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The role of endothelial injury in worsening congestive heart failure (CHF) remains unquantified. This study evaluates the Endothelial Activation and Stress Index (EASIX) for predicting short-term mortality in patients with critical CHF. This was a retrospective cohort study using the Medical Information Mart for Intensive Care-IV (2008-2022). Adults with CHF admitted to the intensive care unit were stratified by ln(EASIX) quartiles. The primary endpoint was 30-day all-cause mortality. Multivariable Cox regression, restricted cubic splines, and subgroup analyses were performed. Among 4556 patients (median age 72.1 years, 42.8% female), the highest EASIX quartile (Q4) had a 44.2% 30-day mortality rate versus 19.2% in Q1 (adjusted hazard ratio [HR] = 1.6, 95% confidence interval [CI]: 1.27-2.02, P < .001). A nonlinear association was observed (nonlinearity P = .008) with an inflection point at ln(EASIX) = 0.05. Beyond this threshold, each unit increase in ln(EASIX) conferred a 14.2% higher mortality risk (HR = 1.142, 95% CI: 1.062-1.227). Ln(EASIX) remained predictive after full adjustment for severity scores and treatments, with the highest quartile (Q4) exhibiting a 60% increased mortality risk (adjusted HR = 1.60, 95% CI: 1.27-2.02). EASIX is a robust predictor of short-term mortality in patients with critical CHF, particularly valuable in nonsepsis populations. Its simple calculation (lactate dehydrogenase/creatinine/platelets) that refines risk stratification beyond conventional severity scores.

In recent years, the roles of gut microbiota and circulating cytokines in chronic obstructive pulmonary disease (COPD) have gradually attracted attention. However, it remains unclear whether cytokines act as mediators from gut microbiota to COPD. This study utilized the mediation Mendelian randomization analysis method to explore the potential causal effects of gut microbiota and cytokines on COPD and reveal the potential mechanistic connections between them. We aggregated data from large-scale genome-wide association studies. Inverse variance weighted was used as the primary statistical method, and a series of sensitivity analyses were conducted to test the reliability of the Mendelian randomization results. We identified 24 gut microbiota species that show robust associations with COPD risk, with results supported by sensitivity analyses. Specifically, 11 gut microbiota species may increase the risk of COPD, while the remaining 13 species have a protective effect. Additionally, we observed associations between 7 circulating cytokines and COPD risk, among which 6 may increase the disease risk and 1 may reduce the disease risk. Mediation analysis revealed the complex regulatory roles of 4 key cytokines (LIF, IL-1A, CXCL10, CD6) between gut microbiota and COPD. This study reveals that circulating cytokines can act as potential mediators between gut microbiota and COPD. These findings not only deepen our understanding of the pathophysiological mechanisms of COPD but also provide new perspectives for the early intervention and treatment of COPD.

With the global expansion of breast cancer screening, early-stage detection, particularly clinical stage T1 breast cancer, has become increasingly common. Accurate prognosis for T1 cancer is closely linked to lymph node metastasis status. While breast ultrasound and mammography are standard for screening, they are suboptimal for axillary lymph node assessment. This study aimed to predict lymph node metastasis by analyzing primary tumor imaging characteristics. We retrospectively analyzed 148 patients with pathologically confirmed stage T1 breast cancer. Multivariate logistic regression identified independent risk factors for lymph node metastasis from breast ultrasound and mammography features. Subsequently, a line graph model was established to predict axillary lymph node metastasis. A predictive nomogram was developed and validated, demonstrating good discrimination with area under the receiver operating characteristic curve of 0.78 (training set) and 0.72 (validation set). The model also showed favorable calibration and clinical utility via decision curve analysis. In conclusion, this model can provide risk stratification for clinical T1-stage breast cancer axillary lymph node metastasis, which to some extent aids clinical decision-making, thereby reducing missed diagnoses and unnecessary invasive procedures. However, further prospective validation is still required.

