Medicine最新文献

Uterine fibroids, the most common monoclonal benign tumors of the uterine smooth muscle, show an increasing incidence with age. Currently, social media platforms such as TikTok, YouTube, and Bilibili are increasingly becoming important channels for disseminating health information. However, the quality and reliability of content related to uterine fibroids on these platforms are often unsatisfactory. This study aims to systematically evaluate the quality and content characteristics of uterine fibroid-related videos on 3 major short-video platforms - TikTok, YouTube, and Bilibili - using validated assessment tools. A total of 300 videos (100 per platform) uploaded between 2020 and 2025 were included. Video quality was assessed using the The Journal of the American Medical Association benchmark criteria, modified DISCERN instrument, and Global Quality Score. Content features, uploader identity, presentation format, and engagement metrics were also analyzed. Statistical analyses included nonparametric tests and Spearman correlation. Bilibili consistently outperformed TikTok and YouTube in all quality metrics (The Journal of the American Medical Association, DISCERN, Global Quality Score), though overall video quality across platforms was moderate. Video duration was positively correlated with quality scores (ρ ≈ 0.33 for DISCERN). No significant associations were found between engagement metrics (likes/comments) and professional quality ratings. Key content features such as animated demonstrations, source attribution, and inclusion of recent research advances were significantly associated with higher quality. Overall, content across all platforms exhibits deficiencies. However, videos related to uterine fibroids on Bilibili demonstrate relatively fewer shortcomings, while notable quality disparities persist among the different platforms. Content creators should prioritize videos of 2 to 10 minutes with evidence-based features to improve reliability. Viewers are advised to focus on content depth and source credibility rather than superficial engagement metrics. Enhanced platform regulation and public awareness are urgently needed.

Rationale: Immune checkpoint inhibitors (ICIs) have revolutionized the management of head and neck squamous cell carcinoma, particularly in the recurrent/metastatic setting. Although the combination of ICIs and radiotherapy (RT) in locally advanced disease has not yet demonstrated clear survival benefits, the strong biological rationale for their synergistic action continues to support investigation, especially in frail or elderly patients unfit for standard chemoradiotherapy.

Patient concerns: An 83-year-old male presented with odynophagia, dysphagia, significant weight loss, and right cervical swelling, all impairing oral intake and quality of life.

Diagnoses: Moderately differentiated squamous cell carcinoma (G2) of the oropharynx (right base of tongue), human papillomavirus-negative, programmed death-ligand 1 combined positive score = 30. The tumor was staged as cT4a cN3b M1.

Interventions: The patient underwent hypofractionated RT (50 Gy in 20 fractions) delivering only to the primary lesion, followed by pembrolizumab 200 mg every 3 weeks. One pulmonary oligoprogressive lesion was treated with stereotactic body RT (60 Gy in 8 fractions). After 29 cycles of pembrolizumab, treatment was discontinued due to the onset of immune-related grade 3 hepatotoxicity. Two additional pulmonary oligoprogressive lesions were treated with stereotactic body radiotherapy, 55 Gy in 5 fractions.

Outcomes: A complete response was achieved and maintained at both the primary tumor and nodal sites. Following immunotherapy discontinuation, liver biopsy confirmed immune-related cholangitis. Despite persistent elevation of cholestatic markers, disease control on T and N was preserved. A new pulmonary oligoprogression is currently under active surveillance.

Lessons: This case supports the hypothesis of synergism between RT and immunotherapy in an elderly and frail patient with advanced head and neck squamous cell carcinoma. Hypofractionated RT on the primary tumor alone, combined with ICIs, may lead to sustained locoregional control. Immune-related hepatic toxicity, while clinically significant, did not preclude stable disease.

