Medicine最新文献

In observational studies, there has been an association found between spleen volume and Crohn disease. We conducted a two-way, two-sample Mendelian randomization analysis to determine whether these associations have a causal relationship. Single nucleotide polymorphisms (P < 5 × 10-8) were used as instrumental variables for spleen volume and Crohn disease. Estimates of the genetic associations between spleen volume and Crohn disease were obtained from the Integrative Epidemiology Unit, European Bioinformatics Institute, UK Biobank, and FinnGen databases. Analysis was performed using MR-Egger regression, weighted median estimator, inverse variance weighted, simple model, and weighted model. Genetically predicted spleen volume was found to be associated with Crohn disease. In the IEU database, the odds ratios (ORs) for Crohn disease caused by spleen volume were 1.237 (95% CI, 1.056-1.417, P = .021), and the ORs for spleen volume caused by Crohn disease were 1.015 (95% CI, 0.985-1.044; P = .049). In the EBI database, the ORs for Crohn disease caused by spleen volume were 1.292 (95% CI, 1.120-1.463, P = .003), and the ORs for spleen volume caused by Crohn disease were 1.026 (95% CI, 1.005-1.046; P = .013). Results from the UKB and FinnGen databases showed no causal relationship between the two. The summary results showed that Crohn disease caused an increase in spleen volume, with ORs of 1.009 (95% CI, 1.000-1.018; P = .047). This study provides evidence for a mutual causal relationship between spleen volume and an increased risk of Crohn disease.

Rationale: Congenital factor V deficiency is classified as a rare bleeding disorder that is expressed in an autosomal recessive manner and generally occurs in 1 in a million people. This disorder is accompanied by a variety of clinical manifestations, which can easily lead to misdiagnosis. This is the first report to identify the factor V gene variant c.2439delC (p.I814Lfs*23) in exon 13.

Patient concerns: A 13-year-old boy was admitted with a suspected left iliac fossa abscess. He had been previously diagnosed with and underwent management for a left iliac fossa abscess at a local hospital. The patient was treated with antibiotics and underwent surgical excision; however, his left iliac fossa mass reappeared. Platelet count and function, prothrombin time, and activated partial thromboplastin time were all normal.

Diagnoses: The patient was considered to have congenital factor V deficiency following the measurement of coagulation factor activity, and the diagnosis was confirmed by genetic testing.

Interventions: The mass was diagnosed as an abscess and the patient was treated with antibiotics at the local hospital. Surgical resection was performed, after which the mass was identified as a hematoma. The patient was then transferred to our hospital for treatment with fresh frozen plasma (FFP) infusion.

Outcomes: The left iliac fossa mass stopped growing and the coagulation function exhibited a significant improvement. At discharge, the patient was recommended to seek medical help before any surgical intervention or following trauma, and when a deep hemorrhage is identified, the patient should undergo timely infusion with FFP.

Lessons: This case report presents a rare occurrence of congenital factor V deficiency resulting in a left iliac fossa hematoma mistaken for an abscess, which resulted in unnecessary antibiotic therapy and surgery. This case emphasizes that coagulation factor deficiency should be highly suspected for joint mass combined with coagulation dysfunction.

Obstructive sleep apnea (OSA), significantly impacts public health, with varying prevalence rates across populations. Positional obstructive sleep apnea (POSA) is a subtype in which OSA predominantly occurs in the supine position. This study investigated the prevalence and characteristics of exclusive positional obstructive sleep apnea (e-POSA) in a representative Saudi population. Data from a previous cohort study on the prevalence of OSA in Saudi Arabia were utilized. A 2-phase approach was used: the first phase involved a screening questionnaire, and the second phase involved confirmatory polysomnography (PSG). E-POSA was defined as an apnea-hypopnea index (AHI) in the supine position at least twice as high as that in the lateral position, with the lateral AHI not exceeding 5. Then, an exploration method was used to estimate the prevalence of e-POSA. There were 235 OSA patients included in this study. The prevalence of e-POSA among the OSA patients was 21.28%, with a higher prevalence in females (26.76%) than in males (18.90%). However, the estimated prevalence of e-POSA in the Saudi population was 1.86%. Patients with e-POSA tended to be younger and to have lower AHI, Epworth Sleepiness Scale (ESS) and arousal index scores (P < .001). Multivariate analysis revealed that the rapid eye movement (REM) related AHI and nonsupine AHI were predictors of e-POSA (P < .01). E-POSA is common in patients with OSA. However, the estimated prevalence of e-POSA across the general population was 1.86%. Patients with e-POSA have milder disease, and the AHI-REM and AHI-nonsupine were identified as predictors.

