Medicine最新文献

Patients with chronic kidney disease (CKD) are frequently exposed to environmental heavy metals, which can easily aggravate the condition or even accelerate death. The association between the metal mixture inflammatory index (MMII) and mortality in CKD patients has not been investigated yet. The MMII was developed using reduced rank regression models to gauge the systemic inflammatory potential of a multi-metal mixture. We analyzed data from 2569 CKD patients who participated in the National Health and Nutrition Examination Survey (1999-2018) with follow-up until December 31, 2019. The association between MMII and mortality was explored via multivariate COX regressions. Patients were divided into 3 groups according to tertiles of MMII: MMII-1 (-0.699 to 0.06), MMII-2 (0.060-0.268), and MMII-3 (0.268-1.329). Compared to MMII-1, the hazard ratios for all-cause, non-cardiovascular disease (CVD), and cancer mortality in MMII-3 were 1.30 (1.01-1.67), 1.49 (1.09-2.03), and 2.44 (1.33-4.49), respectively. In this nationally representative sample of U.S. CKD patients, MMII was closely associated with an increased risk of all-cause, non-CVD, and cancer mortality.

Myasthenia gravis (MG) is an autoimmune neuromuscular junction disease classified as early onset MG (EOMG), which typically occurs before the age of 50 years, and late-onset MG (LOMG), which occurs after the age of 50 years. The contribution of different immune cell subsets to MG pathogenesis is not fully understood. To address this, we conducted 2-sample Mendelian randomization (MR) analyses incorporating 731 peripheral immunophenotypes associated with MG. To further explore cellular mechanisms, we analyzed an existing single-cell RNA sequencing (scRNA-seq) dataset derived from the peripheral blood of patients with MG during and after the myasthenic crisis phase. In MR analyses, IVW results suggested that 42 immunophenotypes were risk or protective factors for LOMG, whereas 28 immunophenotypes were involved in EOMG. Comprehensive sensitivity analyses confirmed the absence of heterogeneity and horizontal pleiotropy. Among these, the proportion of effector memory CD4 + T cells emerged as the most significant factor associated with an increased risk of LOMG. Single-cell analyses revealed an expansion of these cells in patients with LOMG during the myasthenic crisis stage compared with the stable stage, with functional annotations showing strong similarities to activated CD4 + T cells treated with TGF-β and IL-4. This study identified effector memory CD4 + T cells as a significant risk factor for LOMG through MR analyses and further explored an existing scRNA-seq dataset. The role of effector memory CD4 + T cells, potentially mediated by TGF-β and IL-4, in LOMG pathogenesis and disease exacerbation, highlighting the need for further functional studies.

Hydrogen sulfide (H2S) has been shown to alleviate bone and joint inflammation in osteoarthritis (OA). Exploring the connection between H2S and OA could reveal novel therapeutic avenues for treating this condition. This study utilized H2S as the exposure variable and OA as the outcome within a Mendelian randomization framework. Data for genome-wide association studies related to both exposure and outcome were sourced from the IEU OpenGWAS project. To estimate causal relationships, inverse variance weighted method was employed, along with supplementary analytical techniques (MR-Egger, weighted median, simple mode, and weighted mode), and sensitivity studies were carried out to evaluate our results' dependability. The inverse variance weighted analysis revealed that the abundance of a specific gut bacterial pathway involved in the reduction process of sulfate "SO4ASSIM.PWY..sulfate.reduction.I..assimilatory." acts as a protective factor against hospital-diagnosed knee osteoarthritis, with an odds ratio of 0.687 (95% confidence interval = 0.479-0.987, P = .042). In contrast, gut bacterial pathway abundance associated with sulfate assimilation and cysteine biosynthesis "SULFATE.CYS.PWY..superpathway.of.sulfate.assimilation.and.cysteine.biosynthesis" was linked to increased risk for hospital-diagnosed OA, showing an odds ratio value of 1.120 (95% confidence interval = 1.000-1.255, P = .049). Sensitivity analyses validated the strength of the causal relationship between the gut bacterial pathway abundance and OA. We identified that the gut bacterial pathway abundance associated with H2S "SO4ASSIM.PWY..sulfate.reduction.I..assimilatory." acts as a protective factor for OA suggesting its potential role in OA treatment and offering new avenues for research on H2S in the treatment of OA in this context.