Endometriosis is a chronic inflammatory disease that can cause many problems such as dipmenorrhea, dyspareunia, pelvic pain, and infertility. The aim of this study was to investigate the clinical, demographic, and laboratory characteristics that are primarily considered in the management of patients with endometrioma, focusing on the effects of cyst size and laterality. This study included 210 patients aged 18 to 50 who underwent endometrioma surgery. Demographic characteristics, infertility histories, surgical procedures, antral follicle counts, and laboratory parameters (CA-125, follicle stimulating hormone, anti-Müllerian hormone [AMH], and estradiol) of the patients were compared by classifying them according to endometrioma size and bilaterality. Endometrioma size was classified as ≤30, >30 to ≤50, >50 to ≤70, and >70 mm. This was a retrospective, observational study. No significant differences in age or reproductive history, including gravida and parity, were observed between groups. However, body mass index was significantly lower in the >70 mm group. Additionally, the rates of pelvic pain and infertility were higher in patients with bilaterality or larger endometriomas (P = .022, P = .029). The >70 mm and with bilaterality group had the lowest preoperative AMH levels and the highest CA-125 levels compared to the ≤30 mm and without bilaterality group (P = .009, P = .008). To improve statistical robustness, an additional literature-based stratification using a 50 mm cutoff and bilaterality was applied, and further comparative and regression analyses were performed. In the logistic regression analysis, Low AMH levels were independently associated with the presence of large (>50 mm) and bilateral endometriomas (odds ratio = 0.12, 95% confidence interval [CI]: 0.04-0.41; P = .002). In conclusion, larger and bilateral endometriomas tend to be associated with lower AMH levels, and further research aimed at better elucidating the underlying mechanisms of this relationship is needed to help resolve existing inconsistencies in the literature.

Rationale: Duodenal stump leakage followed by intra-abdominal hemorrhage is a rare but serious complication of gastrectomy. Managing this condition is highly challenging. We describe a novel approach using a combined intra- and extraluminal drainage system that proved to be a simple, safe, and effective solution.

Patient concerns: A 66-year-old male with a history of hypertension and coronary artery disease presented with a 1-year history of epigastric distension and discomfort. After undergoing radical total gastrectomy for gastric adenocarcinoma, he developed increased abdominal drain output and pain, followed by acute hemorrhage from the drain site.

Diagnoses: Postoperative duodenal stump leak (diagnosed on postoperative day [POD] 6 by computed tomography scan) complicated by subsequent rupture and hemorrhage of the left hepatic artery (confirmed on POD 10 during emergency laparoscopy).

Interventions: The initial duodenal leak (POD 6) was managed with computed tomography-guided percutaneous catheter drainage. On POD 10, due to an acute intra-abdominal hemorrhage, emergency surgery was performed. After securing hemostasis of the left hepatic artery and primary suturing of the duodenal leak, a 20-French T-tube was inserted into the duodenum for intraluminal decompression. A double-cannula system was then placed adjacent to the leak site for continuous extraluminal irrigation and suction.

Outcomes: Following the procedure, the patient's condition improved steadily. The double-cannula irrigation system was removed on POD 30, and the patient was discharged. The T-tube was clamped on POD 30 and successfully removed on POD 48. The patient recovered completely without further complications.

Lessons: The technique of T-tube intraluminal drainage combined with continuous extraluminal irrigation via a double-cannula system provides an effective management strategy for duodenal stump leakage complicated by intra-abdominal hemorrhage. This case highlights that optimal outcomes in such complex scenarios are best achieved through a comprehensive strategy that integrates innovative surgical techniques with systematic perioperative nutritional and metabolic support.

Nonalcoholic fatty liver disease (NAFLD) is a growing health burden worldwide. The association between blood selenium (Se) and NAFLD in naturally menopausal women remains unclear. This study aimed to evaluate the association of blood Se levels with the prevalence of NAFLD, hepatic steatosis, and liver fibrosis in the US naturally menopausal women population. This study analyzed the dataset from the 2017 to 2018 National Health and Nutrition Examination Survey, including 595 naturally menopausal women. Weighted logistic regression models were used to evaluate the cross-sectional association between blood Se levels and the prevalence of NAFLD. Linear regression and ordinal logistic regression were used to evaluate the association between blood Se levels and liver steatosis and fibrosis. All analyses were conducted using the R survey package. There were no significant associations of blood Se levels with NAFLD in 3 adjusted models (odds ratio [OR] = 0.52, 95% confidence interval [CI], 0.04-7.11; OR = 0.66, 95% CI, 0.04-9.82; OR = 0.79, 95% CI, 0.08-8.08). However, in the fully adjusted model, blood Se levels showed a negative association with liver fibrosis (β = -2.32, 95% CI, -4.21, -0.43). Participants were divided into quartiles (Q1-Q4) based on the distribution of blood Se concentrations within the study cohort. The specific cutoff points were Q1 group (<173.67 μg/L), Q2 group (173.67 to <189.15 μg/L), Q3 group (189.15 to <204.35 μg/L), and Q4 group (≥204.35 μg/L). Compared with the reference group (Q1 group, <173.67 μg/L), significant inverse associations were also found for the higher Se groups (Q3 group: OR = 0.23, 95% CI, 0.1-0.53; Q4 group: OR = 0.28, 95% CI, 0.12-0.66). Our results showed that blood Se levels were not significantly associated with the prevalence of NAFLD in a US population of naturally menopausal women, but higher blood Se levels were negatively associated with liver fibrosis. Further research is needed to assess the causal relationship between exposure and disease risk.

