Open Medicine最新文献

Aim: This study investigates the diagnostic accuracy of five inflammatory biomarkers - delta neutrophil index (DNI); C-reactive protein/albumin ratio (CAR); procalcitonin (PCT); immature granulocytes count (IGc); and hemoglobin, albumin, lymphocyte, platelet score (HALPs) - in detecting acute appendicitis (AA) and identifying the most reliable marker for distinguishing complicated from non-complicated cases.

Materials and methods: A prospective, cross-sectional study was conducted in a tertiary hospital emergency department, including 100 histopathologically confirmed AA patients and 100 healthy controls. Biomarker levels were analyzed using receiver operating characteristic curves. Sensitivity, specificity, and optimal cut-off values were determined via the Youden index, while logistic regression identified independent predictors of complicated appendicitis (CA).

Results: DNI exhibited the highest diagnostic accuracy for AA (AUC: 0.87, 95% CI: 0.821-0.919, p < 0.001) with 92% specificity and 69% sensitivity at a cut-off of 71.88. CAR (AUC: 0.853) and PCT (AUC: 0.852) showed similar performance, whereas IGc (AUC: 0.695) and HALPs (AUC: 0.627) were less effective. DNI also outperformed the Alvarado score in predicting CA (AUC: 0.698 vs 0.626) and was an independent predictor (OR: 3.18, 95% CI: 1.40-7.24, p = 0.006).

Conclusions: DNI demonstrated superior diagnostic performance for AA and was the most reliable marker for identifying CA. Its integration into clinical practice may enhance early diagnosis and reduce unnecessary surgeries, improving outcomes.

Aim: The aim of this study is to characterize gut microbiome alterations in newly diagnosed subacute thyroiditis (SAT) patients, and identify potential microbial signatures associated with SAT and treatment response.

Methods: Fecal samples collected from 20 newly diagnosed SAT patients and 20 healthy controls were analyzed using 16S ribosomal RNA gene sequencing. Bioinformatics analysis was performed to assess alpha and beta diversity, taxonomic composition, and differential abundance of gut microbiota between the groups. Correlations between gut microbiome and clinical parameters were also investigated.

Results: Newly diagnosed SAT patients exhibited significant alterations in gut microbiota composition. There was increased abundance of Escherichia-Shigella, Bifidobacterium, Akkermansia, Veillonella, and Streptococcus, while the abundance of Bacteroidetes, Faecalibacterium, Prevotella, Roseburia, and Ruminococcus were significantly decreased. Prednisolone treatment partially normalized the gut microbiota, with Lactobacillus, Lactobacillaceae, Lactobacillus reuteri, and Prevotella emerging as key biomarkers in post-treatment SAT. Significant correlations were found between specific gut microbiome and clinical markers.

Conclusion: SAT is associated with distinct gut microbiome alterations, partially reversible with treatment, which suggest a potential role for the gut microbiome in SAT pathogenesis and treatment response.

Objectives: Acute ischemic stroke caused by internal carotid artery (ICA) occlusion carries high risks of disability and death. While treatments such as thrombolysis, mechanical thrombectomy, and revascularization offer benefits, many patients experience limited recovery. Molecular hydrogen, with its antioxidant and anti-inflammatory properties, shows promise as a neuroprotective agent. This case report explores the adjunctive use of molecular hydrogen-rhodiola therapy in a patient with ICA occlusion, with a focus on immune modulation and clinical outcomes.

Case presentation: A 68-year-old male with a history of paroxysmal atrial fibrillation presented with left-sided hemiplegia and was diagnosed with right ICA occlusion (NIH Stroke Scale: 12; modified Rankin Scale: 5). Endovascular thrombectomy was attempted but unsuccessful (modified Thrombolysis in Cerebral Infarction score = 0). The patient subsequently underwent superficial temporal artery to middle cerebral artery bypass surgery. Postoperatively, he was initiated on daily molecular hydrogen-rhodiola capsule therapy. Serial immunological assessments demonstrated a progressive increase in type 1 regulatory T (Tr1) cells and regulatory B cells, along with enhanced T-cell immunoglobulin and mucin-domain containing-3 (TIM-3) expression on cytotoxic T (Tc) cells. Clinically, the patient exhibited marked neurological recovery, with motor strength improving from Medical Research Council grade 1 to grade 5 in the affected limbs over six months. Notably, steroid therapy was discontinued without relapse, and no adverse events were observed.

Conclusion: This case highlights the potential of molecular hydrogen-rhodiola therapy as a safe and effective adjunctive treatment for ischemic stroke due to ICA occlusion. Notable improvements in immune modulation and motor function support its possible role in neurovascular recovery.

Introduction: Ultrasound-guided erector spinae plane block (ESPB) was originally developed for the treatment of neuropathic chest pain and has since been used in various thoracic, lumbar, and sacral surgeries.

Objective: This study aimed to establish whether unilateral or bilateral ESPB is more effective for pain management in laparoscopic cholecystectomy.

