Medicine最新文献

This study aims to investigate the impact of surgery-radiotherapy (S-RT) interval on the prognosis of high-risk endometrial cancer (EC) patients receiving postoperative adjuvant therapy. It evaluates the effect of different interval times on disease-free survival (DFS) to provide clinical treatment recommendations. This retrospective study included 150 high-risk EC patients who underwent surgery at our hospital between February 2021 and February 2023. Patients were categorized into 3 groups based on the S-RT interval: short interval (1-4 weeks), medium interval (5-8 weeks), and long interval (>8 weeks). Baseline data, treatment characteristics, and follow-up data were collected and analyzed. Primary outcomes included DFS and the effect of S-RT interval on DFS. Kaplan-Meier method was used for survival analysis, and multivariate Cox regression model - adjusting for key confounding factors such as age, Fédération Internationale de Gynécologie et d'Obstétrique stage, pathological type, deep myometrial invasion, lymphovascular space invasion (LVSI), and lymph node metastasis - was applied to evaluate independent prognostic factors. The 2-year DFS rate for the short interval group was 55%, significantly higher than the medium interval group (49%) and long interval group (24%), with statistically significant differences between the groups (P < .001). Cox regression analysis indicated that the S-RT interval is an independent prognostic factor for DFS, with the long interval (>8 weeks) group showing a significantly increased risk of recurrence compared to the short interval group (HR = 1.9, 95% CI: 1.4-2.5, P < .001). Pathological features such as deep myometrial invasion, LVSI positivity, and lymph node metastasis were also independent prognostic factors. The timing of postoperative radiotherapy initiation significantly affects prognosis in high-risk EC patients, even after adjusting for key clinical and pathological variables. Delayed radiotherapy (>8 weeks) markedly increases recurrence risk. These findings suggest that shortening the S-RT interval may improve DFS. However, the results need to be validated in larger sample sizes and multi-center prospective studies before generalization.

Obesity is a significant risk factor for female infertility. The conicity index (C-index) is an important measure for assessing body fat distribution, but its relationship with female infertility is not well understood. This study aims to investigate the correlation between the C-index and female infertility. The research data is sourced from the National Health and Nutrition Examination Survey conducted between 2013 and 2018. Female infertility is evaluated using a reproductive health questionnaire, and the C-index is calculated based on waist circumference, body mass index, and height. A multiple factor logistic regression model is utilized to analyze the correlation between the C-index and the incidence of infertility. Additionally, the restricted cubic spline method is applied to examine the dose-response relationship between the C-index, treated as a continuous variable, and female infertility. Subgroup analyses are performed to investigate the consistency of associations across various demographic and health-related factors. A total of 3496 female patients were included in this study, with 412 diagnosed with infertility. The results of the multiple logistic regression analysis indicated that the C-index is associated with female infertility. As the C-index grouping level increased, the odds of female infertility prevalence also increased (odds ratio: 1.80, 95% confidence interval [95% CI]: 1.25-2.59, P = .002). This association was consistent across all subgroups. Ultimately, 3 multiple regression models were retained. The results from the linear relationship test and restricted cubic spline analysis demonstrated that as the C-index level continued to rise, the odds of female infertility prevalence increased gradually (P for nonlinear = .834, P for overall < .001). There is a positive relationship between the C-index and infertility in American women. Utilizing C-index measurements can aid in the early identification of infertile women, and managing obesity based on C-index results may help decrease the incidence of infertility.

The purpose of this study is to explore the potential mechanism of Si-Wu-Tang (SWT) against esophageal squamous cell carcinoma (ESCC). Initially, 18 active molecules and 96 related targets of SWT obtained from publicly accessible databases. Through Genecards database queries and gene differential expression analysis combined with weighted gene correlation network analysis (WGCNA) on the GSE20347 dataset of ESCC, 3649 disease targets were identified. A subsequent analysis of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment was performed on 51 disease-drug intersection genes using the R language. Additionally, we identified 3 target hub genes (CDK1, NCOA1, and CHRM3) utilizing machine learning tools. Single-gene GSEA results suggested that hub genes may influence several signaling pathways and biological processes. Immune infiltration analysis demonstrated that SWT might impact the tumor immune microenvironment in ESCC by acting on hub targets. Molecular docking demonstrated the presence of affinity between target hub proteins and active compounds. This study revealed that SWT might exert its therapeutic effects on ESCC through multi-targets and multi-mechanisms.

