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Agranulocytosis and bloodstream infections (BSIs) are common complications in patients with hematological disorders and they are life-threatening. This study aims to explore the association between agranulocytosis and 30-day mortality in individuals with hematological disorders and BSIs. In this retrospective cohort study, neutrophil levels were measured in patients presenting with fever and diagnosed with a hematological disorder at Tongde Hospital of Zhejiang Province between March 2018 and August 2023. The primary outcome was all-cause 30-day mortality. Multivariate Cox proportional hazard models were used to identify factors associated with survival among patients with hematological disorders and BSIs. Survival outcomes between agranulocytosis (neutrophils < 0.5 × 109/L) and non-agranulocytosis (neutrophils ≥ 0.5 × 109/L) were compared via the Kaplan-Meier method. Subgroup analyses were conducted, stratified by relevant effect covariates. The study included 113 (56.8%) males and 86 (43.2%) females, with a median age of 57.4 years. The overall 30-day mortality rate was 33.7% (67/199), with mortality rate of 26.1% (24/92) in the non-agranulocytosis group and 40.2% (43/107) in the agranulocytosis group (P = .036). After adjusting for potential confounders, a significant association between a 2% increase in the 30-day mortality rate and a 0.1 × 109/L decrease in neutrophil levels was observed (95% confidence interval [CI]: 1.00-1.03, P = .006). Furthermore, agranulocytosis was associated with a 95% increase in 30-day mortality compared to non-agranulocytosis (95% CI: 1.10-3.46, P = .023). The findings from the subgroup and stratified analyses were consistent and robust. Agranulocytosis was positively associated with all-cause 30-day mortality in patients with hematological disorders and BSIs. It served as a significant early prognostic indicator for hematological patients who develop BSIs.

The causal relationships among depression, hypertriglyceridemia, and cardiomyopathy remain undefined. Cardiomyopathy encompasses both ischemic heart disease (IHD) and dilated cardiomyopathy (DCM). Inverse variance weighted random-effect, inverse variance weighted fixed-effect, maximum likelihood estimation, MR-Egger, weighted median, and penalized weighted median were employed to evaluate the causal relationship between exposure and outcome. Stepwise testing and multivariable Mendelian randomization analyses were employed in the mediation analysis. The onset of depression precipitates an increase in triglyceride levels, which in turn escalates the risk of developing DCM. The onset of depression not only directly escalates the risk of developing IHD but also indirectly amplifies this risk by elevating triglyceride levels. Exacerbation of depression was observed to lead to an elevation in triglyceride levels (odds ratio [OR]: 1.093, 95% confidence interval [CI]: 1.041-1.149, P < .001). There was no direct causal link established between depression and DCM (P = .392). The incidence of depression was associated with an increased risk of developing IHD (OR: 1.019, 95% CI: 1.011-1.026, P < .001). Elevated triglyceride levels were found to augment the risk of both IHD (OR: 1.019, 95% CI: 1.015-1.023, P < .001) and DCM (OR: 1.240, 95% CI: 1.047-1.469, P = .013). In the causal pathway between depression and DCM, triglycerides were found to mediate 100% of the effect. In the relationship between depression and IHD, triglycerides accounted for a mediation proportion of 8.4%.

