Medicine最新文献

Subjective well-being is a key indicator of healthy aging. However, its relationship with family communication still requires thorough discussion. Data from the 2022 Psychology and Behaviour Investigation of Chinese Residents survey was utilized. The World Health Organization-5 Well-being Index assessed subjective well-being. The Brief Health Literacy Scale, the 10-Item Family Communication Scale, and the Brief Self-Efficacy Scale measured health literacy, family communication, and self-efficacy, respectively. A structural equation model verified path relationships. This cross-sectional study involved 2201 elderly chronic disease patients aged 60 and above. Initially, multiple collinearity tests and common method analysis were conducted, followed by determination of covariates through partial correlation analysis. After controlling for covariates, the results of the structural equation model showed a good fit for the sequential mediation model, with all paths being significant. The subjective well-being of the elderly chronic disease patients is positively correlated with family communication. Health literacy and self-efficacy play a chain mediating role in this relationship.

Rationale: Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy, is an acute heart condition that mimics acute coronary syndrome and usually affects postmenopausal women. In young patients with autoimmune disorders like systemic lupus erythematosus (SLE), it is uncommon and difficult to diagnose. This case report emphasizes emotional stress and autoimmune flare as co-triggers of TCM and contributes to the limited literature on such presentations.

Patient concerns: A 27-year-old woman with SLE presented with acute chest discomfort, palpitations, and shortness of breath after her father's sudden death. She also mentioned weariness, joint discomfort, and anxiety, all of which are typical of a lupus flare.

Diagnoses: Electrocardiography revealed sinus tachycardia as well as ST-segment increases in the anterior leads. Troponin I and NT-proBNP levels were found to be increased. Coronary angiography revealed normal coronary arteries, while echocardiography revealed apical ballooning of the left ventricle, confirming the diagnosis of TCM.

Interventions: The patient was given intravenous methylprednisolone for lupus flare management, as well as metoprolol, intravenous fluids, hydroxychloroquine, and lisinopril after stabilization. Emotional support and education on stress management were also provided.

Outcomes: The patient's cardiac function and lupus activity improved significantly. She was discharged in stable condition after 6 days and remained asymptomatic 3 months later, with no return of cardiovascular symptoms and complete echocardiographic resolution.

Lessons: This case reinforces the importance of evaluating TCM in young SLE patients with acute chest pain, particularly when emotional stress is involved. Excluding coronary artery disease is essential, and effective management requires a multidisciplinary approach that treats both cardiac and autoimmune components. Preventing recurrence demands integrating emotional and psychological support into the care of chronically ill individuals.

Patients undergoing assisted reproductive technology (ART) often experience considerable fertility-related stress, which may adversely affect their marital adjustment. The Knowledge-Attitude-Practice (KAP) model provides a theoretical framework for understanding patient cognition and behavior. This study aimed to investigate the relationship between fertility-related stress and marital adjustment, as well as its influencing factors. A retrospective analysis was conducted on 200 ART patients, divided into a high-stress group (n = 100) and a low-stress group (n = 100) based on the median fertility stress score. KAP model scores and marital adjustment levels were compared between groups. Pearson correlation analysis, multivariate linear regression, and subgroup analysis by educational level were employed. The high-stress group had significantly lower scores across all KAP dimensions - knowledge (68.5 ± 9.2 vs 75.3 ± 8.6), attitude (72.1 ± 10.4 vs 78.9 ± 9.1), and practice (65.7 ± 11.0 vs 71.8 ± 10.2) - as well as lower marital adjustment scores (82.3 ± 12.5 vs 91.7 ± 11.3; all P < .001). Fertility stress showed a significant inverse association with marital adjustment (r = -0.48; β=-0.37; P < .001), while higher knowledge and practice scores were independent positive predictors (both P < .01). Subgroup analysis indicated a stronger negative correlation among patients with higher education (r = -0.52 vs -0.39). These findings suggest not only statistical but also practical significance, as stress reduction and enhancement of knowledge and behavioral practice may directly contribute to better marital adaptation in clinical settings. Higher fertility-related stress is associated with poorer marital adjustment in ART patients. Marital adaptation is closely linked to KAP model components. Greater attention should be given to highly educated individuals, with targeted interventions to improve knowledge and practice capacities to alleviate stress and enhance marital adjustment.