The objective was to evaluate potential genetic associations between biliary system disorders and cortical and subcortical brain structural changes using Mendelian randomization analyses. This study focused on 4 diseases, including primary sclerosing cholangitis, cholecystitis, intrahepatic cholangiocarcinoma, and gallstone disease, and total bilirubin levels as indicators of biliary system disorders. Genome-wide association studies summary statistics from the ENIGMA consortium were utilized to assess the directional associations between these biliary system diseases and changes in brain structure, including the cerebral cortex (N = 51,665) and subcortical brain structures (N = 30,717). Inverse variance weighted was the primary method for conducting MR analysis. Furthermore, sensitivity analysis was conducted to evaluate the robustness of our findings. At the regional level, a decrease in the thickness of the pars opercularis was supposedly linked to genetically predicted total bilirubin levels (P = .00014). Decreased cortical thickness and surface area of the paracentral lobule were nominally associated with genetically predicted cholecystitis (PTH = .024; PSA = .042). Genetically predicted gallstone disease was correlated with an increased surface area of the transverse temporal gyrus (P = .023), while it was nominally associated with decreased thickness of the transverse temporal gyrus (P = .015), inferior parietal gyrus (P = .042), and middle temporal gyrus (P = .017). Furthermore, genetically predicted intrahepatic cholangiocarcinoma was associated with decreased thickness of the pars opercularis (P = .026) and surface area of the superior parietal gyrus (P = .013), while the thickness of the para hippocampal gyrus was increased without global weighted (P = .012) and with global weighted (P = .022). By comparison, genetically predicted primary sclerosing cholangitis was associated with a modest increase in the surface area of the para hippocampal gyrus, both with global weighted (P = .015) and without global weighted (P = .012), and was also linked to the increased thickness of the paracentral lobule (P = .016). No significant evidence of multiple testing effects or heterogeneity was observed. The research suggests an association between changes in the cerebral cortex and biliary system disorders, indicating an indirect impact of these abnormalities on cortical structures.

Differentiated thyroid carcinoma (DTC) frequently requires radioactive iodine therapy, yet accurately predicting short-term therapeutic response remains challenging. Radiomics offers a means to quantify intratumoral heterogeneity from routine imaging. We aimed to develop and internally validate a Single-photon emission computed tomography (SPECT)-based radiomics nomogram for predicting 6-month response after RAI in DTC. We conducted a single-center retrospective study of 420 patients with DTC. Post-therapy 131I SPECT/CT images were processed to extract image biomarker standardisation initiative-aligned radiomic features in MATLAB; features passing reproducibility (ICC ≥ 0.80) and redundancy (|r|<0.85) filters were entered into a nested-cross-validation (CV) least absolute shrinkage and selection operator to derive a radiomics score, which was combined with clinicopathologic variables to build a nomogram. Model performance was assessed for discrimination (receiver operating characteristic area under the curve [AUC]), calibration (concordance index [C-index]; calibration intercept/slope), and clinical utility (decision-curve analysis); internal validation used outer 10-fold CV and 1000 bootstrap with permutation testing. Multicollinearity was checked by variance inflation factor. Interobserver reproducibility was high: 79/107 (73.8%) features achieved ICC ≥ 0.80 (median ICC 0.88), and the median mask-level Dice was 0.87. The nomogram showed AUC = 0.853 (95% confidence interval: 0.786-0.892) and C-index = 0.889 (95% confidence interval: 0.812-0.934) with good calibration. Internal validation yielded CV-AUC = 0.846 (SD 0.037) and bootstrap optimism-corrected C-index = 0.876/AUC = 0.848; permutation AUCs centered near 0.50. Decision-curve analysis indicated clinical net benefit across thresholds 0.15 to 0.95. All validation was internal; no external cohort was available. Radiomics score, age, regional lymph node metastasis, extrathyroidal extension, and tumor diameter independently influence the therapeutic outcome of RAI in DTC patients. In this exploratory, single-center study, the SPECT-based radiomics nomogram demonstrates promising internal performance; however, it must undergo external, multi-center validation and, if necessary, local recalibration before it can be considered for routine clinical use.

