare professionals and diabetes-related organizations in Japan.

Benign prostatic hyperplasia-related lower urinary tract symptoms are highly prevalent in middle-aged and older men. Compared to traditional transurethral resection of the prostate (TURP), minimally invasive surgical therapies (MISTs) aim to provide meaningful symptom relief. This review evaluated the efficacy, safety, and procedural characteristics of 5 representative MISTs: water vapor thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic artery embolization (PAE), temporary implantable nitinol device (iTIND), and Aquablation. A systematic literature search was conducted in PubMed (2018-2023), supplemented by backward citation tracking. Clinical studies reporting International prostate symptom score (IPSS), quality of life (QoL), and/or maximum flow rate (Qmax) were included, with higher-level evidence prioritized. Long-term data show that WVTT and PUL provide durable symptom improvement, achieving 48% IPSS reduction and 35% IPSS improvement, respectively, at 5 years. Aquablation has a lower rate of retrograde ejaculation than TURP. Importantly, no new sexual dysfunction has been reported after WVTT or PUL. The long-term retrograde ejaculation rate with iTIND is 4%. Most MISTs can be performed in an outpatient setting under local anesthesia. For prostates >80 cm3, PAE achieved >44% volume reduction. In summary, MISTs offer personalized treatment options for benign prostatic hyperplasia, though evidence strength varies. Aquablation has the strongest evidence for larger prostates, while WVTT and PUL are guideline-recommended for medium-sized glands. PAE is suitable for older/high-risk patients, and iTIND shows promise but requires more long-term data. Future research should focus on comparative trials to optimize patient selection.

Background: Psoriasis is a chronic inflammatory skin disorder affecting 2% to 3% of the global population and is increasingly linked to systemic complications, including cardiovascular events like stroke. This meta-analysis aimed to clarify the relationship between psoriasis and stroke risk.

Methods: We systematically searched PubMed, Google Scholar, and Cochrane databases for observational studies published through December 2024 that evaluated stroke risk in psoriasis patients. Studies were selected according to PRISMA guidelines, and data were extracted on patient characteristics, study design, and adjusted risk estimates.

Results: A total of 18 studies involving 705,602 psoriasis patients and 17,971,569 controls were included. Using a random-effects model, the overall pooled hazard ratio (HR) for stroke in psoriasis patients was 1.24 (95% confidence intervals [CI]: 1.15-1.35, P <.05). When stratified by disease severity, mild psoriasis had an HR of 1.09 (95% CI: 1.02-1.16), whereas severe psoriasis showed a higher risk with an HR of 1.36 (95% CI: 1.21-1.53). Regional analyses indicated increased stroke risk in Asia (HR = 1.08), Europe (HR = 1.26), and North America (HR = 1.49). Age subgroup analysis further supported a consistent association across different age groups.

Conclusion: Our meta-analysis indicates that psoriasis is associated with a significantly increased risk of stroke, particularly among patients with severe disease and older age. These findings highlights the importance of comprehensive cardiovascular risk management in individuals with psoriasis. Further research needed to explore the underlying mechanism in this high-risk population.

Patients with prolonged symptoms of COVID-19 (PSC) show various symptoms, especially fatigue, which affect their activities of daily living and inhibit their return to social life. As there is no standard treatment for PSC, we developed a treatment regimen that includes Japanese traditional (Kampo) medicine according to patient symptoms and condition. This study aimed to investigate the progression of symptoms in patients with PSC using this treatment regimen and to assess differences in background factors that affect the improvement of symptoms in patients. We conducted a prospective, observational study and collected data from patients with PSC who visited a hospital in Japan between May 2022 and December 2023. The patient performance status (PS, 0-9) and 16 symptoms on a numerical rating scale (NRS, 0-10) were recorded at each visit. A total of 114 patients were analyzed. The group with a first visit general fatigue score equal to or greater than the median (GMGF group) took more time to achieve PS ≤ 2 (hazard ratio [95% confidence interval (CI)], 0.405 [0.253-0.650], P < .001) and the end of visit milestone (0.283 [0.150-0.532], P < .001) compared to the group with a first visit general fatigue score less than the median (LMGF group). The group with ≥90 days from the onset to the first visit (≥90 days group) reached the end of visit milestone significantly later (0.510 [0.267-0.974], P = .041) than the group with <90 days from the onset (the <90 days group). The odds ratios (95% CI) for achieving PS ≤ 2 and the end of visit milestone within 3 months of the first visit in the GMGF group were 0.140 (0.046-0.425, P < .001) and 0.148 (0.058-0.380, P < .001), respectively. The ≥90 days group experienced difficulty in achieving the end of visit milestone within 3 months of the first visit (odds ratio [95% CI], 0.430 [0.179-1.035], P = .06). Patients with PSC who have a high general fatigue score at their first visit may have difficulty improving their symptoms. Early treatment, including Kampo medicine, can promote the improvement of PSC symptoms.

Rationale: Taking scorpions (whether through traditional Chinese medicine decoctions containing scorpion or through cooking) carries a potential risk of nephrotoxicity, which deserves people's attention.