The study aimed to evaluate the effectiveness of atrioventricular nodal slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia (AVNRT) and examine its impact on the atrioventricular conduction function. A retrospective analysis was performed on the clinical data of 90 AVNRT patients who underwent radiofrequency ablation at our institution between August 2018 and February 2021. Based on the presence or absence of slow pathway conduction during the procedure, patients were classified into the slow pathway elimination group (SPE group) and the slow pathway improvement group (SPI group). Procedure-related parameters, His bundle electrogram, atrioventricular nodal effective refractory period (AVN-ERP), Wenckebach point of anterograde atrioventricular nodal conduction (AVN-WKB), Wenckebach point of retrograde atrioventricular nodal conduction (VAV-WKB), myocardial function were compared between the 2 groups. Additionally, the recurrence rates 1 and 2 years post-ablation were noted. Both groups reported a 100% success rate for the procedure. Post-ablation, 42 patients exhibited persisting atrioventricular nodal slow pathway, whereas 48 showed its disappearance, signifying the absence of the jump phenomenon and atrial echo. Post-ablation, the SPI group showed an increase in slow pathway AVN-ERP compared to pre-ablation values (P < .05), with no significant change in the fast pathway AVN-ERP (P > .05). The SPE group showed a reduction in both slow pathway and fast pathway AVN-ERP post-ablation (P < .05). Post-ablation, both slow pathway and fast pathway AVN-ERP in the SPI group were higher than in the SPE group (P < .05). AVN-WKB and VAV-WKB values increased in both groups after ablation (P < .05). There were no recurrences 1 or 2 years after ablation in the SPE group and 1 case of recurrence 2 years after ablation in the SPI group (2.38%). Different ablation endpoints during radiofrequency ablation had no apparent impact on atrioventricular conduction time, recurrence rate, and myocardial function in patients with AVNRT, but they advanced AVN-WKB and VAV-WKB. Slow pathway improvement led to an elongation of slow pathway AVN-ERP, while slow pathway elimination resulted in a reduction of both slow pathway and fast pathway AVN-ERP.

Background: Several studies have shown that the long noncoding RNA (lncRNA) CBR3-AS1 is overexpressed in various cancers and is playing an oncogene role. This meta-analysis aims to elucidate the relationship between lncRNA CBR3-AS1 expression and the prognosis and clinicopathological features of cancer patients.

Methods: A comprehensive and systematic search was conducted in PubMed, Web of Science, Cochrane Library, and EMBASE database. Pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were employed to evaluate the association between lncRNA CBR3-AS1 expression and clinical outcomes and clinicopathological features in cancer patients.

Results: This meta-analysis finally enrolled 9 studies comprising 800 cancer patients. The combined results indicated that lncRNA CBR3-AS1 overexpression was significantly associated with shorter overall survival (pooled hazard ratios = 1.69, 95% CI 1.28-2.21, P < .001). Furthermore, elevated lncRNA CBR3-AS1 expression was closely correlated with larger tumor size (large vs small OR = 2.17, 95% CI: 1.50-3.14, P < .0001), lymph node metastasis (yes vs no OR = 2.75, 95% CI: 1.67-4.51, P < .0001), distant metastasis (yes vs no OR = 3.08, 95% CI: 1.82-5.23, P < .0001), and advanced tumour, node, metastasis stage (III/IV vs I/II OR = 2.82, 95% CI: 1.68-4.75, P < .0001).

Conclusion: Upregulated expression of lncRNA CBR3-AS1 showed significant association with unfavorable survival and indicated worse clinicopathological outcomes in multiple kinds of human cancer, and therefore might serve as a promising prognosis biomarker and therapeutic target for cancers.

Patients with dialysis are at high risk of reoperation after lumbar spinal fusion surgery. However, the risk of reoperation after short-segment (≤2 fusion levels) lumbar spinal fusion surgery in this patient group has not been completely investigated. This study aimed to compare the risk of reoperation after short-segment lumbar spinal fusion surgery between patients with dialysis and matched controls without dialysis. We retrospectively evaluated 85 patients who underwent short-segment lumbar spinal fusion surgery at a single institution. Based on the current dialysis treatment, patients were divided into the non-dialysis and dialysis groups. We compared the patients' characteristics, surgical data, pre- and postoperative radiographic measurements, locomotive functional levels in activities of daily living (ADL), rate of whole reoperation, and cause-specific incidence of reoperation such as adjacent segmental disease (ASD) and implant failure between the non-dialysis and dialysis groups. Then, these variables were compared after adjusting for age, sex, and body mass index (BMI) via a propensity-score-matched analysis. In total, 68 patients in the non-dialysis group and 17 patients in the dialysis group were included in this study. The dialysis group was significantly younger and had a lower postoperative ADL status than the non-dialysis group. Moreover, the dialysis group had a significantly higher rate of whole reoperation (8.8% vs 41.2%, P = .003), reoperation due to ASD (4.4% vs 23.5%, P = .027), and reoperation due to implant failure (0.8% vs 11.8%, P = .038) than in the non-dialysis group. Based on a propensity-score-matched analysis, the dialysis group had a significantly higher rate reoperation rate after short-segment lumbar spinal fusion surgery than the non-dialysis group (0.0% vs 58.3%, P = .005). The current study firstly clarified that patients with dialysis are at significantly high risk of reoperation even after short-segment lumbar spinal fusion surgery.