This study aims to evaluate the value and feasibility of the freehand technique in magnetic resonance imaging-guided breast lesion localization. The effects of the extent of background parenchymal enhancement, proportion of fibroglandular tissue (FGT), histopathological results, breast imaging reporting and data system (BI-RADS) category, lesion type, lesion location and seniority of the radiologist on repositioning after puncture and therefore on the operation time were analyzed. The chi-square test and the Kaplan-Meier and log-rank tests were used for statistical analysis, and logistic and Cox regression analyses were used to construct a predictive model. Repositioning after puncture was more frequently required for radiologists with low seniority than for those with high seniority (P < .001) and for nonmass enhanced (NME) lesions than for mass lesions (P = .029). Logistic regression analysis revealed that high seniority radiologists rarely had to reposition patients (odds ratio [OR] = 0.077, 95% CI = 0.023-0.262, P < .001), whereas NME lesions required patient repositioning (OR = 2.363, 95% CI = 1.219-4.583, P = .011). The median localization times for high and low seniority radiologists were 9 and 13 minutes, respectively (P < .001). The median localization times for NME and mass lesions were 14 and 10 minutes, respectively (P < .001). Cox regression analysis revealed that high seniority shortened the operation time (OR = 2.306, 95% CI = 1.630-3.263, P < .001) and that NME lesions prolonged the operation time (OR = 0.409, 95% CI = 0.297-0.564, P < .001). The freehand technique is a feasible technique that reduces the duration of magnetic resonance imaging-guided breast lesion localization and is not affected by many factors, highlighting its potential for widespread adoption.

This study aimed to develop a machine learning (ML)-based model to identify risk factors for postoperative pain following video-assisted thoracoscopic surgery (VATS) lobectomy in non-small cell lung cancer (NSCLC) patients. This retrospective study analyzed data from 100 NSCLC patients who underwent VATS. Least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation identified predictive factors. Patients were split into training (80%) and testing (20%) sets. Seven ML algorithms were trained, with performance evaluated via receiver operating characteristic curve, sensitivity, specificity, and accuracy. The shapley additive explanations (SHAP) method interpreted the best-performing model. LASSO regression identified 11 predictors. The random forest (RF) model achieved the highest predictive performance (AUC: 0.901, 95% CI: 0.833-0.969). SHAP analysis highlighted elevated pro-gastrin releasing peptide, tumor volume, red cell distribution width, lactic dehydrogenase, and white blood cell count as risk factors, while dexmedetomidine and higher hemoglobin were protective. A simplified model retained comparable accuracy (DeLong test P = .4846). The RF-based ML model effectively predicts post-VATS pain risk in NSCLC patients, demonstrating potential to guide future research on preoperative risk assessment and personalized interventions. External validation in a larger cohort is required before clinical application.

Stroke is a global cerebrovascular disease. This study mainly explores the association between red cell distribution width to albumin ratio (RAR) and all-cause mortality in stroke survivors, which is helpful for the prognostic management of stroke survivors. Using data from the 1999 to 2018 National Health and Nutrition Examination Survey, Cox regression, restricted cubic spline analysis, receiver operating characteristic curve, and subgroup analysis were applied to assess the relationship between RAR and all-cause mortality in stroke survivors. Sensitivity analysis was also conducted to ensure the robustness of the findings. A total of 1838 stroke survivors were included, with 861 deaths recorded over a median follow-up of 6.42 years. A nonlinear relationship was observed between RAR and all-cause mortality. When RAR was <4.24, it was significantly positively associated with all-cause mortality (hazard ratio = 2.16, 95% confidence interval: 1.77-2.64). In the fully adjusted multivariable model, stroke survivors in the highest quartile of RAR (Q4) had a 1.95 times higher risk of all-cause mortality compared to those in the lowest quartile (Q1). Receiver operating characteristic analysis demonstrated that RAR had good predictive value for all-cause mortality (area under the curve > 0.6). Subgroup analysis showed that there were significant interaction effects between RAR and all-cause mortality in stroke survivors across gender, race, and educational level. Elevated RAR is closely associated with increased all-cause mortality in stroke survivors. This marker may serve as a reliable prognostic indicator for stroke survivors.

