Medicine最新文献

The incidence of coronary heart disease (CHD) has increased. This study employed scientific statistical methods to explore the medication rules of Chinese herbal medicines (CHMs) to treat CHD and provide a scientific and reliable theoretical basis for the improvement of patient symptoms. We systematically retrieved relevant studies related to CHMs used to treat CHD from the VIP, CNKI, Wanfang. We used Microsoft Excel 2019 to establish a database and the Ancient and Modern Medical Case Cloud Platform to conduct frequency, association rule, cluster analyses and complex network analysis. Summarize the prescribed medication rules of Chinese medicine for the internal treatment of CHD and visualize the graphic representation. We obtained 144 papers with 362 experimental cases and 149 herbs based on the screening criteria. These records, which include the medical expertise of well-known provincial and local Traditional Chinese Medicine practitioners spanning over 2 decades, hold significant value in directing the clinical use of medications and the creation of novel drugs. The three most frequently used herbs were Radix et Rhizoma Salviae Miltiorrhizae (Danshen), Rhizoma Chuanxiong (Chuanxiong), and Radix Astragali (Huangqi). Fifteen of the 20 flavors of high-frequency herbs appear in the Shen Nong's Classic of the Materia Medica (Shén Nóng Bĕn Căo Jīng). These medications are crucial for the flow of Qi and the management of a number of cardiac disorders. The properties and taste of herbs were mainly warm and sweet, respectively. We obtained 25 association rules and 5 new clusters. The Chuanxiong Rhizoma (Chuanxiong) and Radix et Rhizoma Salviae Miltiorrhizae (Danshen) herb pair had the strongest correlation. We found that famous Chinese medicine practitioners who have been treating CHD for many years utilize Blood-invigorating and supplementing medicines. At the same time, they collaborated with Bulbus Allii Macrostemi (Xiebai) and Ramulus Cinnamomi (Guizhi) to diffuse Bì and unblock Yang. The Buyang Huanwu Decoction (BYHWD) and Shengmai San (SMS) were the primary CHM prescription for CHD. In addition, we further verified the experience of not using Radix Paeoniae Alba (Baishao) for chest oppression, not using Rhizoma Pinelliae (Banxia) for dry mouth, and not using Rhizoma Atractylodis Macrocephalae (Baizhu) for constipation.

This study aims to use echocardiography to explore the prevalence of pulmonary hypertension (PH) in maintenance hemodialysis patients with different vascular accesses and analyze the risk factors for combined PH. A cross-sectional analysis was conducted on 757 end-stage renal disease patients receiving maintenance hemodialysis. Patients were categorized by the type of access used during echocardiographic examination: central vein catheter (CVC) and autogenous arteriovenous fistula (AVF)/arteriovenous graft (AVG). They were further grouped by tricuspid regurgitation velocity to determine PH prevalence. Multinomial logistic regression analysis evaluated the relevant risk factors. (1) Among maintenance hemodialysis patients, 39.23% had a moderate to high likelihood of PH; 248 patients (32.76%) had diastolic dysfunction, 184 patients (24.31%) had pericardial effusion, 381 patients (50.33%) had left ventricular hypertrophy, and 268 patients (35.40%) had aortic regurgitation. Diastolic dysfunction may indicate early heart failure and PH progression. (2) In the CVC group, 62 patients (24.22%) had moderate PH, and 9 (3.52%) had severe PH. Left atrium diameter (OR = 1.086, 95% CI 1.024-1.151, P = .006 and OR = 1.123, 95% CI 1.001-1.260, P = .048) showed statistical significance in moderate and severe PH groups, respectively. Right ventricular end-systolic diameter (RVDS) (OR = 1.519, 95% CI 1.151-2.005, P = .003) was significant in the severe PH group. (3) In the AVF/AVG group, 158 patients (31.54%) had moderate PH, and 68 (13.57%) had severe PH. RVDS (OR = 1.183, 95% CI 1.078-1.298, P < .001 and OR = 1.607, 95% CI 1.413-1.829, P < .001) showed significance in moderate and severe PH groups. Left atrium diameter (OR = 1.060, 95% CI 1.004-1.120, P = .035) showed significance in the severe PH group. The incidence of PH in maintenance hemodialysis patients is high and is closely related to volume overload, vascular access type, and right ventricular enlargement. For patients with right ventricular dilation (e.g., RVDS > 25 mm) or moderate to severe PH, careful evaluation of the benefit-risk ratio for AVF/AVG should be conducted. In selected high-risk cases, alternative access such as CVC may be appropriate. Prospective studies are needed to further compare the long-term effects of different access types on PH progression.