This study aims to investigate the impact of multimodal analgesia (MMA) nursing on postoperative pain management and recovery outcomes in patients undergoing hepatectomy. A retrospective cohort study was conducted involving 120 patients who underwent elective hepatectomy between January 2023 and January 2024. Patients were divided into a conventional analgesia nursing group (n = 60) and a MMA nursing group (n = 60). Postoperative pain intensity (Visual Analogue Scale), analgesic consumption, recovery-related indicators, complication rates, and patient-reported outcomes were compared between groups. Baseline characteristics were comparable between groups (P > .05). Visual Analogue Scale scores at 6, 12, 24, and 48 hours postoperatively were significantly lower in the MMA nursing group (P < .001). The MMA group also demonstrated reduced analgesic consumption, earlier ambulation and bowel-function recovery, shorter hospital stays, and a lower incidence of postoperative complications (P < .05). Patient satisfaction, compliance, and pain-management knowledge were significantly improved. Multimodal analgesia nursing effectively improves postoperative pain control, accelerates recovery, reduces complications, and enhances patient-reported outcomes after hepatectomy, supporting its clinical value within Enhanced Recovery After Surgery-based perioperative care.

This study aims to compare the clinical efficacy and bleeding risk of ticagrelor and clopidogrel in elderly patients after percutaneous coronary intervention (PCI). A retrospective analysis was performed on 161 elderly patients (aged ≥65 years) who underwent PCI at our hospital between June 2022 and June 2024. Patients were divided into a ticagrelor group (TG; n = 82) and a clopidogrel group (CG; n = 79) based on their postoperative antiplatelet therapy regimen. Baseline clinical data were compared between the 2 groups. The patients were followed up for 12 months. The primary outcome measure was the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, acute myocardial infarction, ischemic stroke, and unplanned revascularization. Secondary outcomes included bleeding events (classified according to the Bleeding Academic Research Consortium criteria), stent-related events, platelet function parameters, adverse drug reactions, and quality of life scores (SF-36 scale). Logistic regression analysis was performed to identify factors associated with MACE. The overall bleeding event rate was higher in the TG than that in the CG (18.29% vs 7.59%, P = .053), with most cases classified as mild-to-moderate bleeding. The overall incidence of stent thrombosis was lower in the TG than in the CG (1.22% vs 5.06%, P = .203). Subgroup analyses indicated that ticagrelor showed a trend toward reducing MACE in patients with both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Platelet function tests showed that the platelet aggregation rates in the TG were significantly lower than those in the CG at 24 hours and 7 days after surgery (P < .05). Regarding adverse drug reactions, the incidence of dyspnea was significantly higher in the TG than that in the CG (13.41% vs 2.53%, P < .05). Multivariable logistic regression analysis showed that increasing age (odds ratio = 1.075, 95% confidence interval [CI]: 1.011-1.142, P = .028) and a history of myocardial infarction (odds ratio = 2.981, 95% CI: 1.032-8.712, P = .046) were independent risk factors for MACE. In elderly patients undergoing PCI, ticagrelor demonstrates a potential advantage over clopidogrel in preventing MACE, with stronger platelet inhibition and lower rates of stent thrombosis; however, this benefit is accompanied by a higher risk of bleeding and adverse reactions, such as dyspnea.

This study aims to investigate symptom characteristics in postoperative chemotherapy patients with colorectal cancer (CRC) and identify their symptom clusters and core symptoms to provide a basis for developing precise symptom management strategies. Convenience sampling was used to select 302 patients with postoperative chemotherapy for CRC as the research object. The general data questionnaire and the Chinese version of the MD Anderson Symptom Inventory-Gastrointestinal Cancer were used for investigation. Exploratory factor analysis was conducted to extract symptom clusters, followed by constructing a symptom network model using R software. Core symptoms were identified by calculating centrality indicators. Exploratory factor analysis identified 5 symptom clusters with a cumulative variance contribution rate of 64.53%, including chemotherapy-related symptoms, psychological symptoms, neurotoxicity-related symptoms, gastrointestinal symptoms, and CRC-specific symptoms. Analysis of symptom prevalence revealed poor appetite (85.4%) as the most common symptom. Network analysis showed that distress (rs = 1.04, re = 1.04) exhibited the highest node strength and expected influence, while fatigue (rc = 0.0047) demonstrated the strongest centrality, confirming it as a core symptom. Distress and fatigue are core symptoms in the symptom network of postoperative chemotherapy patients with CRC. Clinical interventions should focus on these core targets to alleviate overall symptom burden by blocking interactions between symptoms.

Although the elderly population is significantly vulnerable to Corona Virus Disease 2019 (COVID-19) infection, research pertaining to this demographic remains relatively limited. Therefore, this study aimed to summarize the clinical characteristics, assess risk factors for death in hospitalized patients with COVID-19 aged ≥90 years, and provide insight into the treatment of severe/critically ill patients. This cross-sectional study was conducted at a tertiary hospital in Beijing, including patients aged ≥90 years hospitalized with COVID-19 from December 1, 2022, to February 28, 2023. We collected clinical data and used a multivariable logistic regression model to identify mortality risk factors. The calibration curve further confirmed the predictive capabilities of the model. The study included 150 patients, with 54 severe/critical cases and an overall in-hospital mortality rate of 31 (20.7%) patients. Multivariable logistic regression revealed a decreased lymphocyte percentage (odd ratio (OR) 0.81 [95% confidence interval (CI) 0.72-0.92], P = .001) and venous thrombosis of lower limbs (OR 5.49 [95% CI 1.56-19.35], P = .008) significantly increased mortality risk. Paxlovid use within 5 days of symptom onset (OR 0.20 [95% CI 0.04-0.95], P = .042) reduced the risk. A decreased lymphocyte percentage and venous thrombosis of the lower limbs were associated with an increased risk of death. Conversely, the use of Paxlovid was correlated with a reduced risk of death among patients with COVID-19 aged ≥90 years.