Hip fractures in the elderly, especially among the Chinese population, are among the most serious complications of osteoporosis. As age increases, the incidence of these fractures rises. In this study, we seek to identify a range of lifetime occupational physical-demand factors that may serve as potential indicators of hip-fracture risk in Chinese individuals aged 65 years and older. Our aim is to inform preventive strategies and occupational health policies by enhancing understanding of how long-term physical work demands contribute to fracture risk across the aging population. This study employed a retrospective cohort design and was conducted at the Affiliated Hospital of Yan'an University. We included patients who underwent surgical treatment for intertrochanteric fractures or femoral neck fractures between January 2017 and December 2021. The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines to enhance transparency and methodological reporting. A total of 434 patients were included in this study, comprising 95 with light, 297 with moderate, and 42 with heavy occupational physical demand. Unadjusted multivariate logistic analysis revealed that moderate occupational physical demand was associated with a decreased risk of hip fracture (OR = 3.57, 95% CI: 2.01-6.33, P <.0001; compared to heavy occupational physical demand). Adjusted multivariate logistic model Ⅰ showed that moderate occupational physical demand (OR = 3.35, 95% CI: 1.75-6.44. P = .0003; compared to heavy occupational physical demand) remained associated with hip fracture. Fully adjusted multivariate logistic model Ⅱ also showed that moderate occupational physical demand (OR = 2.83, 95% CI: 1.51-5.97, P = .0032; compared to heavy occupational physical demand) remained associated with hip fracture. Compared to heavy physical demand, moderate occupational physical demand might be associated with a higher risk of hip fracture among older adults.

Background: Triple-negative breast cancer (TNBC) is a subtype of breast cancer with a poor prognosis and limited treatment options. Currently, nonmetastatic TNBC is mostly treated with neoadjuvant chemotherapy, but comparisons between these neoadjuvant regimens are dearth.

Methods: PubMed, Embase, Medline, Cochrane Library, Web of ClinicalTrials.gov, and major international conference databases were systematically searched for randomized controlled trials (RCTs) on the efficacy of various neoadjuvant chemotherapy treatments in patients with TNBC from inception to January 2025. The primary research endpoint was the pathological complete response (pCR) rate. The secondary endpoint was the odds ratios (ORs) at different time points of event-free survival (EFS) and overall survival (OS). The tertiary endpoints were the hazard ratios (HRs) of EFS and OS compared by Bayesian network meta-analysis, as well as corresponding Bayesian network meta-regression analysis with the median follow-up time as the covariate. The above processes were conducted by RStudio 4.2.2 orchestrated with STATA 17.0 MP.

Results: For the primary endpoint, compared to regimens containing anthracycline and taxanes (AT), regimens containing anthracycline, taxanes, platinum, and programmed cell death protein-1 (ATPtPD1) showed significant higher pCR rate (OR = 5.68). For the secondary endpoint, compared to AT, ATPtPD1 showed significant longer EFS/OS. For EFS: OR = 2.28 at 18th month; OR = 2.43 at 24th month; OR = 3.21 at 30th month; OR = 4.23 at 36th month; OR = 4.62 at 42nd month; OR = 4.04 at 48th month. For OS: OR = 3.56 at 18th month; OR = 2.23 at 24th month; OR = 2.49 at 30th month; OR = 2.49 at 36th month; OR = 3.17 at 42nd month; OR = 2.97 at 48th month. For the tertiary endpoints, for HR of EFS, compared to AT, ATPtPD1 indicated significant advantage (HR = 2.24, 95% confidence interval [CI]: 1.42-3.59), after meta-regression analysis, shows advantages as well (HR = 2.29, 95% CI: 1.39-3.89). For HR of OS, compared to AT, ATPtPD1 indicated significant advantage (HR = 2.67, 95% CI: 1.03-7.35), after meta-regression analysis, shows advantages as well (HR = 2.70, 95% CI: 1.18-6.33).