Materials and methods: A total of 54 adult patients undergoing laparoscopic cholecystectomy were divided into three groups: unilateral ESPB, bilateral ESPB, and a control group (no ESPB). The unilateral ESPB group received 20 mL of 0.25% bupivacaine preoperatively at the T8 vertebral level. The bilateral ESPB group received 20 mL of 0.25% bupivacaine to both sides of the vertebra. The control group received no intervention, and all three groups received general anesthesia. Intraoperatively, all patients received 50 mg of dexketoprofen and 1 mg/kg of tramadol. Postoperative tramadol use and visual analog scale (VAS) scores were recorded at 0 min, 30 min, 2 h, 6 h, 12 h, and 24 h.

Results: Demographic characteristics did not differ significantly between the groups. At the 6 h post-surgery, the VAS scores in the bilateral ESPB group were significantly lower than the control group (p < 0.001). Total tramadol use in 24 h was significantly lower in the bilateral ESPB group compared with the control group (p = 0.003).

Conclusions: Bilateral ESPB could be a valuable component of multimodal analgesia strategies in laparoscopic cholecystectomies.

Objective: Transforming growth factor beta (TGF-β) is a key regulator of macrophage polarization, yet its role in high-altitude pulmonary hypertension (HAPH) remains poorly understood. This study aimed to explore the effects of TGF-β on macrophage polarization under high-altitude conditions and elucidate the molecular mechanisms driving macrophage phenotypic changes in HAPH, with potential therapeutic implications.

Methods: A HAPH rat model was established by exposing rats to a hypoxic environment simulating 5,000 m altitude for 4 weeks. Rats were prophylactically treated weekly with the TGF-β inhibitor SB-431542. Pulmonary artery pressure and right ventricular hypertrophy index were measured to confirm model establishment. Hematoxylin and eosin staining, immunohistochemistry, and western blotting were used to assess TGF-β-Smad2/Smad3 signaling and macrophage polarization.

Results: The HAPH group showed significantly increased pulmonary artery pressure and right ventricular hypertrophy index compared to controls. These changes were associated with elevated M2 macrophage levels, increased anti-inflammatory cytokines (IL-4 and IL-10), and enhanced TGF-β and Smad2/Smad3 signaling. TGF-β inhibition reversed these effects.

Conclusion: The TGF-β-Smad2/Smad3 pathway promotes macrophage M2 polarization, driving HAPH progression through anti-inflammatory cytokine release. Inhibiting this pathway reduces M2 polarization and alleviates HAPH in rats, highlighting its therapeutic potential.

Background: Although deep brain stimulation (DBS) has been proven to enhance motor function in Parkinson's disease (PD) patients, its potential adverse impact on cognitive function remains ambiguous. This study aimed to explore the effects of DBS on cognitive function in patients with advanced PD.

Methods: PubMed, EBSCO, Cochrane Library, Web of Science, and Embase were searched for randomized controlled trials (RCTs) and cohort studies on DBS and advanced PD from inception to January 2025. The main cognitive function assessment tools include but are not limited to Mini-MENTAL State Examination (MMSE) and Mattis Dementia Rating Scale (MDRS).

Results: A total of 7 RCTs and 11 cohort studies were included. Analyses reveals no significant differences in MMSE (mean difference [MD] = -0.33, P = 0.19) and MDRS (MD = -0.75, P = 0.08) between the DBS group and the best medical therapy (BMT) group overall. However, the DBS group had significantly worse cognitive function after treatment than the BMT group in phonemic fluency (MD = -3.17, P = 0.03). No significant differences were observed between the groups in other domains, including information processing, memory, executive function, and visuospatial function.

Conclusions: DBS poses a potential risk to cognitive function in patients with advanced PD.

Objectives: To investigate the association between red cell distribution width (RDW) and early kidney injury.

Methods: Data were obtained from the 2003-2004 National Health and Nutrition Examination Survey, including 3,633 adult participants. Early kidney injury was defined according to the 2024 Kidney Disease: Improving Global Outcomes guidelines as eGFR ≥60 mL/min/1.73 m² with urinary albumin-to-creatinine ratio (UACR) 30-300 mg/g, or eGFR 45-60 mL/min/1.73 m² with UACR <30 mg/g. Multivariate logistic regression was used to assess the association between RDW and early kidney injury, adjusting for demographic, socioeconomic, and clinical confounders (age, sex, race, education, poverty index, hypertension, diabetes). Receiver operating characteristic curves were applied to determine the optimal RDW cutoff, and restricted cubic spline (RCS) models were used to explore dose-response relationships.

Results: After adjusting for confounders, there is a positive correlation between RDW and early kidney injury (OR = 1.26, 95% CI: 1.08-1.45, p = 0.013). RDW quartile analysis showed that the highest quartile group (>13.1%) had a 1.74-fold risk compared to the lowest group (<12.1%) (95% CI: 1.27-2.40, p < 0.001). RCS confirmed a nonlinear dose-response relationship (nonlinear p < 0.05). The area under the curve for RDW predicting early kidney injury was 0.86. At the optimal cutoff value of 12.7%, sensitivity was 87.5% and specificity was 71.42%. In the hypertensive population (n = 1,190), RDW still significantly predicted early kidney injury (OR = 1.26, 95% CI: 1.10-1.47, p = 0.007).