Breastfeeding-associated nipple trauma can compromise feeding effectiveness and contribute to early discontinuation. This single-center retrospective case-control study enrolled breastfeeding mothers who attended routine lactation consultation visits at our institution between June 2022 and June 2025, including 56 mothers with clinically documented nipple fissures and 56 controls without fissures. Maternal demographic, obstetric, infant, and feeding-related variables were extracted from electronic medical records and standardized lactation assessment forms. Analyses were conducted using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk). Continuous variables are reported as mean ± standard deviation or median (interquartile range ), and categorical variables as n (%). Group comparisons used the Welch t test, Mann-Whitney U test, chi-square test, or Fisher exact test as appropriate. Univariate and multivariable logistic regression models were used to identify factors associated with nipple fissures, reporting odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Baseline characteristics were largely comparable; postpartum weight change differed between groups (P = .011). Mothers with nipple fissures reported less exclusive breastfeeding (P = .005), shorter feeding duration (P < .001), and more frequent poor latch and pain during suckling (both P < .001). In univariate analyses, exclusive breastfeeding and longer feeding duration were associated with lower odds of fissures, whereas poor latch, pain, and early bottle introduction were associated with higher odds. In multivariable analysis, shorter feeding duration (per 5-minute increase: aOR = 0.510, 95% CI 0.301-0.863; P = .012), pain during suckling (aOR = 3.826, 95% CI 1.143-12.808; P = .030), and early bottle introduction (aOR = 3.063, 95% CI 1.020-9.192; P = .046) remained independently associated with the presence of nipple fissures; however, given the retrospective design, these findings should be interpreted as associations rather than causal relationships. The retrospective single-center design and potential temporal ambiguity limit causal inference.

Myocardial ischemia is a leading cause of cardiovascular morbidity and mortality; however, early and noninvasive diagnosis remains challenging. Conventional diagnostic methods, including electrocardiography, coronary angiography, and myocardial perfusion imaging have limitations in detecting early-stage ischemia. This study aimed to identify plasma metabolite biomarkers associated with early myocardial ischemia using liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF/MS) based metabolomics. Eighty-nine patients with suspected myocardial ischemia hospitalized at Kyungpook National University Hospital were screened. After applying exclusion criteria, 43 patients were enrolled and divided into 2 groups: control (n = 24, no angiographic stenosis) and case (n = 19, >70% stenosis in vessels with a diameter of ≥2.5 mm). All participants underwent an exercise stress test based on the Bruce protocol. Plasma samples were collected before and 10 minutes after exercise. Untargeted LC-QTOF/MS profiling was performed, and multivariate analyses (principal component analysis and orthogonal partial least squares-discriminant analysis) were used to identify differential metabolites. Receiver operating characteristic analysis was conducted to evaluate diagnostic performance. Multivariate modeling revealed distinct metabolic differences between the groups. Thirteen metabolites were significantly altered in both groups, while 9 changed exclusively in the ischemia group following exercise. Notably, several phosphatidylcholine (PC) species - PC (O-18:5/2:0), PC (O-16:0/22:4), PC (O-18:4/18:2), and PC (20:4/20:4) - as well as 13Z-docosenamide, differed significantly between groups. Receiver operating characteristic analysis identified 3 key metabolites - 13Z-docosenamide, PC (16:0/22:5), and PC (18:1/20:4) - with excellent discriminative performance (area under the curve = 0.941; 95% confidence interval: 0.865-1.000; sensitivity, 92%; specificity, 93%). Pathway analysis indicated that exercise-induced ischemia was associated with alterations in phospholipid, sphingolipid, and fatty acid metabolism, reflecting hypoxia-mediated energy shifts and oxidative stress. LC-MS-based metabolomic profiling identified distinct lipid metabolic signatures associated with early myocardial ischemia. The metabolites 13Z-docosenamide, PC (16:0/22:5), and PC (18:1/20:4) demonstrated strong diagnostic potential and may serve as early biomarkers for the noninvasive detection of myocardial ischemia. Further validation in independent cohorts might be required to confirm their clinical applicability.

