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Acute heart failure (AHF) remains associated with high short- and long-term mortality, particularly in patients admitted to the intensive care unit (ICU). Reliable biomarkers for early risk stratification are urgently needed. The creatinine-to-albumin ratio (CAR), integrating renal function and nutritional-inflammatory status, may serve as a novel prognostic marker in critically ill AHF patients. We conducted a retrospective cohort analysis using the Medical Information Mart for Intensive Care IV database, including 7620 patients with a 1st ICU admission for AHF. CAR was calculated from serum creatinine and albumin measured at ICU admission. The primary endpoint was 28-day all-cause mortality; secondary endpoints included 180-day and 365-day all-cause mortality. Survival outcomes were analyzed using Kaplan-Meier curves, Cox proportional hazards regression models, and restricted cubic spline analyses. Patients with higher CAR levels had significantly higher 28-, 180-, and 365-day mortality (all log-rank P < .001). In multivariate Cox models, elevated CAR was independently associated with increased mortality, and this association was consistent across all adjustment models. Restricted cubic spline analyses confirmed a nonlinear dose-response relationship between CAR and short- and long-term mortality risk. Subgroup analyses demonstrated consistent associations across most patient subgroups, without significant interactions. CAR is a simple and accessible prognostic biomarker that independently predicts short- and long-term mortality in critically ill patients with AHF admitted to the ICU. Incorporating CAR into clinical practice may improve early risk stratification and guide management decisions. Prospective studies are warranted to validate its clinical utility.

Subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) are the primary subtypes of hemorrhagic stroke. Obesity and dietary factors may play significant roles in their pathogenesis, yet the genetic causal relationships and potential mediating pathways remain unclear. This study utilized publicly available genome-wide association study databases and applied Mendelian randomization (MR) methods to systematically evaluate the causal associations between obesity, nutritional intake (fats, proteins, and carbohydrates), alcohol intake, and both SAH and ICH. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted on the genes associated with significant risk factors to explore potential biological pathways and mediating factors. Independent validation was performed using data from East Asian populations. MR analysis revealed positive causal relationships between obesity, alcohol intake, and nutritional intake with both SAH and ICH. Fat intake was identified as a significant risk factor for ICH, while protein intake was significantly associated with SAH. Validation results in East Asian populations were consistent with the primary analyses. Reverse MR analysis did not detect any reverse causal associations. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses indicated that genes associated with fat intake were enriched in the thiamin metabolism pathway, while those related to protein intake were enriched in immune and inflammatory pathways. Thiamine may mediate the relationship between fat intake and ICH, whereas uric acid may act as a mediator between protein intake and SAH. This study elucidated the potential genetic causal relationships between obesity, diet, alcohol consumption, and hemorrhagic stroke, highlighting thiamin and uric acid as potential key mediating factors. These findings provide a genetic basis and potential intervention targets for stroke prevention.

This study aims to investigate the presence of NUF2 component of NDC80 kinetochore complex (NUF2) in tissues of lung adenocarcinoma (LUAD) and its correlation with infiltration of immune cells, clinical features, and prognosis of patients. A variety of online tools and websites were used to explore the role of NUF2 in LUAD. Verified by cellular and immunohistochemistry. The expression of NUF2 messenger RNA (mRNA) is notably elevated in LUAD, and its levels significantly influence the prognosis of patients with this condition. Additionally, NUF2 expression levels were observed to be associated with survival outcomes across different subgroups, including TNM stage, pathological stage, gender, age, and smoking behavior. We discovered 80 key genes linked to NUF2-associated genes, which play a crucial role in the organelle fission pathway in individuals with NUF2. Furthermore, methylation of NUF2 demonstrates a positive relationship with the levels of chemokines, their receptors, immunoinhibitors, and immunostimulators in LUAD. At the single-cell level, NUF2 expression ranges from highest in spermatocytes, followed by oocytes, and is lowest in erythroid cells. The predominant mutations observed in NUF2 within LUAD cases include amplification and other mutations. Moreover, evaluations utilizing the receiver operating characteristic (ROC) curve, along with time-dependent ROC analysis, indicated that the predictive accuracy of NUF2 is significantly enhanced. The prognosis for LUAD correlates with both immune cell infiltration and the expression levels of NUF2. In vitro studies with A549 cells revealed considerably higher mRNA expression levels when compared to BEAS-2B cells. Immunohistochemical assessments confirmed the presence of elevated NUF2 protein expression in human LUAD samples. NUF2 exhibits high expression levels in tissues and cells of LUAD, and is associated with the infiltration of immune cells within the tumor microenvironment as well as patient outcomes. Thus, NUF2 represents a promising target for the clinical treatment of LUAD.

