Medicine最新文献

This study aimed to evaluate the impact of multimodal education management using illustrated pathway with video education (IPVE) on rehabilitation quality after total knee arthroplasty. A retrospective cohort study design was adopted. Patients were grouped based on the median of final SF-36 quality of life scores. LASSO regression was used to screen predictive variables, and multivariate logistic regression was used to construct prediction models. The predictive performance of 5 machine learning algorithms was compared, and model efficacy was evaluated using ROC curves, calibration curves, and decision curve analysis. SHAP method was used to analyze feature importance. Multimodal education management using IPVE was significantly associated with better rehabilitation quality after total knee arthroplasty. A total of 223 patients who underwent total knee arthroplasty from October 2022 to January 2025 were included, with 121 cases (54.3%) in the high-quality rehabilitation group and 102 cases (45.7%) in the low-quality group. LASSO regression identified 4 key predictive variables: age, IPVE implementation, knee range of motion at discharge, and final knee function score. Multivariate logistic regression analysis showed that each 1-year increase in age reduced the probability of high-quality rehabilitation by 17.2% (P<.001), IPVE implementation was significantly associated with better rehabilitation quality (P<.001), each 1° increase in knee range of motion at discharge increased the probability of high-quality rehabilitation by 17.3% (P<.001), and each 1-point increase in final knee function score increased the probability of high-quality rehabilitation by 11.2% (P = .043). The random forest model performed best, with the AUC, sensitivity, specificity, accuracy, and F1 score all reaching 1.000, whereas the traditional logistic regression model had an AUC of 0.924. SHAP analysis showed that age was the most important predictive feature, and implementation of IPVE had a significant impact on rehabilitation quality. Multimodal educational management using an illustrated pathway combined with video-based education was significantly associated with improved rehabilitation quality after total knee arthroplasty.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis with limited treatment options. This systematic review and meta-analysis aimed to evaluate the evidence regarding the use of bimekizumab for treating moderate-to-severe HS, focusing on its clinical efficacy, safety, and outcomes across different clinical parameters.

Methods: We followed the "preferred reporting items for systematic reviews and meta-analyses" (PRISMA) guidelines and performed a systematic search for trials that compared bimekizumab with a placebo in patients with moderate-to-severe HS. A comprehensive search of PubMed, Web of Science, Cochrane CENTRAL, and Embase was conducted up to April 2025. The primary outcome of efficacy was the percentage of patients who reached "HS Clinical Response 50" (HiSCR50), with secondary outcomes including HiSCR75, reduction in skin pain, and safety (evaluated by serious adverse events). Two reviewers independently assessed the risk of bias using the Cochrane risk-of-bias 2 tool. A fixed-effects model was used for meta-analysis. The study protocol was preregistered in PROSPERO (CRD420251025763).

Results: Three RCTs, encompassing 1218 participants, were included. Bimekizumab made it substantially more probable that the HiSCR50 would be reached (RR: 1.64; 95% CI [1.37-1.97]; P <.00001) than the placebo. Patients who received bimekizumab were also substantially more likely to achieve higher response levels, HiSCR75 (RR: 1.98; 95% CI [1.52-2.59]; P <.00001) and a considerable reduction in skin pain (RR: 2.29; 95% CI [1.54-3.42]; P <.0001). For all measures of efficacy, both the every-two-week and every-four-week dosage schedules were better than the placebo. The occurrence of serious adverse events did not differ significantly between the bimekizumab and placebo groups (RR: 2.34; 95% CI [0.80-6.79]; P = .12).

Conclusion: The evidence, although derived from a limited number of trials, demonstrates the superiority of bimekizumab over placebo. For patients with moderate-to-severe HS, bimekizumab showed significantly improved outcomes compared to placebo in terms of enhancing clinical response and lessening skin pain. Although no statistically significant increase in serious adverse events was observed, a potential risk cannot be definitively ruled out given the numerical imbalance.