This study aimed to identify risk factors for preoperative deep vein thrombosis (DVT) in Pilon fracture patients and develop a nomogram model. This study retrospectively analyzed hospitalized patients with Pilon fractures from January 2017 to December 2022 in a tertiary referral and university-affiliated hospital. Multivariate logistic regression analysis was used to identify risk factors for preoperative DVT, and a nomogram model was developed. Besides internal validation, patient data from January 2023 to December 2024 served as an external validation set to assess the model's performance. A total of 1994 eligible patients were included, with 1432 in the training set and the others in the validation set. Multivariate analysis revealed 6 independent factors associated with preoperative DVT in patients with Pilon fractures. Risk factors (odds ratio [OR] > 1) included age >60 years (OR = 1.77, 95% confidence interval [CI]: 1.02-3.08, P = .044), delay from injury to duplex ultrasonography (days) (OR = 1.19, 95% CI: 1.13-1.26, P < .001), neutrophil-to-lymphocyte ratio > 3.17 (OR = 5.19, 95% CI: 2.70-9.98, P < .001), fasting blood glucose > 6.1 mmol/L (OR = 2.31, 95% CI: 1.08-4.95, P = .031), and D-dimer > 1.34 mg/L (OR = 3.96, 95% CI: 1.81-8.66, P = .001). Albumin was identified as a protective factor (OR = 0.87, 95% CI: 0.83-0.92, P < .001), indicating that low albumin levels correlate with increased DVT risk. The concordance index and Brier score of the nomogram were 0.829 and 0.033 in the training set, and the corrected values after internal validation were 0.796 and 0.035, respectively. The receiver operating characteristic curve, the calibration curve, the Hosmer-Lemeshow test, and the decision curve analysis performed well in both the training and validation cohorts. This study developed a personalized nomogram model with 6 predictors, which allows surgeons to stratify the risk of preoperative DVT in patients with Pilon fractures.

Nausea is common in migraines and is one of the most prevalent neurological disorders. Although migraine prophylaxis is known to reduce nausea, the impact of nausea treatment on migraine headache frequency remains unclear. DA-9701, a prokinetic derived from Corydalis tuber and Pharbitidis semen, offers serotonin 5-HT1A/5-HT4 agonism and D2 antagonism, with a reduced risk of adverse effects associated with traditional D2 antagonists. This study assessed the efficacy and short-term tolerability of DA-9701 in treating nausea and migraine and evaluated its secondary effect on reducing the frequency of migraine headaches. A cohort of 110 migraineurs with nausea received DA-9701 for 1 month. Using a headache diary, the monthly frequency of headache and nausea was recorded during a 1-month baseline and a 1-month treatment period. Changes in the number of nausea days per month were measured as the primary outcome. Changes in headache days and days requiring acute rescue medication were assessed as secondary outcomes using the DIEPSS. Further analyses were performed according to the migraine subtypes EM and CM. Nausea days decreased by 53.7% (-4.65 days; 95% confidence interval (CI) -10.66 to -4.66 days; P <.001). Headache days were reduced by 52.2% (-8.18 days; 95% CI -15.35 to -11.19 days;P <.001), and rescue medication days by 44.8% (-3.46 days; 95% CI -6.75 to -1.00 days; P <.001). In the CM group, changes in headache days were more prominent than those in nausea days (-13.47 vs -7.12 days; P <.001). No EPS or other clinically relevant adverse events were observed. DA-9701 was well tolerated and reduced both nausea and headache in migraineurs. The CM data suggest a potential independent prophylactic effect of DA-9701 on migraine headache. Larger randomized controlled trials are warranted.

Background: The aim of this study was to evaluate the preventive effect of transcutaneous acupoint electrical stimulation (TEAS) on emergence agitation after general anesthesia in pediatric patients undergoing tonsillectomy.

