Medicine最新文献

This study specifically evaluated physical fitness trends among college students in Jiangxi province from 2018 to 2020, amid the emergence and influence of the COVID-19 pandemic. A cohort of 20,202 students (5622 boys and 14,580 girls) from a Jiangxi-based university underwent standardized physical fitness testing. Differences across years were analyzed using Kruskal-Wallis H and Wilcoxon Signed-rank tests, with stratification by sex and body composition. The overall fitness scores increased significantly during the study period. However, cardiorespiratory endurance declined markedly in both genders (boys' 1000 m: +25.4 seconds; girls' 800 m: +21.5 seconds). Concurrently, the overweight prevalence among boys increased progressively (2018:11.9%; 2019:13.8%; 2020:14.4%), while upper-body strength remained critically low (pull-ups: ~5). Contrastingly, 2020 saw improvements in vital capacity, standing long jump, and sit-and-reach across both genders, and in boys' 50-m dash performance (-0.08 seconds). The COVID-19 pandemic significantly impaired cardiorespiratory endurance despite overall fitness gains. Future interventions should prioritize the development of indoor-compatible endurance training protocols for restricted environments.

Background: The integration of large language models (LLMs) such as ChatGPT into radiology has introduced new possibilities for structured reporting. While these models are designed to improve the clarity, accuracy, and efficiency of radiology workflows, their diagnostic performance and clinical reliability are still not well established. We aimed to systematically review the diagnostic accuracy, sensitivity, specificity, and clinical utility of ChatGPT and related LLMs in generating structured radiology reports.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with the International Prospective Register of Systematic Reviews (CRD42025639804). PubMed and Google Scholar were searched for retrospective diagnostic accuracy studies involving ChatGPT or similar LLMs applied to structured radiology reporting. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A narrative synthesis summarized performance metrics across imaging modalities and artificial intelligence model types. Due to the variability in methodologies and outcome reporting, a meta-analysis was not conducted.

Results: Twenty-eight out of the 1428 studies were included in this review, which were published between 2023 and 2024. GPT-4 consistently outperformed earlier models, achieving up to 99% accuracy in liver magnetic resonance imaging and 94% in brain magnetic resonance imaging interpretation. GPT-4o showed higher sensitivity in chest imaging (75%) with a specificity of 95%. Other domain-specific models also demonstrated high performance, including augmented transformer assisted radiology intelligence (98% accuracy) and Vicuna (96% accuracy). However, variability in diagnostic capability was observed, with models like GPT-4V underperforming in musculoskeletal and gastrointestinal imaging. The overall risk of bias according to the Quality Assessment of Diagnostic Accuracy Studies 2 tool was moderate, with common issues in patient selection and index test standardization.

Conclusion: ChatGPT and similar LLMs show promising accuracy and applicability in structured radiology reporting, particularly for chest, brain, and liver imaging. However, their performance remains inconsistent across modalities, and further prospective studies with standardized protocols are needed before routine clinical adoption.

Background: Chikungunya virus (CHIKV) poses a significant burden on affected populations, presenting substantial challenges to public health. This study aimed to assess the seroprevalence of the CHIKV in the Horn of Africa.

Methods: We conducted a systematic review and meta-analysis by searching PubMed/MEDLINE, Scopus, Scientific Direct, Google Scholar, and reference lists for primary articles published from the inception of the database until November 30, 2023. The inclusion criteria covered seroprevalence studies of CHIKV in Ethiopia, Kenya, Somalia, South Sudan, Sudan, Eritrea, Uganda, and Djibouti. Pooled seroprevalence was estimated using a random effects model, and the meta-analysis was conducted with R Studio version 4.3.1 and the Metapro package. The study protocol adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered in PROSPERO, CRD42023477057.