By analyzing the relevant literature, we can accurately grasp the current status of diagnosis and treatment of chronic total occlusion of coronary artery, and clarify the development trend, research frontiers and hotspots of this disease. A literature search with "chronic total occlusion" as the title was performed in the Web of Science database. The title, author, abstract, keywords, institution, publication, country, reference, and other endnotes of the selected literature were exported in the form of text. The author, country, institution, and keywords of the literature were analyzed through Citespace and VOSviewer. The United States has the highest proportion of articles. The institution with the largest number of publications in this field is the Minneapolis Heart Institute Foundation. Brilakis Emmanouil S is the author with the most published articles. The journal system with the largest number of articles in this field is Cardiac Cardiovascular Systems. The keywords with the highest frequency are "chronic total occlusion," "percutaneous coronary intervention," "recanalization," and "revascularization." The burst detection analysis of hot keywords shows that "algorithm," "management," and "mortality" are the research hotspots in this field in recent years. At present, the research on this disease mainly focuses on the opening of occluded coronary arteries through various treatment methods. In the near future and the next few years, the research hotspots may be the scoring system algorithms for the treatment of chronic total occlusion of coronary artery and the management strategies for patients.

Following improved accessibility to medical services, the phenomenon of polypharmacy in elderly patients with comorbidity has been increasing globally. Polypharmacy patients are prone to drug interactions, adverse drug reactions, and even the risk of death etc. Therefore, there is an urgent need to fully understand the current status and characteristics of drug use in elderly patients with chronic diseases, focusing on polypharmacy factors to ensure that medications for elderly patients are effective and safe. To collect and analyze the characteristics of the current drug use situation in elderly patients with chronic diseases in Chongqing and further explore the influencing factors for polypharmacy, providing references for formulating more effective and safe medication regimens for elderly patients. Most elderly patients affected with chronic diseases in Chongqing were willing to go to hospitals or pharmacies to buy medicines. However, they were not familiar with their disease conditions and drug-related adverse reactions and could not be regularly followed up or monitored. The number of diseases, medications, and adverse drug reactions increased with the increasing age of elderly patients. The problem of irrational use of drugs in elderly patients with chronic diseases was relatively prominent, especially the use of traditional Chinese medicines. The medication situation in elderly patients with chronic diseases was not optimistic, and the problem of polypharmacy was relatively prominent. Further large-scale studies are needed to provide a certain reference for improving the current status of drug use in elderly patients.

Increasingly, the shared risk factors and pathological processes of atherosclerosis and abdominal aortic aneurysm (AAA) are being recognized. The aim of our study was to identify the hub genes involved in the pathogenesis of atherosclerosis and AAA. The analysis was based on 2 gene expression profiles for atherosclerosis (GSE28829) and AAA (GSE7084), downloaded from the Gene Expression Omnibus database. Common differential genes were identified and an enrichment analysis of differential genes was conducted, with construction of protein-protein interaction networks, and identification of common hub genes, and predicted transcription factors. The analysis identified 133 differentially expressed genes (116 upregulated and 17 downregulated), with the enrichment analysis identifying a potential important role of integrins and chemokines in the common immune and inflammatory responses of atherosclerosis and AAA. Regulation of the complement and coagulation cascades and regulation of the actin cytoskeleton were associated with both diseases, with 10 important hub genes identified: TYROBP, PTPRC, integrin subunit beta 2, ITGAM, PLEK, cathepsin S, lymphocyte antigen 86, ITGAX, CCL4, and FCER1G. Findings identified a common pathogenetic pathway between atherosclerosis and AAA, with integrin-related genes playing a significant role. The common pathways and hub genes identified provide new insights into the shared mechanisms of these 2 diseases and can contribute to identifying new therapeutic targets and predicting the therapeutic effect of biological agents.

This study was intended to determine whether rapid rehabilitation nursing can enhance postoperative rehabilitation and life quality for breast cancer (BC) patients. One hundred seventy-two patients with BC treated in our hospital from March 2020 to September 2022 were included in this retrospective study and divided into the observation group (n = 86) and control group (n = 86) based on the different nursing methods that they received. The control group accepted routine nursing care, and the observation group accepted rapid rehabilitation nursing intervention. The amount of intraoperative blood loss, anesthesia awake time, postoperative drainage tube removal time, postoperative time of getting out of bed, length of hospital stays, incidence of postoperative complications, and postoperative recovery rate of affected limb, Barthel index and quality of life instruments for cancer patients: breast cancer (QLICP-BR) of BC patients were analyzed. The amount of intraoperative bleeding in the observation group was less, and the difference was statistically significant (P < .05). The awake time of anesthesia, the time of pulling out the drainage tube after operation, the time of getting out of bed after operation and the time of hospitalization in the observation group were significant shorter (P < .05). The incidence of postoperative complications in the observation group was notably lower (P < .05). The excellent and good rate of postoperative rehabilitation of the affected limbs in the observation group was notably higher (P < .05). Before nursing, there exhibited no notable difference in the scores of Barthel index (P > .05). After 10 days of nursing, the score of Barthel index in the observation group was notably higher (P < .05). After 10 days of nursing, the QLICP-BR score of the observation group was significant higher (P < .05). Rapid rehabilitation nursing is beneficial to reduce the intraoperative blood loss of BC patients, shorten the recovery time of anesthesia, promote the excellent and good rate of rehabilitation of affected limbs, and improve the quality of life.