Chronic obstructive pulmonary disease (COPD) and acute kidney injury (AKI) are significant public health burdens, and emerging observational studies have suggested a potential link between them. However, causality remains unclear. This study aimed to investigate the causal relationship between COPD and AKI using two-sample Mendelian randomization (MR) analyses. We utilized 11 independent single-nucleotide polymorphisms associated with COPD to perform two-sample MR analyses on 2 AKI datasets (GCST90018790 and ACUTERENFAIL). Inverse variance weighted (IVW), weighted median, MR-Egger, and weighted mode methods were employed to estimate causal effects. Sensitivity analyses included MR-Egger intercept tests for directional pleiotropy and Cochran Q tests for heterogeneity. A reverse MR analysis was also conducted using 9 AKI-associated single-nucleotide polymorphisms to assess the potential causal effect of AKI on COPD. IVW analysis indicated a significant causal effect of genetically predicted COPD on increased risk of AKI in both GCST90018790 (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.13-1.46, P = 1.19 × 10-4) and ACUTERENFAIL (OR = 1.23, 95% CI: 1.02-1.48, P = .031) datasets. The weighted median method supported these findings in the GCST90018790 dataset. No significant pleiotropy or heterogeneity was detected across sensitivity analyses. In contrast, reverse MR analyses did not reveal a causal effect of AKI on COPD (IVW OR = 0.99, 95% CI: 0.94-1.04, P = .70), with consistent null results across all methods and no evidence of pleiotropy or heterogeneity. Our findings provide genetic evidence supporting a potential causal effect of COPD on increased risk of AKI, but not vice versa. Our results suggest that COPD liability is consistent with an increased propensity for AKI, warranting further exploration of potential biological mechanisms linking pulmonary and renal dysfunction.

The blood urea nitrogen (BUN) and blood urea nitrogen-to-creatinine ratio (BCR) are elevated in patients with upper gastrointestinal bleeding (UGIB). If bleeding persists after an initial endoscopic hemostasis, BUN levels will remain elevated or continue to increase. When identifying the occurrence of rebleeding is difficult, clinicians should perform second-look endoscopy, which is costly and invasive. This study aimed to evaluate whether changes in the BCR or BUN levels aid in determining rebleeding in patients with UGIB. Two hundred eleven patients underwent an initial and follow-up endoscopy within 72 hours for non-variceal UGIB at Chungbuk National University Hospital (Cheongju, Korea). We evaluated the changes in the BCR and BUN levels, based on the presence of rebleeding within 72 hours of the initial endoscopy. Twenty-five (11.8%) patients had rebleeding at the follow-up endoscopy within 72 hours after the initial endoscopy. The overall initial BCR was 38.3 ± 16.0 (median: 35.8). The BCR difference at follow-up endoscopy was 14.1 ± 14.5 in the no-rebleeding group and 4.5 ± 13.2 in the rebleeding group (P = .004). The optimal cutoff value of the BCR difference to predict rebleeding was 8.8. The changes in the BUN level at the follow-up endoscopy were 14.4 ± 12.3 mg/dL in the no-rebleeding group and 5.4 ± 9.5 mg/dL in the rebleeding group (P = .001). The optimal cutoff value of the BUN difference that predicted rebleeding was 7.5 mg/dL. Multivariate analysis revealed that older patients tended to have more rebleeding (P = .034). BCR and BUN level changes may aid in determining whether rebleeding has occurred, thereby preventing unnecessary second-look endoscopy in patients with UGIB.

Background: Spinal metastasis (SM) is described as a metastatic malignant bone tumor with a high mortality rate and often leads to symptoms related to spinal cord or nerve compression, such as pain and debilitating neurological dysfunction. In this study, we explored the research hotspots and trends in SM using bibliometric analysis, which provided reliable novel hints and pathways for future exploration.

Methods: We reviewed articles and reviews on SM published in the Web of Science Core Collection between 2000 and 2023. VOSviewer and CiteSpace were used to conduct the bibliometric and knowledge map analyses.

Results: A total of 2325 original articles and reviews published in 489 academic journals by 10,460 authors from 2231 affiliations in 61 countries/regions were retrieved. The United States was the largest contributor. The University of Toronto was the leader in relevant research. Arjun Sahgal was the most published author and Peter C Gerszten had the most co-citations. The Journal of Neurosurgery Spine published the most SM related articles, and Spine was the most commonly cited journal. The preeminent areas of scholarly inquiry concerning SM were centered on minimally invasive treatments, radiation therapy, and the prognosis and management of patients with SM.

Conclusion: SM is a common type of metastatic bone tumor, and its treatment is increasingly shifting towards minimally invasive surgery and radiation therapy, with a growing emphasis on the prognosis and management of SM as a key area for future research.