Totally implantable venous access devices (TIVADs) are widely used in breast cancer patients receiving chemotherapy; however, catheter-related thrombosis can occur and may be asymptomatic. This study aimed to examine the prevalence and associated risk factors of TIVAD-related venous thrombosis in breast cancer patients undergoing chemotherapy. We conducted a retrospective analysis of 143 consecutive breast cancer patients who received TIVAD implantation at our hospital from March 2022 to February 2023. Routine color Doppler ultrasonography of catheter-associated veins was conducted following the conclusion of all chemotherapy cycles and prior to the removal of the TIVAD. Patients were classified into thrombosis and non-thrombosis cohorts. Variables relating to patients, treatments, and catheters were compared among groups. TIVAD-related venous thrombosis was detected in 37 of 143 patients (25.87%); all cases were asymptomatic and identified by routine ultrasound screening prior to TIVAD removal. The median TIVAD retention time was 148 days. A significant difference in TIVAD material was observed between groups (P < .05). No significant differences were found in age, body weight, tumor-node-metastasis (TNM) stage, puncture site, timing of chemotherapy, chemotherapy regimen category, catheter tip position, or TIVAD retention period (all P > .05). Asymptomatic TIVAD-associated venous thrombosis is prevalent among breast cancer patients undergoing chemotherapy. TIVAD material may be linked to thrombosis risk, although the duration of TIVAD retention was not substantially correlated with thrombosis in this population.

Traditional Chinese medicine constitutional theory and diagnostic systems are conducive to promoting health and delaying aging, along with the concept of healthy aging advocated by the World Health Organization. This study aimed to use these diagnostic systems to compare and analyze the constitutional characteristics of older adults and young individuals to identify key areas for healthcare for older adults. This cross-sectional, case-controlled, observational study was conducted in an outpatient setting. The Constitution in Chinese Medicine Questionnaire is a traditional Chinese medicine diagnostic tool that categorizes patients into 9 constitutional types based on symptoms and signs, facilitating disease prediction and prevention. The study participants were categorized into senior and young groups based on age, and their constitutional characteristics were analyzed using the Constitution in Chinese Medicine Questionnaire. The analysis revealed that comorbidities (adjusted odds ratio = 230.9, 95% confidence interval = 25.7-30,823.7) and Blood-stasis constitution (adjusted odds ratio = 16.3, 95% confidence interval = 1.3-2330.9) were the main differences between older adults and young individuals. Subgroup analysis further indicated a significant association between Blood-stasis constitution and osteoarthritis (P = .043). The findings suggest that comorbid diseases and Blood-stasis constitution are key distinguishing characteristics of older adults compared to young individuals. This discovery provides an important basis for seniors' healthcare and emphasizes that the Blood-stasis constitution should be a focus area for health intervention and disease prevention in the elderly.

Menarche significantly affects linear growth, and the extent of height gain after menarche remains a key clinical concern. This study aimed to analyze the relationship between menarche timing and pubertal height gain, determine the extent of height gain after menarche, and assess whether treatment is required in cases of early puberty with advanced bone age (BA). A retrospective chart review of 43 patients aged 12 to 16 years with precocious or early puberty was conducted between January and June 2022. Eight patients were excluded due to treatment with recombinant growth hormone. The remaining 35 patients were divided into 2 groups based on whether they received gonadotropin-releasing hormone (GnRH) agonists. Of the 35 patients, 27 (77.1%) were treated with GnRH agonists. The mean age at menarche was delayed (11.5 ± 1.0 vs 12.1 ± 1.7, respectively). The mean predicted adult height (PAH) before menarche was lower in the untreated than in the treated group (156.7 ± 1.8 and 160.0 ± 1.8 cm, respectively, P < .05) in the treated group. After menarche, mean PAH was 157.0 ± 0.7 cm in the untreated group and 160.5 ± 0.9 cm in the GnRH agonist group (P = .04). Height gain after menarche was greater in the untreated group, 6.6 ± 3.9 versus 4.9 ± 3.0 cm, though it was not statistically significant. Importantly, the final height increase after menarche was negatively correlated with advanced BA before menarche (r = -0.092, P < .001). The mean age at menarche was delayed in the GnRH agonist group, and the final PAH was higher than that in the untreated group. However, a later age at menarche was associated with lower pubertal height gain. An increase in PAH after treatment can be anticipated in patients with an advanced BA.