This study investigates the expression of Yes-associated protein (YAP) and androgen receptor (AR) in osteosarcoma and assess their prognostic significance. A retrospective cohort of 100 osteosarcoma patients and 30 adjacent normal tissues was analyzed by immunohistochemistry. Expression levels were correlated with clinicopathological features and progression-free survival. High expression of YAP (65%) and AR (60%) was significantly more frequent in osteosarcoma than in normal tissues. Both markers were associated with advanced stage and distant metastasis, and their co-overexpression predicted the shortest median progression-free survival (9 months). Interaction analysis confirmed a synergistic effect of YAP and AR on poor prognosis. YAP and AR are frequently co-overexpressed in osteosarcoma and jointly contribute to tumor aggressiveness and unfavorable outcomes. Their combined evaluation may serve as a novel prognostic indicator and potential therapeutic target.

Rationale: Acute hepatitis of unknown origin represents a diagnostic and therapeutic challenge, particularly when common viral, autoimmune, and toxic causes of acute liver injury are excluded.

Patient concerns: We report a case of an adult male. He presents with general fatigue, jaundice, fever, abdominal discomfort. Laboratory findings of severe acute hepatitis and extremely elevated transaminases.

Diagnoses: Full laboratory, serological, and toxicological tests ruled out viral, autoimmune, and drug-induced hepatitis. Metabolic disorders such as Wilson disease and hemochromatosis were also excluded.

Interventions: Supportive therapy consisting of intravenous glucose solutions, silymarin, vitamin C, and ademetionine was initiated.

Outcomes: The patient had rapid clinical improvement, with normalization of liver enzymes at 1-month follow-up.

Lessons: This case shows the importance of a systematic diagnostic approach in acute hepatitis of unknown origin. It suggests that, in adult patients, conservative management with supportive therapy may lead to full recovery despite severe biochemical abnormalities.

The purpose of this study was to investigate the relationship between metabolic syndrome (MetS) and overactive bladder (OAB). This research involved a cohort of 11,078 individuals enrolled from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. We applied restricted cubic spline analysis and weighted multivariable logistic regression to assess the association between MetS and OAB, supplemented by subgroup analyses to reinforce these findings. After full multivariable adjustment, MetS was associated with OAB (odds ratio [OR] = 1.30; 95% confidence interval [CI], 1.12-1.50). When stratified by severity, only moderate MetS was associated with a significantly higher risk of OAB compared to no MetS (OR = 1.61; 95% CI, 1.31-1.98), whereas the association for severe MetS was not statistically significant (OR = 1.31; 95% CI, 0.93-1.84). This is consistent with a significant nonlinear dose-response relationship (P for nonlinearity < .001), where the risk of OAB plateaus at the highest levels of MetS severity. Subgroup analyses were performed to explore the consistency of this association. A trend toward a stronger association was observed in females (OR = 1.60; 95% CI, 1.35-1.89) compared to males (OR = 1.25; 95% CI, 0.97-1.60), with a P-value for interaction of .137. The association also varied by race and appeared to attenuate with increasing age, though the formal test for interaction by age was not statistically significant (P = .061). Our study results indicated a nonlinear association between the MetS score and the risk of OAB (P for nonlinearity < .001). However, further research is needed to confirm our findings.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a commonly used class of antidiabetic medications in the treatment of type 2 diabetes mellitus and obesity management, and it is important to understand public awareness and attitudes toward GLP-1 RAs. This study aims to identify the level of awareness and knowledge about GLP-1 RAs in a heterogeneous population. This is an online survey study that was conducted in Saudi Arabia between December 2024 and January 2025 to examine community awareness and attitudes regarding the use of GLP-1 agonists as a treatment for obesity in Saudi Arabia. The questionnaire tool for this study was developed based on an extensive literature review. Multiple logistic regressions were performed to identify the predictors of knowledge about GLP-1 agonists. A total of 398 participants were included in the analysis. Regarding the GLP-1 enhancers, the majority (289, 72.6%) had heard of them before participating in the online survey. According to our participants, the most familiar one was mounjaro (262, 65.8%). Social media was the most common source (227, 57.0%). The majority reported using GLP-1 enhancers for weight reduction (319, 80.4%). Common side effects included loss of appetite (276, 69.3%), vomiting (196, 49.2%), and abdominal pain (188, 47.2%). The most frequently mentioned contraindications were pregnancy and lactation (295, 74.1%), pediatric age group (204, 51.3%), and kidney conditions (171, 43.0%). Individuals with an income between 5000 to 10,000 Saudi Arabian riyal (SAR) had significantly less knowledge of GLP-1 enhancers compared to those earning <5000 SAR (OR = 018, 95% CI: 0.03-0.99, P = .04). Additionally, individuals who had previously used or were currently using GLP-1 enhancers were significantly more likely to have better knowledge (OR = 6.56, 95% CI: 1.82-23.66, P = .004). Participants were moderately to highly aware of GLP-1 enhancers. Most people took these drugs to lose weight, with side effects including appetite loss, vomiting, and abdominal pain. Lactation, pregnancy, pediatric usage, and kidney problems were common contraindications. Lower-income groups knew more about GLP-1 enhancers than higher-income ones, and former or present users knew the most. Future studies should examine income-related knowledge gaps and social media's educational potential. GLP-1 enhancers' long-term safety, efficacy, and awareness across varied populations must be assessed in longitudinal research.