Background: Tumors are a major threat to human life and health. Neutrophil extracellular traps (NETs) have become a research focus in this context, especially regarding their role in tumor progression. Since the concept of NETs was introduced in 2004, its implications for tumor research have attracted significant scholarly attention. This study aims to explore research trends and cutting-edge hotspots in NETs and tumors through bibliometric analysis and provide new ideas for clinical applications.

Methods: We searched for literature on NETs and tumors published between 2004 and 2023 using the Web of Science database. Microsoft Excel 2019 was used for statistical analysis of influential articles, journals, authors, organizations, countries, and co-cited references. VOSviewer (version 1.6.16) and CiteSpace (V.5.8.R3) were employed for visualizing research data.

Results: The analysis covered 790 articles authored by 4768 individuals from 1134 organizations in 56 countries. China and the United States are the leading contributors. The mechanism of NETs in tumor occurrence and development is likely linked to coagulation, inflammation, and infection. Hot topics in research include dendritic cells and thrombosis, with a shift from laboratory studies to clinical applications, suggesting a growing focus on treatment over etiology.

Conclusion: This study offers the most comprehensive bibliometric analysis of NETs and tumors to date. Future research may focus on developing targeted therapies that block the interaction between NETs and tumors, offering a new direction for cancer treatment.

Iron deficiency anemia (IDA) is the most common form of anemia in pregnancy and remains a significant public health problem worldwide, particularly in low- and middle-income countries. It is one of most common nutritional disorders associated with adverse maternal and fetal complications and increased perinatal mortality. This study aimed to determine the prevalence of IDA among pregnant women and maternal and fetal complications at Churchill and Rumunduru Model Health Centers in Obio-Akpor, Rivers State, Nigeria, between 2019 and 2023. A retrospective descriptive cross-sectional design was employed. The study reviewed 2290 antenatal records of pregnant women, 458 yearly and 229 per health center annually. Structured data extraction form was used to collect information on socio-demographic characteristics, obstetric history, hemoglobin levels, mean corpuscular volume, maternal and fetal complications. Systematic random sampling was applied to select eligible records. Prevalence of IDA in pregnancy revealed values of 58.60%, 74.00%, 60.10%, 54.10%, and 63.10% for 2019, 2020, 2021, 2022, and 2023, respectively. Prevalence values ranged between 54.1% and 74.0% while overall value was 62.0%. Maternal complications observed included pre-eclampsia (9.1-22.3%), post-partum hemorrhage (10.5-25.1%), pre-term labor (7.4-22.3%), maternal distress (14.8-27%), pre-term birth (1.3-6.4%), pre-natal infection (0.4%), and post-natal infection (1.8-7.4%). Fetal complications identified were low birth weight (5.3-26.6%), pre-term (11.9-48%), fetal distress (13.2-21.8%), intrauterine growth restriction (0.4-5.5%), and fetal death (2.2-6.1%). IDA remains highly prevalent among pregnant women in Obio-Akpor, Rivers State, and is associated with maternal and fetal complications. The findings underscore the need for strengthened antenatal care interventions, including early screening, iron supplementation, nutritional counseling, and close monitoring of at-risk pregnancies to reduce adverse outcomes.

Results: A significant association was found between the last pre-splenectomy platelet count and the development of thrombosis within the first postoperative month (P = .045). Overall, VTE occurred in 4.2% of patients within the first month, with portal vein thrombosis being the most common type in both early and late periods. Persistent thrombocytosis (platelets > 4,50,000/mm3) was present in 29.3% of patients at 1 to 6 months and 10.9% after 6 months. In the immune thrombocytopenic purpura subgroup, 71.2% of patients maintained a platelet count above 30,000/mm3 after 6 months. We found no significant association between pre- or post-splenectomy platelet levels and the subsequent development of malignancy.