There are previously stated risk factors for the transition from psoriasis to psoriatic arthritis, but the immune mechanisms in this regard have not been adequately explained. In this study, we aimed to investigate this transition in terms of the complement system. Study was planned as a prospective analytical type. 46 psoriasis and 45 psoriatic arthritis patients were included in this study. Morning stiffness, nail involvement, disease activation questionnaire scores, neutrophil and lymphocyte percentage, neutrophil-lymphocyte rate, high-density lipoprotein, low-density lipoprotein, triglyceride, erythrocyte sedimentation rate, C-reactive protein, uric acid, complement 3 (C3) and 4 (C4) values were evaluated. Enthesis clinical assessment was done with the Leeds enthesis index (LEI). Ultrasonography was used to evaluate the enthesis sites. The severity of skin involvement in psoriasis was evaluated with the psoriasis area severity index (PASI). PASI scores were higher in psoriasis patients, while LEI scores, erythrocyte sedimentation rate and C-reactive protein levels were higher in psoriatic arthritis patients (P = .016, P = <.001, P = .016, P = .027, P = .020, respectively). Among psoriasis patients, C3 levels were higher in the patients with nail involvement (P = .035). C3 levels of psoriasis patients showed a moderate positive correlation between PASI and LEI scores (r = 0.368, r = 0.404, respectively). In psoriasis patients, high-density lipoprotein values were found to be moderately negatively correlated with both C3 and C4 (r = -0.311, r = -0.388, respectively). As a result of this study, C3 levels may play a role in the progression to psoriatic arthritis.

White matter hyperintensities of presumed vascular origin (WMH) are known imaging markers of cerebral small vessel disease and have been associated with future stroke risk, cognitive decline, and other adverse outcomes. However, the pathogenesis of WMH and its correlation with cerebral perfusion and cognitive impairment remain unclear. In this prospective study, we included 128 participants, each of whom underwent cognitive assessments and a three-dimensional pseudo-continuous arterial spin labeling sequence, using post-labeling delay values of 1525 and 2525 ms. The magnetic resonance imaging results of all participants were categorized into 4 groups based on the Fazekas visual rating scale. Variance analyses were conducted among the 4 groups of cerebral blood flow (CBF), and partial correlation analyses were performed between CBF and cognitive function. No clusters with a CBF1525ms difference were identified among the 4 groups. Three clusters with the CBF2525ms differences were identified among the 4 groups. The CBF2525ms of the brain regions with perfusion differences among the 4 groups showed an increasing trend with increasing Fazekas grades. A negative correlation was observed between CBF2525ms in the left lenticular nucleus and the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores (r = -0.306, P < .001, and r = -0.269, P = .002). The CBF2525ms of the right lenticular nucleus was negatively correlated with the MMSE and MoCA scores (r = -0.177, P = .047, and r = -0.179, P = .045). The CBF2525ms of the left thalamus/hippocampus was negatively correlated with the MMSE and MoCA scores (r = -0.226, P = .011, and r = -0.220, P = .013). This indicates that more severe WMH may increase perfusion through collateral circulation in certain brain regions, and their CBF is negatively correlated with cognitive function. This study further unveiled mechanisms behind WMH-related cognitive decline, which has a positive effect on the prevention and treatment of cognitive impairment in patients with WMH.