Background: This comprehensive review aimed to evaluate the efficacy and safety of combining laser or light therapy with topical agents for melasma treatment.

Methods: A comprehensive search was conducted utilizing PubMed, NCBI, Google Scholar, ScienceDirect, Wiley, Embase, and the Cochrane Library. The search aimed to identify pertinent studies from the database's inception until August 31, 2024. This research encompassed 11 randomized controlled trials including 461 people. The melasma area and severity index and its modified variant (mMASI) were employed for outcome assessment. The Cochrane risk-of-bias tool was used to assess study quality. The GRADE (grading of recommendations assessment, development and evaluation) approach was employed to assess the certainty of evidence. Sensitivity analyses were performed to evaluate the robustness of findings. Data were analyzed using RevMan 5.4.1.

Results: Combination therapy demonstrated no significant benefit at 4 weeks, but statistically significant improvements at 8, 12, and 16 weeks (standardized mean difference [SMD]: -0.55; 95% confidence interval: -0.74 to -0.36; P < .00001), indicating a cumulative therapeutic effect. Moderate heterogeneity was observed (I2 = 64%). Sensitivity analysis excluding parallel-design studies (Souza, Bansal, Verma, Qu) confirmed the robustness of efficacy outcomes, with a similar effect size (SMD: -0.45) and reduced heterogeneity (I2 ≈ 41%). Safety analysis showed a significantly higher risk of adverse events in the combination group (OR: 8.96; 95% confidence interval: 3.71-21.64), mainly erythema and post-inflammatory hyperpigmentation. The certainty of evidence was rated as moderate for efficacy and very low for safety outcomes. Both were judged critically important (importance score 9 and 8, respectively) for clinical decision-making.

Conclusion: These findings suggest that combination therapy can effectively enhance melasma treatment. However, careful patient selection and monitoring are crucial due to the risk of side effects. Further large-scale studies with standardized protocols are recommended to validate these findings and optimize treatment strategies.

End-stage renal disease patients rely on regular hemodialysis. The 2023 Sudan conflict displaced large numbers of patients and disrupted health services. We examined dialysis access, complications, and socioeconomic effects among internally displaced patients in Port Sudan. We conducted a descriptive cross-sectional study of 133 end-stage renal disease patients receiving hemodialysis at Port Sudan Dialysis Center. Trained interviewers collected data on demographics, dialysis frequency before vs during the conflict, missed sessions and barriers, self-reported complications, and employment/finances. Data were analyzed using descriptive statistics and chi-square tests. Participants were 58.7% male; 54.1% were aged 40 to 64 years. A decrease was observed in patients receiving 3 sessions/week (from 17.3 to 4.5%), while an increase was observed in those receiving 1 session/week (from 4.5 to 12.8%; P = .003). More than 70% cited transport costs/availability as major barriers, and over 85% missed at least 1 session during active fighting. Unemployment rose from 18.8% to 71.4% (P < .001). Overall, 73.7% reported clinical complications during the conflict period. The conflict was associated with reduced dialysis access and worsening health and economic conditions. Secured transport, protected continuity of care, and targeted financial support are immediate priorities for displaced dialysis patients.

Rationale: Well-differentiated liposarcoma (WDL), a rare mesenchymal tumor with adipocytic differentiation, represents a distinct subtype of liposarcoma (LPS). It demonstrates relatively high incidence and typically arises in the deep soft tissues of the extremities, retroperitoneum, or cervical regions. This case report presents a 55-year-old female patient with a 12.0 cm × 9.0 cm × 6.5 cm tumor in the right gluteal region, which was successfully managed with surgical resection in the absence of distant metastasis.

Patient concerns: A 55-year-old female patient was admitted to our hospital due to right gluteal swelling accompanied by progressive ipsilateral lower limb soreness and numbness for 3 days, which worsened with activity and alleviated at rest, leading to difficulty in walking. Based on clinical manifestations, physical examination, and imaging findings, a preliminary diagnosis of gluteal liposarcoma was considered.

Diagnoses: Histopathological analysis definitively diagnosed a giant WDL located in the right gluteal region.

Interventions: The lesion was completely removed with marginal resection, achieving en bloc excision along the plane outside the tumor capsule.

Outcomes: The patient was discharged on postoperative day 14 without complications. Telephone follow-up at 1, 3, 6 months, and 1 year postoperatively, along with ultrasound and magnetic resonance imaging examinations, revealed no evidence of recurrence.

Lessons: WDL represents a rare neoplastic entity. Due to its nonspecific clinical presentation and diagnostic inexperience, definitive preoperative diagnosis remains challenging. Accurate diagnosis of WDL relies on comprehensive histopathological examination, immunohistochemical profiling, and molecular analysis. Our findings underscore the critical importance of surgical intervention to prevent neurovascular complications and optimize clinical outcomes.