This study aims to explore pathogenesis of postmenopausal osteoporosis and study of active compounds of traditional Chinese medicine (TCM) based on reverse network pharmacology and molecular docking. Targets of "osteoporosis" and "postmenopausal" were obtained from GeneCards, and common targets of both were displayed through Venny Diagram. Extracted list of common targets was input into Metascape for gene ontology analysis to identify pathogenesis and pathway. Protein-protein interaction network was carried out by the String, and Degree was calculated by Cytoscape software to determine key target. Key target of acquisition site was converted from UniProt to TCMSP to collect active compounds of TCM. Target with high Degree was selected for molecular docking with active compound, then corresponding TCM was found from active compound, and finally, key target-active compound-TCM network was constructed to determine active compound and TCM with high Degree. Total 182 common targets of "osteoporosis" and "menopause" were obtained and 17 key targets with high Degree were matched to TCM compounds in TCMSP. Among them, 3 target proteins with highest Degree and 6 TCM compounds with Degree ≥ 5, oral bioavailability ≥ 30%, and drug-likeness ≥ 0.18 were validated for 18 molecular docking tests, and results were stable. Gene ontology analysis mainly shows response to hormone, ossification, and regulation of mitogen-activated protein kinases cascade. Three hundred kinds of TCM were collected from TCMSP, based on effective compounds of TCM. Among them, Chinese herbs with Degree ≥ 4 were Suberect Spatholobus Stem, Ginkgo Seed, Wild Buckwheat Rhizome, Sea Buckthorn Fruit, and Ginkgo Leaf. Reverse network pharmacological thinking were used to predict target, pathway, composition, and TCM of postmenopausal osteoporosis, providing new ideas for finding new targeted drugs.

This study aimed to determine the relationship between the sociodemographic characteristics and attachment styles of liver transplant donors. This descriptive and correlational study included a sample of 156 donors. Data were collected through face-to-face interviews using a Patient Information Form and the Relationship Scales Questionnaire. In addition to normality tests, the Mann-Whitney U test, Kruskal-Wallis test, Bonferroni-corrected P-value, and Spearman correlation coefficient were used in data analysis. The significance level was set at P ≤ .05. The findings revealed that the majority of donors had a dismissive attachment style. Individuals with higher income levels, those living in rural areas, and those not related to the recipient showed a higher tendency toward secure attachment compared to other groups. Donors who had undergone previous surgery exhibited stronger secure attachment and weaker dismissive attachment than those who had not. Based on these results, future studies and organ donation campaigns are recommended to focus on attachment styles and their association with sociodemographic and sociocultural characteristics. The mean age of the participating donors was 31.65 ± 6.67 years, and 76.92% were related to the recipient. Among the donors, 93.6% exhibited a dismissive attachment style. Income level, place of residence, kinship with the recipient, and previous surgical history had a statistically significant effect on secure attachment style (P < .05), explaining 34.4% of the variance (R2 = 0.344). Previous surgical history was found to have a statistically significant effect on the dismissive attachment style (P < .05), accounting for 14.5% of the variance (R2 = 0.145).

This study aims to establish a prognostic nomogram among adenosquamous carcinoma of lung (ASC) patients who received chemotherapy. A total of 704 ASC patients who received chemotherapy were extracted from the Surveillance, Epidemiology, and End Results database. Patients were randomly divided into a training (n = 493) and a validation (n = 211) cohort. Cancer-specific survival (CSS) was the primary endpoint of this study. First, independent prognostic predictors of CSS identified from univariate and multivariate Cox regression analyses were used to construct a prognostic nomogram for predicting 1-, 3-, and 5-year CSS in those patients. Then, calibration curves and receiver operating characteristic curves were used to evaluate the nomogram's prediction accuracy, while decision curve analysis was used to evaluate the nomogram's clinical utility. Finally, a mortality risk stratification system was constructed for this subpopulation. Eight clinical parameters were identified as independent prognostic factors for ASC patients who received chemotherapy, including age, household income, T stage, N stage, bone metastasis, brain metastasis, surgery, and the primary site of the tumor. The calibration curves, receiver operating characteristic, and decision curve analysis showed that the nomogram had excellent discrimination and clinical value. Moreover, the mortality risk stratification system could effectively divide all patients into 3 risk subgroups and achieve targeted patient management. Based on the Surveillance, Epidemiology, and End Results database, a novel prognostic nomogram for predicting 1-, 3-, and 5-year CSS in patients with ASC that underwent chemotherapy has been constructed and validated. The nomogram showed relatively good performance, which could be used in clinical practice to assist clinicians in individualized treatment strategies.