Rationale: Riedel thyroiditis (RT) is categorized as an immunoglobulin G4-related disease (IgG4-RD), a condition that is seldom encountered in clinical practice. IgG4-RDs have been linked to an elevated risk of malignancy. Although prior studies have documented instances where IgG4-RDs were induced by malignant tumors, such occurrences are still rarely reported in both the domestic and international literature.

Patient concerns: A 47-year-old male, asymptomatic except for a palpable right neck nodule detected during routine follow-up, was diagnosed with RT secondary to papillary thyroid carcinoma. To our knowledge, this is the inaugural case of its nature ever documented, providing valuable insights into the relationship between malignant tumors and IgG4-RDs.

Diagnoses: Histopathological examination revealed fibrous tissue hyperplasia, atrophic thyroid follicles, extensive infiltration of lymphocytes and plasma cells, and perivascular inflammation. The pathological diagnosis was consistent with RT.

Interventions: The patient underwent thyroidectomy and neck lymph node dissection.

Outcomes: The patient recovered uneventfully, takes levothyroxine daily to suppress thyroid-stimulating hormone, and undergoes a thyroid ultrasound and thyroid function test every 6 months.

Lessons: RT can mimic malignancy on ultrasound (e.g., thyroid imaging reporting and data system 5 features). Greater awareness and integrated clinicopathologic evaluation may prevent unnecessary surgery.

Rationale: Chordoma is a malignant bone tumor that typically affects structures along the midline. Soft tissue chordoma of the right thigh is an extremely rare entity but significant, as it can create diagnostic challenges and increases the risk of misdiagnosis, making accurate identification essential. This report introduces a diagnostic strategy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for a huge chordoma.

Patient concerns: A 45-year-old man presented with a painless, gradually growing mass on his right thigh for 6 years without weight loss. Imaging studies revealed a huge mass in his soft tissue of the right thigh, raising concerns about pathology.

Diagnoses: Magnetic resonance imaging demonstrated a mass with cystic mixed components, in the middle of the right thigh region with irregular shape and a poorly defined local boundary, measured 267 × 119 × 102 mm, leading to a presumptive diagnosis of malignancy.

Interventions: 18F-FDG PET/CT showed a huge area of heterogeneously increased 18F-FDG uptake (SUVmax, 4.4), and pathology and immunohistochemistry confirmed the diagnosis of conventional chordoma.

Outcomes: He was treated with Imatinib Mesylate (400 mg) orally twice daily. There was no recurrence during the 6-month follow-up, with plans for continued long-term surveillance.

Lessons: This case highlights the diagnostic challenge posed by chordoma of the soft tissue in the thigh, as its radiological appearance can closely resemble other soft tissue tumors. Clinicians should ensure exhaustive assessment including CT, magnetic resonance imaging, and 18F-FDG PET/CT imaging. Pathological confirmation is essential. Despite the rarity of soft tissue chordoma, careful treatment planning including consideration of targeted therapy and long-term follow-up is important to address the risk of late recurrence.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease, and lung cancer is a significant comorbidity with high prevalence and adverse impact on survival. Early detection of IPF and targeted interventions require understanding the associated risk factors and clinical presentation of lung cancer in IPF. This single-center, retrospective cohort study aimed to identify risk factors for lung cancer in IPF patients, investigate its clinical features, and determine its impact on survival. Of the 1481 patients with interstitial lung disease, 436 met the criteria for IPF per American Thoracic Society/European Respiratory Society guidelines. Patients followed up for <6 months (n = 31), patients with both IPF and lung cancer (n = 19), and patients whose data were incomplete (n = 18) were excluded from the study. In the end, the study group consisted of 59 patients who developed lung cancer during follow-up, and the control group consisted of 59 randomly selected IPF patients without cancer. Patients' clinical, radiological, and laboratory data were collected from their medical records. The mean age of the sample, 83.9% of which was male, was 66.9 ± 8.3 years. Emphysema, low body mass index, absence of antifibrotic therapy, presence of weight loss symptoms, and ≥36 pack-years of smoking were significant risk factors for lung cancer (P <.05), as also confirmed by multivariate analysis. Squamous cell carcinoma was the most common histological type (45.8%), with lower lobe predominance (59.3%) and peripheral location (78.0%). Most tumors (78.0%) were within or adjacent to fibrotic tissue. The median time from IPF diagnosis to lung cancer development was 2.80 years. The 0 to 3, 3 to 5, and >5-year mortality rates for patients with and without lung cancer were 15.2% to 3.3%, 35.5%- 8.4%, and 42.3% to 15.2%, respectively (P = .026). Our study identified significant risk factors for lung cancer in IPF patients and demonstrated its negative impact on survival. The presence of emphysema, low body mass index, absence of antifibrotic therapy, and ≥36 pack-years of smoking were significantly associated with lung cancer development. Awareness of these factors is crucial for early diagnosis and appropriate treatment strategy determination, potentially improving outcomes in this high-risk population.