Patient concerns: This article reports a case of a 48-year-old patient who presented with diarrhea and abdominal pain for 3 days and biochemical tests revealed a significant increase in serum creatinine. Based on the clinical inquiry, biochemical examination and imaging report, it is highly suspected that AKI was caused by the medicinal scorpion.

Diagnoses: Acute kidney injury.

Interventions: The treatment involved hydration therapy, along with metabolic promotion and gastric mucosa protection.

Outcomes: Following the treatment, there was a notable reduction in periumbilical distention and pain, with laboratory indicators such as creatinine, urea and uric acid levels returning to normal within 12 days. Follow-ups at 1 week, 1 month, and 3 months after the patient's discharge revealed no signs of recurrence of abdominal pain or diarrhea.

Lessons: This provided a detailed basis and reference examples for the diagnosis of drug-induced AKI, assisting clinicians in making more accurate and efficient judgments regarding the causes when confronted with similar cases.

Immunoglobulin-G4-related disease (IgG4-RD) is a rare recurring fibroinflammatory autoimmune condition that can affect multiple organs. Although it is gaining recognition, few studies have assessed the clinical and economic burden of this disease. This study aimed to characterize patients with IgG4-RD in the United States and describe healthcare resource utilization (HRU) and costs before and after diagnosis. This retrospective cohort study used a validated algorithm to identify commercially insured adult patients with IgG4-RD from health plan claims data obtained from the IQVIA PharMetrics Plus database (January 1, 2011, to June 30, 2022). The index date was defined as the date of the first observed IgG4-RD-related diagnosis. The baseline and study periods were defined as the 12 months before and after diagnosis, respectively. Demographic characteristics were reported on the index date. Clinical characteristics, IgG4-RD-related treatments, and all-cause HRU and healthcare costs (2022 US dollars, payer's perspective) were reported during the baseline and study periods. A total of 295 patients with IgG4-RD were included in the study. Comorbid burden was substantial, with hypertension (31.5%), hyperlipidemia (22.4%), and type 2 diabetes (17.3%) being the most common comorbidities after diagnosis. Most patients received IgG4-RD-related treatment before (60.3%) and after (87.8%) diagnosis, with prednisone being the most common (71.5% after diagnosis). Pancreatic and biliary involvement each occurred in nearly a third of patients. Annual HRU was high before (mean of 30.4 outpatient [OP] visits; 22.7% with ≥1 inpatient [IP] admission, lasting a mean of 9.0 days) and after diagnosis (mean of 40.7 OP visits; 35.3% with ≥1 IP admission, lasting a mean of 10.6 days). Mean annual healthcare costs were 1.5 times higher after diagnosis ($69,753) than before diagnosis ($45,844), predominantly driven by increased OP and IP costs. Patients with IgG4-RD had a substantial clinical and economic burden, including high rates of glucocorticoid use, HRU, and healthcare costs both before and after diagnosis. This may suggest a need for earlier detection and improved management of this complex condition. This study provides important insights into the high clinical and economic burden observed in IgG4-RD. Future studies are warranted to gain a deeper understanding of the possible impact of management strategies on patient outcomes.

Retrorectal tumors are rare and heterogeneous lesions that present significant diagnostic and surgical challenges. Owing to their low incidence, consensus on optimal management strategies is lacking, and large-scale outcome data remain limited. This study aimed to present a large, long-term, single-center experience with retrorectal tumors, focusing on surgical strategies, recurrence outcomes, and the clinical relevance of preoperative biopsy decisions. This retrospective cohort study included 58 patients who underwent surgical treatment for retrorectal tumors between 2000 and 2025. A total of 61 patients were initially enrolled; 3 were censored at their last known contact in the Kaplan-Meier survival analysis. Accordingly, descriptive and comparative analyses were performed on the remaining 58 patients with complete follow-up. Clinical data, including demographics, imaging modalities, surgical approach, histopathological diagnosis, and follow-up outcomes, were collected and analyzed. The surgical approach was determined according to the tumor's relationship to the third sacral vertebra. Statistical analyses included Kaplan-Meier survival estimation and appropriate comparative tests to evaluate postoperative outcomes. The cohort had a mean age of 46.8 ± 14.7 years, with a marked female predominance (81%). All patients underwent preoperative cross-sectional imaging, and preoperative biopsy was performed in 12% of cases. A posterior surgical approach was employed in 91% of patients. Tailgut cysts were the most frequent histopathological subtype (46.6%). No statistically significant association was observed between preoperative biopsy and postoperative complications (P > .05). During long-term follow-up, local recurrence occurred in 2 patients (3.4%). Although not statistically significant, a trend toward increased postoperative complications was observed in patients who underwent preoperative biopsy (P = .067). Although rare, retrorectal tumors can be managed effectively with accurate diagnosis, individualized surgical planning, and vigilant long-term surveillance. Preoperative biopsy should not be performed routinely and should be considered on a case-by-case basis, given its potential complication risk and limited diagnostic yield. This 25-year, single-center experience provides valuable insights into the multidisciplinary management of retrorectal tumors and supports evidence-based clinical decision-making in this anatomically complex region.