This study aimed to develop and validate a positron emission tomography/computed tomography (PET/CT)-based nomogram for individualized prediction of 3-year progression-free survival (PFS) in patients with nasopharyngeal carcinoma (NPC). A total of 128 patients with NPC who underwent pretreatment PET/CT imaging were retrospectively enrolled. Radiomic features were extracted from PET and CT images, and clinical variables were collected. Feature selection was performed using univariate Cox analysis, multivariable Cox analysis, and the least absolute shrinkage and selection operator regression to identify independent predictors. A nomogram was constructed by integrating CT-Radscore, PET-Radscore, and key clinical variables. Model performance in predicting 3-year PFS was evaluated using the concordance index, time-dependent area under the receiver operating characteristic curve, Kaplan-Meier survival curves, calibration curves, and decision curve analysis in both training and validation cohorts. The nomogram incorporating CT-Radscore, PET-Radscore, and lactate dehydrogenase demonstrated robust predictive ability for PFS in NPC. The area under the receiver operating characteristic curve for predicting 3-year PFS was 0.813 in the training cohort and 0.739 in the validation cohort. The corresponding concordance index values were 0.705 and 0.635, respectively. Calibration plots and decision curve analysis confirmed the nomogram's reliability and clinical utility. A PET/CT-based radiomics nomogram (CT-Radscore, PET-Radscore, and lactate dehydrogenase) achieved robust prediction of 3-year PFS and enhanced prognostic stratification in NPC. External validation in larger multi-center cohorts is needed due to the single-center retrospective design and moderate sample size.

Acute myeloid leukemia (AML) is a life-threatening hematological malignancy. With the rapid development of short video platforms, TikTok and Bilibili have become important sources of health information; however, the quality and reliability of AML-related content remain unclear. This study aims to evaluate the content, quality, and reliability of short AML videos on these platforms. The top 150 AML-related videos were collected from each platform using default ranking. Video quality was assessed using 3 validated instruments: the global quality score, modified DISCERN, and the Journal of American Medical Association benchmark. The correlations between user engagement metrics (likes, comments, shares, and favorites) and quality scores were also analyzed. In total, 176 videos were included. Most videos focused on treatment (TikTok and Bilibili: 31.6% and 36.1%, respectively) and prognosis (TikTok and Bilibili: 24.4% vs 17.3%, respectively), while pathogeny and clinical manifestations were insufficiently covered. The overall quality was modest: global quality score median 3.00 (interquartile range [IQR]: 2.00-4.00), modified DISCERN median 2.00 (IQR: 1.00-3.00), and Journal of American Medical Association median 2.00 (IQR: 2.00-3.00). TikTok videos demonstrated a significantly higher engagement than Bilibili videos (P < .05), whereas Bilibili videos were longer (P < .05). Videos uploaded by hematologists received the highest scores across all 3 tools (all P < .001) but showed relatively low user engagement. No correlation was found between engagement metrics and quality scores (P > .05). Short video platforms have become an important source of AML information; however, their overall content quality is limited. Videos created by hematologists are the most reliable; however, user engagement does not reflect information quality. Professional physicians should be encouraged to actively participate in science communication, and platform regulations and algorithm optimization should be strengthened to promote the dissemination of high-quality information.