Results: From a pool of 87,567 potential studies, 34 eligible studies were included in our analysis. Most of the studies were conducted in Kenya (44%). Hospital-based studies were included in 59% of cases. A total of 23,400 participants were involved in the review. Of the 13,397 participants, 6778 (67.6% of those with information) were male. The pooled seroprevalence of CHIKV was 14% (95% CI: 9-23; I2 = 99%). Subgroup analysis was performed. The seroprevalence was higher in studies conducted in population settings: 15% (95% CI: 5-37; I2 = 99%) than in hospital settings. The seroprevalence of chikungunya was high from the 2004 to 2013 period, at 36% (95% CI: 13-68; I2 = 98%). Plaque reduction neutralization tests detected 15% (95% CI: 3-49%; I2 = 94%) of the chikungunya seroprevalence. The seroprevalence of CHIKV among inapparent infections was 17% (95% CI: 8-35; I2 = 98%). The meta-regression analysis revealed that the chikungunya seroprevalence was predicted by the countries of study, age group, and trends of infection over time.

Conclusion: Our review highlights compelling evidence of CHIKV and other arbovirus circulation in the Horn of Africa, revealing diverse seroprevalence rates across different countries, age groups, laboratory tests, clinical manifestations, and time trends. The confirmatory gold standard, the plaque reduction neutralization test, increases diagnostic accuracy.

PsA is a chronic inflammatory joint condition associated with psoriasis, and its underlying mechanisms are not fully elucidated. Serum metabolites, as direct reflections of metabolic status, may influence disease progression by regulating immune cell function; however, the causal relationships and specific pathways require further investigation. The present investigation utilized a 2-sample bidirectional MR methodology, leveraging extensive pooled GWAS data to thoroughly evaluate the causal relationships between 1440 serum metabolites and PsA. Additionally, mediation MR analysis was performed to explore the possible mediating effects of 731 immune cell characteristics. In the primary analysis, inverse-variance weighted was employed, and this was further supported by various sensitivity analyses to confirm the reliability of the findings. The genetic method to infer causality analysis revealed significant positive causal associations between 10 serum metabolites and PsA risk, with quinolinate levels demonstrating the most significant correlation (OR = 1.56, 95% CI: 1.26-1.93); while 4 metabolites (e.g., citrate levels, OR = 0.74, 95% CI: 0.61-0.89) exhibited protective effects. Regarding immune cells, 6 cellular features (e.g., CD20 on B cells) were positively correlated with disease risk, whereas 5 features (primarily HLA-DR expression on monocyte subsets) showed negative correlations. Mediation analysis identified 3 significant pathways,the percentage of the effect explained by the mediator: N6,N6,N6-trimethyllysine levels mediated via B cells (CD20 on IgD+ CD38br), with a proportion of 33.2%; 1-stearoyl-2-docosahexaenoyl-GPE (18:0/22:6) levels mediated through monocytes (HLA-DR on CD14- CD16-) with a 32.0% proportion; the unknown metabolite X-24736 also mediated 42.1% of the protective effect via the same monocyte phenotype. This study revealed that elevated amino acid-related metabolites and glycerophospholipids significantly increase PsA risk through immune cell effects. These are closely associated with PsA pathogenesis and may serve as potential biomarkers. The novel findings underscore metabolic-immune interactions as targets for biomarkers and therapies in PsA, advancing personalized medicine.