This study examines the demographic and clinical characteristics of elderly non-small cell lung cancer patients undergoing chemotherapy, focusing on levels of cancer-related fatigue (CRF), anxiety, depression, sleep, and social support. The goal is to explore the trajectory and predictive factors of CRF development to aid in patient coping. Conducted from October 2022 to October 2023 in a tertiary hospital in Weifang, the longitudinal study assessed CRF, anxiety, depression, sleep quality, and social support at 4 time points during chemotherapy. Repeated measures ANOVA, t-tests, one-way ANOVA, and Pearson correlation analysis were used to evaluate data. Mplus 8.3 software established a latent class growth model (LCGM) to track CRF trajectories, and multinomial logistic regression identified predictive factors for CRF classes. Cancer-related fatigue scores: mean CRF scores at T1, T2, T3, and T4 were 19.33, 28.40, 32.06, and 26.12, respectively. CRF peaked at T3 and then gradually declined, with significant differences in CRF, anxiety, depression, sleep quality, and social support across T1-T4 (P < .05). Significant factors affecting CRF included disease stage, treatment regimen, recurrence, anxiety and depression levels, sleep quality, and social support. Three CRF trajectory classes were identified with the best data fit: low-level slow increase (20 patients), high-level gradual relief (35 patients), and low-level rapid increase (53 patients). Predictors for the high-level gradual relief group included disease stage, anxiety score, and sleep quality score (P < .05). For the low-level rapid increase group, predictors were disease stage, anxiety score, sleep quality score, and social support (P < .05). CRF in elderly non-small cell lung cancer patients undergoing chemotherapy is influenced by disease characteristics, psychological status, sleep quality, and social support. Three distinct CRF trajectories were identified, with disease stage, anxiety, depression, and sleep quality serving as key predictive factors.

This study aims to investigate the differences in response to dienogest (DNG) therapy among patients with 3 different phenotypes of endometriosis: ovarian endometrioma (OMA), superficial peritoneal endometriosis (SUP), and deep infiltrating endometriosis (DIE). This study was a single-center retrospective cohort analysis. A total of 501 consecutive patients with endometriosis diagnosed and treated in our hospital from January 2023 to January 2024 were enrolled and divided into the OMA group (n = 276), SUP group (n = 125), and DIE group (n = 100) based on imaging/surgical phenotypes. All patients received monotherapy with DNG (2 mg/day) for at least 6 months. Differences in pain visual analog scale (VAS) scores, lesion size, serum CA125 levels, quality of life (36-Item Short Form Health Survey), and adverse reactions before and after treatment were compared among the 3 groups. Multivariate logistic regression analysis was used to identify independent influencing factors for significant pain relief (defined as ≥50% reduction in VAS score). At baseline, disease duration, revised American Society for Reproductive Medicine stage and score, CA125 levels, and pain intensity in the DIE group were significantly higher than those in the OMA and SUP groups (P < .001). After 6 months of treatment, pain VAS scores, lesion size, and CA125 levels significantly decreased from baseline in all 3 groups (P < .001). Intergroup comparisons showed statistically significant differences in the reduction of VAS scores (ΔVAS) for dysmenorrhea and chronic pelvic pain (P < .01), with the SUP group showing the smallest improvement. Meanwhile, the lesion reduction rate in the OMA group was significantly higher than that in the SUP and DIE groups (47.5% vs 39.4% vs 37.9%, P < .001). Multivariate regression analysis showed that, compared with the OMA phenotype, the DIE phenotype was an independent negative predictor for significant pain relief (odds ratio = 0.67, 95% confidence interval: 0.43-0.99, P = .046). DNG is significantly effective for all 3 endometriosis phenotypes, effectively relieving pain, reducing lesion size, and improving quality of life. However, patients with the DIE phenotype, due to the inherently more severe nature of their disease, have a relatively lower likelihood of achieving significant pain relief and a higher incidence of adverse reactions, necessitating special attention in clinical management.