The management options for diabetic foot are restricted, and the outlook is unfavorable. Immune cells have been implicated in diabetic foot ulcer (DFU), but the exact role of natural killer T (NKT) cells in DFU remains unclear. Vascular endothelial growth factor B (VEGFB), a member of the VEGF family, is distinguished by its potential roles in metabolic regulation and immune modulation, yet its connection to NKT cells in DFU is unexplored. This study was to identify specific genes associated with NKT cells in DFU and to ascertain potential targets. We analyzed single-cell ribonucleic acid sequencing and bulk transcriptome data from DFU datasets. Differential expression analysis identified genes associated with NKT cells in DFU. Machine learning algorithms were applied to pinpoint the most significant genes from these candidates. The functional characteristics of the identified key gene were further investigated through gene set enrichment analysis and immune infiltration analysis. Single-cell analysis revealed 390 NKT cell-related genes, and differential analysis identified 728 differentially expressed genes. Cross-referencing yielded 37 NKT cell-related differentially expressed genes. Machine learning consistently identified VEGFB as a key biomarker. Functional analysis linked VEGFB to cell adhesion, vasculature development, and angiogenesis pathways. VEGFB was significantly overexpressed in DFU samples compared to controls. Our study identifies VEGFB as a valuable biomarker associated with NKT cells in DFU. The overexpression of VEGFB suggests its involvement in DFU pathogenesis, potentially bridging immune regulation and vascular pathways. This finding enhances the understanding of NKT cell mechanisms in DFU and positions VEGFB as a potential target for future diagnostic and therapeutic strategies aimed at immunomodulation.

Iron status is associated with human aging, but the underlying mechanisms are unclear. We aimed to estimate the causality of the association between iron status and human aging and to quantify the mediating effects of immune cells. Based on genome-wide association studies in European populations, we conducted a two-sample Mendelian randomization analysis to evaluate the causal relationships between 6 iron status biomarkers (iron, ferritin, transferrin saturation percentage, total iron-binding capacity, liver iron content, pancreatic iron content) and 5 types of percentage of immune cells (lymphocyte, neutrophil, monocyte, eosinophil, basophil). Next, we employed a 2-step Mendelian randomization design to investigate the potential role of immune cell proportions in mediating iron homeostasis-driven epigenetic aging. In this study, a 2-step randomization analysis demonstrated that lymphocyte percentage mediates 8.01% (mediation effect: 0.06; 95% confidence interval [CI]: 0.02 to 0.10) of ferritin's total effect on PhenoAge acceleration. Neutrophil percentage explained 4.88% (mediation effect: 0.03; 95% CI: 0.004 to 0.07) of the causal relationship between serum ferritin and PhenoAge acceleration, and 7.76% (mediation effect: 0.04; 95% CI: 0.01 to 0.07) of the causal relationship between transferrin saturation percentage and HannumAge acceleration. Lymphocyte and neutrophil proportions were found to partially mediate the causal association of iron status with epigenetic age acceleration. Interventions on changing the percentage of immune cells would be a potential strategy for regulating the pace of aging.

Background: To investigate the efficacy and safety of methylene blue infiltrating injection (MBI) in alleviating postoperative pain following hemorrhoidectomy.

Methods: In a randomized clinical trial, 60 patients with mixed hemorrhoids undergoing Milligan-Morgan surgery were divided into 2 groups: a study group (n = 30) and a control group (n = 30). Upon surgical completion, patients in the study group received an intraoperative MBI to the surgical incisions. All patients, in both groups, then received the same standard postoperative on-demand intravenous lornoxicam protocol. The primary outcome was anal pain intensity assessed by the visual analog scale scores at 6, 24, 48, and 72 hours. Secondary outcomes included limb movement score, incision edema, duration of the first postoperative defecation, supplemental analgesic consumption, length of hospital stay, hospitalization costs, and serum levels of substance P, 5-hydroxytryptamine, and prostaglandin E2.

Results: No significant differences were observed in baseline characteristics. The study group exhibited significantly lower visual analog scale scores at all time points (all P < .001) and required substantially less supplemental lornoxicam (22.67 ± 17.01 mg vs 56.80 ± 9.32 mg, P < .001). Patients in the study group also had better limb movement scores, less incision edema, a shorter duration of the first postoperative defecation, a reduced hospital stay, and lower medical costs (P < .01). Serum levels of substance P, 5-hydroxytryptamine, and prostaglandin E2 were significantly lower in the study group (all P < .05). No perianal cellulitis, skin necrosis, or thrombosis occurred in either group.

Conclusion: MBI provides effective and safe analgesia after Milligan-Morgan surgery, significantly reducing pain, analgesic consumption, hospital stay, and cost.