This study aims to assess the clinical efficacy of percutaneous curved vertebroplasty (PCVP) in the treatment of osteoporotic vertebral compression fractures (OVCFs) at 2 specified stages: early (symptom-to-surgery time ≤2 weeks) and delayed (symptom-to-surgery time >2 weeks). A retrospective analysis was conducted on 111 patients with OVCF who underwent PCVP at the 983rd Hospital of the Joint Logistic Support Force from June 2018 to June 2023. The patients were categorized into the early group (n = 60, symptom-to-surgery time ≤2 weeks) and delayed group (n = 51, symptom-to-surgery time >2 weeks) based on the interval from pain onset to surgical intervention. Demographic data were collected for both groups. The visual analog scale and Oswestry disability index were used to evaluate surgical efficacy. Perioperative complications were recorded. The kyphotic angle and vertebral height of the affected vertebra were measured preoperatively and postoperatively to assess the vertebral height recovery and kyphotic angle correction. A total of 217 patients were screened, of whom 106 were excluded (39 cases under the age of 60, 57 cases were unable to undergo surgical treatment due to systemic diseases, 10 cases with incomplete follow-up data), resulting in 111 eligible patients. Baseline characteristics were comparable between groups: early group (n = 60; age 73.03 ± 7.76 years; 12 males and 48 females) versus delayed group (n = 51; age 75.20 ± 6.63 years; 12 males and 39 females) (all P > .05). At the 12-month follow-up, the visual analog scale scores showed significant differences: early group (preoperative 8.12 ± 0.46 to postoperative 0.93 ± 0.52) versus delayed group (preoperative 6.55 ± 0.54 to postoperative 1.84 ± 0.37) (intergroup P < .001). The Oswestry disability index also demonstrated significant improvement: early group (preoperative 45.75 ± 1.58 to postoperative 11.68 ± 4.05) versus delayed group (preoperative 45.25 ± 1.98 to postoperative 15.59 ± 4.84) (intergroup P < .001). Regarding kyphotic angle correction, the early group showed a correction of -5.65° ± 1.93° compared to -0.76° ± 1.92° in the delayed group (P < .001). The anterior vertebral height recovery was greater in the early group (3.73 ± 1.71 mm) than in the delayed group (0.61 ± 1.57 mm) (P < .001). The complication rate was significantly lower in the early group at 10% (6/60) compared to 35.2% (18/51) in the delayed group (P = .001). Among elderly patients with OVCF aged >60 years and without contraindications, early PCVP performed within 2 weeks of symptom onset is associated with greater pain relief, enhanced functional improvement, restoration of vertebral height, and reduced complication rates compared to delayed surgery. Owing to the retrospective and observational nature of this study, causal inferences were constrained. Nevertheless, these findings support the consideration of early PCVP as a beneficial treatment strategy for eligible patients.

It has been proven that diabetes mellitus plays an important role in the occurrence and development of joint fractures. In this study, a 2-sample Mendelian randomization (MR) analysis was conducted to investigate the causal relationship between diabetes and ankle fractures. We pooled the data from the published genome-wide association studies. Diabetes mellitus type 2 was derived from pooled genome-wide association study data of 655,666 European individuals (61,714 patients and 1178 controls). Data on ankle fractures were derived from pooled genome-wide association study data in a total of 460,340 European individuals (6479 patients and 453,861 controls). Using diabetes-associated loci as instrumental variables, we used inverse variance weighting, MR-Egger, weighted median, simple multivariate analysis and weighted multivariate analysis to evaluate the association between diabetes and ankle fracture risk. Reverse MR analysis was performed on the Diabetes mellitus type 2 that were found to be causally associated with ankle fractures in forward MR analysis. Sensitivity analysis was used to evaluate the robustness of the results. Statistical analysis showed a significant causal relationship between diabetes and ankle fractures (inverse variance weighting: OR = 1.07, 95% CI = 1.01-1.32, P = .02). Diabetes mellitus is associated with an increased risk of ankle fracture. The results of MR analysis can be used as a guide for the screening of diabetes and ankle fractures, which is helpful to improve the awareness of screening, early diagnosis and early treatment.