The connection between appendiceal disease and cancers of the digestive tract has attracted widespread attention, but conclusion remain controversial. It is still unclear whether appendiceal disease has a definite causal effect on cancer. Our research aims to explore the causal relationship between appendiceal diseases and digestive system tumors. A two-sample Mendelian randomization (MR) analysis was conducted using genome-wide association study datasets to explore the causal impact of appendiceal disease on the risk of cancers. Five different MR methods were used to investigate causality. The stability, heterogeneity, and pleiotropy of MR were also assessed. The presence of appendiceal disease could reduce the incidence of rectal cancer (odds ratio = 0.588, 95% confidence interval: 0.392-0.881, P = .010, by inverse variance weighted method). There was no significant causal effect of appendiceal disease on the risk of other cancers. No horizontal pleiotropy was observed in the MR analysis, and leave-one-out analysis confirmed the stability of the results. The potential causal relationship between appendiceal disease and cancer risk was only observed with rectal cancer in populations of European ancestry. Future work will provide more robust evidence for the connection between appendiceal disease and cancers.

Rheumatoid arthritis (RA) is a chronic, immune-mediated disease with symmetric polyarticular pain and swelling. It includes seropositive RA, marked by specific antibodies, and seronegative RA, without these antibodies. The relationship between immune cells and both types of RA has not been fully elucidated. Therefore, we conducted a two-sample Mendelian randomization analysis with bidirection to evaluate the causal relationship between immune cells and both seropositive and seronegative RA. We utilized data from various genome-wide association studies and employed multiple analytical methods, including inverse-variance weighted and Wald ratio, as the primary method. Additionally, we employed supplementary approaches such as MR-Egger regression, weighted median, and weighted mode. Various sensitivity analyses were used to ensure the robustness of our results. Furthermore, we utilized the false discovery rate method to mitigate type 1 error. We identified 3 immune cell types linked to higher seropositive RA risk, and 16 immune cell types might be influenced by seronegative RA (4 increased and 12 decreased). Notably, HLA-DR+ monocytes were strongly associated with seropositive RA, while changes in immune cell composition in seronegative RA suggest potential biomarkers for its diagnosis. These findings offer valuable insights into RA pathogenesis and highlight the potential for novel diagnostic and therapeutic strategies, particularly for seronegative RA, which lacks reliable biomarkers. Further research is needed to explore the underlying mechanisms and their clinical applications.

The causal relationships between antibody-induced immune responses and the occurrence and mortality of sepsis remain controversial. The 2-sample Mendelian randomization (MR) approach was utilized to reveal the causal associations, along with the potential mediation effects of inflammatory cytokines. The causal associations were analyzed by a 2-sample bidirectional MR analysis, primarily using the inverse variance weighted method. MR-Egger regression, weighted mode, weighted median, and simple mode were conducted as supplementary analyses. Additionally, we performed a 2-step MR to investigate the potential mediation effects of 91 inflammatory cytokines. Cochran Q test was conducted to assess statistical heterogeneity. Potential horizontal pleiotropy was identified with MR-Egger regression intercept test and MR-pleiotropy residual sum and outlier global test. Leave-one-out sensitivity analysis was employed to evaluate the influence of an individual single nucleotide polymorphism on the estimates. The outcomes revealed positive associations between genetically predicted Helicobacter pylori urea antibody levels (odds ratios [ORs] = 1.070, 95% confidence interval [CI]: 1.009-1.134, P = .024), anti-herpes simplex virus type 1 immunoglobulin G seropositivity [OR = 1.071, 95% CI: 1.012-1.134, P = .018], and the risk of sepsis; cytomegalovirus phosphoprotein 52 antibody levels showed significant negative correlation with 28-day mortality in sepsis [OR = 0.830, 95% CI: 0.690-0.999, P = .048]. Surprisingly, the mediation analysis suggested that the 91 inflammatory cytokines did not mediate these associations. H pylori urea antibody and anti-herpes simplex virus type 1 immunoglobulin G seropositivity are pathogenic factors for sepsis, while cytomegalovirus phosphoprotein 52 antibody levels may protect against 28-day mortality in sepsis. Inflammatory cytokines may not mediate these relationships. These findings could contribute to the precise management of sepsis.