Conclusion: Elevated RDW is significantly associated with the risk of early kidney injury and is robust in the hypertensive population. RDW > 12.7% can serve as an economical and convenient screening threshold, especially suitable for early risk stratification of high-risk groups in resource-limited areas. Future prospective studies are needed to validate its causal mechanism and clinical utility.

Background: Flavanols (FLs), a group of polyphenols abundant in cocoa and red wine, have been associated with improved cognitive function, particularly hippocampus-dependent memory in older adults. However, their poor bioavailability has limited understanding of the mechanisms underlying their effects on the brain. This study aimed to investigate the cognitive and molecular responses following acute FLs administration in mice.

Methods: Male C57BL/6J mice were orally administered FLs (25 mg/kg) or distilled water (DW) and subjected to a novel object recognition test. In one experiment, FLs were administered before training, in another, after training. Exploratory behavior and the discrimination index (DI) were analyzed. Hippocampal tissues were collected at 15 min to 4 h post-administration to assess levels of brain-derived neurotrophic factor (BDNF) and phosphorylated extracellular signal-regulated kinase, cAMP response element-binding protein (CREB), and tyrosine kinase receptor type 2 by western blotting.

Results: Mice treated with FLs before training exhibited significantly longer exploration of the novel object and higher DI, whereas no enhancement was observed when FLs were administered after training. CREB phosphorylation increased at 30 min post-administration, and BDNF levels were elevated at 2 and 4 h.

Conclusion: These findings suggest that FLs enhance short-term memory via hippocampal CREB activation and BDNF upregulation. Despite low systemic absorption, the rapid effects observed may involve sensory signaling pathways, potentially triggered by the astringent properties of FLs. This study provides mechanistic insight into the cognitive benefits of dietary FLs.

COVID-19 virus infection can cause disorders of the endocrine system. The aim of this study was to characterize the alterations of nucleotide metabolomic patterns in patients with post-COVID-19 condition (PCC). The study population included 18 patients with PCC alone (PCC-A), 31 patients with PCC combined with type 2 diabetes mellitus (PCC-DM), 20 healthy volunteers (HV), and 20 patients with type 2 diabetes mellitus (DM). Ultraperformance liquid chromatography-mass spectrometry was conducted on plasma metabolites. A total of 116, 178, and 163 differential metabolites were identified in PCC-DM vs PCC-A, PCC-A vs HV groups, and PCC-DM vs DM groups, respectively. Adenine was significantly down-regulated, and purine, thymine, and uracil were significantly up-regulated in the PCC-A group compared with the HV group, and the same results were observed in the PCC-DM group compared with the DM group. Differential metabolites were mainly involved in nucleotide metabolism, especially pyrimidine metabolism in PCC patients. After the arginine stimulation test, cortisol and adrenocorticotropic hormone secretion were reduced in PCC patients. In conclusion, the nucleotide de novo synthesis pathway and the remedial synthesis pathway are seriously damaged in patients with PCC-A, especially in patients with PCC-DM, which leads to the disorder and imbalance of the body cell metabolism pathway.

Background: Patients with locally advanced breast cancer (LABC) and type 2 diabetes mellitus (T2DM) confront dual challenges: hormone-driven tumor progression and metabolic dysregulation. Although metformin has shown antitumor potential, its effect on estrogen modulation and synergy with nursing care remains unclear in clinical settings.

Purpose: To investigate the impact of metformin on estrogen regulation and prognosis-related nursing outcomes in patients with LABC and T2DM.

Methods: This multicenter retrospective cohort study with a prospective randomized intervention component evaluated clinical, metabolic, and care-related indicators during the perioperative period. Serum estradiol (E2) was measured at baseline, post-chemotherapy, and 30 days post-surgery. Glucose metabolism was assessed by fasting blood glucose, HbA1c, and CV%, alongside hypoglycemia monitoring. Care quality metrics included wound healing time, infection rate, chemotherapy adherence, and hospital stay length. Survival outcomes (36-month PFS and OS) were analyzed via Kaplan-Meier curves and Cox models adjusted for age, BMI, and tumor stage. Statistical analysis used SPSS 26.0; continuous variables were expressed as mean ± SD, compared with t-tests; HRs and 95% CIs were reported with P < 0.05 considered significant.

Results: Metformin led to a 19.3% reduction in E2 levels post-chemotherapy, with sustained suppression, outperforming the control group. Glycemic metrics improved: fasting glucose compliance rose to 83.3%, CV% decreased by 38.2%, and hypoglycemia dropped by 66.7%. Wound healing time was shortened by 3.3 days. Chemotherapy adherence reached 92.8% (vs 73.6%) and self-care scores improved by 25.8% (vs 7.2%). Mechanistic analysis indicated enhanced immune microenvironment regulation and reduced pro-inflammatory cytokines.

Conclusion: Metformin, combined with structured nursing care, significantly improves estrogen control, metabolic stability, and survival in LABC patients with T2DM. These findings support its role in integrated pharmaco-nursing management of tumor-metabolic comorbidities.