Early risk stratification of critically ill patients is essential for facilitating timely interventions in the emergency department (ED). This study assessed whether point-of-care ultrasound (POCUS) parameters - specifically, left ventricular ejection fraction (EF) and inferior vena cava (IVC) collapsibility - contribute prognostic value to established early warning scores, including the rapid emergency medicine score, Modified Early Warning Score (MEWS), and Hypotension, Oxygen saturation, low Temperature, ECG changes, Loss of independence (HOTEL) score, in predicting 6-month mortality. In this prospective, single-center study, 59 nontraumatic adult patients admitted to the ED critical care unit between October 2022 and October 2023 were enrolled. Demographic characteristics, vital signs, and clinical scores (rapid emergency medicine score, MEWS, HOTEL, glasgow coma scale, and Alert, Voice, Pain, Unresponsive [AVPU]) were documented at admission, alongside single-time bedside ultrasound measurements of EF and IVC collapsibility. The primary outcome was 6-month mortality. Six-month mortality was observed in 27 patients (45.8%). Non-survivors exhibited significantly lower systolic blood pressure (median 110 vs 142 mm Hg; P = .021) and elevated respiratory rates (median 22 vs 20 breaths/min; P = .021). Additionally, levels of consciousness were reduced (median glasgow coma scale 13 vs 15; P = .002; AVPU P = .003). The MEWS (median 4 vs 2; P = .004) and HOTEL (median 2 vs 1; p<0.001) scores were notably higher in the mortality cohort. Logistic regression analysis identified HOTEL (OR 4.23; 95% confidence interval 1.80-9.95; P = .001) and MEWS (OR 1.57; 95% confidence interval 1.17-2.12; P = .003) as independent predictors of mortality, whereas EF and IVC collapsibility did not reach statistical significance (P = .307 and P = .084, respectively). It is evident that traditional physiological scoring systems, such as the MEWS and HOTEL, continue to serve as reliable instruments for predicting long-term mortality in critically ill patients in the ED. Single-time measurements of EF and IVC collapsibility at admission did not provide additional prognostic value beyond these scores. Future larger, multicentre studies may help to further clarify whether integrated or repeated point-of-care ultrasound (POCUS) assessments could have a role in risk stratification.

This study aimed to explore the potential causal relationship between diabetes and shoulder periarthritis using the Mendelian randomization (MR) approach. Pooled data from large-scale genome-wide association studies were used to identify single nucleotide polymorphisms associated with type 2 diabetes (T2D), rather than a combined diabetes phenotype. T2D was selected as the exposure because existing clinical and epidemiological evidence links shoulder periarthritis primarily to metabolic dysfunction and insulin resistance characteristic of T2D, ensuring genetic independence between the 2. These single nucleotide polymorphisms were used as instrumental variables in a 2-sample MR analysis. The study primarily focused on European populations from publicly available databases. Multiple MR methods (inverse variance weighting, weighted median estimator, and MR-Egger regression) were employed to enhance result robustness. Heterogeneity tests, pleiotropy assessments, and "leave-one-out" sensitivity analyses were performed to validate the findings. The inverse variance weighting analysis showed that the causal effect of diabetes on shoulder periarthritis was odds ratio = 1.00 (95% confidence interval: 0.96-1.04, P = .822), indicating no significant association between diabetes and an increased risk of shoulder periarthritis. Further multi-effect tests revealed no bias, and sensitivity analyses supported the robustness of these results. This 2-sample MR analysis suggests that, based on current genetic data from European populations, diabetes is not an independent causal factor for shoulder periarthritis. These findings offer a genetic perspective on the epidemiological relationship between the 2 conditions, providing clinicians with insights for more accurate identification of risk factors when developing intervention strategies.

This study aimed to explore the molecular mechanisms associated with mitophagy in BO and identified mitophagy-associated BO diagnostic genes. Using Gene Expression Omnibus database data, differentially expressed genes in BO patients vs controls were analyzed via Gene Ontology enrichment. Algorithms like Boruta, least absolute shrinkage and selection operator, and Random Forest screened BO-specific genes. Mitophagy genes were sourced from PathCards and correlated with BO-specific genes via single-sample gene set enrichment analysis (ssGSEA). Receiver operating characteristic curves evaluated the diagnostic performance of these genes. Two hundred and six differentially expressed genes were identified, in which immune-related pathways such as the B-cell receptor signaling pathway and lymphocyte differentiation were significantly enriched. Machine learning screening yielded 30 BO signature genes, among which KLRC3 and CD36 were significantly correlated with ssGSEA enrichment score of the mitophagy gene sets. Receiver operating characteristic analysis confirmed their diagnostic value with AUCs of 0.648 and 0.640, respectively. This finding indicated that KLRC3 and CD36 are not only significantly correlated with ssGSEA enrichment score of the mitophagy gene sets but also have diagnostic value for BO.