Beiqishen Jiangtang Granule, derived from Huangqi Liu Yi Tang and Shengmai Yin, plays a significant role for the therapy of type 2 diabetes mellitus (T2DM). However, the underlying molecular therapeutic mechanisms remain unclear. This study uses an integrated approach combining network pharmacology, molecular docking, and in vitro validation experiments to explore potential bioactive compounds, key targets, major signaling pathways, and underlying molecular mechanisms of Beiqishen Jiangtang Granule in the treatment of T2DM. In this study, network analysis was employed to screen metabolites and potential targets using the TCMSP database, followed by Gene Ontology, kyoto encyclopedia of genes and genomes enrichment analyses to predict the underlying mechanisms, and the protein encoded by the core target was docked with the active ingredient. Using a streptozotocin-induced approach, a T2DM rat model was established to evaluate the bioactivity of Beiqishen Jiangtang Granule on blood glucose levels, lipid profiles, inflammatory cytokines, gene expression, and gut microbiota composition. Network analysis identified 121 primary metabolites and 30 key targets in Beiqishen Jiangtang Granule. Integrated Gene Ontology and kyoto encyclopedia of genes and genomes analyses (27 items) predicted that Beiqishen Jiangtang Granule regulates serum contents of insulin, tumor necrosis factor-alpha, and interleukin-6, and modulates TP53, Akt, and PI3K protein expression to exert hypoglycemic effects. Animal studies confirmed Beiqishen Jiangtang Granule significant glucose-lowering action via these pathways and mRNA regulation. Additionally, Beiqishen Jiangtang Granule was shown to rebalance gut microbiota by enriching beneficial bacterial communities and suppressing the growth of harmful bacteria, aiding T2DM treatment. These findings demonstrate Beiqishen Jiangtang Granule's characterized by multiple components, targets, and pathways mechanisms in treating T2DM. Beiqishen Jiangtang Granule have a very significant therapeutic effect on T2DM by regulating the concentrations of insulin, tumor necrosis factor-alpha and interleukin-6 in serum and influencing the expressions of TP53, Akt and PI3K proteins and mRNA. In addition, Beiqishen Jiangtang Granule can also regulate the imbalance of intestinal flora related to T2DM in patients by promoting the proliferation of beneficial bacteria and inhibiting harmful bacteria, thereby assisting T2DM.

Rationale: Here we report a rare case of a patient with serum immunoglobulin G (IgG) κ and glomerular immunoglobulin A (IgA) λ chain types in proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID). The patient showed clinical improvement after treatment with daratumumab combined with bortezomib and dexamethasone. To date, data on daratumumab use in patients with PGNMID are limited, and its treatment remains challenging.

Patient concerns: We report a rare case of a 50-year-old male patient with PGNMID in whom serum kappa free light chain (FLC) and lambda were significantly higher than average, and immunoglobulins were IgG-kappa and FLC-kappa types. The Bence Jones protein test was positive, and the urine immunofixation electrophoresis revealed a kappa light-chain type.

Diagnoses: Renal biopsy was performed after admission. The pathological diagnosis was IgA λ-type PGNMID combined with acute tubulointerstitial injury and chronic disease.

Interventions: The patient became seriously ill upon admission and progressed rapidly. After administration of the first dose of daratumumab at 100 mg, 3 courses of bortezomib (1.3 mg/m2) were administered in combination with dexamethasone (10 mg) for 21 days.

Outcomes: After 3 sessions of treatment, the patient's blood creatinine level was stable at 300 μmol/L, urine volume was normal, and serum kappa FLC was reduced to 477 mg/L.

Lessons: This rare case of PGNMID showed a discrepancy between serum IgG κ and glomerular IgA λ chain. Treatment with daratumumab, bortezomib, and dexamethasone significantly reduced serum FLC levels and stabilized the blood creatinine level. Daratumumab is a promising drug for the treatment of PGNMID.