Background: Sleep deprivation negatively impacts athletic performance; however, limited research has specifically examined these effects in combat sports athletes, where rapid decision-making and neuromuscular coordination are crucial for success. This study aimed to investigate the impact of partial sleep restriction on cognitive and physical performance in elite karate athletes.

Methods: Fourteen international-level male karate athletes (age: 23.35 ± 4.61 years) completed 2 randomized experimental sessions separated by 1 week: following regular sleep (8 hours) versus sleep restriction (4 hours). Cognitive performance was assessed using the Stroop test, simple reaction time, and multiple-choice reaction time tests. Physical performance was evaluated through the squat jump, modified agility T-test (MAT), and karate-specific aerobic test.

Results: All tests were conducted before and after exercise. Sleep restriction significantly impaired cognitive performance. Stroop reaction times increased under sleep restriction (F = 13.0, P <.01, ηp2 = 0.50) with further deterioration post-exercise (F = 60.27, P <.001, ηp2 = 0.90). Simple reaction time declined following sleep restriction (F = 27.2, P <.001, ηp2 = 0.70). Multiple-choice reaction time remained unaffected at rest but worsened significantly after exercise (F = 5.3, P <.05, ηp2 = 0.30). Physical performance also declined: squat jump height decreased (F = 15.8, P <.001, ηp2 = 0.50), MAT performance deteriorated (F = 28.5, P <.001, ηp2 = 0.70), and karate-specific aerobic test endurance was significantly reduced (P <.001).

Conclusion: Partial sleep restriction substantially impairs both cognitive and physical performance in elite karate athletes, with compounding effects during exercise. Practically, these findings suggest that coaches should educate athletes about the importance of sleep and avoid scheduling intensive training sessions after suspected poor sleep nights. Athletes should prioritize 7 to 9 hours of consistent sleep, particularly before competitions, and minimize late-night activities that disrupt their sleep schedules. Simple sleep hygiene practices, such as maintaining regular bedtimes and avoiding screens before sleep, may help preserve performance capacity.

Background: This study aimed to evaluate the efficacy of acupuncture combined with Chinese herbal medicine in the treatment of gastric ulcers (GU) through a meta-analysis.

Methods: A comprehensive search was conducted in Chinese databases (CNKI, VIP, and Wanfang) and international databases (PubMed, Embase, and the Cochrane Library) to identify available randomized controlled trials (RCTs) published from the inception of each database through January 2025. The primary outcomes considered included overall efficacy rate, Helicobacter pylori (Hp) eradication rate, recurrence rate, gastrin levels, and adverse events. The quality of each included study was assessed using the Cochrane Collaboration's Risk of Bias Tool, and data were analyzed using RevMan 5.3 software.

Results: A total of 1288 articles were initially identified, of which 17 RCTs involving 1632 patients were ultimately included. The meta-analysis demonstrated that acupuncture combined with Chinese herbal medicine was superior to non-acupuncture combined with Chinese herbal medicine in terms of clinical efficacy (OR = 4.83, 95% confidence intervals [CI] = 3.36-6.93, P < .00001), Hp eradication rate (OR = 3.94, 95% CI = 2.35-6.6, P < .00001), recurrence rate (OR = 0.19, 95% CI = 0.1-0.35, P < .00001), and gastrin levels (MD = -18.39, 95% CI = -20.68 to -16.11, P < .00001). Due to the small sample size and low quality of the RCTs included, the overall certainty of the evidence is low.

Conclusion: Compared with the control intervention measures, acupuncture combined with traditional Chinese medicine therapy may be an effective complementary therapy for treating GU. It has shown good clinical efficacy, significantly improving the eradication rate of Hp, gastrin levels, and having a relatively low recurrence rate. No increase in adverse events has been reported, suggesting a favorable safety profile in clinical practice. However, further high-quality, large-scale studies are needed to confirm these results.