Conclusions: Considering efficacy on pCR and OS/EFS together, ATPtPD1 should be considered as the best recommendation in neoadjuvant therapies of TNBC.

Background: This study aims to systematically evaluate the intervention effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on cardiovascular and pulmonary functions in healthy elderly individuals, providing evidence-based recommendations for the development of exercise prescriptions for this population.

Methods: A systematic search was conducted in the PubMed, Web of Science, Cochrane Library, and Google Scholar databases (through March 2025) to identify randomized controlled trials that investigated the effects of HIIT and MICT on cardiovascular and pulmonary functions in elderly individuals. Data were analyzed using RevMan 5.4 and Stata 15.1, employing a random-effects model to calculate the pooled effect size (weighted mean difference) and its 95% confidence interval (95% CI) for maximal oxygen uptake.

Results: A total of 16 studies (n = 1434) were included. In the MICT group (12 studies), maximal oxygen uptake levels were significantly improved (mean difference [MD] = 1.22, 95% CI: 0.90-1.53). In the HIIT group (11 studies), the improvement was more pronounced (MD = 1.62, 95% CI: 1.10-2.13). In studies that included both HIIT and MICT (7 studies), HIIT demonstrated significantly superior improvements compared to MICT (MD = 1.17, 95% CI: 0.52-1.82). Subgroup analysis revealed that the optimal MICT protocol consisted of a moderate duration (>3 months and <6 months), 3 sessions per week, and a session duration of ≥60 minutes. The optimal HIIT protocol involved a moderate duration (>3 months and <6 months), 4 sessions per week, and a session duration of 21 to 39 minutes.

Conclusion: Both HIIT and MICT effectively improve cardiovascular and pulmonary function in elderly individuals, with HIIT yielding more favorable results. MICT is suitable for long-term training in individuals with good tolerance, while HIIT is better suited for short-term interventions for those able to tolerate high-intensity exercise. In clinical practice, the appropriate training regimen should be selected based on individual health status.

Sickle cell anemia (SCA) is an inherited chronic condition that can significantly impact patient's health and quality of life (QoL). Hydroxyurea has been shown as a promising treatment choice, but its effectiveness and patient experiences remain sub-explored, particularly in Saudi Arabia. This study aimed to assess various parameters of SCA patient's health, treatment adherence, and QoL. This is an online survey study that was conducted in Saudi Arabia between December 2023 and February 2024. The current online survey targeted adults diagnosed with SCA in Saudi Arabia. The assessment questions included queries about the general health status, satisfaction with time management and life, hydroxyurea treatment duration, adherence to the prescribed dose, perceived improvement of symptoms, frequency of follow-up with healthcare providers, and side effects experienced. A total of 167 patients participated in this study. Most participants reported their general health as good (41.3% described it as good, and 30.5% described it as very good). Enjoyment in life and satisfaction with time management were also prevalent, with 36.5% and 65.3% reporting moderate to extreme satisfaction, respectively. For hydroxyurea treatment, most of them were using it for >3 years (29.3%), and the majority reported a high level of symptom improvement (48.5%). The adherence to the prescribed doses was generally high (70.1%) despite the challenges posed by forgetfulness (15.6%) and side effects (8.3%). Although 86.8% reported an improved general QoL, some patients reported facing the challenges of side effects such as gastrointestinal disturbances (58.0%) and hair loss (62.9%). Nonetheless, some complained of dissatisfaction with the information given by the healthcare providers concerning hydroxyurea (9.0%) and even had challenges in scheduling the doses (18.0%). The results have generally indicated the beneficial effects of hydroxyurea treatment on the QoL of patients with SCA in Saudi Arabia, despite some challenges in adherence and side effects. Efforts should be made to enhance patients education and support systems to optimize patients' treatment outcomes and satisfaction.