Methods: This prospective, randomized, controlled trial was conducted between January 2025 to May 2025, enrolling 97 pediatric patients undergoing tonsillectomy. Participants were randomly assigned to the control or the TEAS group. Patients received TEAS at Hegu and Neiguan during surgical procedure in group TEAS. Emergence agitation incidence, cerebral oxygen saturation, level of β-EP, NE, E and COR, intraoperative anesthesia consumption, mean arterial pressure and heart rate, pediatric anesthesia emergence delirium score, adverse event and satisfaction level were recorded.

Results: In comparison to the control group, the TEAS group exhibited a significant reduction in the incidence of emergence agitation, pediatric anesthesia emergence delirium scores, intraoperative remifentanil consumption, and levels of β-EP, NE, E and COR. Additionally, cerebral oxygen saturation was notably increased in the TEAS group. Post-intubation, mean arterial pressure and heart rate were also significantly lower in the TEAS group compared to the control group. There were no significant differences in adverse events between the 2 groups. Furthermore, patient satisfaction was higher in the TEAS group than in the control group.

Conclusion: TEAS may reduce the incidence of emergence agitation in pediatric patients undergoing tonsillectomy, potentially by enhancing cerebral oxygenation and mitigating stress levels.

In Japan, the length of stay in acute care hospitals has decreased, resulting in earlier discharge of stroke patients after life-saving treatment. This trend limits opportunities for patients to practice activities of daily living and for clinicians to prepare appropriate discharge plans. Early prediction of discharge destination is therefore essential to support timely rehabilitation and discharge management. This study aimed to develop a decision tree model to predict discharge destination using data obtained within 3 days of hospitalization. A retrospective observational study was conducted on 150 acute stroke patients. Clinical and demographic characteristics, medical history, cognitive status, National Institutes of Health Stroke Scale (NIHSS), Brunnstrom recovery stage, and motor- and cognitive-functional independence measure (M-FIM, C-FIM) scores were collected. Participants were randomly divided into training (n = 106) and test (n = 44) datasets. Ninety-one patients were discharged home and 59 to other facilities. NIHSS, M-FIM, and C-FIM were identified as key predictors. Patients with NIHSS ≤ 3.5, or with NIHSS > 6.5 combined with M-FIM > 23.5 and C-FIM > 29.5, had a 100% probability of home discharge, whereas those with NIHSS > 6.5 and M-FIM ≤ 23.5 had only a 14.7% chance. The model achieved 86.4% accuracy, with sensitivity of 91.7% and specificity of 80.0%. These findings suggest that combining early neurological and functional assessments provides a reliable basis for anticipating discharge outcomes, thereby aiding rehabilitation planning and effective patient management in acute stroke care.

This study aims to identify risk factors associated with postpartum hemorrhage (PPH) volume in pregnant women diagnosed with placenta previa. We retrospectively collected data on PPH volume in consecutive pregnant women at the First People's Hospital of Zunyi between March 24, 2020, and February 28, 2024. The outcome variable, PPH volume, was divided into 5 categories: <500 mL, 500 to 1000 mL, 1001 to 1500 mL, 1501 to 2000 mL, and > 2000 mL, according to the Chinese Medical Association (CMA) obstetric guideline (2023 edition). These data were documented within 24 hours of birth. We examined maternal characteristics and concurrent pregnancy conditions to identify the potential risk factors for PPH volume. Univariate and multivariate ordered logistic regression analyses were used to determine the association between these factors and PPH volume, with the analysis conducted using SPSS statistical software (version 26.0). In total, 246 pregnant women were included in this retrospective study. Univariate analysis revealed that gestational hypertension increased the risk of an elevated volume of PPH, with an odds ratio (OR) of 5.336 (95% confidence interval [CI]: 1.204-23.656). This significance persisted in the multivariate ordered logistic regression analysis (OR = 6.445, 95% CI: 1.414-29.371), suggesting that pregnant women diagnosed with gestational hypertension are approximately 6.445 times more likely to experience a higher level of PPH volume than those without this condition. The mode of delivery, particularly cesarean section, was initially associated with a lower volume of PPH (OR = 0.393, 95% CI: 0.226-0.685); however, this association was not statistically significant in the multivariate analysis. Gestational hypertension significantly contributes to an increased PPH volume in patients with placenta previa. Clinicians must diligently monitor and manage such patients to mitigate the risk of severe PPH and related complications. Further research is required to validate our findings.