The role of noise pollution as a risk factor for Alzheimer disease (AD) is unclear, with observational studies yielding conflicting results susceptible to confounding and reverse causality. To clarify this relationship, we performed a 2-sample Mendelian randomization (MR) study using summary statistics from large-scale genome-wide association studies of European populations. Genetically predicted daytime and evening noise exposure was used as an instrumental variable to assess a causal effect on AD risk. The primary analysis was conducted using the inverse-variance weighted method, with weighted median and MR-Egger methods as key sensitivity analyses. We assessed instrument validity and pleiotropy using the Cochran Q test, the MR-Egger intercept, and leave-one-out analysis. Our MR analysis found no evidence of a causal association between genetically predicted daytime noise (odds ratio [95% confidence interval] = 0.999 [0.993-1.006], P = .819) or evening noise (odds ratio [95% confidence interval] = 0.999 [0.993-1.005], P = .643) and the risk of AD. Sensitivity analyses were consistent, with no evidence of heterogeneity or directional pleiotropy. In conclusion, this study does not support a direct causal link between noise and AD. While our findings mitigate common observational biases, they do not preclude indirect mechanisms whereby noise may influence AD pathogenesis via established risk pathways, such as chronic sleep disruption and cardiovascular stress. Studies are needed to focus on disentangling these potential indirect effects.

This study aims to determine the potential causal relationship between type 2 diabetes (T2D) and autoimmune liver disease (AILD) using Mendelian randomization (MR) combined with clinical case analysis. Summary statistics for T2D, autoimmune hepatitis, primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) were sourced from open genome-wide association study databases. The IVW method was used as the primary analysis. Additional sensitivity analysis was also performed to validate our results. Subsequently, clinical information on patients with AILD was collected retrospectively, while multiple potentially confounding independent effects were assessed using multivariate logistic regression analysis. The results of the forward MR analysis showed that genetically predicted T2D was associated with reduced risk of PSC (IVW: odds ratio [OR] = 0.85, 95% confidence interval [CI], 0.77-0.94, P = .001). Furthermore, the results of the reverse MR analysis revealed the genetically predicted PBC (OR = 1.96, 95% CI 1.31-3.40, P = .016) had a significant correlation with the higher risk of T2D (IVW: OR = 1.02, 95% CI, 1.00-1.04, P = .025). An analysis of the clinical sample revealed that the prevalence of T2D among patients with AILD was 27.6%. Notably, multifactorial logistic regression analysis indicated that immunoglobulin G and total bilirubin levels may serve as independent factors influencing the occurrence of T2D. Genetic evidence demonstrated that T2D reduced the risk of PSC, while PBC increased the risk of T2D. Clinical data further confirmed a high prevalence of T2D in patients with autoimmune liver disease, suggesting a bidirectional relationship that warrants further validation.

MicroRNAs (miRNAs) are implicated in breast cancer progression and prognosis. This study employed a Mendelian randomization (MR) framework to investigate causal relationships between plasma circulating miRNAs and breast cancer. miRNA expression quantitative trait loci were extracted from 2 independent cohorts. High-confidence miRNAs and their associated single-nucleotide polymorphisms were selected for 2-sample MR analyses using inverse-variance weighted and MR-Egger methods. Differential expression analysis and univariate Cox regression identified survival-associated genes in breast cancer, while enrichment analyses revealed pathways and biological processes linked to candidate targets. Pan-cancer analyses of miRNAs and targets were conducted via the ENCORI platform. Initial MR analyses in the discovery phase identified hsa-miR-100-5p, hsa-miR-125b-5p, and hsa-miR-339-5p as significantly associated with reduced breast cancer risk (P < .05), suggesting potential protective roles. A total of 1291 survival-associated differentially expressed genes were identified, with 39 overlapping targets implicated in miRNA-mediated breast cancer intervention. Enrichment analyses highlighted their involvement in cell cycle regulation and p53 signaling pathway. In the validation cohort, only hsa-miR-339-5p confirmed a protective effect on breast cancer risk, while hsa-miR-100-5p and hsa-miR-125b-5p did not reach significance. Pan-cancer profiling demonstrated aberrant miRNA expression across malignancies, prognostic relevance in multiple cancers, and significant negative correlations between miRNAs and target genes in breast tumors. Our findings provide novel insights into the causal roles of miRNAs in breast cancer pathogenesis and underscore their potential as noninvasive biomarkers and therapeutic targets. Future studies should prioritize functional validation and clinical translation of these miRNAs.