This study aimed to investigate the bidirectional causal relationship between depressed mood and premature ovarian insufficiency (POI) using a Mendelian randomization (MR) method. Genome wide association study data on depressed mood and POI were obtained using the IEU Open genome wide association study website. Closely related and independent single nucleotide polymorphisms (SNPs) were screened as instrumental variables (IVs) from depressed mood according to preset thresholds, and the association between depressed mood and the risk of developing POI was mainly assessed using inverse-variance weighted (IVW); the heterogeneity of SNPs was also assessed using CochranQ test. The MR-PRESSO test was used to detect the presence of outlier SNPs, and the MR-Egger intercept test was used to test the horizontal pleiotropy of SNPs. A "leave-one-out" sensitivity analysis was performed to test whether the MR results were influenced by a single SNP, and a 2-way MR analysis was performed by interchanging the screening processes for depressed mood and POI. The results of MR analysis indicated that there was no causal relationship between depressed mood and the occurrence of POI (odds ratio = 0.601, 95% confidence interval: 0.105-3.430, P = .566), and in the reverse MR analysis, there was no significant causal relationship between POI and depressed mood (odds ratio = 0.999, 95% confidence interval: 0.996-1.003, P = .663), none of the instrumental variables in the bidirectional MR analysis showed horizontal pleiotropy and heterogeneity. Genetics-based MR analysis found no significant causal relationship between depressed mood and POI.

Percutaneous endoscopic gastrostomy (PEG) is used in patients requiring long-term nutritional support and is more physiological than parenteral nutrition. Various minor and major complications may develop during the procedure. This study aimed to evaluate how the timing of the skin incision during the procedure affects complications. In 80 out of a total of 192 patients, a skin incision was made after lidocaine injection, and in 112 patients, a skin incision was made while the PEG tube was being pulled out of the stomach. Both groups were monitored for possible complications and compared using appropriate statistical methods. A total of 192 patients, 94 women and 98 men, were included in this study. The median age of the patients was 77 years. The most common indications for PEG were cerebrovascular disease, Alzheimer disease, and hypoxic encephalopathy. The most common complication was PEG tube dislocation. Other complications that developed included peristomal infection/cellulitis, bleeding, peristomal leak, PEG tube obstruction, and buried-bumper syndrome. Indications and comorbid conditions showed a similar distribution in both groups. No statistically significant differences were found in terms of complications between the groups. PEG is a very effective procedure with appropriate indications and preparation and has low rates of serious complications. There was no difference in terms of complications that may occur between making the incision after applying a local anesthetic to the skin and making it while the PEG tube was being removed from the stomach.

This study aims to investigate the incidence of postoperative complications following vacuum-assisted excision (VAE) of benign breast tumors and identify the associated risk factors, in order to support clinical risk assessment and perioperative management. A retrospective review was conducted of 100 female patients who underwent ultrasound-guided VAE for benign breast lesions at our institution between December 2023 and December 2024. Patients were categorized into a complication group (n = 30) and a non-complication group (n = 70) based on the occurrence of complications within 30 days postoperatively. Clinical and procedural characteristics were compared between the 2 groups. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors. A predictive model was established and evaluated using the receiver operating characteristic curve and calibration curve. A nomogram was constructed for individualized risk prediction. The overall 30-day complication rate was 30.00%. The most common complications were hematoma (12.00%), subcutaneous ecchymosis (11.00%), pain (9.00%), skin depression (5.00%), and wound infection (1.00%). Univariable analysis indicated that tumor size, number of lesions, distance from the skin, surgeon experience, and compression time were significantly associated with postoperative complications (P < .05). Multivariable analysis identified tumor size (odds ratio [OR] = 2.12, 95% CI: 1.12-4.00), distance from the skin <5 mm (OR = 2.62, 95% CI: 1.08-6.35), compression time <10 minutes (OR = 2.80, 95% CI: 1.18-6.63), and surgeon experience <3 years (OR = 2.42, 95% CI: 1.02-5.73) as independent risk factors. The model demonstrated good discriminative ability (area under the curve = 0.826, 95% CI: 0.732-0.921) and acceptable calibration (Hosmer-Lemeshow P = .239). The nomogram provided an intuitive visualization for individualized complication-risk prediction. Complications after VAE for benign breast tumors are relatively common, with hematoma, ecchymosis, and pain being the most frequent. Larger tumors, superficial lesions, insufficient postoperative compression, and limited surgeon experience significantly increase the risk of complications. The prediction model and nomogram offer a practical tool for individualized perioperative risk assessment and complication prevention.